GAS GANGRENE

Dr. Ehsanur Reza ShovanDr. Ehsanur Reza Shovan

• 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 high-voltage electrical injuries.

Causative agent

• Clostribium species – spore forming, Gram +ve

• They are present in the soil and have also been isolated from the human gastrointestinal tract and female genital tract.

• Non-clostridial gas-producing organisms such as coliforms have also been isolated in 60–85% of cases of gas gangrene.

Anaerobic environment

Distension oftissues

InterferingBlood supply

Ischemia/gangrene

Toxemia anddeath

Spores germinate

CarbohydratesFermentation

Gas productionIn tissues

PATHOGENESISIncubation period is

1-7 days

vegetative cells multiply

Pathogenesis

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.

Crepitation in tissues,sickly sweet odor discharge,rapidly progressing necrosis,fever, hemolysis, toxemia,

shock,renal failure, and death

Presentation

Culture and sensitivity

Storming fermentation

Lecithinase test

Lab. Investigations

G

A

S

I

N

S

O

F

T

T

I

S

S

U

E

G

A

S

I

N

U

T

E

R

U

S

G

A

S

I

N

U

T

E

R

U

S

G

A

S

I

N

U

T

E

R

U

S

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

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

Prevention

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.

OrTetracycline 0.5 g intravenously

or 1 g orally every 6 hours.

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

Do this in a septic theatre, or even in the out-patient department,

and not where clean cases go for operation.

EXPLORATION

AMPUTATION

Amputate under a tourniquet Close the stump by delayedprimary 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