Streptococcal
infections
The first warning of an attack is often malaise, shiver-ing and a fever. After a few hours the affected area of skin becomes red, and the eruption spreads with a well-defined advancing edge. Blisters may develop on the red plaques (Fig. 14.5). Untreated, the con-dition can even be fatal, but it responds rapidly to systemic penicillin, sometimes given intravenously. The causative streptococci usually gain their entry through a split in the skin, e.g. between the toes or under an ear lobe.
Episodes
can affect the same area repeatedly and so lead to persistent lymphoedema. Low
dosage long-term oral penicillin V will usually cut down the frequency of
recurrences. The cause of the original skin split, perhaps a minor tinea pedis,
should be treated too.
This inflammation of the skin occurs at a deeper level than erysipelas. The subcutaneous tissues are involved; and the area is more raised and swollen, and the erythema less marginated than in erysipelas. Cellulitis often follows an injury and favours areas of hypo-static oedema. Streptococci, staphylococci or other organisms may be the cause. Treatment is elevation, restasometimes in hospitalaand systemic antibiotics, sometimes given intravenously.
A
mixture of pathogens, usually including streptococci and anaerobes, is
responsible for this rare condition, which is a surgical emergency. At first
the infection resembles a dusky, often painful, cellulitis, but it quickly
turns into an extending necrosis of the skin and subcutaneous tissues. A deep
‘stab’ incision biopsy through the skin into the fascia may be neces-sary to
obtain material for bacteriological culture. A magnetic resonance imaging (MRI)
scan may help to establish how far the infection has spread. The prognosis is
often poor despite early surgical de-bridement and prompt intravenous
antibiotics, even when given before the bacteriological results are available.
It
is convenient to mention this here, but the causat-ive organism is Erysipelothrix
insidiosa and not a streptococcus. It infects a wide range of
animals, birds and fish. In humans, infections are most common in butchers,
fishmongers and cooks, the organisms penetrating the skin after a prick from an
infected bone. Such infections are usually mild, and localized to the area
around the inoculation site. The swollen purple area spreads slowly with a
clear-cut advancing edge. With penicillin the condition clears quickly; without
it, resolution takes several weeks.
The
infective agent is the bacillus Rochalimaeahenselae. A few
days after a cat bite or scratch, areddish granulomatous papule appears at the
site of inoculation. Tender regional lymphadenopathy follows some weeks later,
and lasts for several weeks, often being accompanied by a mild fever. The
glands may discharge before settling spontaneously. There is no specific
treatment.
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