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