Epidemiology ,control and management of gas gangrene
1.
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) .
4.
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
21.
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 .
25.
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 .
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
