STUDIES OF HEMOLYTIC STREPTOCOCCAL INFECTION I. FACTORS INFLUENCING THE OUTCOME OF ERYSIPELAS

Abstract

I.[long dash]A survey was made of 1400 patients with erysipelas admitted to the Boston City Hospital during a period of 11 years. Erysipelas occurs at all ages, more often after the age of 20 years. It follows wound infections or arises as a complication of acute tonsillitis, acute sinusitis, acute otitis media or mastoiditis, puerperal sepsis, infections of the umbilicus and hemolytic streptococcal empyema. It is especially common in the presence of chronic debilitating diseases. Mortality depends upon the age of the individual, the presence of bacteriemia and whether it complicates a debilitating disease or a hemolytic streptococcal infection elsewhere. The mortality of these cases was 16.4%.[long dash]II. The clinical courses of 30 patients with erysipelas and the serological reactions that can be demonstrated during and following the disease were studied. The antistreptolysin (antihemolysin) of the blood serum increased during the course of the disease, and frequently remained above the original titer for periods of 40 days to 6 mos. The highest titer was usually reached within the first 20 days after the onset of the illness. Increases in streptococcidal power of the blood could not be correlated with recovery. It was considered to be a response on the part of the host to the streptococcal infection. The complement titer of the blood increased more than 0.1 cc. in 5, decreased more than 0.1 cc. in 9, and remained the same in 16. Generally, there was an adequate amt. of complement present for phagocytosis. Only 1 of the 30 patients reacted positively to Dick toxin; 24 patients showed positive reactions to 0.1 mgm. of the nucleo-protein of hemolytic streptococcus. 3 patients developed agglutinins against their own organisms in titers varying from 1 to 40 to 80. The mechanism of recovery from erysipelas is discussed.