Infectious diseases. Gas gangrene (most important)

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Infectious diseases. Gas gangrene (most important)

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21. Gas gangrene

Gas gangrene is a severe anaerobic infection of soft tissues, primarily muscles, accompanied by the formation of gas and severe intoxication.

Etiology. There are six most common pathogens of gas gangrene: Clostridium perfringens, Clostridium novyi, Clostridium septicum, Clostridium histolyticum, Clostridium bifermentans, Clostridium fallax. All these microorganisms are small (0,5-5 microns) Gram-positive rods.

Pathogenesis and pathomorphology. The development of gas gangrene is facilitated by:

1) getting into the wound clostridia;

2) dead tissue, in which the level of oxygen is reduced.

Factors predisposing to the development of infection include trauma, ischemia, foreign bodies in the wound, or infection with other microorganisms. Gas gangrene syndrome is caused by the action of toxins produced by multiplying clostridia. The reproduction of bacteria in tissues is accompanied by the release of gas (hydrogen and carbon dioxide), determined by palpation.

Clinical manifestations. Clostridia infection syndrome consists in the multiplication of pathogens in the wound with minor pain and the absence of general reactions. The surface of the wound is usually uneven, has an untidy appearance, serous-purulent discharge is dark brown in color and fetid. The healing process is slow. Along with clostridia, anaerobic streptococcus can be released from the wound.

Anaerobic cellulitis often develops initially, but may complicate other forms of wound infection. The incubation period is 3-4 days. Clostridia multiply in already dead tissues affected by trauma and subsequent ischemia.

Anaerobic myonecrosis is the most severe form of gas gangrene. The incubation period can last from several hours to 1-2 months, more often - no more than 3 days. The disease begins acutely, there are severe pain in the wound, local swelling and swelling. The muscle tissue in the affected area is edematous and pale. As the infection progresses, the muscles become brick red and lose their ability to contract.

Diagnosis. The diagnosis of gas gangrene must be established in the early stages of the disease, based on clinical data, the results of laboratory tests, including microscopy and bacteriological examination, and x-ray examination.

Treatment. The most reliable method of treatment for gas gangrene is surgical debridement and removal of all infected tissues. Penicillin G given intravenously is not a substitute for surgery.

Prevention. The main methods of preventing gas gangrene include early, correctly and carefully performed wound treatment, which excludes the possibility of infection.

Author: Pavlova N.V.

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