GAS GANGRENE

2.2 CLOSTRODIAL MYONECROSIS (GAS GANGRENE)

This infection is caused by a group of gram positive spore-
bearing organisms of the Clostrodia group.
The prominent members are the
Welchi Septicum,
Welchi Oedematiens
Welchi Perfrigens.
These organisms are found in the intestines of man and other
animals and, thus, contamination of wound occurs from soil or street accidents.
This is because of animal excreta in the soil

Gas forming organisms can also cause the disorder in cases of
Leak, from the patient's own gastrointestinal tract(peritonitis
and colostomies).
Other organisms known to produce gas are Anaerobic Streptococci
and E. Coli.
Clostrodium Septicum myonecrosis is, known to be associated with malignancy.

Severe wounds with massive damage of muscle with impairment of
vascular supply(low oxygen tension) contaminated with Clostrodial organisms are most likely to develop gas gangrene.
This type of infection has been encountered more often in times of
war, because of severe injuries inflicted.

In modern times, industrial and motor traffic accidents can also
be severe and produce ideal conditions of low oxygen tension
which in the presence of contamination, would lead to gas
gangrene.

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TETANUS 4

IMMUNIZATION
A non-immunized individual (one who has not received Tetanus
Toxoid) requires passive immunization by intramuscular
administration of HUMAN HYPER-IMMUNE GLOBULIN containing 500
units of Tetanus antitoxin.

In addition,he receives the initial TETANUS TOXOID dose of 0.5
ml. Aluminium Phosphate, adsorbed Tetanus Toxoid intramuscularly.
This is followed by another injection of toxoid 4-6 weeks later.
Third injection can be given in 6-12 months.

TREATMENT
Treatment of established case consists of :
i) Immediate surgical care.Any wound suspected to be contaminated
with Clostrodium Tetani i.e.all street accidents need CLEANING
and
DEBRIDEMENT.
Wounds can be left OPEN till the patient has recovered from
convulsive
stage of the disease,if this stage has already manifested.

ii) Antibiotic therapy with PENICILLIN is effective against
vegetative cells of Clostridium tetani.

iii)Use of muscle relaxant and SEDATION with Barbiturates

iv) Maintenance of fluid-electrolyte and nutritional balance.

v)Where tetanus toxoid and human immunoglobulin have not been

given, horse serum ANTITOXIN should be given before surgery
in doses of 15,000 units to 50,000 units half intravenously
and half intramuscularly after skin test for sensitivity.

vi) Care of the respiratory tract (removal of secretions).

vii)Care of the bladder (catheter) and fecal impaction

viii)Nursing care in a quite dimly-lit room.

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TETANUS 3

CLINICAL MANIFESTATIONS
The usual incubation period for tetanus is from 7 to 10 days
after injury.
It may even occur as late as 30 days.
- The first symptom is usually lock-jaw (Trismus) and is followed
by spasms in different parts of the body leading to difficulty in
swallowing and stiff neck.
- Pain and tenderness may also be felt at the site of the
original injury.
- There may be accompanying tachycardia and fever.
- Increased excitability to all stimuli including noise sets off
tonic (continous) and clonic (intermitant) spasms.
- In the late period,the patient has tonic spasm of the facial
muscles (risus sardonicus) and the posterior trunk muscles
(opisthotonus).
Death results from
* exhaustion
* toxaemia
* respiratory infection and
* respiratory failure

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TETANUS 2

Nature of Wounds

Wounds superficial or deep may be contaminated with Cl. tetanus in street accidents.
However, a prerequisite for multiplication of Cl. tetanus is the
presence of a LOW OXYGEN tension within the wound.
Rarely, organisms may be lodged in an old healed wound and RE-
INJURY of the same area may produce the required conditions of
low oxygen tension.

In India, tetanus is also met with post abortion, and after
delivery period, in woman.
It may effect the new born, and is referred to as tetanus
NEONOTARUM.(80,0000 deaths per year worldwide)
In many countries, infection is also occurs among narcotic
addicts, since they inject themselves with drugs under less than
ideal conditions.
Symptoms of the disorder are the result of an exotoxin (tetnospasmin)
that travels along the nerve sheaths to the central nervous
system,
It lowers the threshold of excitability of the
motor neurone cells.

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