Gas gangrene

Gas gangrene (also known as "Clostridial myonecrosis") is a bacterial infection that produces gas within tissues in gangrene. It is a deadly form of gangrene usually caused by Clostridium bacteria. It is a medical emergency.

Features

Gas gangrene can cause myonecrosis, gas production, and sepsis. Progression to toxemia and shock is often very rapid.

Pathophysiology

Gas gangrene is caused by exotoxin-producing Clostridial species (most often Clostridium perfringens, and C novyi but less commonly C. septicum or C. ramnosum), which are mostly found in soil but also found as normal gut flora, and other anaerobes (e.g. Bacteroides and anaerobic streptococci). The exotoxin is commonly found in C. perfringens type A strain and is known as alpha toxin. These environmental bacteria may enter the muscle through a wound and go on to proliferate in necrotic tissue and secrete powerful toxins. These toxins destroy nearby tissue, generating gas at the same time.

Other organisms may rarely cause gas gangrene(for example, Klebsiella pneumoniae in the context of diabetes).

A gas composition of 5.9% hydrogen, 3.4% carbon dioxide, 74.5% nitrogen and 16.1% oxygen was reported in one clinical case.

Treatment

Treatment is usually debridement and excision with amputation necessary in many cases. Antibiotics alone are not effective because they do not penetrate ischaemic muscles enough to be effective. However, penicillin is given as an adjuvant treatment to surgery. In addition to surgery and antibiotics, hyperbaric oxygen therapy (HBOT) is used and acts to inhibit the growth of and kill the anaerobic C. perfringens.

Additional images

<gallery perrow=2> Image:Hemipelvectomy gas gangrene.jpg|Hemipelvectomy for gas gangrene. Image:Gas gangrene pathology slide.jpg|Muscle biopsy examined under the microscope (haematoxylin-eosin stain, zoom 100×). The large white areas between the muscle fibers are due to gas formation. Image:Clostridium perfringens gas gangrene.jpg|Gram stain of a muscle biopsy showing Gram-positive, rod-shaped, anaerobic, spore-forming bacteria in the infected muscle tissue. The result is highly compatible to an infection with Clostridium perfringens. Image:Gas gangrene shoulder.jpg|Gas gangrene of the shoulder. </gallery>

Translation of "Gas gangrene"

German: Gasbrand, Croatian: Plinska gangrena, Italian: Gangrena gassosa, Japanese: ガス壊疽, Dutch: Koudvuur, Polish: Zgorzel gazowa, Portuguese: Gangrena gasosa, Russian: Гангрена газовая, Swedish: Gasbrand.