Erisipela

Descripción General

Definición

La erisipela es una infección de la piel que afecta la dermis Dermis A layer of vascularized connective tissue underneath the epidermis. The surface of the dermis contains innervated papillae. Embedded in or beneath the dermis are sweat glands; hair follicles; and sebaceous glands. Skin: Structure and Functions superior y los LOS Neisseria vasos linfáticos superficiales.

Epidemiología

• Se desconoce la incidencia exacta.
• Afecta con mayor frecuencia a niños pequeños y adultos mayores.
• Las extremidades inferiores son el sitio más comúnmente afectado, seguidas por la cara.
• El 29% de los LOS Neisseria pacientes recidiva dentro de los LOS Neisseria 3 años.

Etiología

• Agente más común:
  • Streptococcus Streptococcus Streptococcus is one of the two medically important genera of gram-positive cocci, the other being Staphylococcus. Streptococci are identified as different species on blood agar on the basis of their hemolytic pattern and sensitivity to optochin and bacitracin. There are many pathogenic species of streptococci, including S. pyogenes, S. agalactiae, S. pneumoniae, and the viridans streptococci. Streptococcus beta-hemolítico del grupo A (S. pyogenes)
• Agentes menos comunes:
  • Staphylococcus aureus Staphylococcus aureus Potentially pathogenic bacteria found in nasal membranes, skin, hair follicles, and perineum of warm-blooded animals. They may cause a wide range of infections and intoxications. Brain Abscess ( en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum casos de erisipela ampollosa)
  • Streptococcus Streptococcus Streptococcus is one of the two medically important genera of gram-positive cocci, the other being Staphylococcus. Streptococci are identified as different species on blood agar on the basis of their hemolytic pattern and sensitivity to optochin and bacitracin. There are many pathogenic species of streptococci, including S. pyogenes, S. agalactiae, S. pneumoniae, and the viridans streptococci. Streptococcus del grupo B ( en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum neonatos)
• Factores de riesgo:
  • Antecedentes de traumatismo cutáneo menor
  • Linfedema
  • Insuficiencia arteriovenosa
  • Inmunodeficiencia
  • Antecedentes recientes de mastectomía, cirugía pélvica o derivación (drenaje linfático alterado)
  • Mordeduras de animales, incluidos insectos y perros
  • Afecciones dermatológicas subyacentes, como eccema, psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis o lupus cutáneo
  • Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus mellitus

Fisiopatología y Presentación Clínica

Fisiopatología

• Las bacterias entran en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la barrera cutánea alfectada (e.g., úlcera, ampolla, mordedura de perro).
• La invasión de la dermis Dermis A layer of vascularized connective tissue underneath the epidermis. The surface of the dermis contains innervated papillae. Embedded in or beneath the dermis are sweat glands; hair follicles; and sebaceous glands. Skin: Structure and Functions superior produce eritema y aumento de volumen local de la piel ( edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema).
• Propagación de agentes bacterianos y citocinas inflamatorias a través de vasos linfáticos superficiales.
• A diferencia de la celulitis:
  • No penetra la dermis Dermis A layer of vascularized connective tissue underneath the epidermis. The surface of the dermis contains innervated papillae. Embedded in or beneath the dermis are sweat glands; hair follicles; and sebaceous glands. Skin: Structure and Functions profunda ni el tejido subcutáneo
  • Siempre es no purulenta

Presentación clínica

• Inicio agudo
• Generalmente, está asociada y puede ser precedida por síntomas sistémicos:
  • Fiebre alta y escalofríos
  • Dolor Dolor Inflammation muscular y articular
  • Náuseas y vómitos
  • Cefalea
  • Malestar general
• Comúnmente involucra piernas, manos (unilaterales) y cara
• Eritema:
  • Nítidamente demarcado
  • Bordes elevados progresivos, a veces con aclaramiento central
  • “Signo de la mariposa” en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la cara
  • “Signo de la oreja de Milian”: erisipela auricular
  • Apariencia de “piel de naranja”: formación de hoyuelos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la piel debido al AL Amyloidosis edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema alrededor de los LOS Neisseria folículos pilosos
• Edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema
• Calor Calor Inflammation
• Sensibilidad
• Linfangitis: líneas rojas que irradian de la lesión
• Linfadenopatía regional
• Presentaciones más severas:
  • Hemorragia cutánea, petequias y necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage
  • Vesículas y ampollas (se ha HA Hemolytic anemia (HA) is the term given to a large group of anemias that are caused by the premature destruction/hemolysis of circulating red blood cells (RBCs). Hemolysis can occur within (intravascular hemolysis) or outside the blood vessels (extravascular hemolysis). Hemolytic Anemia asociado a la toxina estafilocócica)

Diagnóstico y Tratamiento

Diagnóstico

Antecedentes:

• Traumatismo cutáneo local:
  • Arañazos
  • Pinchazos de aguja
  • Mordeduras de animales
• Afecciones médicas subyacentes e inmunodeficiencias
• Antecedentes de infecciones cutáneas previas
• Cirugías recientes de tejidos blandos

Examen físico:

• Placas eritematosas bien delimitadas características
• Linfadenopatía
• Fiebre

Estudios de laboratorio:

• No son necesarios en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum casos no complicados.
• Recuento elevado de leucocitos
• Los LOS Neisseria marcadores inflamatorios (velocidad de eritrosedimentación, proteína C reactiva) pueden estar elevados.

Imagenología:

• No es necesaria si el diagnóstico es claro
• Ultrasonido de tejidos blandos: puede descartar un absceso y una infección más profunda
• Tomografía computarizada (TC) con contraste intravenoso/resonancia magnética (RM): para descartar otro proceso

Cultivos:

• Los LOS Neisseria hemocultivos y los LOS Neisseria cultivos de heridas no son indicados de forma rutinaria.
• Hemocultivos para síntomas sistémicos graves/ sepsis Sepsis Systemic inflammatory response syndrome with a proven or suspected infectious etiology. When sepsis is associated with organ dysfunction distant from the site of infection, it is called severe sepsis. When sepsis is accompanied by hypotension despite adequate fluid infusion, it is called septic shock. Sepsis and Septic Shock.
• Cultivos de heridas:
  • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes inmunocomprometidos, si es posible un organismo poco probable.
  • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum infecciones recurrentes

Tratamiento

Casos no complicados:

• Antibióticos orales durante 5–14 días:
  • Penicilina oral (amoxicilina)
  • Cefalosporina (si es alérgico a la penicilina)
  • Clindamicina
• Elevación de la extremidad afectada para reducir el edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema
• Compresas frías
• Tratamiento del dolor Dolor Inflammation y la fiebre sintomática

Casos que requieren hospitalización y antibióticos intravenosos:

• Presentación grave: ampollas, necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage cutánea, signos de sepsis Sepsis Systemic inflammatory response syndrome with a proven or suspected infectious etiology. When sepsis is associated with organ dysfunction distant from the site of infection, it is called severe sepsis. When sepsis is accompanied by hypotension despite adequate fluid infusion, it is called septic shock. Sepsis and Septic Shock
• Ancianos
• Lactantes
• Compromiso inmunitario/ diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus mal controlada
• No mejora con antibióticos orales
• Antibióticos intravenosos:
  • Necesita tener cobertura estreptocócica y estafilocócica
  • Cefazolina, ceftriaxona o clindamicina

Desbridamiento quirúrgico: puede ser necesario para casos graves con necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage cutánea

Diagnóstico Diferencial

• Celulitis: es una infección bacteriana de la piel común y dolorosa que afecta las capas más profundas de la dermis Dermis A layer of vascularized connective tissue underneath the epidermis. The surface of the dermis contains innervated papillae. Embedded in or beneath the dermis are sweat glands; hair follicles; and sebaceous glands. Skin: Structure and Functions y el tejido subcutáneo. Se presenta como un área eritematosa y edematosa que se siente cálida y sensible al AL Amyloidosis tacto. Esta afección es causada más comúnmente por S. aureus S. aureus Potentially pathogenic bacteria found in nasal membranes, skin, hair follicles, and perineum of warm-blooded animals. They may cause a wide range of infections and intoxications. Staphylococcus y S. pyogenes. El diagnóstico es generalmente clínico y el tratamiento consiste en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum antibióticos según los LOS Neisseria microorganismos sospechosos.
• Fascitis necrosante: una infección rápidamente progresiva que produce una necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage extensa del tejido subcutáneo, la fascia Fascia Layers of connective tissue of variable thickness. The superficial fascia is found immediately below the skin; the deep fascia invests muscles, nerves, and other organs. Cellulitis y el músculo. Más comúnmente causada por Streptococcus Streptococcus Streptococcus is one of the two medically important genera of gram-positive cocci, the other being Staphylococcus. Streptococci are identified as different species on blood agar on the basis of their hemolytic pattern and sensitivity to optochin and bacitracin. There are many pathogenic species of streptococci, including S. pyogenes, S. agalactiae, S. pneumoniae, and the viridans streptococci. Streptococcus del grupo A, pero a menudo involucra a otros tipos de bacterias en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum una infección mixta. Se presenta con necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage, crepitación, ampollas y decoloración púrpura de la piel. El tratamiento consiste en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum un desbridamiento quirúrgico de emergencia con antibióticos de amplio espectro.
• Dermatitis Dermatitis Any inflammation of the skin. Atopic Dermatitis (Eczema): término general para una erupción cutánea edematosa. Esta afección es causada por una infección o una reacción alérgica, generalmente no causada por bacterias. El tratamiento es con antihistamínicos y esteroides tópicos.
• Foliculitis: inflamación localizada del folículo piloso o de las glándulas sebáceas causada principalmente por S. aureus S. aureus Potentially pathogenic bacteria found in nasal membranes, skin, hair follicles, and perineum of warm-blooded animals. They may cause a wide range of infections and intoxications. Staphylococcus. Se presenta como eritema, pápulas, pústulas y sensibilidad del área afectada.
• Impétigo: una infección cutánea muy contagiosa de la epidermis Epidermis The external, nonvascular layer of the skin. It is made up, from within outward, of five layers of epithelium: (1) basal layer (stratum basale epidermidis); (2) spinous layer (stratum spinosum epidermidis); (3) granular layer (stratum granulosum epidermidis); (4) clear layer (stratum lucidum epidermidis); and (5) horny layer (stratum corneum epidermidis). Skin: Structure and Functions superior. Esta afección es causada por S. aureus S. aureus Potentially pathogenic bacteria found in nasal membranes, skin, hair follicles, and perineum of warm-blooded animals. They may cause a wide range of infections and intoxications. Staphylococcus o Streptococcus Streptococcus Streptococcus is one of the two medically important genera of gram-positive cocci, the other being Staphylococcus. Streptococci are identified as different species on blood agar on the basis of their hemolytic pattern and sensitivity to optochin and bacitracin. There are many pathogenic species of streptococci, including S. pyogenes, S. agalactiae, S. pneumoniae, and the viridans streptococci. Streptococcus del grupo A. Se presenta con un área eritematosa cubierta por pequeñas vesículas, pústulas y/o costras color miel. El tratamiento es con antibióticos.
• Síndrome de piel escaldada por estafilococos: un trastorno cutáneo ampolloso causado por una infección local, generalmente debida a S. aureus S. aureus Potentially pathogenic bacteria found in nasal membranes, skin, hair follicles, and perineum of warm-blooded animals. They may cause a wide range of infections and intoxications. Staphylococcus. Se presenta con fiebre y eritema sensible y difuso, ampollas intraepidérmicas y desprendimiento de la capa superficial de la piel, dejando un aspecto rojo “escaldado”. El tratamiento implica antibióticos por vía intravenosa.