Erysipelas can spread rapidly if not treated promptly. Blood cultures are positive in only about
5% of cases (25).
Treatment
There has never been a documented report of group A streptococci resistant to penicillin, and
thus penicillin remains the drug of choice, intravenous (IV) penicillin G (2 million units every
6 hours). Other alternative agents include first generation cephalosporins or clindamycin.
Agents such as erythromycin and the other macrolides are limited by their rates of resistance
and the fluoroquinolones are generally less active than theb-lactam antibiotics againstb-
hemolytic streptococci.
CELLULITIS
Cellulitis is an acute, spreading pyogenic inflammation of the dermis and subcutaneous tissue
(26,27).S. aureusand group Ab-hemolyticStreptococcusspp. are the common organisms
(Fig. 2). Cellulitis commonly begins as erythema, edema, and pain and lacks demarcation. It
often occurs in the setting of local skin trauma from skin bite, abrasions, surgical wounds,
contusions, or other cutaneous lacerations. Edema also predisposes patients to cellulitis.
Specific pathogens are suggested when infections follow exposure to seawater (Vibrio
vulnificus) (28,29), freshwater (Aeromonas hydrophila) (30), or aquacultured fish (S. iniae) (31).
A. baumanniiis an emerging infection in patients who experience war trauma.A. baumannii
presented as cellulitis with a “peau d’orange” appearance with overlying vesicles and, when
untreated, progressed to necrotizing infection with bullae (hemorrhagic and nonhemorrhagic)
(32). Lymphedema may persist after recovery from cellulitis or erysipelas and predisposes
patients to recurrences. Recurrent cellulitis is usually due to group AStreptococcusand other
b-hemolytic streptococci. Recurrent cellulitis in an arm may follow impaired lymphatic
drainage secondary to neoplasia, radiation, surgery, or prior infection and recurrence in the
lower extremity may follow saphenous venous graft or varicose vein stripping. In addition,
Figure 1 Facial erysipelas involving the right cheek.
Sharp demarcation between the erythema and right
cheek is evident.298 Sharma and Saravolatz