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For further information, see CMDT Part 35-05: Clostridial Diseases

KEY FEATURES

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

    • Clostridium perfringens

    • Clostridium ramosum

    • Clostridium bifermentans

    • Clostridium histolyticum

    • Clostridium novyi

  • Also referred to as gas gangrene

  • Trauma and injection drug use are common predisposing conditions

  • Sudden onset of pain and edema in and around a contaminated wound

  • Prostration and systemic toxicity

  • Presence of gas in infected tissue

CLINICAL FINDINGS

Symptoms and Signs

  • Hypotension and tachycardia

  • Fever usually present but not proportionate to infection severity

  • Painful, edematous wound with surrounding pale skin; skin becomes deeply discolored, with coalescent, red, fluid-filled vesicles as disease progresses

  • Pain is often severe, not concomitant with initial findings, which can be a clue to diagnosis

  • Foul-smelling brown, blood-tinged discharge

Differential Diagnosis

  • May present similarly to necrotizing group A streptococcal infections and wound infections due to curved gram-negative organisms such as Vibrio vulnificans

  • Other bacteria, including enteric gram-negative organisms and anaerobes, can produce gas in infected tissue as well

DIAGNOSIS

  • Gas gangrene is a clinical diagnosis, and empiric therapy is indicated if the diagnosis is suspected

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

  • Gas in the tissue by palpation or radiograph (but this finding is neither sensitive nor specific)

  • Gram-positive rods in culture or smear of exudate

  • Toxins produced in devitalized tissues under anaerobic conditions result in

    • Shock

    • Hemolysis

    • Myonecrosis

TREATMENT

  • Surgical debridement of infected areas is essential, with radical surgical excision often necessary

  • Penicillin, 3–4 million units every 4 hours intravenously, is an effective adjunct

  • Clindamycin, 600–900 mg every 8 hours intravenously, may decrease production of bacterial toxin

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

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