Synonym(s)
edema malignes; Gaseous edema disease; Gas Gangrene; Gas oedema; grangraena emphysematosa
DefinitionThis section has been translated automatically.
Severe, life-threatening wound infection caused by clostridia in the absence of air Gas gangrene is classified as clostridial myonecrosis.
Notice!
Obligation to report illness and death!PathogenThis section has been translated automatically.
Clostridium perfringens (80-90% of infections), C. novyi or C. septicum (together almost 20% of cases); rarely Clostridium histolyticum. Obligatory anaerobic spore formers.
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EtiopathogenesisThis section has been translated automatically.
Infection of wounds with extensive tissue ruptures and pocket-rich soft tissue injuries with toxin-forming anaerobes.
Clinical featuresThis section has been translated automatically.
- Local: Painful, oedematous wound, blue-green to brownish skin colour, foul-smelling wound secretion; spontaneous or pressurised gas escape. Partly brittle, partly dissolving, gas-containing (x-ray) musculature.
- General: Physical deterioration: Intoxication, tachycardia, hypotension, agitation, haemolysis, anaemia, jaundice.
Differential diagnosisThis section has been translated automatically.
Gas formation in wounds during infections by pathogens such as E.coli, Bacteroides, Klebsiella, Proteus.
General therapyThis section has been translated automatically.
Myonecrosis, clostridial. Start therapy even on suspicion! Transfer to surgical intensive care.
Cave!
Risk of toxic cardiovascular failure, sepsis, anuric kidney failure! Immediate surgical revision with broad exposure, excision of necrotic tissue and open drainage! Hyperbaric oxygenation (controversial procedure!) after surgery.Notice! Create aerobic wound conditions!
Internal therapyThis section has been translated automatically.
- High-dose antibiotics are first choice: benzylpenicillin (e.g. penicillin Grünenthal) 20-40 million IU/day distributed over 4-6 ED as a short infusion in combination with metronidazole (e.g. Clont), adults: 2-3 times 500 mg/day i.v., children: 20 mg/kg bw/day i.v. or p.o. distributed over 3 ED.
- Alternatively: cefotaxime (e.g. claforan) 2-3 times/day 2 g i.v. (max. 4 times/day 3 g) in combination with metronidazole (e.g. Clont), adults: 2-3 times/day 500 mg/day i.v., children: 20 mg/kg bw/day i.v. or p.o. distributed over 3 ED.
- In case of penicillin allergy: Imipenem (e.g. Zienam): adults: 3-4 times 0.5-1.0 g/day i.v., infants: 60 mg/kg bw/day distributed over 4 ED. Alternatively: erythromycin (erythrocin i.v.), adults 2 g/day i.v. in 4 ED, children 20-30 mg/kg bw/day i.v. in 4 ED. Alternatively linezolid (cyvoxide): adults 2 times/day 600 mg i.v.
Progression/forecastThis section has been translated automatically.
Mortality: 30-50%.
ProphylaxisThis section has been translated automatically.
Benzylpenicillin in high dosage: 5-20 million IU/day i.v. over 14 days.
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Incoming links (10)
Edema, malignant; Gangraena emphysematosa; Gaseous edema disease; Gas gangrene; Gas oedema; Myonecrosis, clostridial; Pasteurellose; Penicillin g; Sepsis skin changes; Tungiasis;Outgoing links (8)
Antibiotics; Cefotaxime; Excision; Imipenem/cilastatin; Linezolid; Metronidazole; Myonecrosis, clostridial; Penicillin g;Disclaimer
Please ask your physician for a reliable diagnosis. This website is only meant as a reference.
Prof. Dr. med. Peter Altmeyer