1. D R . P R A FU LL A P A T I L.
SHR I . C HA MU N D A MA T A H OMOE OPA T HI C ME D I C A L
COL LE G E A N D HOS PI T A L , J A L G A ON .
Gas Gangrene
2. ⚫Gangrene refers to the death of body tissue due to
either a lack of blood flow or a serious bacterial
infection. Gangrene commonly affects the
extremities, including your toes, fingers and limbs,
but it can also occur in your muscles and internal
organs.
4. DEFINITION:
⚫It is a highly fatal, rapidly spreading infection caused
By clostridial organisms which results in
myonecrosis.
⚫Gas gangrene also known as Clostridial myositis,
clostridial myonecrosis, infective gangrene of the
muscles.
5.
6. AETIOLOGY:
⚫The disease is caused by
1.Clostridium perfringens ( Clostridium.welchii)-the
commonest organism (60%). Other organisms are
2.Clostridium septicum
3.Clostridium oedematiens
4.Clostridium histolyticum.
These are gram-positive, anaerobic spore-bearing bacilli.
8. RISK GROUP:
⚫In patients who have had lower limb amputations
performed for ischaemic gangrene, infection can
occur from patient's own bowel organisms.
⚫High velocity gun shot wounds with perforation of
hollow viscus are also associated with risk of
developing gas gangrene (military wound).
⚫Immunocompromised patients are at risk.
9.
10.
11. ⚫Toxins and their effect:
Lecithinase Dermonecrosis
,Hemolysis
Beta toxins Necrosis of tissue
proteinase Breakdown of collagen fibre
Hyaluronidase Break the cement substance
of muscle cell
12. CLINICAL FEATURES:
⚫ Severe pain and gross oedema of the wound.
⚫ Sutured wound is under tension.
⚫ Thin brownish fluid escapes which has sickly sweet odour.
⚫ Palpable crepitus .
⚫ Colour changes in the muscles.
⚫ Skin becomes khaki-coloured due to haemolysis.
⚫ Anxious and alert
⚫ Toxic and ill
⚫ Rapid increase in the pulse rate
⚫ Hypotension due to suppression of adrenals
⚫ Vomiting
⚫ Low grade fever
13. DIAGNOSIS:
⚫To examine the pus under microscope after staining
with Giemsa stain.
⚫Presence of gas indicates anaerobic metabolism.
⚫Anaerobic streptococci also produce gas.
15. TREATMENT:
• Emergency surgery which includes excision of all
dead muscles and necrotic tissues by using generous,
long incisions-debridement.
• Penicillin to be continued.
• Blood transfusions before, during and after
surgery.
• Polyvalent anti-gas gangrene serum.
• Hyperbaric oxygen will reduce the amount of
toxin produced by the organisms (controversial).
• Do not hesitate to amputate if it saves the life,
because this is the only measure in late cases.
