A Family Doctor’s Tale – GAS GANGRENE
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DOC I HAVE GAS
GANGRENE
What is Gas Gangrene?
Gas Gangrene is a toxic rapidly progressive clostridial infection causing muscle necrosis.
What is the cause of Gas Gangrene?
The known cause is the clostridium perfringens bacteria which are spore forming, anaerobic, gram positive bacilli.Rarely it also can be caused by Group A streptococcus, Staphylococcus aureus and Vibrio vulnificus.
It normally live a saprophytic existence in intestinal tract of humans and animals and in soil.
There are 4 reasons which predispose to muscle invasion by the bacilli and exotoxin production:
1.impaired local blood supply
2.metallic bodies, clothing or dirt in wound
3.presence of necrotic tissue and hemorrhage
4.growth of aerobic germs in wound or uterine cavity
Under these conditions, the bacilli multiply anaerobically. As the bacteria grows it produces gas in body tissues and releases toxins which can damage tissues .
Toxins diffuse to surrounding muscle and causes tissue death, damage to blood cells and blood vessels resulting in gangrene.
What are the symptoms of Gas Gangrene
The symptoms are:
1. inflammation of the tissue at the site of infection-pale skin color, later becoming dusky and changing to dark red or purple
2.very painful tissue swelling
3.The edges of the infected area expand so quickly that destruction of the involved tissue can be seen over a few minutes.
4.Air can be felt under the skin
5.Blisters filled with brown-red fluid
6.foul-smelling brown-red or bloody fluid
7.Increased heart rate
8.Moderate fever
9.sweating
10.jaundice
If the condition is not treated, the person can develop shock with decreased blood pressure (hypotension), kidney failure, coma, and finally death.
Diagnosis of Gas Gangrene:
The person may be in shock. A doctor might feel air under the skin .
1.Anaerobic tissue and fluid cultures may reveal Clostridium species
2.Blood culture may grow the bacteria causing the infection
3.Gram stain of fluid from the infected area may show gram-positive rods (Clostridium species) or other bacterial types.
4. Xrays, MRI and CT scan may show gas in the tissues
Treatment of Gas Gangrene:
1.Treatment is always urgent. The affected person will need to have surgery quickly to remove dead, damaged, and infected tissue (debridement).
2.Surgical removal (amputation) of an arm or leg may be needed to control the spread of infection.
3.Patients should get antibiotics, preferably clindamycin together with penicillin. Intravenous antibiotics is given first followed by oral antibiotic
4.Pain killers to control pain.
5.Hyperbaric oxygen may help to provide oxygen to the infected tissues
Prognosis of Gas Gangrene:
The gangrene is progressive and often fatal.
Prevention of gas gangrene:
1.Always clean the wound thoroughly with hydrogen peroxide
2. watch for signs of infection such as redness, pain or swelling around a wound
