Gas gangrene, diagnosis and treatment

1. Ministry of Health of Ukraine
Donetsk National Medical University
Subject : Epidemiology
“GAS GANGRENE”
SUBMITTED TO : N.I. OPERCHUK
By: SRISHTI GUPTA
Group: 503 A.m.
2022

2. INTRODUCTION
Gangrene is the death of body tissue.
Clostridial myonecrosis, a type of gas gangrene, is a fast- spreading and
potentially life-threatening form of gangrene caused by a bacterial infection
from Clostridium bacteria. The infection causes toxins to form in the tissues,
cells, and blood vessels of the body. These bacteria will release toxins that cause
tissue death and release a gas.
“Rapidly spreading gangrene affecting injured tissue infected by a soil bacterium
and accompanied by the evolution of foul-smelling gas”

4. CAUSES
Clostridium 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.
Gas gangrene is most commonly caused by the Clostridium perfringens bacterium. In some
cases, it may be caused by group A Streptococcus bacteria. The infection occurs suddenly and
spreads quickly. Gas gangrene generally develops at a recent surgical or injury site. In rare cases,
it may happen spontaneously, without an apparent cause.
Certain injuries have a higher risk of causing gas gangrene, including: muscle injuries severely
damaged tissues wounds that are very deep, wounds that are contaminated with stool or dirt,
especially those that might occur on a farm You are also at an increased risk for developing this
condition if you have: diabetes arterial disease colon cancer frostbite open fractures used a
contaminated needle to inject substances into your muscles.

5. 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,
★ Tachycardia.
★ Air under the skin
★ Pain around the wound
★ Swelling around wound
★ pale skin that quickly turns gray, dark red, purple, or black blisters with foul-smelling discharge
★ excessive sweating increased heart rate Vomiting yellow skin and eyes (jaundice) is a late sign

6. ETIOLOGY
Clostridium species produce more toxins and
exhibit higher degrees of virulence than any
other bacterial taxon.
Four species of Clostridium (Clostridium
botulinum, Clostridium perfringens,
Clostridium tetani, and Clostridium sordelli)
are responsible for most human infections.

8. The infection involves deeper tissue such as a muscle which can lead to a rapidly
spreading infection along tissue planes, and patients often present with sepsis.
The infection may develop hours to weeks after the initial trauma and
inoculation. The inoculation of the bacteria does not always cause gas gangrene,
and there are host and organism factors that determine the progression to
infection.
Immunocompromised patients and those with local tissue hypoxia (due to
trauma or poor vascular supply) are most at risk.

9. RISK FACTORS
➢ Diabetes
➢ Blood vessel disease
➢ Severe injury or surgery
➢ Smoking
➢ Obesity
➢ Immunosuppression
➢ Medications or drugs
➢ Complications of COVID-19

10. Toxicokinetics
Common toxins produced by C. perfringens:
● Alpha toxin: Lecithinase (or phospholipase) that breaks down cell membrane resulting in
cell death and tissue necrosis. This toxin is also hemolytic and cardiotoxic.
● Beta toxin: Necrosis of tissue
● Delta toxin: Hemolysin
● Epsilon toxin: Acts to increase cell membrane permeability; permease.
● Iota toxin: Necrosis of tissue
● Kappa toxin: Collagenase, gelatinase, necrosis of tissue. Especially leads to destruction of
blood vessels and connective tissue.
● Lambda toxin: Protease
● Mu toxin: Hyaluronidase
● Nu toxin: Deoxyribonuclease, hemolytic and necrosis of tissue
● Phi toxin: Hemolysin, cytolysin

11. CO-INFECTIONS
Co-infection with Toxoplasma gondii and
Clostridium perfringens in a postpartum
woman with uterine gas gangrene.
Coinfection of Clostridium perfringens and
Escherichia coli in gas-producing perianal
abscess.

12. DIAGNOSIS
Skin culture test to determine the presence of Clostridium perfringens as well as
other bacteria
Blood tests to look for an abnormally high white blood cell count that can
indicate an infection
Imaging tests like a X-ray, MRI or Arteriogram
Surgery to assess the spread of gas gangrene within the body

13. Treatment in peaceful time
Debridement, is a surgical procedure to remove dead, damaged and infected tissues
is performed. This is usually the first-line treatment. Amputation, which is the
surgical removal of arm or leg, is sometimes done to prevent the spread of infection.
Antibiotics [penicillin and clindamycin] are given to control the infection.
Hyperbaric oxygen therapy is used to treat Clostridium perfringens infection.
Repairing damaged blood vessels to improve blood flow to the affected area.
Performing a type of reconstructive surgery called skin graft to treat damaged
tissues. During a skin graft, healthy skin is removed from an unaffected part of the
body and attached over the damaged area. This helps in restoring any skin damage
caused by gas gangrene.
Sometimes septic abortion can lead to the development of uterine gas gangrene, and
it requires removal of the uterus.

14. Treatment during blockade of the city
❏ If dry gangrene, apply betadine [as it is readily available in most home first-
aid kits] and do not disturb. It will autolytically debride.
❏ If it is wet, maggots are the first choice to debride and eliminate infection
[usually this is only if the maggots are available in sterilized/ controlled
environment]
❏ During this procedure, clean fly larvae are placed on the affected area to eat
away dead tissue and remove bacteria.
❏ Conservative debridement may also be a consideration
❏ Antipyretics that are present at home like paracetamol and aspirin can be
given.
❏ The pain can be managed using analgesics like Ibuprofen etc.`

15. Improvised Treatment
Herbal treatments such as extracts of :-
❖ Haridra (Curcuma longa),
❖ Neem (Azadirachta indica) which has healing and antiseptic properties.
❖ Honey : Applying honey on gangrenous area helps in decreasing foul odour and also
dehydrates bacteria .
Keeping fever at bay using cold compress.
Pain management using Over the counter medications [OTC].
Antibiotic treatment in early stages.
Chinese herbs which have anti-inflammatory and antimicrobial effects.
The wounds should be exposed for drainage and washed with 3% liquid hydrogen peroxide for
disinfection.
The effectiveness of the sulfonamide compounds is also helpful in the prevention of infection.

16. Treatment for kids under 5 years
The management includes aggressive resuscitation with I.V. fluid, blood and
broad spectrum parenteral antibiotics.
Surgical debridement of necrotic tissues will control spread of infection and
induce reduction of systemic toxicity.
The wound should be copiously irrigated with dilute hydrogen peroxide solution
and normal saline; then packed with a povidone iodine soaked gauze pack.
Elevate the child's arm or leg above the level of his or her heart as often as can be
done. This will help decrease swelling and pain. Prop the child's arm or leg on
pillows or blankets to keep it elevated comfortably.
Use of antipyertic and analgesics to treat swelling, pain and fever.
Use of cold compress to keep the temperature normal.

17. Have the child rest as directed. Do not let the child play contact sports. Recovery
may take several weeks.
Give the child a variety of healthy foods. Healthy foods will help them heal.
Healthy foods include fruits, vegetables, whole-grain breads, low-fat dairy
products, beans, lean meats, and fish.

18. Resilience
Resilience is typically defined as the capacity to recover from difficult life
events.“It’s your ability to withstand adversity and bounce back and grow despite
life’s downturns.”
Resilience isn’t a fixed trait. Flexibility, adaptability, and perseverance can help
people tap into their resilience by changing certain thoughts and behaviors.
Research shows that students who believe that both intellectual abilities and
social attributes can be developed show a lower stress response to adversity and
improved performance.

19. Infection with C. perfringens diminishes mature neutrophils in bone marrow
which take a longer time for the body to cope up with. he impairment of the
innate immune system by the inhibition of granulopoiesis is crucial for the
pathogenesis of C. perfringens to promote disease to a life-threatening infection.

20. How to not let the infection to spread outside the hospital.
● Observe hand hygiene- Hands are the
most common vehicle for
transmission of organisms and “hand
hygiene” is the single most effective
means of preventing the horizontal
transmission of infections among
hospital patients and health care
personnel.

21. ● Gloves - Sterile gloves should be worn after hand hygiene procedure while
touching mucous membrane and non-intact skin and performing sterile
procedures. Clean, non-sterile gloves are safe for touching blood, other
body fluids, contaminated items and any other potentially infectious
materials.Change gloves between tasks and procedures in the same patient
especially when moving from a contaminated body area to a clean body area
Never wear the same pair of gloves for the care of more than one patient .
● Gown - Wear a gown to prevent soiling of clothing and skin during
procedures that are likely to generate splashes of blood, body fluids,
secretions or excretions.
● Mask, eye protection/face shield - Wear a mask and adequate eye
protection (eyeglasses are not enough), or a face shield to protect mucous
membranes of the eyes, nose and mouth during procedures and patient care
activities that are likely to generate splashes/sprays of blood and body fluids,
etc.,
● Shoe and head coverings

22. ● Disinfect and Keep Surfaces Clean - Between patients, every room in a facility should be cleaned
thoroughly with a bleach-containing cleanser. This helps to prevent accidental transmission of
infections as new patients are admitted. Furthermore, non-patient areas, such as the breakroom
and nurses’ station should be cleaned daily.
● Safe Management and Care of Environment - The environment for patients and healthcare staff
must be safe for practice. Even if an area may look clean many dangerous micro-organisms can
live on surfaces. There are many hotspots for these pathogens to live such as door handles, rails,
tables, etc. Therefore, the cleaning of these high-risk touchpoints is essential. When cleaning it is
essential the appropriate cleaning products and disinfectants are used. Healthcare professionals
should be aware of the schedules and responsibilities for cleaning and disinfecting the area and
every facility should have strict cleaning protocols.
● Safe Management of Equipment - It is essential any equipment you introduce into the healthcare
facility is fit for purpose and intended for medical use. Where possible you should ensure the
equipment comes with a robust service package and staff members are adequately trained on the
safe use of this equipment.

23. Advices for patients who can’t get into hospital
Maggot debridement. This is a nonsurgical alternative to traditional debridement.
During this procedure, clean fly larvae are placed on the affected area to eat away
dead tissue and remove bacteria.
Plenty of fluids and rest to stop from dehydration.
Use of betadine on affected area to keep the infection at bay.
Keeping the affected limb elevated to reduce swelling.
Use of hydrogen peroxide to irrigate the wound.
Use of at home antibiotics that are present at home.
In cases where the gangrene is widespread, a finger, toe, or even a limb may need to
be amputated and the need to consult a doctor increases as it can be
treated/amputation can be done in only sterile environments.

24. PREVENTION
The best ways to prevent gangrene are to:
★ Manage your health conditions - If you have diabetes, keep your blood sugar
levels under control. Check your hands, feet, and legs regularly for signs of
injury, slow wound healing, or other skin problems. Follow your doctor’s advice
on living with other conditions that affect your blood flow like peripheral artery
disease or Raynaud’s phenomenon.
★ Watch your wounds- Get medical care right away if you see signs of infection.
★ Don’t smoke- Tobacco can damage your blood vessels.
★ Keep a healthy weight- Extra pounds can put pressure on your arteries, blocking
blood flow.
★ Stay warm- Frostbite also blocks blood flow and can lead to gangrene.
★ Protect your feet if you have diabetes.
★ Protect your feet if you have peripheral vascular disease.