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Clostridial Gas Gangrene Clinical Presentation

  • Author: Don R Revis, Jr, MD; Chief Editor: John Geibel, MD, DSc, MSc, MA  more...
 
Updated: Jul 16, 2014
 

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.

  • 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.[3, 4] 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.[5] 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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Contributor Information and Disclosures
Author

Don R Revis, Jr, MD Consulting Staff, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine

Don R Revis, Jr, MD is a member of the following medical societies: American College of Surgeons, American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons, American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Charles V Sanders, MD Edgar Hull Professor and Chairman, Department of Internal Medicine, Professor of Microbiology, Immunology and Parasitology, Louisiana State University School of Medicine at New Orleans; Medical Director, Medicine Hospital Center, Charity Hospital and Medical Center of Louisiana at New Orleans; Consulting Staff, Ochsner Medical Center

Charles V Sanders, MD is a member of the following medical societies: American College of Physicians, Alliance for the Prudent Use of Antibiotics, The Foundation for AIDS Research, Southern Society for Clinical Investigation, Southwestern Association of Clinical Microbiology, Association of Professors of Medicine, Association for Professionals in Infection Control and Epidemiology, American Clinical and Climatological Association, Infectious Disease Society for Obstetrics and Gynecology, Orleans Parish Medical Society, Southeastern Clinical Club, American Association for the Advancement of Science, Alpha Omega Alpha, American Association of University Professors, American Association for Physician Leadership, American Federation for Medical Research, American Geriatrics Society, American Lung Association, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Association of American Medical Colleges, Association of American Physicians, Infectious Diseases Society of America, Louisiana State Medical Society, Royal Society of Medicine, Sigma Xi, Society of General Internal Medicine, Southern Medical Association

Disclosure: Received royalty from Baxter International for other.

Chief Editor

John Geibel, MD, DSc, MSc, MA Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director, Surgical Research, Department of Surgery, Yale-New Haven Hospital; American Gastroenterological Association Fellow

John Geibel, MD, DSc, MSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, Society for Surgery of the Alimentary Tract

Disclosure: Received royalty from AMGEN for consulting; Received ownership interest from Ardelyx for consulting.

Additional Contributors

Fred A Lopez, MD Associate Professor and Vice Chair, Department of Medicine, Assistant Dean for Student Affairs, Louisiana State University School of Medicine

Fred A Lopez, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, Infectious Diseases Society of America, Louisiana State Medical Society

Disclosure: Nothing to disclose.

References
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