Erysipelas (non-necrotising bacterial cellulitis): are tests needed?
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Typical, uncomplicated erysipelas treated in the community
No further tests
- Clinical diagnosis: no laboratory tests, no sampling, no imaging. Mark the edges of the plaque with a felt-tip pen (or photograph it) and review the patient if progress is not favourable within 24 to 48 hours.
Do not order
- FBC, CRP, ESR: no routine value in uncomplicated erysipelas [2]; no additional test is recommended [1].
- Streptococcal serology (ASO, anti-DNase B): microbiological tests, serology included, are often negative [2] and are not recommended in the simple form [1].
- Routine blood cultures and sampling of the portal of entry: reserved for the situations in the next tab [1].
- Routine venous Doppler ultrasound looking for thrombosis: not recommended (prevalence of deep vein thrombosis 0.8 to 2%) [2]; preventive anticoagulation is discussed according to thromboembolic risk factors [1].
Samples: special situations (bite, water, travel, healthcare, suppuration, treatment failure, immunosuppression)
Bacteriology, before the antibiotic
- Bacteriological sample of the portal of entry or of pus (direct examination, culture, susceptibility testing)
- Blood cultures (if high fever or chills, immunosuppression or signs of severity)if neededThe recommendation provides for local samples “and possibly blood cultures” in these situations [1]. Blood cultures are rarely positive (1 to 20%); the IDSA reserves them for signs of severity, certain risk settings (cancer, neutropenia, immunosuppression), trauma and bites, as cited by the supporting document [2].
Do not order
- Laboratory tests in primary care when necrotising fasciitis is suspected: not recommended, they delay urgent surgical management [1].
Sources (6)
- Haute Autorité de santé, Société française de dermatologie, Société de pathologie infectieuse de langue française. Prise en charge des infections cutanées bactériennes courantes. Recommandation de bonne pratique, texte des recommandations, février 2019.
- Haute Autorité de santé, Société française de dermatologie, Société de pathologie infectieuse de langue française. Prise en charge des infections cutanées bactériennes courantes. Argumentaire scientifique, février 2019.
- National Institute for Health and Care Excellence. Cellulitis and erysipelas: antimicrobial prescribing. NICE guideline NG141, publiée le 27 septembre 2019.
- Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014;59(2):e10-52.
- Organisation mondiale de la santé. The WHO AWaRe (Access, Watch, Reserve) antibiotic book. 2022. Chapitre 16 : infections légères de la peau et des tissus mous (impétigo, érysipèle, cellulite).
- Ramakrishnan K, Salinas RC, Agudelo Higuita NI. Skin and Soft Tissue Infections. Am Fam Physician. 2015;92(6):474-83.