Adult ; Anti-Inflammatory Agents ; therapeutic use ; Coronary Vasospasm ; complications ; physiopathology ; Coronary Vessels ; diagnostic imaging ; Electrocardiography ; Gas Gangrene ; complications ; therapy ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Male ; Pericarditis ; complications ; physiopathology

Gas gangrene, a subset of necrotizing myositis, is a bacterial infection that produces gas in tissues in gangrene. It is usually caused by Clostridium species, most commonly Clostridium perfringens. Streptococcus anginosus is a rare cause of gas gangrene, with very few cases reported. We report a rare case of traumatic gas gangrene caused by S. anginosus in a 57-year-old female with diabetes after being stabbed with scissors.
Bacterial Infections ; Clostridium ; Clostridium perfringens ; Diabetes Mellitus ; Female ; Gangrene ; Gas Gangrene* ; Humans ; Middle Aged ; Myositis ; Streptococcus anginosus* ; Streptococcus*

Traumatic gas gangrene is a fatal infection mainly caused by Clostridium perfringens. It is a challenge to manage gas gangrene in open wounds and control infection after debridement or amputation. The aim of the present study was to use vacuum sealing drainage (VSD) with continuous irrigation of potassium permanganate to manage infective wounds of gas gangrene and observe its clinical efficacy. A total of 48 patients with open traumatic gas gangrene infection were included in this study. Amputations were done for 27 patients, and limb salvage procedures were performed for the others. After amputation or aggressive debridement, the VSD system, including polyvinyl alcohol (PVA) foam dressing and polyurethane (PU) film, with continuous irrigation of 1:5000 potassium permanganate solutions, was applied to the wounds. During the follow-up, all the patients healed without recurrence within 8-18 months. There were four complications. Cardiac arrest during amputation surgery occurred in one patient who suffered from severe septic shock. Emergent resuscitation was performed and the patient returned to stable condition. One patient suffered from mixed infection of Staphylococcal aureus, and a second-stage debridement was performed. One patient suffered from severe pain of the limb after the debridement. Exploratory operation was done and the possible reason was trauma of a local peripheral nerve. Three cases of crush syndrome had dialysis treatment for concomitant renal failure. In conclusion, VSD can convert open wound to closed wound, and evacuate necrotic tissues. Furthermore, potassium permanganate solutions help eliminate anaerobic microenvironment and achieve good therapeutic effect on gas gangrene and mixed infection. VSD with continuous irrigation of potassium permanganate is a novel, simple and feasible alternative for severe traumatic open wounds with gas gangrene infection.
Adolescent ; Adult ; Aged ; Child ; Drainage ; Female ; Gas Gangrene ; etiology ; therapy ; Humans ; Male ; Middle Aged ; Negative-Pressure Wound Therapy ; methods ; Potassium Permanganate ; therapeutic use ; Retrospective Studies ; Therapeutic Irrigation ; Treatment Outcome ; Young Adult

Most cases of gas gangrene caused by Clostridium species begin with trauma-related injuries but in rare cases, spontaneous gas gangrene (SGG) can occur when patients have conditions such as advanced malignancy, diabetes, or immunosuppression. Clostridium perfringens, a rare cause of SGG, exists as normal flora of skin and intestines of human. Adequate antibiotics with surgical debridement of infected tissue is the only curative therapeutic management. Mortality rate among adults is reported range of 67-100% and majority of deaths are occurred within 24 hours of onset. We experienced a case of SGG on the trunk, buttock and thigh in a neutropenic patient with acute lymphoblastic leukemia. His clinical course was rapid and fatal during pre-engraftment neutropenic period of allogeneic stem cell transplantation.
Adult ; Anti-Bacterial Agents ; Buttocks ; Clostridium ; Clostridium perfringens* ; Debridement ; Gas Gangrene* ; Humans ; Immunosuppression ; Intestines ; Mortality ; Neutropenia* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Skin ; Stem Cell Transplantation* ; Thigh

BACKGROUNDMortality rates for patients with gas gangrene from trauma or surgery are as high as 25%, but they increase to 50%-80% for patients injured in natural hazards. Early diagnosis and treatment are essential for these patients.

METHODSWe retrospectively analyzed the clinical characteristics and therapeutic results of 19 patients with gas gangrene of the limbs, who were injured in the May 2008 earthquake in the Wenchuan district of China's Sichuan province and treated in our hospital, to seek how to best diagnose and treat earthquake-induced gas gangrene.

RESULTSOf 226 patients with limbs open injuries sustained during the earthquake, 53 patients underwent smear analysis of wound exudates and gas gangrene was diagnosed in 19 patients. The average elapsed time from injury to arrival at the hospital was 72 hours, from injury to definitive diagnosis was 4.3 days, and from diagnosis to conversion of negative findings on wound smear analysis to positive findings was 12.7 days. Anaerobic cultures were also obtained before wound closure. The average elapsed time from completion of surgery to recovery of normal vital signs was 6.3 days. Of the 19 patients, 16 were treated with open amputation, two with closed amputation, and 1 with successful limb salvage; 18 patients were successfully treated and one died.

CONCLUSIONSIn earthquakes, rapid, accurate screening and isolation are essential to successful treatment of gas gangrene and helpful in preventing nosocomial diffusion. Early and thorough debridement, open amputation, and active supportive treatment can produce satisfactory therapeutic results.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Earthquakes ; Extremities ; pathology ; surgery ; Female ; Gas Gangrene ; diagnosis ; surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

Subcutaneous emphysema of lower extremity is a rare disease entity. Crepitation and swelling on physical examination and gas on radiographs raise the concern of infection due to the presence of gas gangrene forming organisms. Therefore, delay of diagnosis and appropriate management can be a major predisposing factor for sepsis and further associated high mortality. We experienced a rare case of subcutaneous emphysema of the right lower extremity after knee arthroscopy; life-threatening infection was ruled out by physical examination and laboratory testing. The patient recovered uneventfully with conservative management. Therefore, we report on this case with a review of current literature.
Arthroscopy* ; Causality ; Diagnosis ; Diagnosis, Differential ; Gas Gangrene ; Humans ; Knee* ; Lower Extremity* ; Mortality ; Physical Examination ; Rare Diseases ; Sepsis ; Subcutaneous Emphysema*

Adult ; Cellulitis ; diagnosis ; etiology ; Dyspnea ; diagnosis ; etiology ; Gas Gangrene ; complications ; diagnosis ; Humans ; Male

We report here on a fatal case of abdominal gas gangrene. Two days after gastrectomy, a 56-year-old man presented with intractable abdominal pain and fever of a sudden onset, which quickly progressed over several hours to septic shock. Despite of the unexplained gas collections in the abdominal muscle, fascia, and subcutaneous layers on computed tomography scan, its clinical significance was overlooked. Emergency laparotomy was initially scheduled because of concern that there may have been a perforated viscus. At the time of monitoring for the anesthesia, we noticed marbled skin discoloration and the subcutaneous emphysema had spread on his flank. Shortly after the initial suspicion of gas gangrene, cardiac arrest developed during the arterial line cannulation. Despite prompt resuscitation measures, including the administration of catecholamines and the application of extracoporeal membrane oxygenation, he eventually died. Anesthesiologists need to understand this fulminant disease because extensive debridement under general anesthesia is essential for the treatment of abdominal gas gangrene.
Abdominal Muscles ; Abdominal Pain ; Anesthesia ; Anesthesia, General ; Catecholamines ; Catheterization ; Debridement ; Emergencies ; Fascia ; Fever ; Gas Gangrene ; Gastrectomy ; Heart Arrest ; Humans ; Laparotomy ; Membranes ; Middle Aged ; Oxygen ; Resuscitation ; Shock, Septic ; Skin ; Subcutaneous Emphysema ; Vascular Access Devices

Porphyromonas gingivalis is a gram-negative, anaerobic, rod-shaped bacterium originally classified within the Bacteroides genus, and a major etiological agent in the initiation and progression of severe periodontal disease. P. gingivalis has occasionally been involved in otitis media, lung abscesses, gas gangrene, appendicitis, sinusitis, paranasal mucocele, peri-tonsillar abscesses, pleura-pulmonary infections, and thoracic empyema. We report the case of a 44-year-old male who presented with a brain abscess in which the organism, presumably originated from his poor dentition. He was successfully treated with surgical drainage and antibiotics.
Abscess ; Adult ; Anti-Bacterial Agents ; Appendicitis ; Bacteroides ; Brain ; Brain Abscess ; Dentition ; Drainage ; Empyema, Pleural ; Gas Gangrene ; Humans ; Lung Abscess ; Male ; Mucocele ; Otitis Media ; Periodontal Diseases ; Porphyromonas ; Porphyromonas gingivalis ; Sinusitis

Porphyromonas gingivalis is a gram-negative, anaerobic, rod-shaped bacterium originally classified within the Bacteroides genus, and a major etiological agent in the initiation and progression of severe periodontal disease. P. gingivalis has occasionally been involved in otitis media, lung abscesses, gas gangrene, appendicitis, sinusitis, paranasal mucocele, peri-tonsillar abscesses, pleura-pulmonary infections, and thoracic empyema. We report the case of a 44-year-old male who presented with a brain abscess in which the organism, presumably originated from his poor dentition. He was successfully treated with surgical drainage and antibiotics.
Abscess ; Adult ; Anti-Bacterial Agents ; Appendicitis ; Bacteroides ; Brain ; Brain Abscess ; Dentition ; Drainage ; Empyema, Pleural ; Gas Gangrene ; Humans ; Lung Abscess ; Male ; Mucocele ; Otitis Media ; Periodontal Diseases ; Porphyromonas ; Porphyromonas gingivalis ; Sinusitis