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aka "St. Anthony's Fire"
| • | also differs in that lymphatic involvement (“streaking”) is prominent |
| • | considered to be a strep infection (usually group A, occasionally group C or G) |
| • | suspect H. influenzae type B in any patient with cellulitis of head or neck who appears toxic and/or in danger of airway compromise (rare in adults) |
clinically:
| • | face or legs; usually no portal of entry found |
| • | indurated, erythematous plaque, with sharply demarcated border (“cliff-drop sign”) |
| • | overlying epidermis may become bullous, pustular or necrotic |
| • | not easy to confirm diagnosis; histology – neutrophils, organisms in dermis and lymphatics |
treatment:
| • | because almost always strep, drug of choice is penicillin (?probably not anymore) |
| • | definitive bacteriologic diagnosis is difficult to obtain |
| • | culture of needle aspirate, skin biopsy or blood usually negative |
| • | patients often appear worse in the first 1 or 2 days of antimicrobial therapy (probably secondary to dying organism suddenly releasing enzymes) |
recurrence:
| • | each attack probably causes some lymphatic damage from inflammation and scarring, which increases likelihood of further episodes |
| • | treat any predisposing conditions to prevent recurrence (tinea pedis, excema, dry skin) |
| • | if recurrences continue --> prophylactic antibiotics: IM benzathine PCN Q month, or oral PCN or erythromycin for 1 week each month |
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