Department of Dermatology, University of Muenster, Muenster, Germany.
Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany.
J Dtsch Dermatol Ges. 2020 Dec;18(12):1417-1424. doi: 10.1111/ddg.14252. Epub 2020 Oct 9.
Erysipelas, caused by beta-hemolytic streptococci, and limited cellulitis, frequently caused by Staphylococcus aureus or other bacteria, are skin and soft tissue infections characterized by typical clinical signs. However, despite the therapeutical relevance they are often not differentiated (e.g in clinical trials). Erysipelas are efficiently treated with penicillin, while limited cellulitis is treated with more wide-spectrum antibiotics. This study investigates whether parameters such as CRP, blood counts or novel parameters like immature granulocytes could serve as biomarkers to distinguish between these entities.
For this retrospective analysis 163 patients were included. We compared laboratory markers in patients with erysipelas (n = 68) to those with limited cellulitis (n = 41) of the leg. Both erysipelas and limited cellulitis were defined clinically, with an additional aspect for erysipelas being a prompt response to penicillin.
Erysipelas were characterized by higher levels of inflammation. CRP and leukocyte counts are the best parameters to discriminate between both infections. A CRP value ≥ 3.27 mg/dl indicated the diagnosis of erysipelas with 75 % sensitivity and 73.2 % specificity.
Our results support the thesis that erysipelas and limited cellulitis are distinct infections as defined in the German guidelines and that an assessment of CRP and leukocytes is useful for differential diagnosis.
丹毒是由β-溶血性链球菌引起的，局限性蜂窝织炎常由金黄色葡萄球菌或其他细菌引起，均为具有典型临床特征的皮肤和软组织感染。然而，尽管具有治疗相关性，但它们通常未被区分（例如在临床试验中）。青霉素可有效治疗丹毒，而局限性蜂窝织炎则需要更广泛的抗生素治疗。本研究旨在探讨 CRP、血细胞计数或不成熟粒细胞等新参数是否可作为区分这些疾病的生物标志物。
本回顾性分析纳入了 163 例患者。我们比较了腿部丹毒（n=68）和局限性蜂窝织炎（n=41）患者的实验室标志物。丹毒和局限性蜂窝织炎均通过临床定义，丹毒还需要对青霉素有迅速反应。
丹毒的炎症水平更高。CRP 和白细胞计数是区分这两种感染的最佳参数。CRP 值≥3.27mg/dl 提示丹毒诊断，其灵敏度为 75%，特异性为 73.2%。
我们的结果支持丹毒和局限性蜂窝织炎是德国指南定义的两种不同感染的观点，CRP 和白细胞计数评估有助于鉴别诊断。
