Clostridial Gas Gangrene Clinical Presentation

Updated: Jun 14, 2019
  • Author: Shahab Qureshi, MD, FACP; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Presentation

History

Obtaining a thorough medical history is important. It helps the physician identify risk factors that may affect the progression of the disease and the prognosis.

  • Pain

    • Increasing pain after surgery or trauma

    • Out of proportion to physical findings

    • Sudden onset

    • May be severe

  • Prior trauma

  • Prior surgery, including abortions

  • Diabetes mellitus

  • Alcoholism

  • Drug abuse

  • Advanced age

  • Chronic debilitating disease(s)

  • Immunocompromised state

    • Steroid use

    • Malnutrition

    • Malignancy

    • Acquired immunodeficiency syndrome (AIDS)

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Physical

Perform a thorough physical examination before focusing on the involved body part, as follows:

  • Vital signs - May indicate systemic toxicity and include no or low-grade fever, tachycardia (relative tachycardia), tachypnea, hypotension, or hypoxia

  • Edema bullae

  • Erythema with purplish black discoloration

  • Extreme tenderness

  • Brownish skin discoloration (bronzing, brawny) with bullae

  • Profuse, "dish-watery," serous drainage from ruptured bullae

  • Discharge - May have a peculiar, "mousy," sweet odor

  • Minimal crepitant bullae

  • Crepitant tissue - May extend well beyond any skin discoloration, edema, or bleb formation

  • Mental status - Paradoxically, may be depressed early during the disease course; sensorium then may clear as the disease progresses and the patient is near death

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Causes

The disease process must include tissue inoculation and a low oxygen tension environment. More than 50% of cases are preceded by trauma. [5, 6] Other cases occur spontaneously or in patients after operative procedures.

  • Trauma

    • Compound fractures

    • Foreign bodies

    • Frostbite

    • Thermal or electrical burns

    • Subcutaneous or intravenous injection of medications or illicit drugs

    • Pressure sores

    • Motor vehicle crashes

  • Postoperative

    • Gastrointestinal tract surgery

    • Genitourinary tract surgery

    • Abortion

    • Amputation

    • Tourniquets, casts, bandages, or dressings applied too tightly

  • Spontaneous

    • This also is known as nontraumatic, idiopathic, or metastatic gas gangrene.

    • It most often is mixed infection caused by C septicum, C perfringens, and C novyi. Several series report a mortality rate that approaches 100%.

    • The gastrointestinal tract is the source of organisms. The organisms escape the bowel by translocation, enter the bloodstream, and seed distant sites where they can cause gas gangrene. This process may also result in a more localized infection that involves the viscera or intra-abdominal compartment.

    • Approximately 80% of patients without trauma have an overt or occult malignancy. Of these, approximately 40% are hematologic malignancies and an additional 34% are colorectal. [7] Survival from this process should initiate a search for an occult malignancy if none has been documented previously in patients without trauma.

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Complications

See the list below:

  • Death

  • Amputation

  • Permanent deformity or disability

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