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For further information, see CMDT Part 33-05: Clostridial Diseases

Key Features

  • A life-threatening muscle infection produced by any one of several clostridia, such as

    • Clostridium perfringens

    • Clostridium ramosum

    • Clostridium bifermentans

    • Clostridium histolyticum

    • Clostridium novyi

  • Trauma and injection drug use are common predisposing conditions

  • Sudden onset of pain and edema in a contaminated wound

  • Prostration and systemic toxicity

  • Presence of gas in infected tissue

Clinical Findings

  • Hypotension and tachycardia

  • Painful, edematous wound with surrounding pale skin

  • Foul-smelling brown, blood-tinged discharge

Diagnosis

  • Brown to blood-tinged watery exudate, with skin discoloration of surrounding area

  • Gas in the tissue by palpation or radiograph

  • Gram-positive rods in culture or smear of exudate

  • Toxins produced in devitalized tissues under anaerobic conditions result in

    • Shock

    • Hemolysis

    • Myonecrosis

Treatment

  • Surgical débridement with radical excision as necessary

  • Penicillin, 2 million units every 3 hours intravenously (other antimicrobials active against anaerobes are also effective)

  • Clindamycin

    • May decrease the production of bacterial toxin

    • Some experts recommend adding clindamycin, 600–900 mg every 8 hours intravenously, to penicillin

  • Anecdotally, hyperbaric oxygen may be beneficial in conjunction with surgery and antimicrobial therapy

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