Clostridium perfringens A is important in
Infection with gas formation
in the soft tissue.
Fasciitis or suppurative myositis:
Infection and gas in the muscle planes.
or gas gangrene:
a life-threatening disease.
Range of infections
Incubation period is
Crepitation in tissues,
foul smelling discharge,
rapidly progressing necrosis,
fever, hemolysis, toxemia, shock,
renal failure, and death
Culture and sensitivity
(1) Do a thorough wound toilet.
(2) In high risk wounds give the patient
penicillin 1.5 megaunits 4 hourly,
Isolate the patient from other surgical patients
10 megaunits of benzyl
penicillin daily for 5 days as
four 6 hourly doses.
Tetracycline 0.5 g
or 1 g orally every 6 hours.
Clostridia not sensitive to
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.
Amputate under a tourniquet
Close the stump by delayed
Contamination of devitalized tissue
with the spores, germination of the spores,
release of tetanospasmin, the toxin reaches CNS
by retrograde axonal transport or via the bloodstream
the toxin is fixed to gangliosides in spinal
cord or brainstem and exerts its actions
Inhibits release of an inhibitory
(e.g., GABA or glycine) which acts on
postsynaptic spinal neurons
(causing spastic paralysis).
Confined to the musculature of
primary site of infection
(infection of the umbilical wound):
mortality > 90%, and developmental
defects are present in survivors.
Generalized tetanus first the area of
injury, then the muscles of the jaw
(trismus or lockjaw risus sardonicus.
Other voluntary muscles become
involved gradually, resulting in
generalized tonic spasms (opistotonus).
Death usually results from interference
with respiration. The mortality rate of
generalized tetanus: ~50%.
Prevention is much more
important than treatment:
1. Active immunization
‘Booster shot’ for
individuals. This may be
accompanied by antitoxin
injected into a different
area of the body.
2. Proper care of wounds.
Surgical débridement to remove
the necrotic tissue.
3. Prophylactic use of antitoxin.
4. Antibiotic treatment.
*Patients with symptoms of tetanus
should receive muscle relaxants,
sedation and assisted ventilation.
Prevention and treatment