Gas gangrene, or gas edema, is a condition that is life-threatening and its former dangerousness has survived into the modern medical era.
What is gas gangrene?
The infectious-toxic disease of gas gangrene, which is characterized by a sudden onset as well as a short, usually fatal course, is also referred to in medical jargon as gas edema, gas gangrene or gas phlegmon, as well as other terms. Gas gangrene (gas edema) is an infectious disease because it can be triggered by microorganisms that carry the disease. The pathogens in gas gangrene (gas edema) mainly affect the so-called soft tissues of the organism, which leads to very specific symptoms, which in the majority of cases lead to the death of the sick person. The cause of the extreme pathogenicity of the disease pathogens is based on the destruction of the tissue, resulting in the demise of the affected organ or organ system.
Causes
The causes of gas gangrene (gas edema) are the invasion of pathogenic bacteria of the clostridial strains. These bacteria can multiply in the absence of air and enter the organism through unnatural body openings and damaged tissue areas. As a rule, wounds caused by injuries with heavily contaminated wound areas are considered predestined sites. The clostridia that lead to gas gangrene (gas edema) are not basically disease-causing. However, unfavorable accompanying health conditions of the infected patients lead to an accelerated multiplication of these spores. A weakened immune system, further major injuries, diseases of the metabolic system, or carcinomas can favor a negative course of disease in gas gangrene (gas edema).
Symptoms, complaints, and signs
Gas gangrene is an extremely life-threatening disease that spreads very rapidly. Starting with the infected local wound, the surrounding tissue dies very quickly and, if left untreated, leads to severe sepsis. Initially, there are local symptoms. Approximately two days after infection with the bacterium Clostridium perfringens, necrosis of the tissue around the wound begins. Initially, the wound pain increases sharply. At the same time, the region around the wound swells and forms a so-called wound edema. A brownish-yellow to bluish-black discoloration occurs in the affected area. A cloudy and brown secretion seeps from the wound, which is very foul smelling. A noticeable crackling sound is typical when touching the diseased area. This crackling, also known as crepitation, is caused by a strong gas formation due to the decomposition of the dead tissue. Furthermore, the bacterial toxins also decompose the muscles in the affected area. After the initial local spread of the infection, the bacteria enter the bloodstream and cause life-threatening sepsis. Sepsis is manifested by a drastic drop in blood pressure and an enormous increase in heart rate (palpitations). Due to the bacterial toxins, increased blood clotting with the formation of thrombi initially takes place in small blood vessels. After the clotting factors are rapidly depleted, internal bleeding then occurs, which can lead to fatal multiple organ failure.
Diagnosis and course
The course of the disease gas gangrene (gas edema) with the typical symptoms can at the same time provide clear clues for an accurate diagnosis. After the penetration of the spores into the organism, after the injury takes place, 5 to 48 hours pass until strong signs of inflammation of the wound appear. Massive redness, swelling, unbearable pain and a hot wound environment push those affected by gas gangrene to the doctor. When feeling the initially localized wound area, the physician hears a crackling sound in gas edema. Gas gangrene can be clearly identified by the formation of CO2 and the secretion of wound water typical of gas gangrene. Patients with gas edema become progressively weaker, develop fever and often sepsis. In the final stage of gas gangrene, the loss of kidney function and the failure of almost all organs lead to a lethal outcome. Diagnosis of gas edema is mainly limited to palpation and visual findings, as well as microbiological examinations and radiographic options.
Complications
Gas edema can be life-threatening to the patient if not treated.In most cases, this results in severe wound pain. The wound is swollen and turns a brown color. There is also a foul odor at the wound, which can also secrete a liquid. The affected area often also causes pain at rest, which can lead to sleep problems. Also caused by the pain are restrictions in movement. Furthermore, the wound can become inflamed due to the gas edema and blood poisoning can occur, which can lead to death. It is not uncommon for fever and vomiting to occur. The patient’s quality of life is considerably reduced by the gas edema. Treatment usually involves surgical intervention and medication. This often proceeds without complications if it is initiated at an early stage. In most cases, this results in a consistently positive course of the disease. Life expectancy is reduced only if treatment is not immediate or if poor hygiene prevails at the wound site.
When should one go to the doctor?
A doctor should be consulted as soon as there are unusual changes in an existing wound on the body. If the wound does not heal visibly within a few days, a follow-up visit to a doctor should be initiated. If there is redness of the skin, pain or swelling of the wound, there is cause for concern. A medical clarification of the symptoms should be made as soon as the existing complaints increase in intensity or spread further. Since gas gangrene is a life-threatening condition, it is necessary that timely medical attention be given. If an unpleasant odor of the wound is noticed or if there is a discharge with a brownish discoloration, a doctor is needed. If noises occur when palpating the wound, it is advisable to consult a doctor. Fatigue, general weakness or an elevated body temperature are considered unusual and should be examined by a physician as well as treated. In case of nausea, vomiting or a general feeling of illness, a doctor should be consulted. If the existing performance capacity continuously decreases, the need for sleep increases and everyday tasks can no longer be performed as usual, a visit to the doctor is required. Treatment is also essential as soon as functional disorders occur or the state of health gradually deteriorates.
Treatment and therapy
Although the incidence of mortality from gas gangrene remains worryingly high at present, therapeutic help can in principle be provided. This is based on a combination of one or more surgical procedures to remove infested tissues and administration of potent antibiotic drugs. The aim of this measure is to specifically combat the pathogens by stopping their ability to divide. The main drugs used in drug therapy are highly effective and high-dose broad-spectrum antibiotics developed for anaerobic bacteria. In the case of advanced symptoms, the therapy is many times more difficult. Most sufferers must be treated with extensive surgical procedures that may result in organ and limb loss. A therapeutic approach known as hyperbaric oxygenation in gas gangrene is known from numerous other diseases as oxygen therapy. Here, the patients with gas edema are treated in hyperbaric chambers. Extensive intensive therapy measures are required to keep the most seriously ill patients with gas gangrene alive and to stabilize their condition as far as possible. To increase the chances of a nonfatal outcome in gas edema, it is imperative to initiate treatment for gas gangrene as early as possible.
Outlook and prognosis
Gas gangrene is a serious condition that is fatal in 30 to 50 percent of cases. The lethality is even higher in endogenous gas gangrene, which predominantly affects immunocompromised individuals. Prognosis is better when gas edema occurs in the extremities. Disease of the trunk is fatal in about 50 to 70 percent of cases. If the disease is detected early and treated effectively, complete recovery is possible. Often, the affected limbs have to be amputated. This is accompanied by physical and psychological complications. Even with a positive course, severe physical limitations almost always remain after gas gangrene.In addition to scarring and other skin changes, there are also paraesthesia, paralysis or phantom pains, which limit the well-being. In the case of positive gas gangrene, life expectancy is not necessarily limited. Severe edema of the torso or head increases the risk of infection and other life-threatening sequelae. Basically, then, gas gangrene offers a relatively poor prognosis. With early diagnosis and successful therapy, a partial cure is possible. Most affected individuals suffer permanently from the consequences of the necrotic infection.
Prevention
To prevent gas gangrene, even simple tips are enormously helpful. If wounds are injured or heavily soiled, they must be intensively cleaned and disinfected. After these activities, the involved wound areas must be sterilely dressed. The healing process of gas gangrene wounds should be constantly monitored. If the wounds are poorly and insufficiently cleaned, preventive antibiotic medication against gas edema may be useful.
Aftercare
In the case of gas gangrene, the affected person has only limited options for aftercare. In this case, the affected person should first and foremost have the burn treated medically in order to prevent further complications and discomfort to the skin. The earlier the treatment is initiated, the better the further course of the disease. In general, the harmful source of the gas gangrene should be immediately put out of action to prevent further damage to the skin. In many cases, however, pathogens must also be stopped in the process if they are responsible for the gas gangrene. In this case, the affected person is usually given antibiotics and other medications. Regular administration of these drugs should be observed, and possible side effects and interactions should also be clarified in advance. Antibiotics must not be taken together with alcoholic beverages, as their effect is otherwise alleviated by the alcohol. Often, those affected by gas gangrene also need the help and support of friends and family to avoid psychological discomfort. In this case, loving and intensive care is also often necessary. In severe cases, however, gas gangrene can also lead to a reduced life expectancy for the affected person.
What you can do yourself
If gas gangrene has been diagnosed, open wound treatment is usually given directly. Subsequently, the affected person is indicated to care for the wound carefully to avoid further infection or to prevent the spread of any clostridia still present. If surgery is necessary, the affected person should take it easy. The most important self-help measure is to cure the disease well. At the same time, instructions regarding personal hygiene and wound care must be followed. Sometimes a suitable diet can support the healing process and reduce the discomfort. The doctor must check the wound regularly and, under certain circumstances, adjust the medication. In many cases, antibiotics are prescribed, which must be taken by the sick person strictly according to the doctor’s instructions. If side effects become apparent, the physician must be informed. After consultation with the physician, natural preparations may be used under certain circumstances to reduce pain. If no further complications occur, gas gangrene usually heals after a few days to weeks and requires no further medical treatment. Adequate wound care can prevent the development of further gas edema. However, if infection occurs again, the attending physician must be consulted immediately.
