Gas gangrene

ppt

1. Dr.Prafulla Patil. Shri.Chamundamata Homoeopathic Medical College AND Hospital,Jalgaon. Gas Gangrene

2. Gangrene refers to the death of body tissue due to either a lack of blood flow or a serious bacterial infection. Gangrene commonly affects the extremities, including your toes, fingers and limbs, but it can also occur in your muscles and internal organs.

3. Types of gangrene:- 1.Dry gangrene. 2.Wet gangrene. 3.Gas gangrene. 4.Internal gangrene. 5.Fournier’s gangrene.

4. DEFINITION: It is a highly fatal, rapidly spreading infection caused By clostridial organisms which results in myonecrosis. Gas gangrene also known as Clostridial myositis, clostridial myonecrosis, infective gangrene of the muscles.

5. AETIOLOGY: The disease is caused by 1.Clostridium perfringens ( Clostridium.welchii )-the commonest organism (60%). Other organisms are 2.Clostridium septicum 3.Clostridium oedematiens 4.Clostridium histolyticum. These are gram-positive, anaerobic spore-bearing bacilli .

6. SOURCE OF INFECTION: Manured soil or cultivated soil, normal intestines.

7. RISK GROUP: In patients who have had lower limb amputations performed for ischaemic gangrene, infection can occur from patient's own bowel organisms. High velocity gun shot wounds with perforation of hollow viscus are also associated with risk of developing gas gangrene (military wound). Immunocompromised patients are at risk.

8. Toxins and their effect: Lecithinase Dermonecrosis ,Hemolysis Beta toxins Necrosis of tissue proteinase Breakdown of collagen fibre Hyaluronidase Break the cement substance of muscle cell

9. CLINICAL FEATURES: Severe pain and gross oedema of the wound. Sutured wound is under tension. Thin brownish fluid escapes which has sickly sweet odour. Palpable crepitus . Colour changes in the muscles. Skin becomes khaki-coloured due to haemolysis. Anxious and alert Toxic and ill Rapid increase in the pulse rate Hypotension due to suppression of adrenals Vomiting Low grade fever

10. DIAGNOSIS: To examine the pus under microscope after staining with Giemsa stain . Presence of gas indicates anaerobic metabolism . Anaerobic streptococci also produce gas.

11. PROPHYLAXIS: 1. Debridement: 2 . Prophylactic antibiotics: 3 . Judicious and minimal use of tourniquet: If possible, 4 . Gentle but effective application of plaster cast

12. TREATMENT: • Emergency surgery which includes excision of all dead muscles and necrotic tissues by using generous, long incisions-debridement . • Penicillin to be continued. • Blood transfusions before, during and after surgery. • Polyvalent anti-gas gangrene serum. • Hyperbaric oxygen will reduce the amount of toxin produced by the organisms (controversial). • Do not hesitate to amputate if it saves the life, because this is the only measure in late cases.

13. HOMOEOPATHIC TREATMENT: -Arsenicum -Crotalus -Secale -Carbo vegetabilis -Lachesis mutus -Polygonum punctatum -Sulphuricum acidum