Gas gangrene

Gas gangrene

• 1.
  D R .P R A F U L L A P A T I L . S H R I . C H A M U N D A M A T A H O M O E O P A T H I C M E D I C A L C O L L E G E A N D H O S P I T A L , J A L G A O N . Gas Gangrene
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   Gangrene refersto the death of body tissue due to either a lack of blood flow or a serious bacterial infection. Gangrene commonly affects the extremities, including your toes, fingers and limbs, but it can also occur in your muscles and internal organs.
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   Types ofgangrene:-  1.Dry gangrene.  2.Wet gangrene.  3.Gas gangrene.  4.Internal gangrene.  5.Fournier’s gangrene.
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  DEFINITION:  It isa highly fatal, rapidly spreading infection caused By clostridial organisms which results in myonecrosis.  Gas gangrene also known as Clostridial myositis, clostridial myonecrosis, infective gangrene of the muscles.
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  AETIOLOGY:  The diseaseis caused by 1.Clostridium perfringens ( Clostridium.welchii)-the commonest organism (60%). Other organisms are 2.Clostridium septicum 3.Clostridium oedematiens 4.Clostridium histolyticum. These are gram-positive, anaerobic spore-bearing bacilli.
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  SOURCE OF INFECTION: Manured soil or cultivated soil, normal intestines.
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  RISK GROUP:  Inpatients who have had lower limb amputations performed for ischaemic gangrene, infection can occur from patient's own bowel organisms.  High velocity gun shot wounds with perforation of hollow viscus are also associated with risk of developing gas gangrene (military wound).  Immunocompromised patients are at risk.
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   Toxins andtheir effect: Lecithinase Dermonecrosis ,Hemolysis Beta toxins Necrosis of tissue proteinase Breakdown of collagen fibre Hyaluronidase Break the cement substance of muscle cell
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  CLINICAL FEATURES:  Severepain and gross oedema of the wound.  Sutured wound is under tension.  Thin brownish fluid escapes which has sickly sweet odour.  Palpable crepitus .  Colour changes in the muscles.  Skin becomes khaki-coloured due to haemolysis.  Anxious and alert  Toxic and ill  Rapid increase in the pulse rate  Hypotension due to suppression of adrenals  Vomiting  Low grade fever
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  DIAGNOSIS:  To examinethe pus under microscope after staining with Giemsa stain.  Presence of gas indicates anaerobic metabolism.  Anaerobic streptococci also produce gas.
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  PROPHYLAXIS: 1. Debridement: 2. Prophylacticantibiotics: 3. Judicious and minimal use of tourniquet: If possible, 4. Gentle but effective application of plaster cast
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  TREATMENT: • Emergency surgerywhich includes excision of all dead muscles and necrotic tissues by using generous, long incisions-debridement. • Penicillin to be continued. • Blood transfusions before, during and after surgery. • Polyvalent anti-gas gangrene serum. • Hyperbaric oxygen will reduce the amount of toxin produced by the organisms (controversial). • Do not hesitate to amputate if it saves the life, because this is the only measure in late cases.
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  HOMOEOPATHIC TREATMENT:  -Arsenicum -Crotalus -Secale -Carbovegetabilis -Lachesis mutus -Polygonum punctatum -Sulphuricum acidum