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gas gangrene.ppt
Gas gangrene is a rapidly progressive, potentially fatal condition caused by Clostridium bacteria. It is characterized by necrosis of muscles and soft tissues due to bacterial toxins and enzymes. The bacteria enter through wounds and produce spores that germinate under anaerobic conditions, releasing toxins and gases. This leads to pain, swelling, skin blisters, and a sweet smelling discharge. Aggressive antibiotic treatment with penicillin and debridement or amputation of infected tissues is needed to prevent shock and death. High risk individuals include those with wounds, diabetes, or poor circulation.
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gas gangrene.ppt
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- 2. • It isa rapidly progressive, potentially fatal condition characterized by widespread necrosis of the muscles and subsequent soft-tissue destruction. • This is a dreaded consequence of inadequately treated missile wounds, crushing injuries and high- voltage electrical injuries.
- 3. Causative agent • Clostribiumspecies – spore forming, Gram +ve c. Perfringens (mostly) c.novyi c.septicum
- 4. • They arepresent in the soil and have also been isolated from the human gastrointestinal tract and female genital tract. • Non-clostridial gas- producing organisms such as coliforms have also been isolated in 60–85% of cases of gas gangrene.
- 5. Anaerobic environment Distension of tissues Interfering Blood supply Ischemia/ gangrene Toxemiaand death Spores germinate Carbohydrates Fermentation Gas production In tissues PATHOGENESIS Incubation period is 1-7 days vegetative cells multiply
- 6. Pathogenesis - Bacteria enters the brokenskin or wound - Spores are produced - The bacteria present in circulation system the anaerobic tissue present - The bacteria are grow and ferment the muscle carbohydrate - The toxins (lecithinase) and enzyme are produced Examples of enzyme: colagenases, proteases and lipases - These enzymes will kill other host cell and extend the anaerobic environment - Produce gases (nitrogen, hydrogen sulphide and carbon dioxide) - Crepitant tissue ( destroyed tissue)
- 7. Epidemiology – The personsat risk those with Diabetes Mellitus, blood vessel disease and colon cancer – Contact with contaminated cloth and other foreign material – Trauma or recent surgical wound
- 9. Symptoms • High fever •Shock • Massive tissue destruction • Blackening of skin • Severe pain around a skin of wound • Blisters with gas bubbles form near the infected area, • the heartbeat and breathing become rapid.
- 10. Crepitation in tissues, sicklysweet odor discharge, rapidly progressing necrosis, fever, hemolysis, toxemia, shock, renal failure, and death Presentation
- 13. Culture and sensitivity Stormingfermentation Lecithinase test Lab. Investigations
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- 18. Prevention • Cleaning thewound • Avoid the contaminated material • improve circulation in patients with poor circulation • antitoxin
- 19. (1) Do athorough wound toilet. (2) In high risk wounds give the patient penicillin 1.5 megaunits 4 hourly, or tetracycline Prevention
- 20. Treatment • High dosesof antibiotic : Penicillin • The dead tissue is removed or limbs are amputated • No vaccine
- 21. 10 megaunits ofbenzyl penicillin daily for 5 days as four 6 hourly doses. Or Tetracycline 0.5 g intravenously or 1 g orally every 6 hours. Clostridia not sensitive to metronidazole, some other anaerobic bacteria are, so give it.
- 22. Do this ina septic theatre, or even in the out-patient department, and not where clean cases go for operation. EXPLORATION
- 24. AMPUTATION Amputate under atourniquet Close the stump by delayed primary suture
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- 27. Stump of aboveknee amputation
- 28. • Patients shouldbe admitted to ICU and treated aggressively with careful monitoring. • The role of HBO is not as clear as in necrotising fasciitis but it is recommended in severe cases if the facilities are available. – increases the normal oxygen saturation in the infected wounds by 1000-fold leading to • Bacteriocidal effect, • Improves neutrophil function, • Enhanced wound healing