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Gas gangrene

Last updated: November 16, 2020

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Gas gangrene (also known as clostridial myonecrosis) is a life-threatening necrotizing soft tissue infection commonly caused by the rapid proliferation and spread of Clostridium perfringens from a contaminated wound. The clinical picture includes excruciating muscle pain, edema with subsequent skin discoloration (red-purple to black) and gas production. Crepitus, as well as a feathering pattern of gas in soft tissue imaging, are generally present. Without treatment, gas gangrene is fatal in almost 100% of cases. Surgical debridement in combination with antibiotic therapy reduces this figure by half.

Ubiquitous C. perfringens spores contaminate a wound → bacterial reproduction under anaerobic conditions ↑ secretion of exotoxins, especially C. perfringens alpha-toxin (a phospholipase lecithinase) → degradation of phospholipids → tissue destruction (myonecrosis), inhibition of leukocyte function, and gas production gas separation into healthy tissue → further colonization and more local tissue destruction further exacerbation of anaerobic conditions by the development of edema

Gas gangrene is a medical emergency that can rapidly progress to multi-organ failure.

Perfringens perforates: C. perfringens causes gas gangrene that leads to severe tissue damage.

  • Imaging: Radiography, CT, or MRI typically show a characteristic feathering pattern of the soft tissue.
  • Laboratory tests
  • Surgical exploration
    • Affected muscle does not bleed or contract, and may be pale or discolored red-purple to black.
    • Histopathological findings of biopsy [1]
      • Myonecrosis and destruction of surrounding degenerative tissue (muscle, skin fat, subcutaneous tissue)
      • Presence of pathogens; without inflammatory infiltrate


The differential diagnoses listed here are not exhaustive.

The most important steps of management are immediate surgical debridement and antibiotic therapy. Patients should receive supportive therapy and intensive care.

References:[1]

  • Mortality rate [3]
    • Untreated: ∼ 100%
    • With appropriate treatment: 20–30%
  1. Stevens DL, Bryant A. Clostridial myonecrosis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. http://www.uptodate.com/contents/clostridial-myonecrosis?source=preview&search=%2Fcontents%2Fsearch&anchor=H18#H18%20https://goo.gl/t9dGif.Last updated: May 12, 2016. Accessed: September 20, 2016.
  2. Buboltz JB, Murphy-Lavoie HM. Gas Gangrene. StatPearls. 2020 .
  3. Miller ML. Causes of rhabdomyolysis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. http://www.uptodate.com/contents/causes-of-rhabdomyolysis?source=see_link.Last updated: September 19, 2014. Accessed: September 22, 2016.