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gas gangrene (anaerobic cellulitis)
Tissue infection with gas-producing anaerobic bacteria.
Etiology:
1) Clostridium welchii
2) Clostridium novyi
3) Clostridium septicum (more common with GI malignancy, colon cancer)
4) Clostridium sordellii
5) Clostridium histolyticum
6) Clostridium perfringens (more common after trauma)
Clinical manifestations:
1) history of deep contaminated wound or GI malignancy
2) sudden onset of pain in affected muscles
- pain out of proportion to physical examination
3) fever
4) tachycardia
5) hypotension
6) pallor
7) apathy
8) stupor
9) foul-smelling discharge from wound
10) discoloration of surrounding tissue may be present
11) crepitus in subcutaneous tissue or muscular layers
Laboratory:
1) complete blood count: leukocytosis
2) gram-stain of wound discharge may reveal gram-positive bacilli (encapsulated)
3) apparently blood cultures not indicated*
* even if signs of sepsis & administration of empiric antibiotics
Radiology:
- air in fascial planes*
* imaging should not delay surgical consultation
Management:
1) antibiotics
- penicillin plus clindamycin
2) surgical emergency: exploration & debridement
3) hyperbaric oxygen
Related
cellulitis
Clostridium
necrotizing fasciitis
General
fasciitis
gangrene
References
- DeGowin & DeGowin's Diagnostic Examination, 6th edition,
RL DeGowin (ed), McGraw Hill, NY 1994, pg 886-87
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998
- Kurylo JC, Schmidt AH
Gas Gangrene of a Prosthetic Hip
N Engl J Med 2014; 371:1917. November 13, 2014
PMID: 25390742
http://www.nejm.org/doi/full/10.1056/NEJMicm1400498