Comorbidities as Risk Factors for Acute and Recurrent Erysipelas

Abstract

BACKGROUND: Erysipelas is a common infectious skin disease. A typical feature of erysipelas, especially on the lower limbs, is the tendency to reoccur and the study aimed to define the comorbidities associated with it.
 AIM: We aimed to investigate systemic and local comorbidities in patients diagnosed with erysipelas on the lower limbs.
 MATERIAL AND METHODS: We conducted a retrospectively-prospective, population-based cohort study which included all patients diagnosed with erysipelas on the lower limbs, during two years. Patients were divided into two groups: patients with first episode and patients with recurrent erysipelas. These two groups were compared, with particular emphasis on systemic and local comorbidities.
 RESULTS: The study included 313 patients, of which 187 with the first episode of erysipelas and 126 with a recurrent. Regarding the analyzed systemic risk factors, the recurrent erysipelas was significantly associated with obesity (p < 0.0001), insulin dependent diabetes mellitus (p = 0.0015), history of malignant disease (p = 0.02) and tonsillectomy (p = 0.000001). For a p-value < 0.0001, significantly more frequent finding of peripheral arterial occlusive disease, chronic oedema/lymphoedema, fungal infections of the affected leg and chronic ulcer was confirmed in recurrent erysipelas. Neuropathy had 23% of the recurrent cases and 8.6% in patients without recurrence, and the difference was found to be significant for p = 0.0003. The only dissection of the lymph nodes was found more frequently in recurrent erysipelas (p = 0.017), but no associations with other analysed local surgery on the affected leg. Patients with recurrent erysipelas had ipsilateral coexisting dermatitis p = 0.00003 significantly more frequent. Minor trauma often preceded the first episode of erysipelas p = 0.005.
 CONCLUSION: Identification and treatment of modifiable risk factors are expected to reduce the risk of a subsequent episode of erysipelas on the lower limbs

Risk factors of recurrent erysipelas in adult Chinese patients: a prospective cohort study

“…Erysipelas is an acute inflammation of the skin and its reticular lymphatic vessels, which is prone to recur in the lower extremities, face, and other anatomical areas. It is frequently caused by β-hemolytic streptococci group A ( Streptococcus pyogenes ) and rarely caused by streptococci groups B, C, or G [ 1 , 2 ]. The following characteristics differentiate erysipelas from other forms of tissue infections: (1) an acute, warm, slightly painful, bright red erythema with a shiny surface and a sharply defined margin as well as tongue-shaped processes, usually located a few centimeters away from the entry site; (2) a systemic inflammatory response immediately from the onset, marked by fever or at least shivering and rarely chills; and (3) increased erythrocyte sedimentation rate (ESR), increased C-reactive protein (CRP) level, and/or neutrophilia [ 3 ].…”

In Search of Risk Factors for Recurrent Erysipelas and Cellulitis of the Lower Limb: A Cross-Sectional Study of Epidemiological Characteristics of Patients Hospitalized due to Skin and Soft-Tissue Infections

“…In our study, similarly as in Inghammar et al [11] erysipelas recurrence was significantly associated with increased BMI, but not with other comorbidities associated with the metabolic syndrome (hypertension, diabetes mellitus, or dyslipidemia). In a study by Brishkoska-Boshkovski et al [3], in addition to an association between obesity (but no differences in mean BMI) and RE, the recurrence was also linked to diabetes mellitus treated with Interdisciplinary Perspectives on Infectious Diseases insulin. Obesity and diabetes were also independent predictors of lower limb cellulitis recurrence in a large longitudinal cohort study by Cannon et al [12].…”

“…Erysipelas and cellulitis are common, acute, bacterial infections of the skin and underlying soft tissue. Traditionally, erysipelas was distinguished from cellulitis by a more distinct, elevated border and it was presumed to be different in etiology, but recently this distinction has been put into question by many authors [1][2][3].…”

“…It is frequently assumed that erysipelas and cellulitis are caused by group A streptococci and Staphylococcus aureus, but other streptococci and Gram-negative bacteria seem to be the causative agents in some cases [2][3][4]. ese infections usually affect the lower limb and can be diagnosed clinically in patients presenting with sudden onset of pain, edema, erythema, and increased warmth of affected localization, as well as systemic symptoms such as fever and chills.…”

Soft tissue myoepithelial carcinoma—a case report with molecular and electron microscopic analysis

“…Three years after diagnosis, the patient is alive without any recurrence or metastases. In regards to adverse events, the patient has experienced mild lymphedema in relation to physical activity and a case of erysipelas two years postoperatively, which is known to occur more often in patients that have had lymph node dissection performed (13).…”