The diagnosis is based primarily on physical findings. Leukocytosis with an increase in the neutrophil count is common. Performing a needle aspiration of the infection site is rarely successful at isolating an organism, but swabbing the portal of entry, when identifiable, may have a higher success rate. Blood cultures are positive in only around 5 percent of patients.7 Serologic testing to determine ASO and anti-DNAase B titers may be more specific but is of little use acutely in the ED.
The differential diagnosis includes other forms of local cellulitis. Some believe that necrotizing fasciitis is a complication of erysipelas infections and should be considered in all cases.
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