Erysipelas of the leg (cellulitis) in sub-Saharan Africa: a multicentric study of 562 cases

Abstract

INTRODUCTIONErysipelas also called bacterial dermo-hypodermitis is an infection of deep skin layers, mainly due to streptococcus [1,2]. Facial localization became become less frequent while the infection is currently developed on the leg [3,4]. Erysipelas of the leg is a common skin infection in dermatology consultation in sub-Saharan Africa [5][6][7][8]. However monocentric studies are rather conducted in these areas instead of multicentric type studies. We aimed at describing the epidemiological and clinical characteristics of erysipelas of the leg, and ABSTRACT Introduction: Erysipelas of the leg is a common and serious infection. We carried out this study aiming at describing the epidemiological and clinical characteristics, and assessing the risks factors associated with the local complications of erysipelas of the leg in sub-Saharan Africa. Methods: This was a prospective multicentric study carried out in the dermatology units of Hospitals located in seven sub-Saharan African countries during a period of 12 months. Patients aged 15 and above with a first episode of erysipelas of the leg were recruited. Results: In this study, 562 patients were recruited, having a mean age of 43.7±16.9 years and a sex-ratio (M/F) of 0.67. Patients infected on one leg were 562 while those infected with two were 27. Bullous forms of the disease were observed in 95 patients, while purpuric forms were observed in 167 patients. The existence of a point of entry (485 cases), obesity (230), lymph edema (130) and the use of bleaching agents (97) were the mains risk factors. Complications during the course of the infection such as necrotizing fasciitis (34 cases) and abscesses (63 cases) were observed. They were due to the use of antibiotics and non-steroidal anti-inflammatory treatments, and the use of cataplasm. Conclusion: This study reveals that existence of a point of entry, obesity and lymph edema, and the use of bleaching agents were the mains risk factors influencing the local complications of erysipelas of the leg. Necrotizing fasciitis and abscesses were influenced by the use of antibiotics and non-steroidal anti-inflammatory treatments, and the use of cataplasm.

Risk factors and complications of lower limb cellulitis in Africa: a systematic review

“…A total sample of 3031 participants were included, among which were 1973 cases of lower limb cellulitis. 20–24 26 27 The risk of bias was judged to be low, moderate and high in three, 20–22 three 24 27 28 and one study, 26 respectively.…”

“…Five studies reported on the complications of lower limb cellulitis 21 23 24 26 27 of which three provided data on the factors associated with these complications. 24 26 27 The overall prevalence of complications (any complication) ranged from 8.9% to 47.4%, table 4 . Complications of cellulitis were classified as local and general complications.…”

“…With the increasing prevalence of obesity in Africa, owing to westernisation and urbanisation, and the increasing number of persons practising voluntary skin depigmentation, the burden of cellulitis in Africa, is likely to increase in subsequent years and therefore warrants surveillance and control. 24 33 34 38 Sadly, cellulitis is still given very little consideration in Africa, as is evident by the limited number of studies on the subject in this part of the world. Majority of the identified risk factors of cellulitis are potentially modifiable.…”

A Retrospective Review Of Lower Limb Cellulitis In A Regional Hospital In Ghana

“…It is commonest in the lower limbs and usually affects older people with the incidence significantly increasing with age 1,6,10,14 . However, in Sub Sahara Africa, it affects relatively young patients [15][16][17] . In this study, the commonest age group with lower limb cellulitis was 30-39 years with a mean age of 38.8 years.…”

The causes of member’s lymphoedema: a retrospective study of 309 cases in Dakar

“…Dans notre série, la Pénicilline retard a été administrée chez plus de la moitié des patients (52,4%) pour la prévention des DHB. Les raisons de cette prophylaxie sont liées au risque élevé de DHB sur un membre lymphoedèmateux, confirmé par beaucoup d'études [29].…”