2 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.
3 Causative agent c.novyi Clostribium species – spore forming, Gram +ve c. Perfringens(mostly)c.novyic.septicum
4 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.
6 Pathogenesis Examples of enzyme: colagenases, proteases and lipases - Bacteria enters the broken skin or wound- Spores are produced- The bacteria present in circulation systemthe anaerobic tissue present- The bacteria are grow and ferment the muscle carbohydrate- The toxins (lecithinase) and enzyme are producedExamples of enzyme: colagenases, proteases and lipases- These enzymes will kill other host cell and extend the anaerobic environment- Produce gases (nitrogen, hydrogen sulphide and carbon dioxide)- Crepitant tissue( destroyed tissue)
7 EpidemiologyThe persons at risk those with Diabetes Mellitus, blood vessel disease and colon cancerContact with contaminated cloth and other foreign materialTrauma or recent surgical wound
9 Symptoms High fever Shock Massive tissue destruction Blackening of skinSevere pain around a skin of woundBlisters with gas bubbles form near the infected area,the heartbeat and breathing becomerapid.
10 Crepitation in tissues, sickly sweet odor discharge, PresentationCrepitation in tissues,sickly sweet odor discharge,rapidly progressing necrosis,fever, hemolysis, toxemia, shock,renal failure, and death
18 Prevention Cleaning the wound Avoid the contaminated material improve circulation inpatients with poor circulationantitoxin
19 Prevention (1) Do a thorough wound toilet. (2) In high risk wounds give the patientpenicillin 1.5 megaunits 4 hourly,or tetracycline
20 Treatment High doses of antibiotic : Penicillin The dead tissue is removed or limbs are amputatedNo vaccine
21 Tetracycline 0.5 g intravenously 10 megaunits of benzyl penicillin daily for 5 days as four 6 hourly doses.OrTetracycline 0.5 g intravenouslyor 1 g orally every 6 hours.Clostridia not sensitive to metronidazole,some other anaerobic bacteria are, so give it.
22 Do this in a septic theatre, or even in the out-patient department, EXPLORATIONDo this in a septic theatre,or even in the out-patient department,and not where clean cases go for operation.
28 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 toBacteriocidal effect,Improves neutrophil function,Enhanced wound healing