Myonecrosis, clostridialA48.0
Synonym(s)
Clostridial myonecrosis; Clostridium cellulitis; Clostridium myositis; Gas fire; Gas Gangrene; Gas oedema; Gas phlegmons; Klostridal myonecrosis
DefinitionThis section has been translated automatically.
Specific infectious muscle disease.
PathogenThis section has been translated automatically.
- Mainly Clostridium perfringens, more rarely Clostridium novii, C. histolyticum, C. septicum, C. sporogenes, C. bifermentans, C. putrificum and Gram-positive anaerobic cocci.
- Clostridia are anaerobic, Gram-positive, spore-forming, rod-shaped bacteria of the family Clostridiaceae. They occur ubiquitously in nature and can also be found in the human intestinal tract. The spores are ubiquitous in the soil.
Notice! Clostridium perfringens may also be involved in purulent, non-gas-forming infections.
ClassificationThis section has been translated automatically.
According to tartar there are 3 different diseases:
- Syndrome of "simple contamination": caused by Clostridium sporogenes, bifermentans, putrificum and Gram-positive cocci.
- "Anaerobic cellulitis.
- Anaerobic clostridial myonecrosis (" gas gangrene").
Occurrence/EpidemiologyThis section has been translated automatically.
Worldwide spread. Infections are more common among war wounded.
Clinical featuresThis section has been translated automatically.
- Incubation time: 12-96 hours.
- "Simple Contamination": green-blackish, superficial wound coating and moderately increased inflammatory parameters with little impairment of the general condition.
- Anaerobic cellulitis: subcutaneous gas inclusions, usually originating from a dirty-smelly wound, limited exclusively to the subcutaneous tissue.
- Anaerobic, clostridial myonecrosis: gas gangrene infection, affected is the striated musculature, ballooned swelling of the muscles of the extremity with palpable emphysema (crepitations), severe local pain, reduced general condition with cold sweat and cerebral dysfunction. There is hardly any pus (since Clostridium perfringens has a cytolytic effect). Leukopenia often occurs. Mostly the extremities are affected, more rarely pleural and pulmonary involvement (haemorrhagic infarction), in the late stages haemolysis, icterus, death by renal failure.
DiagnosisThis section has been translated automatically.
- In the x-ray: characteristic feathering of the musculature.
- Histology of the peripheral musculature: microscopy after Gram staining.
Differential diagnosisThis section has been translated automatically.
necrotizing fasciitis; gas formation in wounds caused by pathogens such as E.coli, Bacteroides, Klebsiella, Proteus.
TherapyThis section has been translated automatically.
- Wound debridement, possibly amputation of the extremity.
- Hyperbaric oxygen therapy: 3 treatments within the first 24 hours after diagnosis at 300 kPa for 90 minutes followed by a decompression phase (Boerema scheme). In the following days 2 hyperbaric treatments/day. Hyperbaric oxygen therapy can only be used for patients with intensive care if intensive medical care is also possible inside the pressure chamber.
Internal therapyThis section has been translated automatically.
- Antibiotics in high doses, 1st choice Benzylpenicillin (e.g. Penicillin Grünenthal) 20-40 million IU/day distributed over 4-6 ED as short infusion in combination with Metronidazol (e.g. Clont), adults: 2-3 times 500 mg/day i.v., children: 20 mg/kg bw/day i.v. or p.o. distributed over 3 ED.
- Alternatively: cefotaxime (e.g. claforan) 2-3 times/day 2 g i.v. (max. 4 times/day 3 g) in combination with metronidazole (e.g. Clont), adults: 2-3 times/day 500 mg/day i.v., children: 20 mg/kg bw/day i.v. or p.o. distributed over 3 ED.
- In case of penicillin allergy: Imipenem (e.g. Zienam): adults: 3-4 times 0.5-1.0 g/day i.v., infants: 60 mg/kg bw/day distributed over 4 ED. Alternatively: erythromycin (erythrocin i.v.), adults 2 g/day i.v. in 4 ED, children 20-30 mg/kg bw/day i.v. in 4 ED. Alternatively linezolid (cyvoxide): adults 2 times/day 600 mg i.v.
Progression/forecastThis section has been translated automatically.
- Syndrome of "simple contamination": good prognosis.
- "Anaerobic cellulitis: good prognosis.
- Anaerobic clostridial myonecrosis ("gas gangrene"): high mortality.
LiteratureThis section has been translated automatically.
- Brook I (2007) Microbiology and management of soft tissue and muscle infections. Int J Surg 15 ahead of print
- Parasca I, Damian L, Albu A (2006) Infectious muscle disease. Rome J Internal Med 44: 131-141