Hemostasis in erysipelas – modern concepts

Abstract

Introduction : Erysipelas is a common, ubiquitous bacterial infection of the skin mainly caused by Streptococcus pyogenes - group A beta-hemolytic streptococcus. The current epidemiology of the disease demonstrates an upward trend in cases with primary and recurrent erysipelas, a change in the site of predilection – from face to lower limbs, and an increase of severe cases with a hemorrhagic or bullous-hemorrhagic component. To date, the alterations in hemostasis due to streptococcal bacterial infection are still not well defined. Despite the advanced treatment of erysipelas, in approximately 10% of patients with hemorrhagic and bullous-hemorrhagic erysipelas, a skin necrosis has occurred. The combination of severe types of erysipelas with local and general predisposing factors such as diabetes mellitus, obesity, chronic vessel insufficiency results in recurrences and complications with high percentage of disability. In addition, streptococcal infections may have fulminant progression as for every 1 hour delay of adequate treatment, the percent of mortality increases with 7.5%. Aim:  The purpose of this paper is to establish the current concepts and observations of hemostatic changes in erysipelas. Materials and Methods : Literature referred in MEDLINE, Web of Science, Scopus has been studied. Results : The hemostasis changes in erysipelas are not well researched. The available literature is insufficient as the studies are based on a small number of patients, which prevents any significant conclusions. Conclusion : The increasing incidence of patients with severe form of erysipelas stresses the need to intensify the study of hemostasis in erysipelas. Knowing the mechanisms of coagulation changes might help to predict and prevent severe, irreversible complications.