gas gangrene dr. ehsanur reza shovan. it is a rapidly progressive, potentially fatal condition...
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GAS GANGRENE
Dr. Ehsanur Reza ShovanDr. Ehsanur Reza Shovan
• It is a rapidly progressive, potentially fatal condition characterized by widespread necrosis of the muscles and subsequent soft-tissue destruction.
• This is a dreaded consequence of inadequately treated missile wounds, crushing injuries and high-voltage electrical injuries.
Causative agent
• Clostribium species – spore forming, Gram +ve
• They are present in the soil and have also been isolated from the human gastrointestinal tract and female genital tract.
• Non-clostridial gas-producing organisms such as coliforms have also been isolated in 60–85% of cases of gas gangrene.
Anaerobic environment
Distension oftissues
InterferingBlood supply
Ischemia/gangrene
Toxemia anddeath
Spores germinate
CarbohydratesFermentation
Gas productionIn tissues
PATHOGENESISIncubation period is
1-7 days
vegetative cells multiply
Pathogenesis
Epidemiology
– 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
Symptoms
• 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.
Crepitation in tissues,sickly sweet odor discharge,rapidly progressing necrosis,fever, hemolysis, toxemia,
shock,renal failure, and death
Presentation
Culture and sensitivity
Storming fermentation
Lecithinase test
Lab. Investigations
G
A
S
I
N
S
O
F
T
T
I
S
S
U
E
G
A
S
I
N
U
T
E
R
U
S
G
A
S
I
N
U
T
E
R
U
S
G
A
S
I
N
U
T
E
R
U
S
Prevention • Cleaning the wound• Avoid the contaminated material• improve circulation in patients with poor circulation• antitoxin
(1) Do a thorough wound toilet.(2) In high risk wounds give the patient penicillin 1.5 megaunits 4 hourly, or tetracycline
Prevention
Treatment
• High doses of antibiotic : Penicillin
• The dead tissue is removed or limbs are amputated
• No vaccine
10 megaunits of benzyl penicillin daily for 5 days as four 6 hourly doses.
OrTetracycline 0.5 g intravenously
or 1 g orally every 6 hours.
Clostridia not sensitive to metronidazole, 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.
EXPLORATION
AMPUTATION
Amputate under a tourniquet Close the stump by delayedprimary suture
Myonecrosis of right leg
Myonecrosis of left foot
Stump of above knee amputation
• Patients should be admitted to ICU and treated aggressively with careful monitoring.
• The role of HBO is not as clear as in necrotising fasciitis but it is recommended in severe cases if the facilities are available.– increases the normal oxygen saturation in the
infected wounds by 1000-fold leading to• Bacteriocidal effect, • Improves neutrophil function, • Enhanced wound healing
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