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This 47 year old patient was admitted to hospital with a suspected deep venous thrombosis of the right leg. Within 6 hours, the patients leg is dark, discoloured and has an associated surgical emphysema. A necrotising soft tissue infection is suspected. What is the most likely causative organism? a) Staphylococcus aureus b) Streptococcus viridans c) Streptococcus pyogenes d) Clostridium perfinigens. e) Staphylococcus epidermidis Ok, let’s break it down! This is a photograph before right leg amputation (hemipelvectomy) of a patient with gas gangrene. The right thigh is edematous (swollen) and discoloured with necrotic bullae (large blisters). Crepitation is detected on deep palpation. At this juncture, the patient is in shock. Gas gangrene, a subset of necrotizing myositis, is an infectious disease emergency associated with extremely high morbidity and mortality. Organisms in the spore-forming clostridial species, including Clostridium perfringens, Clostridium septicum, and Clostridium novyi, cause most of the cases. A nonclostridial form is caused by a mixed infection of aerobic and #anaerobic organisms. The #hallmarks of this disease are rapid onset of myonecrosis with muscle swelling, severe pain, gas production, and sepsis. Production of hydrogen sulfide and carbon dioxide gas begins late and dissects along muscle bellies and fascial planes. These local effects create an environment that #facilitates rapid spread of the #infection. Systemically, #exotoxins may cause severe hemolysis. Hemoglobin levels may drop to very low levels and, when occurring with hypotension, may cause acute tubular necrosis and renal #failure. A rapidly progressive infection can quickly result in shock. The combination of aggressive surgical debridement (#fasciotomy for compartment syndrome) and effective antibiotic therapy is the determining factor for successful treatment of gas gangrene.

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Very informative

Thank you doctor
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Thanks informative article

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