TAILIEUCHUNG - Chapter 135. Gas Gangrene and Other Clostridial Infections (Part 3)

Spontaneous nontraumatic clostridial myonecrosis (gas gangrene). A man in his 50s presented with severe pain in the right upper extremity. Over several hours, he developed progressive swelling and discoloration in that extremity (A), with hemorrhagic ecchymoses and bullae (B). Gram's stain of aspirate from bullous lesions revealed gram-positive bacilli (C). The patient underwent amputation of the extremity. Tissue Gram's stain (D) also showed gram-positive bacilli, and surgical cultures grew C. septicum. Subsequent evaluation of the patient led to the diagnosis of invasive colonic carcinoma. (Images used with permission of Stephen Calderwood, MD, and .) Clostridia have been isolated from suppurative infections. | Chapter 135. Gas Gangrene and Other Clostridial Infections Part 3 Spontaneous nontraumatic clostridial myonecrosis gas gangrene . A man in his 50s presented with severe pain in the right upper extremity. Over several hours he developed progressive swelling and discoloration in that extremity A with hemorrhagic ecchymoses and bullae B . Gram s stain of aspirate from bullous lesions revealed gram-positive bacilli C . The patient underwent amputation of the extremity. Tissue Gram s stain D also showed gram-positive bacilli and surgical cultures grew C. septicum. Subsequent evaluation of the patient led to the diagnosis of invasive colonic carcinoma. Images used with permission of Stephen Calderwood MD and www. idimages. org. Clostridia have been isolated from suppurative infections of the female genital tract particularly tuboovarian and pelvic abscesses. The major species involved has been C. perfringens. Most of these suppurative infections are mild with no evidence of uterine gangrene. C. perfringens has been isolated from as many as 20 of diseased gallbladders at surgery. One clinical syndrome emphysematous cholecystitis is caused by clostridial species at least 50 of the time. In this syndrome gas forms in the biliary radicles and the wall of the gallbladder. Emphysematous cholecystitis is seen most often in diabetic patients. Although the mortality rate in this entity is higher than in more common forms of cholecystitis there is no evidence of myonecrosis. Clostridia are among the many organisms found in empyema fluid or isolated by transtracheal aspiration from patients with lung abscesses. There is no unique clinical clue to the presence of clostridia as opposed to other organisms in these infections. C. perfringens has been reported as a cause of empyema arising from aspiration pneumonia pulmonary emboli and infarction. However the majority of cases of clostridial empyema are secondary to trauma. Skin and Soft Tissue Infections Various categories of traumatic

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