Bullous erysipelas: A retrospective study of 26 patients

Guberman, Dror; Gilead, Leon; Zlotogorski, Abraham; Schamroth, J. M.

doi:10.1016/s0190-9622(99)70009-5

Cited by 29 publications

(21 citation statements)

References 7 publications

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“…The majority of our patients were females (84.6%), at a time when only 58% of the patients treated at our Department for uncomplicated erysipelas were females (data not shown). In another study of bullous erysipelas, Guberman et al [7] also reported the same striking female predominance (84.6%). Although this was interpreted by the authors as coincidental, our study reinforces the aspect that this gender predominance is not likely to be coincidental.…”

Section: Discussionmentioning

confidence: 63%

Bullous Erysipelas: Clinical Presentation, Staphylococcal Involvement and Methicillin Resistance

Krasagakis

Samonis²,

Maniatakis³

et al. 2006

Dermatology

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Background: Erysipelas is a bacterial infection of the dermis and hypodermis, mostly of streptococcal origin. Bullous erysipelas represents a severe form of the disease. Objective: To evaluate the clinical and microbiological characteristics and treatment of bullous erysipelas. Methods: Patients with a diagnosis of bullous erysipelas who were treated at the Department of Dermatology, University Hospital of Heraklion, Crete, Greece, between the years 1996 and 2001 were retrospectively studied. Results: Fourteen patients (11 women, 3 men) with bullous erysipelas were evaluated. The lesions were located on the legs and face in 9 and 4 patients, respectively. The median duration of disease before hospital admission was 4 days. Eight patients had fever at presentation. Local trauma and various lesions were common causes for pathogen entry. The initial empirical antibiotic treatment included intravenous β-lactams and was modified according to the sensitivities of the isolated strains. Staphylococcus aureus was isolated from 7 (50%), while S. warneri, Streptococcus pyogenes and Escherichia coli grew from the lesions of 3 other patients. Six out of 7 S. aureus strains were methicillin resistant (MRSA) but susceptible to several other non-β-lactam antibiotics such as quinolones, vancomycin, rifampicin and trimethoprim/sulfamethoxazole. Conclusion: Our findings suggest that S. aureus is frequently involved in and probably contributes in synergy with β-hemolytic streptococci to the complicated course of bullous erysipelas. The frequency of MRSA isolation suggests that β-lactam antibiotics may not be sufficient for the treatment of bullous erysipelas anymore, at least in areas with a high incidence of MRSA strains. The role of other classes of antibiotics providing adequate coverage for MRSA has to be evaluated in prospective clinical trials.

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Section: Discussionmentioning

confidence: 63%

Bullous Erysipelas: Clinical Presentation, Staphylococcal Involvement and Methicillin Resistance

Krasagakis

Samonis²,

Maniatakis³

et al. 2006

Dermatology

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“…Acute non-necrotizing bacterial cellulitis of the leg (erysipelas) is a common infection of the skin and subcutaneous tissue causing significant morbidity [1][2][3]. Foot dermatomycosis (tinea pedis and onychomycosis) may constitute an important, treatable risk factor for bacterial cellulitis of the leg [4].…”

Section: Introductionmentioning

confidence: 99%

Chronic Dermatomycoses of the Foot as Risk Factors for Acute Bacterial Cellulitis of the Leg: A Case-Control Study

Roujeau¹,

Sigurgeirsson

Korting³

et al. 2004

Dermatology

174

145

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Objective: To assess the role of foot dermatomycosis (tinea pedis and onychomycosis) and other candidate risk factors in the development of acute bacterial cellulitis of the leg. Methods: A case-control study, including 243 patients (cases) with acute bacterial cellulitis of the leg and 467 controls, 2 per case, individually matched for gender, age (±5 years), hospital and admission date (±2 months). Results: Overall, mycology-proven foot dermatomycosis was a significant risk factor for acute bacterial cellulitis (odds ratio, OR: 2.4; p < 0.001), as were tinea pedis interdigitalis (OR: 3.2; p < 0.001), tinea pedis plantaris (OR: 1.7; p = 0.005) and onychomycosis (OR: 2.2; p < 0.001) individually. Other risk factors included: disruption of the cutaneous barrier, history of bacterial cellulitis, chronic venous insufficiency and leg oedema. Conclusions: Tinea pedis and onychomycosis were found to be significant risk factors for acute bacterial cellulitis of the leg that are readily amenable to treatment with effective pharmacological therapy.

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“…Such study raises two important questions about the aetiology and management of erysipelas, namely: (1) what is the role of S. aureus in the aetiology of erysipelas and its corollary, and (2) should penicillin be considered as the fi rst-line antibiotic therapy for erysipelas? These questions are unfortunately hindered by a blurred nosologic frontier between erysipelas and cellulitis.…”

Section: Staphylococcus Aureusmentioning

confidence: 99%

“…Its typical clinical presentation includes skin tenderness, erythema and oedema. In more or less 5% of the patients, bulla formation occurs [1,2] . This particular form of erysipelas is associated with longer hospital stays than the non-bullous forms.…”

mentioning

confidence: 99%

“…This particular form of erysipelas is associated with longer hospital stays than the non-bullous forms. However, bullous erysipelas appears to be more prevalent in elderly persons and in patients with diabetes mellitus [1,2] , so that it remains unknown whether its more protracted course is related to host characteristics or to more virulent pathogens.In this issue of Dermatology , Krasagakis et al[3] report a series of 14 patients with bullous erysipelas and show that this form of erysipelas is frequently associated with the isolation of Staphylococcus aureus from the lesions. Such study raises two important questions about the aetiology and management of erysipelas, namely:…”

mentioning

confidence: 99%

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