GAS GANGRENE

It is a rapidly progressive, potentially fatal condition characterized by widespread necrosis of the muscles and subsequent soft-tissue destruction.
This is a dreaded consequence of inadequately treated missile wounds, crushing injuries and highvoltage electrical injuries.

Causative agent
Clostridium species spore forming, Gram +ve

c.septicum

c.novyi
c. Perfringens (mostly)

 They are present in the soil and have also been isolated from the human gastrointestinal tract and female genital tract. Non-clostridial gasproducing organisms such as coliforms have also been isolated in 6085% of cases of gas gangrene.

vegetative cells multiply Spores germinate Carbohydrates Fermentation

Anaerobic environment

PATHOGENESIS
Incubation period is 1-7 days

Gas production In tissues

Toxemia and death

Distension of tissues Interfering Blood supply Ischemia/ gangrene

Pathogenesis
- Bacteria

enters the broken skin or wound

- Spores

- The toxins (lecithinase) and enzyme are produced bacteria are grow and ferment the muscle carbohydrate the anaerobic tissue present
- The

Examples of enzyme: colagenases, proteases and lipases

- These enzymes will kill other host cell and extend the anaerobic environment - Produce gases (nitrogen, hydrogen sulphide and carbon dioxide) - Crepitant tissue ( destroyed tissue)

are produced

- The bacteria

present in circulation system

Epidemiology
The persons at risk those with Diabetes Mellitus, blood vessel disease and colon cancer Contact with contaminated cloth and other foreign material Trauma or recent surgical wound

Symptoms
High fever Shock Massive tissue destruction Blackening of skin Severe pain around a skin of wound Blisters with gas bubbles form near the infected area, the heartbeat and breathing become rapid.

Presentation
Crepitation in tissues, sickly sweet odor discharge, rapidly progressing necrosis, fever, hemolysis, toxemia, shock, renal failure, and death

Lab. Investigations

Culture and sensitivity Storming fermentation Lecithinase test

Prevention
Cleaning the wound Avoid the contaminated material improve circulation in patients with poor circulation antitoxin

Prevention
(1) Do a thorough wound toilet. (2) In high risk wounds give the patient penicillin 1.5 megaunits 4 hourly, or tetracycline

Treatment
High doses of antibiotic : Penicillin The dead tissue is removed or limbs are amputated No vaccine

10 megaunits of benzyl penicillin daily for 5 days as four 6 hourly doses. Or Tetracycline 0.5 g intravenously or 1 g orally every 6 hours.

Clostridia not sensitive to metronidazole, some other anaerobic bacteria are, so give it.

EXPLORATION

Do this in a septic theatre, or even in the out-patient department, and not where clean cases go for operation.

AMPUTATION
Amputate under a tourniquet Close the stump by delayed primary suture

Myonecrosis of right leg

Myonecrosis of left foot

Stump of above knee amputation

 Patients should be admitted to ICU and treated aggressively with careful monitoring. The role of HBO is not as clear as in necrotising fasciitis but it is recommended in severe cases if the facilities are available.
increases the normal oxygen saturation in the infected wounds by 1000-fold leading to
Bacteriocidal effect, Improves neutrophil function, Enhanced wound healing