gas gangrene (anaerobic cellulitis)
Jump to navigation
Jump to search
Introduction
Tissue infection with gas-producing anaerobic bacteria.
Etiology
- Clostridium welchii
- Clostridium novyi
- Clostridium septicum (more common with GI malignancy, colon cancer)
- Clostridium sordellii
- Clostridium histolyticum
- Clostridium perfringens (more common after trauma)
Clinical manifestations
- history of deep contaminated wound or GI malignancy
- sudden onset of pain in affected muscles
- pain out of proportion to physical examination
- fever
- tachycardia
- hypotension
- pallor
- apathy
- stupor
- foul-smelling discharge from wound
- discoloration of surrounding tissue may be present
- crepitus in subcutaneous tissue or muscular layers
Laboratory
- complete blood count: leukocytosis
- gram-stain of wound discharge may reveal gram-positive bacilli (encapsulated)
- apparently blood cultures not indicated*
* even if signs of sepsis & administration of empiric antibiotics
Radiology
- air in fascial planes*
* imaging should not delay surgical consultation
Management
- antibiotics
- penicillin plus clindamycin
- surgical emergency: exploration & debridement
- hyperbaric oxygen
More general terms
Additional terms
References
- ↑ DeGowin & DeGowin's Diagnostic Examination, 6th edition, RL DeGowin (ed), McGraw Hill, NY 1994, pg 886-87
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
- ↑ Kurylo JC, Schmidt AH Gas Gangrene of a Prosthetic Hip N Engl J Med 2014; 371:1917. November 13, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25390742 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMicm1400498