Combating the Insidious Enemy: Epidemiology, Pathophysiology, and Treatment of Clostridial Gas Gangrene

Abstract

Clostridial gas gangrene is a life-threatening condition having dreaded features like myonecrosis, gas production, and sepsis and is usually caused by Clostridium perfringens which exists in the soil and as part of the gastrointestinal flora of humans. The disease is a noncommunicable one and the infection generally occurs in traumatic wounds with soil contamination and surgery involving the bowel; nonetheless, a spontaneous gangrene is also reported. Common characteristics of inciting events include contamination of the site with Clostridium sp. and devitalization of tissue. Areas with low oxygen concentration are ideal for these infections; anaerobic conditions impel Clostridium sp. to convert itself from spore to the vegetative form which produces toxins, say α-toxin and θ-toxin which in a row are responsible for tissue damage and systemic manifestations. On successful infection, it destroys RBCs, platelets, and polymorphonuclear leukocytes (PMNs), causing widespread cell membrane and capillary damage which establish the typical pathophysiology. Initially the wound becomes swollen and the affected skin primarily appears to be blistered with hemorrhagic bullae, red and feels warm with pain upon touching before progressing to a bronge, brown or black color. Foul-smelling brown-red or bloody discharge drip from the affected tissues or wound and with time signs of sepsis, toxemia, septic shock, and multiorgan failure become evident. For managing the infected patients, an early diagnosis is crucial. Other successive indispensible measures include aggressive resuscitation, surgical debridement, antibiotic therapy, and supportive intensive care. Delays in doing so increase tissue loss and mortality which are directly proportional to time of intervention.