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GasGangreneClinicalPresentation:History,Physical,Causes
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History
Thehistoryinpatientswithgasgangrenedependsontheprecipitatingfactorsoftheinfection.Mostpatientswith
posttraumaticgasgangrenehavesustainedseriousinjurytotheskinorsofttissuesorhaveexperiencedopen
fractures.PatientswithpostoperativegasgangrenehavefrequentlyundergonerecentsurgeryoftheGIorbiliary
tract.Incontrast,thehistoryisusuallyunremarkableinpatientswithoccultmalignancyassociatedspontaneousgas
gangrene.
Asuddenonsetofpainisusuallythefirstsymptomofgasgangrene.Thepaingraduallyworsensbutspreadsonly
astheunderlyinginfectionspreads.
Somepatientsreportafeelingofheavinessintheaffectedextremity.
Alowgradefeverandapatheticmentalstatusmaydevelop.
NextSection:Physical

Physical
Localswellingandaserosanguineousexudateappearsoonaftertheonsetofpain.Theskincharacteristicallyturns
toabronzecolor,thenprogressestoablueblackcolorwithskinblebsandhemorrhagicbullae.Withinhours,the
entireregionmaybecomemarkedlyedematous.Thewoundmaybenonodorousormayhaveasweetmousy
odor.Crepitusfollowsgasproductionattimes,crepitusmaynotbedetectedwithpalpationowingtobrawny
edema.Painandtendernesstopalpationdisproportionatetowoundappearancearecommonfindings.
Tachycardiadisproportionatetobodytemperatureiscommon,andthepatientmayreportafeelingofimpending
doom.
Latesignsofgasgangreneincludehypotension,renalfailure,andaparadoxicalheighteningofmentalacuity.
Insummary,thetypicalsignsandsymptomsofgasgangreneincludeseverepainandtenderness,localswellingto
massiveedema,skindiscolorationwithhemorrhagicblebsandbullae,nonodorousorsweetodor,crepitus,fever,
relativetachycardia,andalteredmentalstatus.
Previous
NextSection:Physical

Causes
Gasgangrenecanbeclassifiedasposttraumatic,postoperative,orspontaneous.

Posttraumaticgasgangrene
Posttraumaticgasgangreneaccountsfor60%ofallgasgangrenecases.
Mostofthesecasesinvolveautomobilecollisions.
Othercomplicationsoftraumaarisefromcrushinjuries,compoundfractures,gunshotwounds,thermalorelectrical
burns,andfrostbite.
Farmorindustrialinjuriescontaminatedwithsoilareespeciallypronetodevelopinggasgangrene.
Intramuscularorsubcutaneousinjectionswithinsulin,epinephrine,quinine,heroinorcocainearerareantecedent
eventsleadingtogasgangrene.

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GasGangreneClinicalPresentation:History,Physical,Causes

Apatientdevelopedgasgangreneafterinjecting
cocaine.Clostridiumsepticumwasisolatedinbothbloodandwoundcultures.

Postoperativeclostridialinfections
Postoperativeclostridialinfectionsfollowcasesofcolonresectionrupturedappendixbowelperforationandbiliary
orotherGIsurgery,includinglaparoscopiccholecystectomyandcolonoscopy.Ithasalsobeenreportedfollowing
liposuctionprocedures. [18]Septicbackstreetabortionsarethemaincauseofuterinegasgangrene.

Spontaneousgasgangrenewithoutexternalwoundorinjury
Spontaneousgasgangrenewithoutexternalwoundorinjuryoccursfrequentlyinpatientswhohaveserious
underlyingconditions.
Colorectaladenocarcinomaisthemostprevalentriskfactorinthisgroup.Hematologicmalignancyisalsoamajor
premorbidcondition.
Inchildren,neutropenia,eitherinducedbychemotherapyorcyclicinnature,representsthesinglemostimportant
riskfactorforspontaneousCsepticuminfections.
Theremainingcasesareassociatedwithdiabetesorneutropeniccolitis.Inmanycases,nopredisposingcondition
canbefound.
AlthoughCperfringensandCsepticuminfectionsarecommonlyreported,Csepticuminfectionpredominates.
PatientswithCsepticuminfectionshaveovertoroccultmalignanciesapproximately5timesmoreoftenthan
patientswithotherclostridialinfections.InalargeseriesofnontraumaticCsepticummyonecrosis,malignant
tumorswereidentifiedin92%ofpatientsofthese,58%hadcolonicadenocarcinomas. [13,21]
Previous
DifferentialDiagnoses
ContributorInformationandDisclosures
Author
HoiHo,MDAssociateDeanforFacultyAffairsandDevelopment,Professor,DepartmentofInternalMedicine,
Director,CenterforAdvancedTeachingandAssessmentinClinicalSimulation(ATACS),PaulLFosterSchool
ofMedicine,TexasTechUniversityHealthSciencesCenterConsultingPhysician,UniversityMedicalCenter
HoiHo,MDisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,AmericanAssociationforthe
AdvancementofScience,AmericanCollegeofForensicExaminersInstitute,AmericanCollegeofPhysicians,
AmericanSocietyforMicrobiology,InfectiousDiseasesSocietyofAmerica
Disclosure:Nothingtodisclose.
Coauthor(s)
EnesKanlic,MDProfessor,DepartmentofOrthopedicSurgery,TexasTechUniversityHealthScienceCenter
Disclosure:Nothingtodisclose.
LorenzoBAragon,MDAssociateProfessor,DepartmentofFamilyMedicine,PaulLFosterTexasTech
UniversityHealthSciencesCenterMedicalDirector,AmbrosioGuillenTexasStateVeteransHome
LorenzoBAragon,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofFamily
Physicians,AMDATheSocietyforPostAcuteandLongTermCareMedicine,SocietyofTeachersofFamily
Medicine,TexasMedicalAssociation
Disclosure:Nothingtodisclose.
JuanBFigueroaCasas,MDAssociateProfessor,DivisionofPulmonaryandCriticalCareMedicine,Texas
TechUniversityHealthSciencesCenter,PaulLFosterSchoolofMedicine
Disclosure:Nothingtodisclose.
DavidGMaxfieldTexasTechUniversityHealthSciencesCenter,PaulLFosterSchoolofMedicine
DavidGMaxfieldisamemberofthefollowingmedicalsocieties:AmericanCollegeofPhysicians,Texas
MedicalAssociation,CongressofNeurologicalSurgeons
Disclosure:Nothingtodisclose.
SpecialtyEditorBoard
FranciscoTalavera,PharmD,PhDAdjunctAssistantProfessor,UniversityofNebraskaMedicalCenter
CollegeofPharmacyEditorinChief,MedscapeDrugReference
Disclosure:ReceivedsalaryfromMedscapeforemployment.for:Medscape.
CharlesVSanders,MDEdgarHullProfessorandChairman,DepartmentofInternalMedicine,Professorof
Microbiology,ImmunologyandParasitology,LouisianaStateUniversitySchoolofMedicineatNewOrleans
MedicalDirector,MedicineHospitalCenter,CharityHospitalandMedicalCenterofLouisianaatNewOrleans
ConsultingStaff,OchsnerMedicalCenter

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GasGangreneClinicalPresentation:History,Physical,Causes

CharlesVSanders,MDisamemberofthefollowingmedicalsocieties:AmericanCollegeofPhysicians,
AllianceforthePrudentUseofAntibiotics,TheFoundationforAIDSResearch,SouthernSocietyforClinical
Investigation,SouthwesternAssociationofClinicalMicrobiology,AssociationofProfessorsofMedicine,
AssociationforProfessionalsinInfectionControlandEpidemiology,AmericanClinicalandClimatological
Association,InfectiousDiseaseSocietyforObstetricsandGynecology,OrleansParishMedicalSociety,
SoutheasternClinicalClub,AmericanAssociationfortheAdvancementofScience,AlphaOmegaAlpha,
AmericanAssociationofUniversityProfessors,AmericanAssociationforPhysicianLeadership,American
FederationforMedicalResearch,AmericanGeriatricsSociety,AmericanLungAssociation,AmericanMedical
Association,AmericanSocietyforMicrobiology,AmericanThoracicSociety,AmericanVenerealDisease
Association,AssociationofAmericanMedicalColleges,AssociationofAmericanPhysicians,InfectiousDiseases
SocietyofAmerica,LouisianaStateMedicalSociety,RoyalSocietyofMedicine,SigmaXi,SocietyofGeneral
InternalMedicine,SouthernMedicalAssociation
Disclosure:ReceivedroyaltyfromBaxterInternationalforother.
ChiefEditor
BurkeACunha,MDProfessorofMedicine,StateUniversityofNewYorkSchoolofMedicineatStonyBrook
Chief,InfectiousDiseaseDivision,WinthropUniversityHospital
BurkeACunha,MDisamemberofthefollowingmedicalsocieties:AmericanCollegeofChestPhysicians,
AmericanCollegeofPhysicians,InfectiousDiseasesSocietyofAmerica
Disclosure:Nothingtodisclose.
AdditionalContributors
PranatharthiHaranChandrasekar,MBBS,MDProfessor,ChiefofInfectiousDisease,ProgramDirectorof
InfectiousDiseaseFellowship,DepartmentofInternalMedicine,WayneStateUniversitySchoolofMedicine
PranatharthiHaranChandrasekar,MBBS,MDisamemberofthefollowingmedicalsocieties:AmericanCollege
ofPhysicians,AmericanSocietyforMicrobiology,InternationalImmunocompromisedHostSociety,Infectious
DiseasesSocietyofAmerica
Disclosure:Nothingtodisclose.
Acknowledgements
TheauthorsandeditorsofMedscapeReferencegratefullyacknowledgethecontributionsofpreviouscoauthors
JeffreyPNelson,MDMiguelAngelPenaRuiz,MDandKarlCBentley,MS,tothedevelopmentandwritingof
thisarticle.
References
1. ChapnickEK,AbterEI.Necrotizingsofttissueinfections.InfectDisClinNorthAm.1996Dec.
10(4):83555.[Medline].
2. GawandeA.CasualtiesofwarmilitarycareforthewoundedfromIraqandAfghanistan.NEnglJMed.
2004Dec9.351(24):24715.[Medline].
3. MurrayCK,HsuJR,SolomkinJS,KeelingJJ,AndersenRC,FickeJR.Preventionandmanagementof
infectionsassociatedwithcombatrelatedextremityinjuries.JTrauma.2008Mar.64(3Suppl):S23951.
[Medline].
4. U.S.casualtystatus.DepartmentofDefense,2004.Availableat
http://www.defenselink.mil/news/casualty.pdf.
5. WangY,HaoP,LuB,YuH,HuangW,HouH,etal.Causesofinfectionafterearthquake,China,
2008.EmergInfectDis.2010Jun.16(6):9745.[Medline].[FullText].
6. WangY,LuB,HaoP,YanMN,DaiKR.Comprehensivetreatmentforgasgangreneofthelimbsin
earthquakes.ChinMedJ(Engl).2013Oct.126(20):38339.[Medline].
7. DeA,VaraiyaA,MathurM,BhesaniaA.Bacteriologicalstudiesofgasgangreneandrelatedinfections.
IndianJMedMicrobiol.2003JulSep.21(3):2024.[Medline].[FullText].
8. HartGB,LambRC,StraussMB.Gasgangrene.JTrauma.1983Nov.23(11):9911000.[Medline].
9. NicholsRL,SmithJW.Anaerobesfromasurgicalperspective.ClinInfectDis.1994May.18Suppl
4:S2806.[Medline].

10. KnappO,MaierE,MkaddemSB,BenzR,BensM,ChenalA,etal.Clostridiumsepticumalphatoxin
formsporesandinducesrapidcellnecrosis.Toxicon.2010Jan.55(1):6172.[Medline].

Apatientdevelopedgasgangreneafterinjectingcocaine.Clostridiumsepticumwasisolatedinbothbloodand
woundcultures.
Gasfeatheringinthearmsofttissueofapatientwithgasgangrene.
Extensionofgasgangrenetothechestwalldespiteinitialdebridement.

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