Bacterial Dermohypodermitis in the Elderly: Epidemiological, Clinical, Etiological, and Progressive Profile in 89 Patients, a Review of the Literature
by Assane Diop1*, Mame Tene Ndiaye2, Papa Gallo Sow3, Saer Diadie4, Jade Kaddoura1, Maïmouna Ba1, Boubacar Ahi Diatta4, Maodo Ndiaye4, Fatimata Ly1, Suzanne Oumou Niang4
1Dermatology/STI Hospital Institute of Social Hygiene of Dakar, Dermatology Cheikh Anta Diop University, Senegal
2Dermatology Albert Royer Hospital Dakar, Dermatology Cheikh Anta Diop University, Senegal
3Alioune Diop University, Community Health UFR, Bambey, Senegal
4Dermatology Aristide Le Dantec Hospital, Dermatology Cheikh Anta Diop University, Dakar, Senegal
*Corresponding author: Assane Diop, Dermatology/STI Hospital Institute of Social Hygiene of Dakar,Dermatology Cheikh Anta Diop University, Senegal.
Received Date: 23 April, 2024
Accepted Date: 6 May, 2024
Published Date: 10 May, 2024
Citation: Diop A, Ndiaye MT, Sow PG, Diadie S, Kaddoura J, et al. (2024) Bacterial Dermohypodermitis in the Elderly: Epidemiological, Clinical, Etiological, and Progressive Profile in 89 Patients, a Review of the Literature. Clin Exp Dermatol Ther 9: 220. https://doi.org/10.29011/2575-8268.100220
Abstract
Background: Bacterial dermohypodermitis (BDH) is the leading reason for hospitalization in our dermatology departments. Voluntary Cosmetic Depigmentation is one of the main risk factors. In sub-Saharan Africa, studies focusing on BDH in the elderly are rare. Our objective was to determine the epidemiological-clinical, etiological, and progressive profile of bacterial dermohypodermitis (BDH) in elderly subjects. Material and methods: This is a cross-sectional, retrospective study, carried out in the two dermatology reference departments in Dakar, over a period of 11 years (January 1, 2011, to December 31, 2021). Any patient aged 65 or over, hospitalized for BDH was included. Results: We collected 89 patients, or 7.66% of BDH cases. The mean age was 73.79 ± 7 years. The sex ratio (M/F) was 0.67. High blood pressure was present in 56.2% (n=50), obesity in 31.5% (n=28) and diabetes in 22.5% (n=20). Patients were febrile in 39.3% (n=35). BDH was necrotizing in 35% (n=31). The topography was leg in 92% (n=82) and buttock in one patient. Polynuclear neutrophil leukocytosis was noted in 63% (52/82). C-Reactive Protein (CRP) was elevated in 95.7% (67/70). The entry point was inter-toe intertrigo in 51.8% (43/83) and plantar fissures in 5.6% (5/83). Death from septic shock was noted in 3 patients. Conclusion: BDH in the elderly is often associated with cardiovascular risk factors. The necrotizing form is very common. However, the prognosis does not seem to be more severe than in adults.
Keywords: Bacterial dermohypodermitis; Elderly; High blood pressure; Obesity.
Introduction
Bacterial dermohypodermitis (BDH) are acute infections of the dermis and hypodermis, most often linked to group A hemolytic beta streptococcus and sometimes to other germs. They include three entities: non-necrotizing bacterial dermohypodermitis or erysipelas (NNBDH), necrotizing bacterial dermohypodermitis without involvement of the fascia (NBDH) and necrotizing bacterial dermohypodermitis with involvement of the fascia or necrotizing fasciitis. In Senegal, they constitute the primary reason for hospitalization in dermatology departments [1,2]. Bacterial dermohypodermitis occurs preferentially in the lower limbs, more rarely in the upper limbs, face, or buttocks. The diagnosis of bacterial dermohypodermitis is essentially clinical. It is based on the appearance of a febrile inflammatory swelling, most often topped by an erythematous plaque. Paraclinical examinations are not necessary for diagnosis but may show a biological inflammatory syndrome. Blood cultures rarely allow a germ to be isolated. The treatment of erysipelas is medical and is essentially based on beta-lactam antibiotics [3]. As for necrotizing bacterial dermohypodermitis, its treatment is medico surgical. The evolution of bacterial dermohypodermitis is generally favorable, but sequelae such as lymphedema, which can progress to elephantiasis, are possible. Primary and secondary prevention of bacterial dermohypodermitis is mainly based on the management of risk factors.
In sub-Saharan Africa, bacterial dermohypodermitis constitutes a public health problem, especially due to voluntary cosmetic depigmentation [4]. In West Africa, particularly in Senegal, studies on bacterial dermohypodermitis in elderly subjects are almost non-existent. Therefore, we carried out this work with the aim of determining the epidemiological, clinical, etiological, and progressive profile of bacterial dermohypodermitis in elderly subjects.
Material and Methods
This is a cross-sectional study, with retrospective data collection, covering the period from January 1, 2011, to December 31, 2021 (11 years). The study was carried out in the two-reference university hospital dermatology departments in Dakar (dermatology departments of the Aristide Le Dantec hospital and the Institute of Social Hygiene of Dakar). Patients were recruited from the hospitalization registers of these two units. All patients aged 65 or over, hospitalized with a febrile or non-febrile inflammatory swelling and diagnosed with bacterial dermohypodermitis, were included. Patients with incomplete or unusable records were not included. A standardized survey form was created for data collection. To ensure data confidentiality, patients’ first and last names were initialed on the survey form. The following data were collected: sociodemographic, clinical, paraclinical, therapeutic and evolutionary. Data entry and analysis were performed using Office 2019 pack software and SPSS 25.0 for mac. Proportions of variables were compared using Chi-square or Fisher tests. The relationship was statistically significant if p ≤ 0.05.
Results
We identified 89 patients aged 65 or over, out of 1161 hospitalized with bacterial dermohypodermitis, a frequency of 7.66%. Non-necrotizing bacterial dermohypodermitis (Figure 1) or erysipelas was reported in 65.2% (n=58) of patients and necrotizing bacterial dermohypodermitis (Figure 2) in 34.8% (n=31).
Figure 1: Erysipelas of the foot and lower extremity of the right leg in an elderly patient with psoriasis.