Gas gangrene • Dangerous wound infection

A rare but dangerous complication of wounds is gas gangrene. The wound infection caused by Clostridial spreads quickly and must be treated immediately. What are the symptoms of gas gangrene and how can you protect yourself?

Gas gangrene is a bacterial infectious disease, usually affecting muscle tissue. It leads to gas formation and the death of affected tissue (necrosis). Left untreated, the infection spreads rapidly, leading to multiorgan failure and then death. Other names for the wound infection are clostridial myonecrosis or myositis, gas edema, gas gangrene, or malignant edema.

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Causes: How does gas gangrene occur?

The main trigger for gas gangrene is infection with the toxin-producing bacterium Clostridium perfringens. In addition, other Clostridial strains such as Clostridium septicum cause the disease, but this is less common. A mixed infection with other bacteria that exploit the weakened state of the immune system is also possible.

After an injury or extensive surgery, the pathogens invade soft tissue such as muscles. Since the bacteria are anaerobic, i.e. they grow when there is a lack of oxygen, they multiply particularly quickly in tissue with poor blood circulation.

In addition, clostridia are part of the natural intestinal flora (microbiome) of humans. With a weakened immune system, injuries or operations on the intestine, the bacteria can get into the soft tissue via the bloodstream. However, this endogenous form is much rarer than the immigration of pathogens from outside.

Risk factors for wound infection

Therefore, there is a particular risk of gas gangrene in wounds that

  • are large
  • go deep and are serious,
  • are contaminated (e.g. with dirt, earth or excrement) or
  • that already contain necrotic tissue.

Gas gangrene symptoms

The incubation period is very short; inflammation begins only a few hours to about four days after the pathogen has penetrated. It spreads quickly, so that sepsis (blood poisoning) quickly develops. As a result of septic shock, there is a risk of acute kidney failure or even multi-organ failure.

Gas gangrene is characterized by crackling of the skin (crepitus) when slight pressure is applied. The cause: Clostridia form gaseous carbon dioxide, which is released in the tissue.

Other signs of gas fire:

  • swollen skin
  • Red-brown to purple or black discolored skin area
  • dark, fluid-filled blisters under the skin
  • severe wound pain
  • sweetish-putrid-smelling wound secretion
  • Fever
  • racing heart (tachycardia)
  • rapid breathing

Intestinal gangrene (clostridial necrotizing enteritis) is a life-threatening special form of infection with Clostridium perfringens. There is a painful urge to defecate (tenesmus), bloody diarrhea and fever. Complications such as intestinal obstruction (ileus), intestinal perforation and bleeding in the gastrointestinal tract can quickly develop. Despite treatment, mortality from this form of gas gangrene is very high.

Diagnosis when an infection is suspected

If there is a suspicion that a patient has been infected with Clostridia, rapid action is required. The first clues are provided by the characteristic symptoms: If a wound swells, discolours and hurts badly, or if blisters have formed, this speaks for the wound infection.

The wound secretion is then usually tested under the microscope with Gram staining for Gram-positive rod-shaped bacteria. Given the severity of the disease, there is not enough time for a precise microbiological detection of the pathogen. If necessary, an X-ray or ultrasound can show accumulations of gas in the tissue.


Rapid therapy required for gas gangrene

First, the wound is carefully cleaned and disinfected. If tissue has already died, it is surgically removed. If the arms or legs are affected, an extremity may be amputated if the gas gangrene is advanced. In this way, the doctors prevent further spread of the wound infection.

Patients are also given antibiotics to kill the bacteria. Penicillin is often combined with clindamycin, alternatives are carbapenem and linezolid. In the event of a shock, drugs that stabilize the circulation are administered. In order to treat organ failure, an attempt is made to replace the organ function – in the case of acute kidney failure, for example, with dialysis.

Since oxygen inhibits clostridial growth, hyperbaric oxygenation can be performed. Patients are ventilated with pure oxygen in a hyperbaric chamber. As a result, a lot of oxygen is dissolved in the blood, which increases the amount in the tissues.

Can you prevent gas fire?

While gas gangrene used to be a common complication of wounds, thanks to today’s hygiene standards in Germany, it is rare. The development of antibiotics has also greatly reduced the number of cases.

To prevent Clostridial infection, wounds should always be cleaned thoroughly. Above all, foreign objects and dirt should be removed carefully. In the case of large and deep wounds, those affected should seek medical help promptly so that the injury is treated professionally. This also applies to people with diabetes mellitus: Due to the metabolic disease, the blood flow to the tissue is usually reduced, so that wounds should be examined by a doctor as a precaution. To avoid infection, patients are usually given prophylactic antibiotics as part of abdominal surgery.

A vaccine against Clostridia is not yet available.

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Source: Lifeline | Das Gesundheitsportal by www.lifeline.de.

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