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Childhood rye
Medical expert of the article
Last reviewed: 05.07.2025
Erysipelas in children is one of the forms of streptococcal infections caused by beta-hemolytic streptococcus, manifested by focal serous-exudative or serous-hemorrhagic inflammation of the skin and subcutaneous fat and general toxic manifestations.
ICD-10 code
A46 Face
Epidemiology of erysipelas in children
The source of infection is a patient with streptococcal infection or a carrier of bacteria. It is often impossible to determine the source.
The mechanism of transmission is airborne and contact through infected objects, most often when the integrity of the skin is compromised.
The development of erysipelas is influenced by the child's individual predisposition. Young children suffering from dermatitis and other skin diseases are more likely to get sick.
Erysipelas occurs as an exogenous and endogenous infection. Endogenous infection develops against the background of chronic lesions. Microtraumas of the skin and the wound surface facilitate the penetration of the pathogen by contact.
The activation of the process in recurrent erysipelas is facilitated by a decrease in immune defense factors, auto- and heterosensitization. Intercurrent diseases, bruises, insect bites should be considered unfavorable factors.
The highest incidence of erysipelas is observed in late summer and autumn, often in the form of sporadic cases.
Children get sick much less often than adults. Newborns can become infected during childbirth from the mother or medical staff, as well as through infected dressings.
The incidence of erysipelas has decreased significantly in recent years, and the mortality rate is practically zero.
Causes of erysipelas
The causative agent of erysipelas is beta-hemolytic streptococcus group A. The poor isolation of streptococcus from the erysipelas focus and its extremely rare isolation from the blood of patients prompted a search for other pathogens. However, the assumption of the existence of a dermatogenic serotype of streptococcus was not confirmed. It has also been established that staphylococcus and other pyogenic bacteria play an etiologic role in complications of erysipelas. It is assumed that L-forms of streptococcus are involved in the etiology of recurrent erysipelas.
Pathogenesis of erysipelas
Beta-hemolytic streptococcus, penetrating exo- or endogenously, multiplies in the lymphatic vessels of the dermis. The local process is formed under the condition of initial sensitization of the skin to hemolytic streptococcus. In the origin of inflammatory changes in erysipelas, along with streptococcal toxins, tissue biologically active substances such as histamine, serotonin and other mediators of allergic inflammation play a huge role.
Symptoms of erysipelas in children
The incubation period lasts from several hours to 3-5 days. The disease usually begins acutely, but in some cases a prodrome is observed in the form of malaise, a feeling of heaviness in the affected limb, paresthesia, and pain in the area of the regional lymph nodes.
The acute onset of the disease is accompanied by headache, chills, an increase in body temperature to 38-40 °C; weakness, nausea, and vomiting are noted. In severe forms, delirium and meningitis are possible.
Classification of erysipelas
Depending on the nature of local manifestations, there are erythematous, erythematous-bullous, erythematous-hemorrhagic and bullous-hemorrhagic forms of erysipelas.
Depending on the severity of intoxication, the disease is divided into mild, moderate and severe forms.
Depending on the frequency of the disease, there are primary, recurrent and recurrent erysipelas; depending on the prevalence of the local process, there are localized, widespread, wandering and metastatic erysipelas.
There are also local (phlegmon, abscess, necrosis) and general (sepsis, pneumonia, etc.) complications of erysipelas.
Diagnosis of erysipelas in children
Erysipelas is diagnosed mainly based on the clinical picture. Laboratory data are of secondary importance: leukocytosis with a neutrophilic shift in the peripheral blood, eosinophilia, toxic granularity of neutrophils, increased ESR.
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Treatment of erysipelas in children
The most effective antibiotics for treating erysipelas are cephalosporins of the third and fourth generations in normal doses for 5-7 days. If necessary, macrolides can be used - erythromycin, azithromycin or metacycline. Sulfonamides can be prescribed. It is advisable to prescribe ascorbic acid, rutin, B vitamins, nicotinic acid, probiotics (acipol, etc.). It is promising to prescribe the immunomodulatory drug Wobenzym, which enhances the effect of antibiotics while reducing their side effects, and also improves lymph flow.