Umbilical erysipelas

　　How is umbilical erysipelas caused? Briefly described as follows:

　　First, pathogenic bacteria

　　The causative bacteria of umbilical erysipelas are most commonly Staphylococcus, followed by Escherichia coli and hemolytic streptococci, etc. According to reports, the main causative bacteria of community-acquired infections are Gram-positive cocci (67.2％); while in cases of hospital-acquired infections, Gram-negative bacilli are the main causative bacteria (56.8％).

　　Second, infection causes

　　1, Acute umbilical erysipelas

　　(1) Neonatal umbilical erysipelas. The main reasons for neonatal umbilical cord infection include: contamination during umbilical cord ligation after birth or the dressing being contaminated with feces and urine before and after the umbilical cord falls off; premature rupture of the amniotic sac, with the umbilical cord being contaminated before birth; contamination of the umbilical cord by bacteria in the birth canal during delivery; contamination by the exudate of the umbilical urachal fistula or yolk sac fistula; secondary infection from umbilical adenoma or sinus.

　　(2) Adult umbilical erysipelas. The umbilical fossa is deep and the skin on the bottom is creased, with dirt and sebum retained, making it difficult to keep the local area clean, or accidentally scratched during cleaning, leading to bacterial invasion and infection.

　　2, Chronic umbilical erysipelas

　　If acute umbilical erysipelas is not cured, it may become chronic umbilical erysipelas and umbilical granuloma; the umbilical cord falls off prematurely, leaving an unhealed wound; there is a foreign body (such as talcum powder) in the umbilical fossa causing long-term chronic irritation, which can cause the umbilical erysipelas to persist and form an umbilical granuloma.

　　Newborns have low immunity. If the umbilical inflammation is not controlled, it can spread to the periumbilical area, forming abdominal wall cellulitis or spreading along the lymphatic vessels, leading to a large-scale infection of the abdominal wall, even extending to the lower chest wall; deep spread can cause peritonitis; through the unoccluded umbilical artery and vein, it can cause deep infection of the abdominal wall or directly enter the blood circulation causing liver abscess, septicemia, and toxic shock. It can also cause umbilical venous thrombosis. If the thrombus extends to the portal vein, it can cause portal vein obstruction, which later develops into extrahepatic portal hypertension.

　　What are the symptoms of umbilical erysipelas? Briefly described as follows:

　　1, Acute umbilical erysipelas

　　(1) Neonatal umbilical erysipelas: The initial symptoms are delayed healing of the umbilical cord wound after falling off and exudation, sometimes with redness and swelling of the umbilical ring, small granulation surfaces visible in the umbilical fossa, or a small amount of mucus or purulent secretion at the umbilical residual end; in severe cases, symptoms such as redness, swelling, heat, and pain due to cellulitis may occur; in more severe infections, there may be significant redness, swelling, and hardening around the umbilicus, with a large amount of purulent secretion. Light pressure on the umbilical area may cause pus to flow out from the umbilical fossa with an odor. Generally, systemic symptoms are mild, and if the infection spreads to the adjacent peritoneum causing peritonitis, the patient may have varying degrees of fever and increased white blood cell count. If the infection spreads through the blood vessels causing sepsis, symptoms such as restlessness, pale complexion, refusal to breastfeed, difficulty breathing, and enlargement of the liver and spleen may occur.

　　(2) Acute umbilical erysipelas: The symptoms include pain, congestion, and edema in the umbilical fossa or around the umbilicus, often with serous secretion with an odor. Physical examination may show moisture in the umbilical fossa, edema around the umbilicus, and tenderness; in severe cases, there may be abscess formation in the umbilical fossa with fever. Lymphadenopathy in the inguinal area may occur, occasionally spreading to the periumbilical area, with systemic symptoms due to deep infection and cellulitis.

　　2, Chronic umbilical erysipelas

　　The umbilical fossa is moist and swollen, with an odor in the exudate, which can be purulent or mixed with blood. Due to the stimulation of the secretion, the surrounding skin can cause eczema-like changes, even ulceration. Adults or older children may report an itchy sensation, frequently scratching the umbilical cord with their hands. Physical examination may show hyperplasia of granulation tissue in the umbilical fossa, with a dark red color, prominent, without mucosal covering, bleeding upon palpation, and most of the courses are long and difficult to heal.

　　Strict sterilization of the umbilical cord can effectively prevent the occurrence of umbilical erysipelas. The local area should be kept dry. Adults can use cotton balls soaked in alcohol to gently clean the inner folds of the umbilical cord, eliminate the moist fluid deep in the umbilical fossa, remove the peeled skin, and keep it dry. The umbilical cord of a newborn should be treated with aseptic technique at birth, and unclean items should not be used to cover the umbilical cord, and it should be kept dry. If the umbilical cord is moist, there is leakage, or the umbilical cord falls off and the wound delays healing, local anti-inflammatory treatment should be performed, and antibiotics may be administered intravenously if necessary to prevent sepsis. Popularize the new method of delivery, strictly implement aseptic operation during umbilical cord cutting, and do a good job of post-cutting care to keep the local area clean and hygienic.

　　What examinations should be done for umbilical erythema? A brief description is as follows:

　　1. Blood test

　　White blood cells are normal or elevated, and when accompanied by systemic infection symptoms, the total white blood cell count and neutrophils are also elevated.

　　2. Bacteriological examination

　　Secretions from the wound can be taken for smears and staining or bacteriological culture as a guide for clinical medication. Blood culture examination can be performed if suspected of sepsis.

　　The following is a brief description of the dietary principles for patients with umbilical erythema:

　　1. Patients with umbilical erythema should eat foods rich in protein, such as meat, fish, eggs, and milk.

　　2. Eat foods rich in dietary fiber, such as sweet potatoes, corn, and potatoes.

　　3. Eat foods rich in vitamins, all vegetables and fruits.

　　4. Avoid smoking and drinking, and avoid greasy, cold, and salty foods for umbilical erythema.

　　Local treatment is the main approach, and generally, antibiotics are not needed.

　　First, treatment in the acute stage

　　Control infection and keep the local area dry.

　　1. Treatment of mild cases: Remove local scabs, use 3% hydrogen peroxide solution and 75% ethanol for cleaning at any time. Adults can use hot salt water compresses to keep the umbilicus dry.

　　2. Treatment of abscess: When the abscess is not localized, it can be externally applied with golden ointment around the umbilicus or physical therapy can be performed to localize the infection, promote the formation of the abscess, and then break outwards. After the abscess forms, it should be incised and drained.

　　3. Treatment of systemic infection: When there is a large amount of pus or complications such as peritonitis and sepsis, a sufficient amount of broad-spectrum antibiotics, such as penicillin, should be administered. Effective antibiotics should be selected based on the results of bacteriological examination.

　　4. Supportive therapy: When systemic infection occurs, attention should be paid to supplement water and electrolytes. To enhance the body's immunity, fresh whole blood, plasma, or albumin can be appropriately administered.

　　Second, treatment in the chronic stage

　　Small granulation tissue wounds can be treated with 10% silver nitrate burn, then coated with antibiotic ointment. Large granulation tissue wounds can be surgically removed or electrosurgically removed. Keeping the umbilical fossa clean and dry is enough for healing.

　　Wounds with secretions should not be treated with talcum powder to avoid stimulating granulation tissue growth.