TAILIEUCHUNG - Chapter 135. Gas Gangrene and Other Clostridial Infections (Part 5)

Diagnosis The diagnosis of clostridial disease, in association with positive cultures, must be based primarily on clinical findings. Because of the presence of clostridia in many wounds, their mere isolation from any site, including the blood, does not necessarily indicate severe disease. Smears of wound exudates, uterine scrapings, or cervical discharge may show abundant large gram-positive rods as well as other organisms. Cultures should be placed in selective media and incubated anaerobically for identification of clostridia. The diagnosis of clostridial myonecrosis can be established by frozen-section biopsy of muscle. The urine of patients with severe clostridial sepsis may contain protein. | Chapter 135. Gas Gangrene and Other Clostridial Infections Part 5 Diagnosis The diagnosis of clostridial disease in association with positive cultures must be based primarily on clinical findings. Because of the presence of Clostridia in many wounds their mere isolation from any site including the blood does not necessarily indicate severe disease. Smears of wound exudates uterine scrapings or cervical discharge may show abundant large gram-positive rods as well as other organisms. Cultures should be placed in selective media and incubated anaerobically for identification of clostridia. The diagnosis of clostridial myonecrosis can be established by frozen-section biopsy of muscle. The urine of patients with severe clostridial sepsis may contain protein and casts and some patients may develop severe uremia. Profound alterations of circulating erythrocytes are seen in severely toxemic patients. Patients have hemolytic anemia which develops extremely rapidly along with hemoglobinemia hemoglobinuria and elevated levels of serum bilirubin. Spherocytosis increased osmotic and mechanical red blood cell fragility erythrophagocytosis and methemoglobinemia have been described. DIC may develop in patients with severe infection. In patients with severe sepsis Wright s or Gram s staining of a smear of peripheral blood or buffy coat may demonstrate clostridia. X-ray examination sometimes provides an important clue to the diagnosis by revealing gas in muscles subcutaneous tissue or the uterus. However the finding of gas is not pathognomonic for clostridial infection. Other anaerobic bacteria frequently mixed with aerobic organisms may produce gas. Clostridial Infections Treatment Table 135-1 Traumatic wounds should be thoroughly cleansed and debrided. Traditionally the antibiotic of choice for severe clostridial infection has been penicillin G 20 million units per day in adults . Penicillin G treatment of gas gangrene has become more controversial because of increasing resistance

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