Gas gangrene

Gas gangrene-PATHOPHYSIOLOGY, ORGANISMS CAUSING, CLINICAL FEATURES, TREATMENT, PROPHYLAXIS

1. II MBBSII MBBS
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2. •It is a rapidly progressive, potentially fatal condition It is a rapidly progressive, potentially fatal condition
characterized by widespread necrosis of the muscles and characterized by widespread necrosis of the muscles and
subsequent soft-tissue destruction. subsequent soft-tissue destruction.
•This is a dreaded consequence of inadequately treated This is a dreaded consequence of inadequately treated
missile wounds, crushing injuries and high-voltage missile wounds, crushing injuries and high-voltage
electrical injuries. electrical injuries.
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3. •Clostridium species – spore forming, Gram +veClostridium species – spore forming, Gram +ve
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4. GAS GANGRENE IS
POLYMICROBIAL IN
NATURE
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5. Growth of Clostridium perfringens (plump rods), Growth of Clostridium perfringens (plump rods),
causing gas formation and separation of the fiberscausing gas formation and separation of the fibers
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Muscle fibers
Clostridium
Gas-filled spaces

6. •They are present in the soil and have also They are present in the soil and have also
been isolated from the human been isolated from the human
gastrointestinal tract and female genital gastrointestinal tract and female genital
tract.tract.
•Non-clostridial gas-producing organisms Non-clostridial gas-producing organisms
such as such as coliformscoliforms have also been isolated in have also been isolated in
60–85% of cases of gas gangrene.60–85% of cases of gas gangrene.
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7. AnaerobicAnaerobic
environmentenvironment
Distension ofDistension of
tissuestissues
InterferingInterfering
Blood supplyBlood supply
Ischemia/Ischemia/
gangrenegangrene
Toxemia andToxemia and
deathdeath
Spores Spores
germinategerminate
Vegetative Vegetative
cells multiplycells multiply
CarbohydratesCarbohydrates
Fermentation Fermentation
Gas productionGas production
In tissuesIn tissues

PATHOGENESISPATHOGENESIS
Incubation period is Incubation period is
1-7 days1-7 days
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075id523727/a/4M2•i78ua5f2c3i4r 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
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11. •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.
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12. Presentation
Crepitation in tissues,
sickly sweet odor discharge,
rapidly progressing necrosis,
fever, hemolysis, toxemia,
shock,
renal failure, and death
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15. Culture and sensitivity
Storming fermentation
Lecithinase test
Lab. Investigations
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16. G
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17. G
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18. G
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19. G
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20. •Cleaning the wound
•Avoid the contaminated material
•improve circulation in patients with poor
circulation
•Treatment with hyperbaric oxygen- to treat
the gas gangrene
•antitoxin
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21. (1) Do a thorough wound toilet.
(2) In high risk wounds give the patient
penicillin 1.5 megaunits 4 hourly,
or tetracycline
Prevention
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22. •High doses of antibiotic : PenicillinHigh doses of antibiotic : Penicillin
•The dead tissue is removed or limbs are amputatedThe dead tissue is removed or limbs are amputated
•No vaccineNo vaccine
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23. 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.
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24. Do this in a septic theatre,
or even in the out-patient department,
and not where clean cases go for operation.
EXPLORATION
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26. AMPUTATION
Amputate under a tourniquet
Close the stump by delayed
primary suture
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27. Myonecrosis of right leg
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28. Myonecrosis of left foot
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29. Stump of above knee amputation
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30. •Patients should be admitted to ICU and Patients should be admitted to ICU and
treated aggressively with careful monitoring. treated aggressively with careful monitoring.
•The role of HBO is not as clear as in The role of HBO is not as clear as in
necrotising fasciitis but it is recommended in necrotising fasciitis but it is recommended in
severe cases if the facilities are available.severe cases if the facilities are available.
–increases the normal oxygen saturation in the increases the normal oxygen saturation in the
infected wounds by 1000-fold leading toinfected wounds by 1000-fold leading to
•Bacteriocidal effect, Bacteriocidal effect,
•Improves neutrophil function, Improves neutrophil function,
•Enhanced wound healingEnhanced wound healing
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DiseaseDisease Signs & Signs &
SymptomsSymptoms
TransmissionTransmissionTreatmentTreatment Prevention & Prevention &
ControlControl
Gas Gas
gangrenegangrene
•Foul odor and intense
pain and swelling at
the wound site
•Soil
•Endogenous transfer
•Surgery
•Cephalosporin
•Hyperbaric oxygen
•Cleaning wounds
•Debridement

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