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GAS GANGRENE Dr. Ehsanur Reza Shovan. It is a rapidly progressive, potentially fatal condition characterized by widespread necrosis of the muscles and.

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Presentation on theme: "GAS GANGRENE Dr. Ehsanur Reza Shovan. It is a rapidly progressive, potentially fatal condition characterized by widespread necrosis of the muscles and."— Presentation transcript:

1 GAS GANGRENE Dr. Ehsanur Reza Shovan

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 Clostribium species – spore forming, Gram +ve c. Perfringens (mostly) c.novyi c.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.

5 Anaerobic environment Distension of tissues Interfering Blood supply Ischemia/ gangrene Toxemia and death Spores germinate Carbohydrates Fermentation Gas production In tissues PATHOGENESIS Incubation period is 1-7 days vegetative cells multiply

6 Pathogenesis - Bacteria enters the broken skin or wound - Spores are produced - The bacteria present in circulation system the anaerobic tissue present - The bacteria are grow and ferment the muscle carbohydrate - The toxins (lecithinase) and enzyme are produced Examples 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 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

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9 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.

10 Crepitation in tissues, sickly sweet odor discharge, rapidly progressing necrosis, fever, hemolysis, toxemia, shock, renal failure, and death Presentation

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13 Culture and sensitivity Storming fermentation Lecithinase test Lab. Investigations

14 G A S I N S O F T T I S S U E

15 G A S I N U T E R U S

16 G A S I N U T E R U S

17 G A S I N U T E R U S

18 Prevention Cleaning the wound Avoid the contaminated material improve circulation in patients with poor circulation antitoxin

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

20 Treatment High doses of antibiotic : Penicillin The dead tissue is removed or limbs are amputated No vaccine

21 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.

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

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24 AMPUTATION Amputate under a tourniquet Close the stump by delayed primary suture

25 Myonecrosis of right leg

26 Myonecrosis of left foot

27 Stump of above knee amputation

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 to Bacteriocidal effect, Improves neutrophil function, Enhanced wound healing


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