Gas gangrene

Causes

Gas gangrene is rare in the United States. The condition is most often caused by a bacteria called Clostridium perfringens. However, it also can be caused by Group A streptococcus. Staphylococcus aureus and Vibrio vulnificus can cause similar infections.

Clostridium is found most everywhere. As the bacteria grow inside the body, it makes gas and harmful substances (toxins) that can damage body tissues, cells, and blood vessels. 

Gas gangrene develops suddenly. It usually occurs at the site of trauma or a recent surgical wound. About 1 in 5 cases occur without an irritating event. Patients most at risk for this usually have underlying blood vessel disease (atherosclerosis or hardening of the arteries), diabetes, or colon cancer.

Symptoms

Gas gangrene causes very painful swelling. The skin turns pale to brownish-red. If you press on the swollen area with your fingers, you may feel gas as a crackly sensation. The edges of the infected area grow so quickly that changes can be seen over a few minutes. The area may be completely destroyed.

Symptoms include:

• Air under the skin (subcutaneous emphysema)
• Blisters filled with brown-red fluid
• Drainage from the tissues, foul-smelling brown-red or bloody fluid (serosanguineous discharge)
• Increased heart rate (tachycardia)
• Moderate to high fever
• Moderate to severe pain around a skin injury
• Pale skin color, later becoming dusky and changing to dark red or purple
• Progressive swelling around a skin injury
• Sweating
• Vesicle formation, combining into large blisters
• Yellow color to the skin (jaundice)

Note: Symptoms usually begin suddenly and quickly worsen.

If the condition is not treated, the person can develop shock with decreased blood pressure (hypotension), kidney failure, coma, and finally death.

Exams and Tests

The health care provider will perform a physical exam. This may reveal signs of shock.

Tests that may be done include:

• Tissue and fluid cultures to test for Clostridium bacteria
• Blood culture to determine the bacteria causing the infection
• Gram stain of fluid from the infected area
• X-ray, CT scan, or MRI of the area may show gas in the tissues.

Treatment

Surgery is needed quickly to remove dead, damaged, and infected tissue. This is called debridement.

Surgical removal (amputation) of an arm or leg may be needed to control the spread of infection. Amputation sometimes must be done before all test results are available.

You will also be given antibiotics, usually penicillin-type and clindamycin. These medicines will be given through a vein (intravenously). Doctors have tried hyperbaric oxygen for this condition, with varying degrees of success. Pain medicines may also be prescribed.

Outlook (Prognosis)

Gas gangrene usually begins suddenly and quickly gets worse. It is often deadly.

Possible Complications

• Coma
• Delirium
• Disfiguring or disabling permanent tissue damage
• Jaundice with liver damage
• Kidney failure
• Shock
• Spread of infection through the body (sepsis)
• Stupor

When to Contact a Medical Professional

This is an emergency condition requiring immediate medical attention.

Call your heath care provider if you have signs of infection around a skin wound. Go to the emergency room or call the local emergency number (such as 911), if you have symptoms of gas gangrene.

Prevention

Clean any skin injury thoroughly. Watch for signs of infection (such as redness, pain, drainage, or swelling around a wound), and consult your health care provider promptly if these occur.

Alternative Names

Tissue infection - Clostridial; Gangrene - gas; Myonecrosis; Clostridial infection of tissues

References

Gerding DN, Johnson S. Clostridial infections. In: Goldman L, Ausiello D, eds.Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 304.

Update Date: 12/6/2011

Updated by: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine. Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.