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Epidemiology ,control and management of gas gangrene
- 2. Definition • Gas gangrene also known as clostridial myonecrosis and is a bacterial infection that produces tissue gas in gangrene. • This deadly form of gangrene usually caused by clostridium perfeingens bacteria. • Gangrene is a condition that arise when a considerable mass of body tissue dies (necrosis) this may occur after any injury
- 3. , infection or in people suffering from any chronic health problem affecting blood circulation. • It can affect any part of the body but typically starts in the toes,feet , fingers and hand ( the extremities) .
- 5. Types of gas gangrene 1.Dry gangrene begins at the distal part of the limb due to ischemia and often appears in the toes and feet of elderly patient due to arteriosclerosis. • Dry gangrene is generally seen due to arterial occlusion. As there is limited putrefaction and bacteria fail to survive,dry gangrene spreads slowly until it reaches the point
- 6. where the blood supply is adequate to keep tissue viable. The affected part is dry , shrunken and dark reddish- black like mummified flesh . 2. Wet gangrene • Wet gangrene occurs in moist tissues and organs such as the mouth, bowel,lungs , cervix, and vulva.bed sores occuring on body parts such as the sacrum,buttocks and heels are also classified as wet gangrene infection
- 7. • Wet gangrene is characterized by numerous bacteria and generally has a poor prognosis ( compared to dry gangrene) due to septicemia.In wet gangrene,the tissue is infected by microorganisms like clostridium perfeingens or bacillus fusiformis that causes the tissues to swell and emit a foetid smell. • Wet gangrene usually develops rapidly due to blockage of venous (mainly) and /or arterial blood flow. The affected part is saturated with stagnant blood,that promotes rapid growth of bacteria.
- 8. 3. Gas gangrene • Gas gangrene is a bacterial infection that produces gas within tissues . It is the most severe form of gangrene usually caused by clostridium perfeingens bacteria. Infection spreads rapidly as the gases produced by bacteria expand and infiltrate healthy tissues in the vicinity. • Gas gangrene is generally treated as a medical emergency as it quickly spreads to the surrounding tissues.
- 9. Epidemiology • Clostriduim species are found in soil , especially soil used for animal husbandry .In medical facilities ,it thrives when unhygienic circumstances prevail,In the United States,the incidence of myonecrosis is only about 1000 cases per year . • During world war l and World war ll clostridial myonecrosis was found in 5% of wounds ,but with improvement in wound care , antisepsis and the use of antibiotics,the incidence had fallen to 0.1% of war related wound infections by the Vietnam war .
- 10. • With the best of care including early recognition, surgical care , antibiotics treatment ,and hyperbaric oxygen therapy – the mortality rate is 20-30 % and can be as low as 5-10% .If untreated ,the disease has a 100% fatality rate .
- 11. CAUSE Gangrene is caused when a body part loses its blood supply due to an injury or an underlying disease. The conditions most commonly responsible for causing gangrene are as follows: • Diabetes • Blood vessel disease such as arteriosclerosis causing hardening of the arteries, in arms or legs.
- 12. • Suppressed immune system (for example, from HIV or chemotherapy ) • surgery • Due to infection or ischemia, such as by the bacteria Clostridium perfringens or by thrombosis (a blocked blood vessel).
- 15. Dry gangrene which is the most common type of gangrene, usually manifests in the following form. • Firstly, the affected part turns red • Then it becomes cold, pale and numb (though some people might experience pain). Furthermore, the body part may begin to change colour from red to brown to black without treatment. The dead tissue may shrivel up and fall away from the surrounding healthy tissue. Wet gangrene progresses much faster than dry gangrene.
- 16. Its symptoms include: • Swelling and redness of the affected body part • Pain which can often be severe • Foul-smelling discharge of pus from a sore in skin • Affected area will change colour from red to brown to black
- 17. The symptoms of Gas gangrene are as follows: • Feeling of heavinessfollowed by severe pain • In most cases of gas gangrene, pressing skin near the affected area will produce a crackling sound caused by a build-up of gas; producing the feeling of crushing fine tinfoil.
- 18. Diagnostic test • Clinical test can be carried out to confirm the diagnosis of gangrene.these include • An increase or decrease in the number of white blood cells can indicate infection . • Tissue culture- A small sample of fluid (or tissue ) from the affected area can be tested for bacteria.this test is called a gram stain . Bacteria are stained with a dye and examined under a microscope.the test is also useful for determining the most effective type of antibiotics to treat
- 19. • Blood culture- A sample of infected blood is removed and placed in a warm environment to encourage the growth of bacteria. • Imaging test - A range of imaging test ,such as x rays ,MRI scans ,CT scan can be used to confirm the presence and spread of gangrene.these test can also be used to study blood vessels in order to identify to the blockages • Surgery - Surgical examination may be necessary to confirm the diagnosis of gas gangrene.
- 20. Prevention and control Check feet daily for problems such as numbness, discoloration,breaks in the skin ,pain or swelling. • Avoid walking barefoot outside and wearing shoes without socks • Wash your feet daily • Avoid using hot water bottles , electric blanket, foot spas,and sitting too close to the fire these may burn the feet , burnt tissue is vulnerable to gangrene • Avoid wearing sandals
- 22. Management Although gangrene can be managed by its symptomatic treatment,yet it is also necessary to diagnosis and treat the underlying cause. Medical management • Antibiotics therapy • In animal models , prompt treatment with antibiotics significantly improves survival rates historically, penicillin G in dosage of 10-24 million was the drug of choice currently,a combination of penicillin and clindamycin is
- 23. • Recent studies show that protein synthesis inhibitors (e.g. clindamycin , chloramphenicol, rifampin, tetracycline ) may be more effective ,bacause they inhibit the synthesis of clostridial exotoxins and lessen the local and systemic toxic effects of these proteins. • Inspite of increasing clindamycin resistant among anaerobes, cases of clindamycin are
- 24. Hyperbaric oxygen therapy An alternative treatment for some forms of gangrene is hyperbaric oxygen therapy. • As the therapy .a specially designed chamber that also contains a plastic hood filled with pure oxygen ,is filled with pressurized air.the plastic hood is then placed over the damaged body part .
- 26. Intensive care • Patient with gas gangrene frequently have end organ failure and other contaminant serious medical conditions that requires intensive supportive care. Serum calcium monitoring • Monitoring serum calcium may need special attention when large areas of necrotic fat may lead to its deposition.
- 27. Surgical management • Infection - Serous infection are usually treated with antibiotics. • Debridement - Is the surgical removal of the dead tissue that results from gangrene. • Vascular surgery- Can be used to restore
- 28. Angioplasty • Where a tiny balloon is placed into a narrow or blocked artery and is inflated to open up the vessel.a small metal tube ,also known as a stent , may also be inserted into the artery to prevent it from getting closed .
- 30. Nursing management 1.Nursing diagnosis Impaired skin integrity rekated to decreased blood flow to the area of gangrene due to obstruction of blood vessels. Goal - maintain peripheral circulation
- 31. Nursing interventions • Assess site of impaired skin integrity and it’s condition • Teach the patient to mobilize because mobilization improve blood flow • Teach about the factors that can increase blood flow elevate the legs slightly lower than the heart
- 32. 2.Nursing diagnosis • Risk for infection related to inadequate primary defence Goal – to prevent infection Nursing interventions • Teach patient to wash hands often and after administering self care • Discuss to patients the following signs of infection, redness, swelling, increased pain • Demonstrate and encourage doing proper dressing • Maintain sterile technique for all procedure
- 33. 3.Nursing diagnosis • Pain , swelling related to gas gangrene Goal – to reduce pain and edema Nursing interventions • Instruct the patient regarding the proper method to control edema and pain • Teach exercise to maintain the heath of unaffected muscles • Instruct the patient to do movement to increase circulation in your body • Use bandages or compression socks to keep pressure on edema
- 34. 4.Nursing diagnosis • Deficient knowledge about disease and long term treatment • Goal --- provide appropriate information about disease • Nursing interventions • Assess the client level of knowledge • Assess the client’s ability to learn • Explain about the disease conditions and treatment • Clarify the client’s doubt
- 35. Patient education • Educate patient with spontaneous gas gangrene about the strong association with occult malignancies , especially GI tract • Educate intravenous drug users about potential falal complications of gas gangrene due to injection of contaminated heroin or other chemicals • Educate pateint with epinephrine auto injectors about the rare but serious complication of gas gangrene associated with uss of the device.
- 36. Clinical research ABSTRACT Clostridial myonecrosis is most often seen in settings of trauma, surgery, malignancy, and other underlying immunocompromised conditions. We present a case of 55-year-old obese woman who developed rapidly progressive gas gangrene in her right leg accompanied by tibial plateau fracture without skin lacerations. She was diagnosed with clostridial myonecrosis and above-the-knee amputation was carried out. This patient made full recovery within three weeks of the initial episode. Several factors, if available, were analyzed for each case: age, cause of injury, fracture location, pathogen, and outcome. Based on our case report and the literature review, emergency clinicians should be aware of this severe and potentially fatal infectious disease and should not delay treatment or prompt surgery consultation.
- 37. SUMMARY We learn about introduction of gas gangrene, definition ,types of gangrene , clinical manifestations, cause,diagnosis, diagnostic evaluation, prevention & control, medical & surgical management, patients education, treatment.
- 38. CONCLUSION Gas gangrene is a pathology rarely encountered in current medical practice. However, due to the sudden onset of rapid progression, gloomy prognosis and increased mortality, it is necessary for emergency and surgical department specialists to keep high suspicion of each contusive wound contaminated with earth and vegetal remains. Early diagnosis, immediate multivalent antigangrenoid serotherapy, extensive surgical debridement, prompt antibiotic therapy with intensive care monitoring ,application of hyperbaric oxygen therapy can lead to survival and rescue of the affected body segment.
- 39. Bibliography • Oxford textbook of medicine volume 1 page no. 553 • Brunners and Siddarth textbook of medical surgical nursing edition 13