Video:Gas gangrene
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Description
Gas gangrene is a bacterial infection that produces tissue gas in gangrene. This deadly form of gangrene usually is caused by Clostridium perfringens bacteria. [1] Treatment includes vancomycin, tazobactam, or ceftriaxone with metronidazole. If gas gangrene is suspected, penicillin plus clindamycin should be added.[2]About one thousand cases of gas gangrene are reported yearly in the United States.[1]
Presentation
A multitude of symptoms is associated with Gas gangrene. Distinctively, black lesions on the skin appear in a bubble form which allows visualization of gas-producing bacteria. Symptoms include:skin discoloration,bubble lesions on skin, necrosis, fever, lightheadedness, tachycardia, hypoesthesia, blisters, crepitus and swelling.[3][4]
Complications
As to the possible complications an individuals may have are the following:delirium, kidney failure, amputation, shock and sepsis.[5]
Cause
Clostridium perfringens is a Gram-positive, rod-shaped, anaerobic, spore-forming pathogenic bacterium of the genus Clostridium.[6][7] C. perfringens is ever-present in nature and can be found as a normal component of decaying vegetation, marine sediment, the intestinal tract of humans and other vertebrates, insects, and soil. It has the shortest reported generation time of any organism at 6 (point) 3 minutes in thioglycolate medium.[8]
Virulence factors
Members of the Clostridium species exhibit a plethora of virulence factors. Common virulence factors associated with gas gangrene include alpha toxin and theta toxin. Clostridium perfringens causes 80 to 90 percent of infections and produces both these toxins.[9]
Mechanism
In terms of mechanism we find that bacteria often possess the ability to create exotoxins to assist them in competing with other microbes in their natural environments. When such bacteria are able to enter a living host, they encounter a vast supply of nutrients, warm conditions, and an abundance of water. This enables the microbes to rapidly proliferate, far in excess of the immune system's capability to defend, as prokaryotic bacteria possess a far greater capacity for multiplication than the host's immune system. The combination of bacterial load and ability to multiply is the basis for the microbes' ability to cause massive infection. Alongside such rapid proliferation is a corresponding mass-production of exotoxin that causes severe damage to local tissue in the host. One such exotoxin is alpha toxin, which is produced by C. perfringens and is the key virulence factor in its pathogenesis.[10]Massive infection, gross injury, and depletion of the host's immune capability result in system-wide sepsis. This is partly due to the burden on the immune system, its corresponding release of inflammatory cytokines, and the distribution of bacterial toxins. [2][11]
Diagnosis
Various diagnostic methods can be employed in the diagnosis of Gas gangrene. Due to low incidence of myonecrosis it is an easy-to-overlook diagnosis, as bacterial infections mostly exhibit the same symptoms. Diagnostic methods include: biopsy of affected tissue, cultures of fluids from inflicted area, magnetic resonance imaging to visualize necrotized subcutaneous tissues and X-rays for air pockets in affected tissues.[2]
Differential diagnosis
The differential diagnosis for gas gangrene is as follows, bacteria sepsis, Emphysematous cholecystitis, Group A streptococcal infections, abdominal abscess, septic shock , Vibrio infection and abdominal trauma.[2]
Treatment
Treatment is usually debridement and excision, with amputation necessary in many cases. Penicillin plus clindamycin is effective against C. perfringens. [12]
Prognosis
Following resolution of myonecrosis, patients will often require further care following the deleterious effects caused by the infection. Skin grafts are often required following removal of necrotic tissues. Former patients will still require hyperbaric oxygen therapy to prevent a recurring infection.[2]
Epidemiology
Clostridium species are found in abundance in soil, especially soil used for animal husbandry.[13]. In medical facilities, it thrives when unhygienic circumstances prevail. In the United States, the incidence of myonecrosis is about one thousand cases per year.[2]
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History
In terms of history we find that Gas gangrene, was first described by Hippocrates in the fifth century B.C. However, the bacterium Clostridium perfringens, the primary cause of gas gangrene, was isolated and named by William H. Welch in 1891. [14][15]
References
- ↑ 1.0 1.1 Jerrold B. Leikin; Frank P. Paloucek, eds. (2008), "Clostridium perfringens Poisoning", Poisoning and Toxicology Handbook (4th ed.), Informa, pp. 892–893, ISBN 978-1-4200-4479-9
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Buboltz, Jerome B.; Murphy-Lavoie, Heather M. (2025). "Gas Gangrene". StatPearls. StatPearls Publishing.
- ↑ "Gas gangrene". www.amboss.com. Archived from the original on 2020-03-22. Retrieved 2021-03-25.
- ↑ "Gas Gangrene - Infections". Merck Manual Consumer Version. Retrieved 21 March 2025.
- ↑ "Gas gangrene: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 16 April 2025.
- ↑ Ryan, Kenneth J.; Ray, C. George (2004). Sherris Medical Microbiology : an Introduction to Infectious Diseases (4th ed.). New York: McGraw-Hill. p. 310. ISBN 978-0-8385-8529-0.
- ↑ Kiu, R; Hall, L. J. (2018). "An update on the human and animal enteric pathogen Clostridium perfringens". Emerging Microbes & Infections. 7 (141): 141. doi:10.1038/s41426-018-0144-8. PMC 6079034. PMID 30082713.
- ↑ "BioNumber Details Page". BioNumbers. Archived from the original on 2013-12-24. Retrieved 2023-05-09.
- ↑ Mehdizadeh Gohari, Iman; A Navarro, Mauricio; Li, Jihong; Shrestha, Archana; Uzal, Francisco; A McClane, Bruce (December 2021). "Pathogenicity and virulence of Clostridium perfringens". Virulence. 12 (1): 723–753. doi:10.1080/21505594.2021.1886777. ISSN 2150-5608. PMC 8043184. PMID 33843463.
- ↑ Awad MM, Bryant AE, Stevens DL, Rood JI (January 1995). "Virulence studies on chromosomal alpha-toxin and theta-toxin mutants constructed by allelic exchange provide genetic evidence for the essential role of alpha-toxin in Clostridium perfringens-mediated gas gangrene". Mol. Microbiol. 15 (2): 191–202. doi:10.1111/j.1365-2958.1995.tb02234.x. PMID 7746141. S2CID 12440686.
- ↑ Stevens, Dennis L.; Bryant, Amy E. (1 September 2002). "The Role of Clostridial Toxins in the Pathogenesis of Gas Gangrene". Clinical Infectious Diseases. 35 (Supplement_1): S93 – S100. doi:10.1086/341928. ISSN 1058-4838. PMID 12173116.
- ↑ Gerard J. Tortora; Berdell R. Funke; Christine L. Case (2010), Microbiology: An Introduction (10th ed.), Benjamin Cummings, p. 646, ISBN 978-0-321-55007-1
- ↑ Bryant, Amy E.; Stevens, Dennis L. "179: Gas Gangrene and Other Clostridial Infections". Harrison's Principles of Internal Medicine (19th ed.)
- ↑ Lawrence, Christopher (12 November 2005). "Gangrene". The Lancet. 366 (9498): 1689. doi:10.1016/S0140-6736(05)67683-0. ISSN 0140-6736. PMID 16291052. Archived from the original on 21 November 2011. Retrieved 18 March 2025.
- ↑ "Gas Gangrene (Clostridial Myonecrosis): Background, Pathophysiology, Epidemiology". eMedicine. 13 June 2023. Retrieved 18 March 2025.