Gas gangrene (gangrene) is caused by Clostridium Perfringens gas gangrene, which are present in water, soil and sewage and are the cause of skin and subcutaneous tissue infections. For humans, the most dangerous thing is gas gangrene, which can develop in deep wounds. If left untreated, it always causes death.
Gas gangreneis a type of severe wound infection most often caused by the bacteriumClostridium perfringens . Sometimes the cause of gas gangrene is other bacteria of the typeClostridium , e.g.Clostridium novyi ,Clostridium septicum ,Clostridium heamoliticum ,Clostridium sordelli , although the infection itself may also be accompanied by other microorganisms that have the ability to grow very rapidly in an oxygen-poor environment.
The gastrointestinal tract of animals and humans is a reservoir of bacteria, from where it enters the ground with faeces. Gas gangrene produces spores that are commonly found in soil and house dust. The bacterium grows in an oxygen-poor environment, therefore it serves the environment of deep wounds contaminated with anaerobic bacteria.
LaseczkaClostridium perfringenscan also cause nosocomial infections. Some strains may constitute the physiological flora of the human digestive tract (colon), and certain types ofClostridium perfringensmay cause food poisoning.
The mortality rate of untreated gas gangrene is 100%.
Bad gas (gangrene) - risk factors
Despite frequent contamination of wounds byC. perfringensThe development of gas gangrene occurs only in 1-2% of cases.
They predispose to getting sick:
- advanced age
- diabetes
- vascular disease
- chronic diseases
- alcoholism
- immunodeficiency in the course of cancer, HIV infection or secondary treatment (glucocorticosteroids or cancer chemotherapy)
Worse gas (gangrene) - how is it formed?
Gas gangrene develops most often in the case of extensive wounds, when there is significant damage and tissue hypoxia. BacteriaClostridiumrapidly act within the infected area, attacking and destroyingbody cells.
In this process, bacteria cause fermentation and release putrid gas into the tissues, which builds up under the skin. It is palpable, that is, by examining the fingers - the wound is plump and swollen. In addition, this gas is visible during X-ray examination.
The danger of infection is that the bacteriaClostridium Perfringensproduce toxins (α-lecithinase, haemolysin, protease toxin, collagenase, hyaluronidase, DNase, neuraminidase, perfringolysin O) and enzymes causing an inflammatory process and subsequent necrosis of muscles and connective tissue with gas production.
Gas gangrene allows bacterial toxins to enter the bloodstream, resulting in toxic shock and death. This is because the toxins and enzymes produced by the bacteria condition tissue invasion, increase vascular permeability and break down blood cells.
Gas gangrene (gangrene) - symptoms and course of the infection
Gas gangrene can cause local inflammation of the subcutaneous tissue as a result of complications after limb amputation, e.g. in the course of diabetes, purulent inflammation of the gallbladder, infections of the uterus, fallopian tubes, and abdominal cavity.
Gangrene sticks are also the cause of nosocomial infections, as well as bacteremia, which can turn into sepsis.
Symptoms of gas gangrene are:
- initially pale swelling and local tenderness at the wound site
- wound exudate with a bland, sweet smell
- features of inflammation - pain, warmth, redness and swelling
- clots form in small blood vessels, followed by a deep purple discoloration indicating tissue necrosis
- blisters filled with brown-black content appear
- rapid progression of changes in the muscles and subcutaneous tissue
- when pressure is applied in the area of the wound, you can feel the crackling of gas bubbles under the skin
- fever (usually below 38.3 degrees Celsius), vomiting, abdominal pain, bloody diarrhea
- increased heart rate, lowered blood pressure, skin bruising, disturbed consciousness
- shock and death (even within 12 hours from the onset of symptoms)
The period of incubation of symptoms from the moment the wound is infected with bacteria is usually 1 day, although it may vary from 1 hour to several weeks, which depends on the rate of bacterial multiplication, i.e. on the oxygen conditions in the wound.
Early symptoms are very sparse. The sudden onset of symptoms and the disproportion between the ailments reported by the patient, especiallypain, initially with small changes in the wound area.
Cases of recurrent gas gangrene have been described. SporesC. perfringenscan survive in tissues up to 20 years after an episode of the disease.
The first symptoms appear within a few to several dozen hours from the moment of infection with the bacterium. The severity of symptoms and pain depends on the infected area - infections only of the skin and subcutaneous tissue are milder, and more severe when the bacteria have entered the muscles.
A wound infected with gangrene develops oozing, transparent or colored (bloody or brown) discharge. The diseased area is hardly swollen and filled with gas, which is referred to as crackling gas bubbles on palpation.
gangrene can lead to clots in the tiny blood vessels. Along with local symptoms, there are also toxic symptoms: general weakness, high fever, vomiting, abdominal pain, bloody diarrhea. Around an open wound, tissue cells are visible from the toxin secreted by the bacteria.
Gas gangrene (gangrene) - diagnosis and treatment
The doctor suspects gas gangrene on the basis of an interview indicating exposure to infectionClostridium Perfringensand a personal examination of the patient. A positive test for one of the toxinsClostridiumin the wound exudate or blood confirms the diagnosis. It is always necessary to perform additional blood tests with the assessment of respiratory fitness and the function of the heart, kidneys and liver.
X-ray examinations of the affected area show gas bubbles located in soft tissues.
Suspicion of gas gangrene requires the immediate initiation of appropriate antibiotic therapy and supportive treatment. It also requires surgical supplies - removal of necrotic tissues as well as adequate blood supply and oxygenation of the infected wound.
Treatment with oxygen under high pressure (hyperbaric therapy) may also be used in the treatment of gas gangrene, especially in gas gangrene located in the torso.
Usually, the patient requires hospitalization in the intensive care unit and treatment that supports vital functions.
Treatment of the disease takes many weeks, and the disease that has been cured usually leaves a permanent disability in the form of body deformities or amputations of the limbs affected by the disease. A patient who has survived gas gangrene requires long-term rehabilitation and reconstructive surgery.
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