Gas Gangrene in Emergency Medicine Differential Diagnoses

  • Author: Anil Shukla, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Jun 22, 2009
 
 

Differential Diagnoses

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Contributor Information and Disclosures
Author

Anil Shukla, MD  Staff Physician, Harvard Affiliated Emergency Medicine Residency, Beth Israel Deaconess Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Carlo L Rosen, MD  Associate Professor of Medicine, Harvard Medical School; Program Director, Vice Chair for Education, Department of Emergency Medicine, Beth Israel Deaconess Medical Center/Harvard Affiliated Emergency Medicine Residency program

Carlo L Rosen, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Jason K Wong, MD  Staff Physician, Department of Emergency Medicine, Jefferson Regional Medical Center

Jason K Wong, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Michelle Ervin, MD  Chair, Department of Emergency Medicine, Howard University Hospital

Michelle Ervin, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, National Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Barry J Sheridan, DO  Chief, Department of Emergency Medical Services, Brooke Army Medical Center

Barry J Sheridan, DO is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

  1. Trott AT. Skin and Soft-tissue Infections. In: Wolfson AB, et al, eds. Harwood-Nuss' Clinical Practice of Emergency Medicine. 4th ed. Lippincott Williams & Wilkins; 2005:715-717.

  2. Folstad SG. Soft tissue infections. In: Tintinalli JE, et al, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. McGraw Hill; 2004:979-986.

  3. Meislin HW, Guisto JA. Soft tissue infections. In: Marx JA, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 5th ed. Mosby-Year Book; 2002:1944-1955.

  4. Stevens DL. The pathogenesis of clostridial myonecrosis. Int J Med Microbiol. Oct 2000;290(4-5):497-502. [Medline].

  5. Brook I. Recovery of anaerobic bacteria from wounds after lawn-mower injuries. Pediatr Emerg Care. Feb 2005;21(2):109-10. [Medline].

  6. Headley AJ. Necrotizing soft tissue infections: a primary care review. Am Fam Physician. Jul 15 2003;68(2):323-8. [Medline].

  7. Bryant AE. Biology and pathogenesis of thrombosis and procoagulant activity in invasive infections caused by group A streptococci and Clostridium perfringens. Clin Microbiol Rev. Jul 2003;16(3):451-62. [Medline].

  8. Miller LG, Perdreau-Remington F, Rieg G, et al. Necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus in Los Angeles. N Engl J Med. Apr 7 2005;352(14):1445-53. [Medline].

  9. Fridkin SK, Hageman JC, Morrison M, et al. Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med. Apr 7 2005;352(14):1436-44. [Medline].

  10. Anesti E, Brooks P, Majumder S. Images in emergency medicine. Gas gangrene. Ann Emerg Med. Jul 2007;50(1):14, 33. [Medline].

  11. Arteta-Bulos R, Karim SM. Images in clinical medicine. Nontraumatic Clostridium septicum myonecrosis. N Engl J Med. Oct 21 2004;351(17):e15. [Medline].

  12. Frazee BW, Lynn J, Charlebois ED, Lambert L, Lowery D, Perdreau-Remington F. High prevalence of methicillin-resistant Staphylococcus aureus in emergency department skin and soft tissue infections. Ann Emerg Med. Mar 2005;45(3):311-20. [Medline].

  13. Schneider DJ, Reid JS. Images in clinical medicine. Gas gangrene associated with occult cancer. N Engl J Med. Nov 30 2000;343(22):1615. [Medline].

  14. Swartz MN. Clinical practice. Cellulitis. N Engl J Med. Feb 26 2004;350(9):904-12. [Medline].

  15. Wang C, Schwaitzberg S, Berliner E, Zarin DA, Lau J. Hyperbaric oxygen for treating wounds: a systematic review of the literature. Arch Surg. Mar 2003;138(3):272-9; discussion 280. [Medline].

  16. Smith-Slatas CL, Bourque M, Salazar JC. Clostridium septicum infections in children: a case report and review of the literature. Pediatrics. Apr 2006;117(4):e796-805. [Medline].

  17. Temple AM, Thomas NJ. Gas gangrene secondary to Clostridium perfringens in pediatric oncology patients. Pediatr Emerg Care. Jul 2004;20(7):457-9. [Medline].

 
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A patient developed gas gangrene after injecting cocaine. Clostridium septicum was isolated in both blood and wound cultures.
Left lower extremity in a 56-year-old patient with alcoholism who was found comatose after binge drinking. Surgical drainage was performed to treat the pyomyositis-related, large, non–foul-smelling (sweetish) bullae. Gram staining showed the presence of gram-positive rods. Cultures revealed Clostridium perfringens. The diagnosis was clostridial myonecrosis.
 
 
 
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