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Gas gangrene
Gas gangrene is caused by Clostridium bacteria entering wounds contaminated with soil or feces. It results in rapid muscle necrosis and toxin production. Clinical features include severe local pain, wound edema and gangrene spreading from the original site. Systemic effects can include shock, organ failure and death. Treatment requires antibiotics, debridement of devitalized tissue, and sometimes amputation. Prevention focuses on thorough wound cleaning and debridement to remove contaminants and devitalized tissue.
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Gas gangrene
- 1. GAS GANGRENE The BattleWound Injury How would YOU battle this wound injury? - Shweta Achuthan Kutty
- 2. • Introduction • Microbiology •Etiology • Pathogenesis • Clinical features • Investigation • Management • Prevention
- 3. INTRODUCTION • War timeinjury : WW1, WW2, Vietnam War …. • Now-a-days: Road traffic accidents, Terrorist attacks, Earthquakes
- 4. • Synonyms: Anaerobicmyonecrosis, Clostridial myonecrosis, Oedematous myonecrosis • Seen in severe wounds with contamination (Class3+4), involves skeletal muscles mostly • Causative organism: Clostridium species • Rapidly progressive myonecrosis sepsis myocardial depression, MOF death • Should be vigilant about – Diabetics, immunocompromised, pts with malignancies
- 5. MICROBIOLOGY • Causative organism: Clostridium spp C. perfringens (welchii) – 60% C. oedematiens, C.septicum, C.histolyticum +/- other anaerobes • Gram positive, spore bearing, capsulated, non- motile • Obligate-aerotolerant anaerobes
- 6. • Source :soil, dust, faeces • Incubation period : 1-2 days
- 7. ETIOLOGY • Soil/faeces contaminatedwounds • Crush injuries: RTA, Earthquakes,Wars • High velocity wounds: Gunshot, Shrapnel, RTA • Post amputation • Ischaemic limb
- 8. PATHOGENESIS SPORES ENTER DEVITALISEDTISSUE GERMINATE BACTERIAL MULTIPLICATION EXOTOXINS LOCAL: MUSCLE NECROSIS+ GAS FORMATION SYSTEMIC: CARDIAC DEPRESSION, MOF
- 9. EXOTOXINS • Lecinthinase: hemolytic,membranolytic, necrotic • Hemolysin: hemolytic • Hyaluronidase • Proteinase
- 10. CLINICAL FEATURES • Commonsites: • limbs>other • Adductor area of legs, buttocks, subscapular region • abdominal wall, viscera- liver (foamy liver), appendix, intestines
- 11. • SEVERE localpain • WOUND- oedematous,tense, tender spreading gangrene Serosanguinous discharge – “decaying apple odour” purple-black-brown-green “KHAKHI” colour haemorrhagic blebs crepitus+
- 12. • Toxic features,fever, tachycardia, altered mental status* • Jaundice • Features of shock- rapid thready pulse, cold extremities, oliguria • DIC • Multiorgan failure •DEATH
- 13. INVESTIGATIONS • CBC • Totalcount • ABG • Xray- limb, chest • CT- chest/abdomen • RFTs • LFTs • Gram stain: Gram positive bacteria (sensitive) • Blood culture: <1% grew C.spp • Upcoming: ELISA for exotoxins, PCR
- 14. TREATMENT Immediate: • Stabilize patient:IV line, fluids, blood transfusion, pressors, ventilate if needed • Polyvalent anti-gas gangrene serum • Antibiotics- inj • Monitor vitals, urine output, electrolytes
- 15. Once stable/ Instable patient: • Cont. antibiotics • Debride and excise all devitalised tissue till bleed seen, H2O2+NS rinses • Guillotine amputation • Hyperbaric O2 therapy
- 16. PREVENTION • Proper debridementof devitalised crush wounds • Devitalised tissue should not be sutured • Adequate cleaning with H2O2 + NS • Penicillin/Antibiotic prophylaxis