Nur Syafiqah Binti Ab Samat 030386

GAS GANGRENE

What is gas gangrene?

It is a rapidly progressive, potentially fatal

condition characterized by widespread necrosis of the muscles and subsequent softtissue destruction.

Causative organism
Clostridium species spore forming, Gram

+ve
c.septicum

c.novyi
c. Perfringens (mostly)

Clostridium sp
They are present in the soil and have also

been isolated from the human gastrointestinal tract and female genital tract. Anaerobic Can survive and multiply only in tissues with low oxygen tension

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 are

- The toxins (lecithinase) and enzyme are produced

- The bacteria are

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)

produced
- The bacteria

grow and ferment the muscle carbohydrate the anaerobic tissue present

present in circulation system

Risk Factors
The persons at risk those with Diabetes Mellitus,

blood vessel disease

Contact with contaminated cloth and other

foreign material
Trauma or recent surgical wound

Clinical features
Intense pain and swelling around the wound Brownish discharge Little or no pyrexia Increase pulse rate Smells characteristic becomes evidence. Patient becomes toxaemia Coma and death

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.

Case scenario
A female, 65 years old from Dungun,

known diabetic on irregular treatment, had history of glass injury at plantar surface of right foot before 20 days was admitted to HSNZ. She had history of fever with rigor & with swelling & redness of right foot since 3 4 days. Where she was diagnosed to have ulcer extending to tendon and muscles. There are some death necrotic tissues.

1 What is the grade of this patient foot ulcer according to Wagner grading system? Give reason?

Answer

Ulcer Classification
Wagners Classification

0 Intact skin (impending ulcer) 1 superficial 2 deep to tendon bone or ligament 3- osteomyelitis 4 gangrene of toes or forefoot 5 gangrene of entire foot

Q.2 What investigation you want to request to exclude other grades? Give reason?

Answer