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Gas gangrene is a potentially deadly form of cell death. A lethal infection producing gas pockets in tissue.

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Gas Gangrene is most often caused by Clostridium perfringens.

This agent is non-motile, anaerobic, spore forming, and gram positive.

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Contaminated dirt, debris, or foreign material making contact with a deep wound.

We typically hear about Gas Gangrene in the context of war time, and this is why. Often the gunshot wound or other battle related injuries wouldn't be properly cleaned in time.

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-Blisters filled with dark fluid (often brown and red)

-Drainage from infected tissues

-Air pockets under skin

-Increased heart rate

-Fever

-Pain around infected skin

-Sweating

-Vesicle formation

-Yellow skin color (Jaundice)

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The most prominent virulence factor of C. perfringens is alpha toxin.

Alpha toxin aids in the breakdown of cell membrane, which results in cell death.

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One way to help diagnose is by taking a gram stain smear directly from the wound of a symptomatic patient. A positive case will show short chains of large, fat gram positive rods with blunt ends.

Another option would be taking a blood culture and running a PCR test. This will help identify if the virulence factor (Alpha toxin) is present.

The final common method to diagnose this infection is preforming an X-ray, MRI, or CT scan of the infected area. This will allow us to see if gas is present in the tissue.

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Surgery is always one of the very first actions taken as this infection can spread. This can be as minor as cutting away a small portion of skin if caught early enough. Though is can be as serious as full limb amputation.

Patients will also be aggressively treated with antibiotics typically given intravenously. This often includes a combination of penicillin (inhibits the cross-linking of peptidoglycan within the cell wall) and clindamycin (prevents peptide bond formation, inhibiting protein synthesis).

Topicals may also be used such as chloramphenicol, which inhibits protein synthesis.

Hyperbaric oxygen treatment is also a treatment option.

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-Amputation: Loss of limb

-Stupor: Unresponsive and can only be woken through vigorous and repeated stimuli

-Liver damage and jaundice

-Kidney failure

-Sepsis: Spread of infection throughout body

-Death

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-Clean skin and wound thoroughly

-Watch for signs of infection

-Visit healthcare provider if any signs of infection appear

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In the US only about 1000 cases occur per year. This number will be higher in less developed countries that have less access to health care. According to a few different studies the mortality rate varies from 5%-30% in previously healthy individuals. The wide range is due to factors such as how early the infection was caught, where the infection was located, and the immune system of the patient.

Patients with previous health concerns such as diabetes have a higher rate of mortality. If untreated the mortality rate is 100%.

Gas gangrene had a higher mortality rate before we had modern day technology. Technology such as x-ray machines have helped medical professionals catch gas gangrene infections before they become life threatening.

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Incubation period- Typically 1-4 days after injury, but can occur as soon as a few hours after the initial injury.

Contains highly resistant spores that can survive in soil, crevices, food, decaying vegetation, feces, and even dehydrated and cooked food.

As previously mentioned, this type of infection was prominent during major war times for our country. Gas gangrene was specifically an issue during WW1.

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Vyas, J. (n.d.). Gas Gangrene. Pennmedicine.org. https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/gas-gangrene#:~:text=Gas%20gangrene%20is%20most%20often%20caused%20by%20bacteria%20called%20Clostridium%20perfringens

Clostridium perfringens. (n.d.). https://www.uta.edu/campus-ops/ehs/biological/docs/PSDS/CLOSTRIDIUM%20PERFRINGENS.pdf

Buboltz, J. B. (2023, January 30). Gas gangrene. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK537030/

Oong, G. C. (2023, July 3). Chloramphenicol. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK555966/#:~:text=Chloramphenicol%20is%20a%20medication%20used,antimicrobials%20that%20inhibits%20protein%20synthesis

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