Gas gangrene is a rapidly progressive, potentially fatal condition characterized by widespread necrosis of muscles and soft tissues. It is caused by Clostridium bacteria that produce toxins and gas when they infect open wounds. Risk factors include wounds from trauma, surgery, or injuries. Symptoms include pain, swelling, fever, and skin blisters around the wound with a foul odor. Treatment involves high doses of antibiotics, removal of dead tissue, and sometimes amputation. Hyperbaric oxygen therapy may also be used in severe cases. Thorough wound cleaning and debridement are important for prevention.

1. II MBBSII MBBS
06/02/17 1

2. • It is a rapidly progressive, potentially fatal conditionIt is a rapidly progressive, potentially fatal condition
characterized by widespread necrosis of the muscles andcharacterized by widespread necrosis of the muscles and
subsequent soft-tissue destruction.subsequent soft-tissue destruction.
• This is a dreaded consequence of inadequately treatedThis is a dreaded consequence of inadequately treated
missile wounds, crushing injuries and high-voltagemissile wounds, crushing injuries and high-voltage
electrical injuries.electrical injuries.
06/02/17 2

3. • Clostridiumspecies – sporeforming, Gram+veClostridiumspecies – sporeforming, Gram+ve
06/02/17 3

4. GAS GANGRENE IS
POLYMICROBIAL IN
NATURE
06/02/17 4

5. Growth of Clostridium perfringens (plump rods),Growth of Clostridium perfringens (plump rods),
causing gas formation and separation of the fiberscausing gas formation and separation of the fibers
06/02/17 5
Muscle fibers
Clostridium
Gas-filled spaces

6. • They are present in the soil and have alsoThey are present in the soil and have also
been isolated from the humanbeen isolated from the human
gastrointestinal tract and female genitalgastrointestinal tract and female genital
tract.tract.
• Non-clostridial gas-producing organismsNon-clostridial gas-producing organisms
such assuch as coliformscoliforms have also been isolated inhave also been isolated in
60–85% of cases of gas gangrene.60–85% of cases of gas gangrene.
06/02/17 6

7. AnaerobicAnaerobic
environmentenvironment
Distension ofDistension of
tissuestissues
InterferingInterfering
Blood supplyBlood supply
Ischemia/Ischemia/
gangrenegangrene
Toxemia andToxemia and
deathdeath
SporesSpores
germinategerminate
VegetativeVegetative
cells multiplycells multiply
CarbohydratesCarbohydrates
FermentationFermentation
Gas productionGas production
In tissuesIn tissuesPATHOGENESISPATHOGENESIS
Incubation period isIncubation period is
1-7 days1-7 days
06/02/17 7

8. 06/02/17 8

9. 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
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
06/02/17 9

10. 06/02/17 10

11. • 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.
06/02/17 11

12. Presentation
Crepitation in tissues,
sickly sweet odor discharge,
rapidly progressing necrosis,
fever, hemolysis, toxemia,
shock,
renal failure, and death
06/02/17 12

13. 06/02/17 13

14. 06/02/17 14

15. Culture and sensitivity
Storming fermentation
Lecithinase test
Lab. Investigations
06/02/17 15

16. G
A
S
I
N
S
O
F
T
T
I
S
S
U
E06/02/17 16

17. G
A
S
I
N
U
T
E
R
U
S
06/02/17 17

18. G
A
S
I
N
U
T
E
R
U
S
06/02/17 18

19. G
A
S
I
N
U
T
E
R
U
S
06/02/17 19

20. • Cleaning the wound
• Avoid the contaminated material
• improve circulation in patients with poor
circulation
• Treatment with hyperbaric oxygen- to treat
the gas gangrene
• antitoxin
06/02/17 20

21. (1) Do a thorough wound toilet.
(2) In high risk wounds give the patient
penicillin 1.5 megaunits 4 hourly,
or tetracycline
Prevention
06/02/17 21

22. • High doses of antibiotic : PenicillinHigh doses of antibiotic : Penicillin
• The dead tissue is removed or limbs are amputatedThe dead tissue is removed or limbs are amputated
• No vaccineNo vaccine
06/02/17 22

23. 10 megaunits of benzyl penicillin daily for
5 days as four 6 hourly doses.
Or
Tetracycline 0.5 g intravenously
or 1 g orally every 6 hours.
Clostridia not sensitive to metronidazole,
some other anaerobic bacteria are, so
give it.
06/02/17 23

24. Do this in a septic theatre,
or even in the out-patient department,
and not where clean cases go for operation.
EXPLORATION
06/02/17 24

25. 06/02/17 25

26. AMPUTATION
Amputate under a tourniquet
Close the stump by delayed
primary suture06/02/17 26

27. Myonecrosis of right leg
06/02/17 27

28. Myonecrosis of left foot
06/02/17 28

29. Stump of above knee amputation
06/02/17 29

30. • Patients should be admitted to ICU andPatients should be admitted to ICU and
treated aggressively with careful monitoring.treated aggressively with careful monitoring.
• The role of HBO is not as clear as inThe role of HBO is not as clear as in
necrotising fasciitis but it is recommended innecrotising fasciitis but it is recommended in
severe cases if the facilities are available.severe cases if the facilities are available.
– increases the normal oxygen saturation in theincreases the normal oxygen saturation in the
infected wounds by 1000-fold leading toinfected wounds by 1000-fold leading to
• Bacteriocidal effect,Bacteriocidal effect,
• Improves neutrophil function,Improves neutrophil function,
• Enhanced wound healingEnhanced wound healing
06/02/17 30

31. 06/02/17 31
DiseaseDisease Signs &Signs &
SymptomsSymptoms
TransmissionTransmission TreatmentTreatment Prevention &Prevention &
ControlControl
GasGas
gangrenegangrene
• Foul odor and intense
pain and swelling at
the wound site
• Soil
• Endogenous transfer
• Surgery
• Cephalosporin
• Hyperbaric oxygen
• Cleaning wounds
• Debridement

32. 06/02/17 32