Gas Gangrene – Symptoms, Causes, Treatment and Prevention

Overview

Gas gangrene is a deadly form of tissue death. It usually develops in case of deep, penetrating wounds.

Gas gangrene or clostridial myonecrosis is a muscle tissue infection caused by toxin-producing germs called clostridia. Louis Pasteur identified the first species of clostridia, Clostridium butyricum, in the year 1861. In 1892, other scientists, including Nuttall and Welch, isolated Bacillus aerogenes capsulatus (a gram-positive anaerobic bacillus) from gangrenous injuries. The current nomenclature of the organism is Clostridium perfringens.

It first gained recognition as a wartime occurrence. Statistics say that this condition complicated 1% and 6% of all open wounds and fractures, respectively, during World War I.

What is Gas Gangrene?

Gangrene refers to the death of tissues in a part of the body due to disruption of the blood supply to the affected area. Gas gangrene, a fast-spreading and potentially life-threatening type of gangrene, results from a bacterial infection from germs, like Clostridium bacteria. The infection leads to the formation of toxins in the cells, blood vessels and tissues of the body. These bacteria release toxins that cause the death of tissue and release a gas.

Gas gangrene leads to muscle tissue death, gas production and spread of infection through the body. It is also known as clostridial myonecrosis or myonecrosis. This usually develops in deep crushing or penetrating wounds like war wounds, which are improperly cleansed.

Types of Gangrene

Following are the types of gangrene:

Dry gangrene: In this type of gangrene, the skin becomes dry and wrinkled and appears black or purplish-blue. It is a slowly developing condition and mainly affects people with high blood sugar and blood vessel conditions like atherosclerosis.

Wet gangrene: A gangrene is called wet when it has a bacterial infection in the affected area. Some of the common features of this condition include blistering, inflammation, and damp appearance. As wet gangrene involves bacterial infection, it spreads quickly and therefore requires immediate medical attention.

Gas gangrene: This type of gangrene impacts the deep muscle tissues. In gas gangrene, your skin is more likely to appear normal initially. However, as the condition progresses, your skin will likely turn pale and then gray to red (purplish). If left untreated, it can be as deadly as wet gangrene.

Internal gangrene: As the name suggests, it affects your internal organs (one or more), including the appendix, intestines, or gallbladder. It happens when blood flow to an organ is blocked. If left untreated, it can be life-threatening.

Fournier’s gangrene: This type of gangrene affects your genital organs. This condition affects men more than women. A urinary tract or genital-area infection might lead to Fournier’s gangrene.

Meleney’s gangrene: It is also known as progressive bacterial synergistic gangrene. It is a rare form of gangrene that occurs following a complicated surgery. Meleney’s gangrene causes pain and discomforting lesions on the skin and is likely to develop within a couple of weeks after surgery.

When to See a Doctor?

Regardless of its type, gangrene is a severe health condition that needs emergency medical assistance. Get in touch with your doctor if you experience unexplained yet persistent pain in any part of your body or any of the signs and symptoms given below:

• Pale, numb, cold, and hard skin surface
• Persistent fever
• High blood pressure, fever
• Skin lesions
• Discoloration of skin
• Blisters
• Swelling
• Foul-smelling discharge from the wounds
• Sudden pain and discomfort at the site of a wound or surgery

Causes for Gas Gangrene

Gas gangrene is usually caused by bacterium Clostridium perfringens, which grows only in the absence of oxygen, or is caused by group-A streptococcus. It usually develops suddenly and occurs at the site of trauma or recent wound. Patients with underlying blood vessel disease atherosclerosis, diabetes or colon cancer are at risk of developing gas gangrene.

Post-traumatic gas gangrene can occur due to trauma arising from crush injuries, compound fractures and gunshot wounds.

Post-operative clostridial infection after a ruptured appendix, bowel perforation, colon resection etc. can also lead to gas gangrene.

Symptoms of Gas Gangrene

Symptoms in gas gangrene begin quickly:

1. Painful swelling. Skin turns pale to brownish red
2. Blisters develop and are filled with brown red fluid
3. Heaviness in affected extremity.
4. Increased heart rate
5. Fever
6. Sweating
7. Vesicle formation which combine into large blisters
8. Yellow colour of the skin

Diagnosing Gas Gangrene

1. Skin culture test to determine the presence of Clostridium perfringens as well as other bacteria
2. Blood tests to look for an abnormally high white blood cell count that can indicate an infection
3. Imaging tests like a routine X-ray, to look at tissues and check for the presence of gas; or special studies like MRI (magnetic resonance imaging) or arteriogram
4. Surgery to assess the spread of gas gangrene within the body

Treatment for Gas Gangrene

1. Debridement, a surgical procedure to remove dead, damaged and infected tissues is performed.
2. Amputation, which is the surgical removal of arm or leg, is sometimes done to prevent the spread of infection.
3. Antibiotics are given to control the infection.
4. Hyperbaric oxygen therapy is used to treat Clostridium perfringens infection.
5. Repairing damaged blood vessels to improve blood flow to the affected area.
6. Performing a type of reconstructive surgery called skin graft to treat damaged tissues. During a skin graft, your physician will remove healthy skin from an unaffected part of the body and attach the same over the damaged area. This helps in restoring any skin damage caused by gas gangrene.
7. Sometimes septic abortion can lead to the development of uterine gas gangrene, and it requires removal of the uterus.

Prognosis for Gas Gangrene

Usually, gas gangrene has a poor prognosis and is often deadly. Symptoms begin suddenly and worsen. Prognosis is good if the incubation period is less than 30 hours. Advanced age and presence of comorbid symptoms are associated with poor prognosis.

Gas Gangrene complications

1. Shock
2. Kidney failure
3. Delirium
4. Liver damage
5. Spread of infection through the body.
6. Disseminated intravascular coagulation
7. Acute respiratory distress syndrome
8. Coma
9. Mental confusion

Preventing Gas Gangrene

Any skin injury should be cleaned thoroughly. Appropriate antibiotic therapy should be given.

Making some lifestyle changes can also help reduce your risk for gas gangrene. These include:

1. Caring for existing health conditions like diabetes or arterial disease properly
2. Avoiding tobacco products
3. Maintaining a healthy weight by working out regularly and eating a healthy diet that mainly consists of vegetables, whole grains and lean protein

Frequently Asked Questions (FAQs)

How quickly does gas gangrene spread? 

Gas gangrene spreads fast, and sometimes you can see visible changes on your skin’s surface in a couple of minutes. If you are experiencing the signs of gas gangrene, seek medical help immediately.

How can we prevent gas gangrene from spreading?

Your doctor will do the following things to stop gas gangrene from spreading:

• Clean your wounds properly.
• Remove dead tissues and foreign objects from the wound.
• Take prescribed antibiotics to prevent infection.

Which Clostridium causes gas gangrene?

Clostridium perfringens usually cause gas gangrene.

What is the difference between dry gangrene and gas gangrene?

Dry gangrene does not lead to infection. However, in the case of gas gangrene, you get a severe infection that can lead to life-threatening complications.

How long does gas gangrene last?

If left untreated, gas gangrene can lead to deadly complications within 48 hours.

References:

https://www.askapollo.com/physical-appointment/general-physician
https://www.apollohospitals.com/patient-care/health-and-lifestyle/understanding-investigations/mri
https://www.apollohospitals.com/apollo-in-the-news/apollo-gleneagles-hospitals-kolkata-inaugurated-the-first-comprehensive-respiratory/
https://www.apollohospitals.com/patient-care/health-and-lifestyle/diseases-and-conditions/gangrene/