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Skin and soft tissue infections (SSTIs) result from microbial invasion and may be mono or polymicrobial in etiology. The present retrospective record-based study described five uncommon SSTIs from a medical college hospital of West Bengal. Clinical samples were collected and processed following standard microbiological procedures and guidelines. Identification and antimicrobial susceptibility testing of etiological agents, wherever applicable, were done by conventional and automated (Vitek-2 Compact) system. We found a case of spontaneous gas gangrene caused by Clostridium septicum, Group-A â-hemolytic Streptococcus mediated necrotizing fasciitis; lesions of Burkholderia pseudomallei and Burkholderia cepacia complex and that of disseminated rhinosporidiosis caused by Rhinosporidium seeberi. We infer that strong clinical suspicion may surface uncommon etiology from unusual presentations of SSTIs making their diagnosis, treatment and relief rapid and uneventful.

Clostridial myonecrosis, commonly known as gas gangrene (GG), is a rapidly progressing and potentially fatal bacterial infection that primarily affects muscle and soft tissue. In the United States, the incidence of GG is roughly 1000 cases per year, while, in developing countries, the incidence is higher. This condition is most often caused by Clostridium perfringens, a Gram-positive, spore-forming anaerobic bacterium widely distributed in the environment, although other Clostridium species have also been reported to cause GG. The CP genome contains over 200 transport-related genes, including ABC transporters, which facilitate the uptake of sugars, amino acids, nucleotides, and ions from the host environment. There are two main subtypes of GG: traumatic GG, resulting from injuries that introduce Clostridium spores into deep tissue, where anaerobic conditions allow for bacterial growth and toxin production, and spontaneous GG, which is rarer and often occurs in immunocompromised patients. Clostridium species produce various toxins (e.g., alpha, theta, beta) that induce specific downstream signaling changes in cellular pathways, causing apoptosis or severe, fatal immunological conditions. For example, the Clostridium perfringens alpha toxin (CPA) targets the host cell’s plasma membrane, hydrolyzing sphingomyelin and phosphatidylcholine, which triggers necrosis and apoptosis. The clinical manifestations of clostridial myonecrosis vary. Some patients experience the sudden onset of severe pain, swelling, and muscle tenderness, with the infection progressing rapidly to widespread tissue necrosis, systemic toxicity, and, if untreated, death. Other patients present with discharge, pain, and features of cellulitis. The diagnosis of GG primarily involves clinical evaluation, imaging studies such as X-rays, computer tomography (CT) scans, and culture. The treatment of GG involves surgical exploration, broad-spectrum antibiotics, antitoxin, and hyperbaric oxygen therapy, which is considered an adjunctive treatment to inhibit anaerobic bacterial growth and enhance the antibiotic efficacy. Early recognition and prompt, comprehensive treatment are critical to improving the outcomes for patients affected by this severe and life-threatening condition.

Absent in melanoma 2 (AIM2), a key component of the IFI20X/IFI16 (PYHIN) protein family, is characterized as a DNA sensor to detect cytosolic bacteria and DNA viruses. However, little is known about its immunological role during pathogenic Clostridium perfringens (C. perfringens) infection, an extracellular bacterial pathogen. In a pathogenic C. perfringens gas gangrene model, Aim2−/− mice are more susceptible to pathogenic C. perfringens soft tissue infection, revealing the importance of AIM2 in host protection. Notably, Aim2 deficiency leads to a defect in bacterial killing and clearance. Our in vivo and in vitro findings further establish that inflammasome signaling is impaired in the absence of Aim2 in response to pathogenic C. perfringens. Mechanistically, inflammasome signaling downstream of active AIM2 promotes pathogen control. Importantly, pathogenic C. perfringens-derived genomic DNA triggers inflammasome signaling activation in an AIM2-dependent manner. Thus, these observations uncover a central role for AIM2 in host defense and triggering innate immunity to combat pathogenic C. perfringens infections.

Abstract Background Necrotizing fasciitis in neonates is a rare and life-threatening infection involving necrosis of the skin, subcutaneous tissues, deep fascia, and sometimes underlying muscles, with a fulminant course and high mortality rate. Necrotizing fasciitis with gas gangrene related to infection of a peripherally inserted central catheter is very rare. Case presentation The patient was a full-term female neonate born by vaginal delivery. Following diagnosis of patent ductus arteriosus, indomethacin was administered from a peripherally inserted central catheter for 3 days. Four days after the termination of medical treatment for the patent ductus arteriosus, the patient developed fever and a severely elevated inflammatory response was identified from blood testing. Around the right anterior chest wall, corresponding to the site of the catheter tip, redness was increased and gas crepitus was felt under the skin. Computed tomography revealed emphysema in the anterior chest, in subcutaneous areas and between muscles. Emergency surgical debridement was performed under a diagnosis of necrotizing fasciitis with gas gangrene. With antibiotic treatment, we started to fill the wound with a dialkyl carbamoyl chloride-coated dressing and povidone-iodine sugar ointment after washing with saline once a day. The patient survived and after 3 weeks of treatment with the dressing, the wound had successfully resolved without motor impairments. Conclusions In addition to medical treatment and prompt surgical debridement, we used dialkyl carbamoyl chloride-coated dressing and povidone-iodine sugar ointment for antiseptic dressings and successfully treated neonatal necrotizing fasciitis with gas gangrene caused by peripherally inserted central catheter infection with Citrobacter koseri.

Clostridium perfringens bacteremia is a rare but rapidly fatal condition, especially in patients exhibiting massive intravascular hemolysis (MIH), gas gangrene, and septic shock. Herein, we present an autopsy case of C. perfringens septicemia exhibiting MIH, gas gangrene, and cytokine storm. The patient was an 84-year-old female with a history of biliary reconstruction surgery for congenital biliary dilatation. She developed MIH, elevated inflammatory mediator levels, thrombocytopenia, and coagulopathy. She went into shock within 1 h of the presentation and died within a few hours. Rapid progression was associated with the transformation of liver abscesses into gas-filled abscesses on computed tomography scan, suggesting the rapid outgrowth of gas-producing bacteria. The patient was finally diagnosed with MIH and gas gangrene due to C. perfringens infection based on the presence of this bacterium in the blood and bile. On autopsy, gas gangrene was observed in almost all organs, originating from the bile duct. Polymerase chain reactions targeting C. perfringens toxins identified the isolated bacterium as C. perfringens type A expressing α-toxin (CPA), perfringolysin O (PFO), and collagenase (ColA). Elevated interleukin 6 and tumor necrosis factor-α expression levels were observed in the serum, and such proinflammatory responses were partially mediated by Toll-like receptor 2. This study elucidated the association between the toxin profiles of clinically isolated C. perfringens and the host cytokine responses in the patient.

Abstract We present an unusual and severe case of spontaneous clostridial myonecrosis (SCM) in an elderly patient, with severe skipping lesions spread throughout the body. CT imaging, combined with postmortem available blood cultures, confirmed the diagnosis. We noted an underrepresentation of SCM in the cohort of elderly patients (≥ 85 years), upon a review of case reports in the literature over the last decade. Given the worldwide demographic change resulting in an increase in the number of visits to emergency departments for this age group, it is likely that SCM is underdiagnosed in these elderly patients. This case report aims to increase awareness among emergency physicians to recognize the disease as well as to provide a treatment guideline, in order to provide better care and outcome.

Abstract Background Liposuction has become one of the most popular cosmetic surgeries in China. However, few studies have discussed infectious shock caused by C. perfringens as one of the causes of death after liposuction. Case presentation A 24-year-old woman was brought to the emergency department (ED) of Guangzhou Chinese Overseas Hospital for treatment. The patient had undergone liposuction in her bilateral lower limbs two days prior. At the ED, the patient was unconscious, and had bilateral equal-sized (diameter, 6 mm) round pupils, no light reflex, a blood pressure (BP) of 71/33 mmHg, a heart rate of 133 bpm, and an SpO2 of 70%. She had bilateral limb swelling, extensive ecchymoses in her lower abdomen and bilateral thighs, local crepitus, blisters, weak pulses on her femoral artery and dorsalis pedis, high skin tension, and hemoglobin of 32 g/L. The patient was diagnosed with Clostridium perfringens infection, and she underwent debridement surgery and supportive treatment. But the patient’s BP could not improve. At 8:28 pm on the day of admission, the patient was declared clinically dead after the electrocardiograph showed a horizontal line and spontaneous respiration ceased. Conclusions Failure to meet surgical disinfection and environmental standards may be the cause of infection of C. perfringens through wounds. Therefore, it is necessary to strengthen the environmental disinfection of the operating room, and standardize the sterile conditions of the operation staff and patients before and during operation. Liposuction surgery necrotizing fasciitis is a rare but fatal complications, especially if diagnosis delay, therefore it is critical for early diagnosis and treatment of gas gangrene.

Clostridium perfringens is an extremely versatile pathogen of humans and livestock, causing wound infections like gas gangrene (clostridial myonecrosis), enteritis/enterocolitis (including one of the most common human food-borne illnesses), and enterotoxemia (where toxins produced in the intestine are absorbed and damage distant organs such as the brain). The virulence of this Gram-positive, spore-forming, anaerobe is largely attributable to its copious toxin production; the diverse actions and roles in infection of these toxins are now becoming established. Most C. perfringens toxin genes are encoded on conjugative plasmids, including the pCW3-like and the recently discovered pCP13-like plasmid families. Production of C. perfringens toxins is highly regulated via processes involving two-component regulatory systems, quorum sensing and/or sporulation-related alternative sigma factors. Non-toxin factors, such as degradative enzymes like sialidases, are also now being implicated in the pathogenicity of this bacterium. These factors can promote toxin action in vitro and, perhaps in vivo, and also enhance C. perfringens intestinal colonization, e.g. NanI sialidase increases C. perfringens adherence to intestinal tissue and generates nutrients for its growth, at least in vitro. The possible virulence contributions of many other factors, such as adhesins, the capsule and biofilms, largely await future study.

Wound infections are among public health problems worldwide. However, progress has been made in improving surgical techniques and antibiotic treatments. Misuse/overuse of antibiotics to prevent and treat bacterial infections eventually leads to increased bacterial resistance with rising incidences of multi-drug resistant (MDR) bacterial strains. The wider dissemination of antibiotics may ultimately result in ineffectiveness to antibiotic therapy, thereby complicating/graving the outcome of a patient. In the present study, a 60-year-old male patient having wound infection with MDR bacterium that ultimately required surgical amputation of the toe was investigated. For the confirmation of MDR bacterium, two culture media viz., MacConkeyAgar and Mueller Hinton Agar media were used. The sensitivity of the isolated strain for various antibiotics was tested using the disc diffusion method. The wound sample was found positive for Gram-positive bacterium that was identified as Clostridium perfringens. The bacterium was screened for 40 antibiotics, and among all the antibiotics, it was found sensitive for only Piperacillin/Tazobactam antibiotic combination. C. perfringens bacterium caused the gas gangrene in the infected wound part of the patient. Amputation of the gangrene –affected foot part was performed by surgery, and with good medical care, the person recovered fast. To the best of our knowledge, this is the first-ever report of MDRC. perfringens single isolate harboring resistance against at least 40 antibiotics tested. More research is needed to develop really new and effective medicines that do not cross-react with antibiotics now in use and have robust activity against MDR organisms.

Abstract Background Gas-producing perianal abscess raises the possibility of clostridial infection, with Clostridium perfringens being the most common causative agent, which is highly lethal if untreated timely. As the treatment of clostridial infections often differs from that of non-clostridial infections, which they may closely resemble, the importance of accurate pathogenic organism identification cannot be overemphasized. The 16S rDNA of bacteria is highly conserved within a species and among species of the same genus but demonstrates substantial variation between different species, thus making it a suitable genomic candidate for bacterial detection and identification. Case presentation Here, we report the case of a 53-year-old patient who was admitted to the hospital for a gas-producing perianal abscess. The patient was managed with ceftizoxime and ornidazole and then received debridement and drainage at the lesion on the second day after admission. The bacterial cultures of the patient isolates from the debridement showed a coinfection of Escherichia coli and Enterococcus faecium. Although perianal redness and swelling subsided obviously after the surgery, the patient was febrile to 38.3℃ with his left upper thigh red and swollen, aggravated with tenderness and crepitus. Considering insufficient debridement and the risk of incorrect identification of pathogens, a second debridement and drainage were performed 4 days after the primary operation, and 16S rDNA sequencing of the isolates implicated Clostridium perfringens infection. Given the discrepancies in diagnostic results and the treatment outcomes, Enterococcus faecium was identified as sample contamination, and a diagnosis of coinfection of Clostridium perfringens and Escherichia coli in gas-producing perianal abscess was confirmed. The patient was then successfully treated with meropenem and vancomycin and was discharged at 27 days of admission. Conclusions This case represents the first report of coinfection of both clostridial and non-clostridial organisms in gas-producing perianal abscess and the first case reporting the use of 16S rDNA sequencing in the diagnosis of perianal abscess. Timely pathogen identification is critical for treating gas-producing perianal abscess and an antibiotic regimen covering both aerobic and anaerobic organisms is recommended before true pathogens are identified.

Abstract Background Gas gangrene is usually manifested as myonecrosis and subcutaneous gas accumulation, but rarely manifested as arterial occlusion or pneumatosis in the right ventricle and the pulmonary artery. Case presentation We report a case of gas gangrene caused by Clostridium septicum. The patient developed gas gangrene after being pecked by a chicken but turned for the better following antibiotic treatment and debriment. Imaging test revealed a rare occlusion of the right femoral artery and pneumatosis in the right ventricle and the main pulmonary artery. Conclusions In the presence of gas gangrene, special care must be taken to prevent against the formation of circulatory air embolism. The gas gangrene-induced gangrene in the limb of this patient might be attributed to the combined action of infection and arterial occlusion. MDT (Multidisciplinary team)-Green Channel mode is conductive to treatment success of gas gangrene.

Abstract Spontaneous gas gangrene of lower limb is rare. It may complicate digestive cancer or neutropenia. We report a case of spontaneous gas gangrene of the lower limb complicating a rectal cancer, initially diagnosed as deep vein thrombosis. The diagnostic delay was fatal.

Clostridial myonecrosis or gas gangrene (myonecrosis) and tetanus are relatively rare nowadays, but they are still considered serious conditions associated with poor prognosis and high mortality. Life-threatening infections caused by Clostridium species have been known and studied for centuries, as they differed from other infections in terms of typical clinical manifestations, challenges of therapy and prevention. The aim of the study was to analyse the global incidence of gas gangrene and tetanus and challenges of prevention and treatment of these diseases. The review of up-to-date scientific literature demonstrated that gas gangrene continues to be a problem due to its rapid progression and challenging treatment. There are two main forms of the disease—traumatic and spontaneous. Traumatic gas gangrene is usually caused by C. perfringens, C. septicum, C. novyi (oedematiens), or C. histolyticum. Its incidence increases dramatically during wars, natural disasters, and other calamities. The literature review demonstrated that over the past 40 years there has been a rise in the frequency of spontaneous gas gangrene caused by C. septicum in people with compromised immune systems, in injecting drug users, and in women during various gynecological procedures and during normal delivery. Despite the effectiveness of the tetanus immunisation programme, the infection remains widespread in countries with insufficient vaccination coverage. The risk of tetanus in developed countries is high among elderly unvaccinated or partially vaccinated people, among injecting drug users, and vaccine refusers. The paper describes some clinical cases of gas gangrene and tetanus which demonstrate problems associated with challenging diagnosis and treatment, low awareness among primary healthcare personnel about mechanisms of anaerobic infection development, and anti-vaccination movement.

Abstract Abdominal crepitus and air in the subcutaneous tissue should be recognized early, as the most common etiologies for subcutaneous emphysema are fatal if not treated acutely. We present the case of a patient who developed subcutaneous emphysema as a consequence of the dehiscence of a previously closed gastrocutaneous fistula.

Abstract Background Colonoscopy is a routine procedure in diagnosis and treatment of colonic disease. While generally regarded as a safe procedure, potentially fatal complications can occur. Gas gangrene is one such complication, with very high mortality. There are few cases of gas gangrene occurring after colonoscopy, making it one of the rarer complications of this procedure. There have been no previously reported cases of a patient surviving such an infection and the optimal treatment strategy is contentious. This report describes a case of intramural gas gangrene of the colon, treated conservatively with antibiotic therapy in which the patient survived with full recovery. Case presentation A 71-year-old, previously healthy male presented 6 h post apparently uncomplicated colonoscopic polypectomy with rigors, nausea, vomiting and right upper quadrant pain. At presentation he was febrile at 40.1 °C but hemodynamically stable. Abdominal computed tomography revealed substantial colonic thickening and several focal intramural gas bubbles (pneumatosis intestinalis) surrounding the polypectomy site. Within 24 h post procedure he became hypotensive and was admitted to ICU in frank septic shock requiring inotropes, and with demonstrable septic myocardial depression. Bloods showed multi-organ derangement with leukocytosis, lactic acidosis, haemolytic anaemia and hyperbilirubinemia. A diagnosis of presumed Clostridial gas gangrene was made, and treatment was initiated with benzylpenicillin, clindamycin, metronidazole and vancomycin. After 4 days in ICU he was stepped down, and discharged after a further 10 days with no surgical or endoscopic interventions. At three-month review he reported being back to full health. Conclusions This case demonstrates that gas gangrene infection is a possible complication of colonoscopic polypectomy. This is a cause of rapid deterioration in post-colonoscopy patients and has been misdiagnosed as colonic perforation in previously reported cases of retroperitoneal gas gangrene. Such misdiagnosis delays antibiotic therapy, which likely plays a role in the high mortality of this condition. Early diagnosis and initiation of antibiotic therapy with benzylpenicillin and clindamycin as seen in this case is essential for patient survival. While surgery is typically performed, non-operative management of pneumatosis intestinalis, and potentially gas gangrene is becoming more common and was utilized effectively in this patient.

Aeromonas hydrophila, widely distributed in various aquatic environments, is recognized as emerging opportunistic pathogens mainly causing gastrointestinal and wound infections. Necrotizing fasciitis and gas gangrene attributable to A. hydrophila are believed to develop mainly in immunocompromised hosts and have required amputation as a life-saving measure in many of these individuals. The present case re-emphasizes the virulent nature of this organism requiring amputation even in an immunocompetent host and hence, the critical need for early recognition and appropriate targeted therapy, especially after minor traumatic injuries which usually tend to get neglected.

Clostridium septicum is a Gram-positive, toxin-producing, and spore-forming bacterium that is recognized, together with C. perfringens, as the most important etiologic agent of progressive gas gangrene. Clostridium septicum infections are almost always fatal in humans and animals. Despite its clinical and agricultural relevance, there is currently limited knowledge of the diversity and genome structure of C. septicum. This study presents the complete genome sequence of C. septicum DSM 7534T type strain as well as the first comparative analysis of five C. septicum genomes. The taxonomy of C. septicum, as revealed by 16S rRNA analysis as well as by genomic wide indices such as protein-based phylogeny, average nucleotide identity, and digital DNA–DNA hybridization indicates a stable clade. The composition and presence of prophages, CRISPR elements and accessory genetic material was variable in the investigated genomes. This is in contrast to the limited genetic variability described for the phylogenetically and phenotypically related species Clostridium chauvoei. The restriction-modification (RM) systems between two C. septicum genomes were heterogeneous for the RM types they encoded. C. septicum has an open pangenome with 2,311 genes representing the core genes and 1,429 accessory genes. The core genome SNP divergence between genome pairs varied up to 4,886 pairwise SNPs. A vast arsenal of potential virulence genes was detected in the genomes studied. Sequence analysis of these genes revealed that sialidase, hemolysin, and collagenase genes are conserved compared to the α-toxin and hyaluronidase genes. In addition, a conserved gene found in all C. septicum genomes was predicted to encode a leucocidin homolog (beta-channel forming cytolysin) similar (71.10% protein identity) to Clostridium chauvoei toxin A (CctA), which is a potent toxin. In conclusion, our results provide first, valuable insights into strain relatedness and genomic plasticity of C. septicum and contribute to our understanding of the virulence mechanisms of this important human and animal pathogen.

Primary hepatic gas gangrene is a form of primary abdominal gas gangrene. The condition is caused by Clostridium perfringens, other clostridia, and non-clostridia bacterial species producing gas. Unlike classical gas gangrene or myonecrosis, the disease develops without a wound or a port of entry. Instead, gas-producing bacteria in the gastrointestinal tract colonize an underlying pathological process with foci of necrosis, producing excessive gas and spreading hematogenously to other organs. Herein we present two autopsy cases of primary hepatic gas gangrene diagnosed on autopsy, with the gross and histological changes that can be considered specific for this rare condition. Both patients had severe underlying liver disease-prone for this entity development. The gross changes in the cases are postmortem subcutaneous emphysema, skin bullae with pooled blood, pneumothorax, pneumoabdomen, abundant gas in the circulatory system, porous structure of the internal organs (tissue gas bubbles), and advanced tissue lysis, not corresponding to the post mortem time. Histology showed optically empty areas of varying size in the internal organs, which weave the structure of the organs and rod-shaped bacteria with scarcity or complete absence of inflammatory reaction.

Gas gangrene is a term reserved for fulminant soft tissue infections caused by Clostridium species. The posttraumatic form of gas gangrene is caused by Clostridium perfringens. Nontraumatic, or spontaneous, gas gangrene is even more rare and is usually caused by Clostridium septicum in two-thirds of cases and by C. perfringens in one-third of cases; the underlying malignancy is often present. It also usually affects patients with some degree of underlying immunocompromised or vascular insufficiency. We report a case of a 30-year-old man with no history of prior trauma presented with pain, paresis of both lower limbs, and developed discolouration of both feet clinically diagnosed to be Leriche's syndrome with dry gangrene. Computed tomography angiography showed infrarenal aortoiliac occlusion and rapidly progressive gas gangrene involving even bladder wall and bone marrow, probably caused by Clostridium septicum. Although several case reports discuss the setting of bowel malignancy, our case illustrates acute onset of aortic iliac occlusion resulting in mesenteric infarction, which is the probable source for the infection.

Abstract Background Even though gas gangrene caused by Clostridium septicum in goats is mentioned in the classical textbooks, we have not managed to find any case description in the literature. Case presentation Clinical signs resembling gas gangrene such as subcutaneous bloating, edema and crepitation were detected at various body parts of nine pregnant animals at the ages of 2–3 years on a hair goat farm (n = 170) located in Bingol province, Eastern Turkey. Five of these suspected animals with severe clinical symptoms died within 2 days. Various samples such as internal organs, edematous skin and edema fluid collected from dead and live animals were analyzed for the presence of clostridial agents by histopathological and microbiological methods. As a result of macroscopic and microscopic examination, lesions of gas gangrene were detected. The suspected isolates were identified and confirmed as C. septicum by bacteriological and molecular methods. Conclusion The present study was the first to report identification of C. septicum as primary agent in the gas gangrene of goats.

Gas gangrene is infectious disease caused by Clostridium perfringens infection.We are presenting extremely rare case of gluteal clostridial myonecrosis after intramuscular injection of diclofenac in immunocompromised young patient on a long-standing corticosteroid therapy presented with sepsis and initially absent clinical signs of severe anaerobic infection. After delayed diagnosis, she was treated with aggressive surgical removal of necrosed tissue and targeted antibiotic therapy which led to a rapid improvement allowing application of a negative-pressure wound therapy device with favorable outcome.This report shows the importance of timely diagnosis with pitfalls of imaging. It confirms that surgical debridement along with specific antibiotic therapy is the mainstay of treatment, but also promotes negative-pressure wound therapy which has proved convenient for accelerated closure of large incisions with tissue loss without any adverse effects or the need for complex reconstructive procedures.

Gas gangrene, caused mainly by the anaerobic bacterium Clostridium perfringens (C. perfringens), causes death within 48 h of onset. Limited therapeutic strategies are available, and it is associated with extremely high mortality. Both C. perfringens alpha toxin (CPA) and perfringolysin O (PFO) are important virulence factors in the development of gas gangrene, suggesting that they are therapeutic targets. Here, we found that verbascoside, a phenylpropanoid glycoside widely distributed in Chinese herbal medicines, could effectively inhibit the biological activity of both CPA and PFO in hemolytic assays. The oligomerization of PFO was remarkably inhibited by verbascoside. Although no antibacterial activity was observed, verbascoside treatment protected Caco-2 cells from the damage caused by CPA and PFO. Additionally, infected mice treated with verbascoside showed significantly alleviated damage, reduced bacterial burden, and decreased mortality. In summary, verbascoside has an effective therapeutic effect against C. perfringens virulence both in vitro and in vivo by simultaneously targeting CPA and PFO. Our results provide a promising strategy and a potential lead compound for C. perfringens infections, especially gas gangrene.

ABSTRACT Clostridium perfringens type A is involved in gas gangrene in humans and animals. Following a traumatic injury, rapid bacterial proliferation and exotoxin production result in severe myonecrosis. C. perfringens alpha toxin (CPA) and perfringolysin (PFO) are the main virulence factors responsible for the disease. Recent in vitro studies have identified an Agr-like quorum-sensing (QS) system in C. perfringens that regulates the production of both toxins. The system is composed of an AgrB membrane transporter and an AgrD peptide that interacts with a two-component regulatory system in response to fluctuations in the cell population density. In addition, a synthetic peptide named 6-R has been shown to interfere with this signaling mechanism, affecting the function of the Agr-like QS system in vitro. In the present study, C. perfringens type A strain ATCC 3624 and an isogenic agrB-null mutant were tested in a mouse model of gas gangrene. When mice were intramuscularly challenged with 106 CFU of wild-type ATCC 3624, severe myonecrosis and leukocyte aggregation occurred by 4 h. Similar numbers of an agrB-null mutant strain produced significantly less severe changes in the skeletal muscle of challenged mice. Complementation of the mutant to regain agrB expression restored virulence to wild-type levels. The burdens of all three C. perfringens strains in infected muscle were similar. In addition, animals injected intramuscularly with wild-type ATCC 3624 coincubated with the 6-R peptide developed less severe microscopic changes. This study provides the first in vivo evidence that the Agr-like QS system is important for C. perfringens type A-mediated gas gangrene. IMPORTANCE Clostridium perfringens type A strains produce toxins that are responsible for clostridial myonecrosis, also known as gas gangrene. Toxin production is regulated by an Agr-like quorum-sensing (QS) system that responds to changes in cell population density. In this study, we investigated the importance of this QS system in a mouse model of gas gangrene. Mice challenged with a C. perfringens strain with a nonfunctional regulatory system developed less severe changes in the injected skeletal muscle compared to animals receiving the wild-type strain. In addition, a synthetic peptide was able to decrease the effects of the QS in this disease model. These studies provide new understanding of the pathogenesis of gas gangrene and identified a potential therapeutic target to prevent the disease.

Clostridium perfringens (C. perfringens) type A strains are the main cause of gas gangrene in humans and animals. Treatment of this lethal disease is limited, and the prognosis is not good. Alpha-toxin (CPA) and perfringolysin O (PFO) secreted by C. perfringens play irreplaceable roles in cytotoxicity to host cells, persistence in host tissues, and lethality of gas gangrene pathology. This work determined the influence of amentoflavone, a biflavonoid isolated from Selaginella tamariscina and other plants, on hemolysis and cytotoxicity mediated by CPA and PFO and evaluated the in vivo therapeutic effect on gas gangrene. Our data showed that amentoflavone could block the hemolysis and cytotoxicity induced by CPA and PFO in vitro, thereby mediating significant protection against mortality of infected mice in a mouse gas gangrene model, efficient bacterial clearance in tissues and alleviation of histological damage in vivo. Based on the above results, amentoflavone may be a potential candidate against C. perfringens infection by reducing CPA and PFO-mediated virulence.

The clostridial diseases of horses can be divided into three major groups: enteric/enterotoxic, histotoxic, and neurotoxic. The main enteric/enterotoxic diseases include those produced by Clostridium perfringens type C and Clostridioides difficile, both of which are characterized by enterocolitis. The main histotoxic diseases are gas gangrene, Tyzzer disease, and infectious necrotic hepatitis. Gas gangrene is produced by one or more of the following microorganisms: C. perfringens type A, Clostridium septicum, Paeniclostridium sordellii, and Clostridium novyi type A, and it is characterized by necrotizing cellulitis and/or myositis. Tyzzer disease is produced by Clostridium piliforme and is mainly characterized by multifocal necrotizing hepatitis. Infectious necrotic hepatitis is produced by Clostridium novyi type B and is characterized by focal necrotizing hepatitis. The main neurotoxic clostridial diseases are tetanus and botulism, which are produced by Clostridium tetani and Clostridium botulinum, respectively. Tetanus is characterized by spastic paralysis and botulism by flaccid paralysis. Neither disease present with specific gross or microscopic lesions. The pathogenesis of clostridial diseases involves the production of toxins. Confirming a diagnosis of some of the clostridial diseases of horses is sometimes difficult, mainly because some agents can be present in tissues of normal animals. This paper reviews the main clostridial diseases of horses.

Abstract Background Gas gangrene is an invasive, fatal anaerobic infection that is characterized by acute, rapid evolution and high mortality. Gas gangrene is often secondary to open fractures with deep wounds but is extremely rare in the patients undergoing elective surgery. Implant removal is a common elective operation in orthopedics after the union of fractures, and the complications of this surgery include infection, nerve injury and re-fracture. However, to the knowledge of the authors, there is no report in the literature on gas gangrene following implant removal. Here, we present a case study of gas gangrene following the removal of an internal fixation device after the union of a tibial plateau fracture. Case presentation A 59-year-old man with a postoperative union of a left tibial plateau fracture after open reduction and internal fixation complained of severe pain in the wound region on the first morning after implant removal surgery, and the incision was severely swollen and filled with hemorrhagic content. On the second morning, the patient’s symptoms were aggravated progressively. The patient experienced delirium on the third morning after surgery, and a physical examination revealed subcutaneous crepitus extending along the length of the limb, and roentgenograms revealed the accumulation of gas in soft tissue. Gas gangrene was highly suspected, and the left femoral amputation was performed the following night at approximately 11 p.m. General supportive therapy and antibiotic therapy were given subsequently, and the patient was recovered and discharged after his vital signs were stable. Conclusions Although gas gangrene is rare, its high mortality and disability indicate that we should pay attention to its prophylaxis, and strict aseptic techniques should be emphasized for even the most minor procedure.

The article contains data on the use of heterologous serum products in the treatment of some infectious diseases and snake bites. Despite achievements of preventive vaccination there are still cases of diphtheria and tetanus registered annually all over the world. Cases of botulism and gas gangrene are not uncommon either. There is also an important problem of snake bites treatment. Heterologous serum is mainly derived from the blood of horses immunized with bacterial anatoxins or toxins (snake venoms). They are included into the Russian List of Vital and Essential Medicines and in the WHO Essential Medicines List. Antivenoms are the only effective antidotes for the bites of venomous snakes, spiders, and scorpions. However, despite a self-evident demand in such products, there is a lack of antitoxic serum caused by the phasing out of its production in some countries, its low economic efficiency and stringent regulatory requirements for the safe production of blood products.

Clostridium perfringens (C. perfringens) is Gram-positive anaerobic, spore-forming rod-shaped bacterial pathogen that is widely distributed in nature. This bacterium is known as the causative agent of a foodborne illness and of gas gangrene. While the major virulence factors are the α-toxin and perfringolysin O (PFO) produced by type A strains of C. perfringens, the precise mechanisms of how these toxins induce the development of gas gangrene are still not well understood. In this study, we analyzed the host responses to these toxins, including inflammasome activation, using mouse bone marrow-derived macrophages (BMDMs). Our results demonstrated, for the first time, that C. perfringens triggers the activation of caspase-1 and release of IL-1β through PFO-mediated inflammasome activation via a receptor of the Nod-like receptor (NLR) family, pyrin-domain containing 3 protein (NLRP3). The PFO-mediated inflammasome activation was not induced in the cultured myocytes. We further analyzed the functional roles of the toxins in inducing myonecrosis in a mouse model of gas gangrene. Although the myonecrosis was found to be largely dependent on the α-toxin, PFO also induced myonecrosis to a lesser extent, again through the mediation of NLRP3. These results suggest that C. perfringens triggers inflammatory responses via PFO-mediated inflammasome activation via NLRP3, and that this axis contributes in part to the progression of gas gangrene. Our findings provide a novel insight into the molecular mechanisms underlying the pathogenesis of gas gangrene caused by C. perfringens.

Immunity defects are important predisposing factors to aggressive infections with high risk of mortality. The case of a teenager with a history of immunodeficiency, who developed gas gangrene infection originated in the left lower limb is reported here. The disease progressed in less than 24 hours, developed systemic involvement and led to multiple organ failure and death. Pathophysiological aspects and features of the agent are reviewed here, highlighting the importance of high index of clinical suspicion and immediate handling.

ABSTRACT To obtain an insight into host-pathogen interactions in clostridial myonecrosis, we carried out comparative transcriptome analysis of both the bacterium and the host in a murine Clostridium perfringens infection model, which is the first time that such an investigation has been conducted. Analysis of the host transcriptome from infected muscle tissues indicated that many genes were upregulated compared to the results seen with mock-infected mice. These genes were enriched for host defense pathways, including Toll-like receptor (TLR) and Nod-like receptor (NLR) signaling components. Real-time PCR confirmed that host TLR2 and NLRP3 inflammasome genes were induced in response to C. perfringens infection. Comparison of the transcriptome of C. perfringens cells from the infected tissues with that from broth cultures showed that host selective pressure induced a global change in C. perfringens gene expression. A total of 33% (923) of C. perfringens genes were differentially regulated, including 10 potential virulence genes that were upregulated relative to their expression in vitro. These genes encoded putative proteins that may be involved in the synthesis of cell wall-associated macromolecules, in adhesion to host cells, or in protection from host cationic antimicrobial peptides. This report presents the first successful expression profiling of coregulated transcriptomes of bacterial and host genes during a clostridial myonecrosis infection and provides new insights into disease pathogenesis and host-pathogen interactions. IMPORTANCE Clostridium perfringens is the causative agent of traumatic clostridial myonecrosis, or gas gangrene. In this study, we carried out transcriptional analysis of both the host and the bacterial pathogen in a mouse myonecrosis infection. The results showed that in comparison to mock-infected control tissues, muscle tissues from C. perfringens-infected mice had a significantly altered gene expression profile. In particular, the expression of many genes involved in the innate immune system was upregulated. Comparison of the expression profiles of C. perfringens cells isolated from the infected tissues with those from equivalent broth cultures identified many potential virulence genes that were significantly upregulated in vivo. These studies have provided a new understanding of the range of factors involved in host-pathogen interactions in a myonecrosis infection.

The anaerobic bacterium Clostridium perfringens expresses multiple toxins that promote disease development in both humans and animals. One such toxin is perfringolysin O (PFO, classically referred to as θ toxin), a pore-forming cholesterol-dependent cytolysin (CDC). PFO is secreted as a water-soluble monomer that recognizes and binds membranes via cholesterol. Membrane-bound monomers undergo structural changes that culminate in the formation of an oligomerized prepore complex on the membrane surface. The prepore then undergoes conversion into the bilayer-spanning pore measuring approximately 250–300 Å in diameter. PFO is expressed in nearly all identified C. perfringens strains and harbors interesting traits that suggest a potential undefined role for PFO in disease development. Research has demonstrated a role for PFO in gas gangrene progression and bovine necrohemorrhagic enteritis, but there is limited data available to determine if PFO also functions in additional disease presentations caused by C. perfringens. This review summarizes the known structural and functional characteristics of PFO, while highlighting recent insights into the potential contributions of PFO to disease pathogenesis.

Clostridium septicum is the causative agent of atraumatic gas gangrene, with α-toxin, an extracellular pore-forming toxin, essential for disease. How C. septicum modulates the host’s innate immune response is poorly defined, although α-toxin-intoxicated muscle cells undergo cellular oncosis, characterised by mitochondrial dysfunction and release of reactive oxygen species. Nonetheless, the signalling events that occur prior to the initiation of oncosis are poorly characterised. Our aims were to characterise the ability of α-toxin to activate the host mitogen activated protein kinase (MAPK) signalling pathway both in vitro and in vivo. Treatment of Vero cells with purified α-toxin activated the extracellular-signal-regulated kinase (ERK), c-Jun N-terminal kinase (JNK) and p38 arms of the MAPK pathway and stimulated the release of TNF-α in a dose-dependent manner. Studies using inhibitors of all three MAPK components suggested that activation of ERK occurred in a Ras-c-Raf dependent manner, whereas activation of JNK and p38 occurred by a Ras-independent mechanism. Toxin-mediated activation was dependent on efficient receptor binding and pore formation and on an influx of extracellular calcium ions. In the mouse myonecrosis model we showed that the MAPK pathway was activated in tissues of infected mice, implying that it has an important role in the disease process.

Subcutaneous emphysema is the presence of gas or air in the subcutaneous tissue plane. The term is generally used to describe any soft tissue emphysema of the body wall or limbs, it can result from benign causes, most commonly secondary to trauma or from a life-threatening infection by gas gangrene or necrotising fasciitis. A case of subcutaneous emphysema involving the upper limb resulting from a trivial laceration to the elbow is reported and the importance of distinguishing between the two causes of subcutaneous emphysema is highlighted

Objective: To report a case of gas gangrene in a fetus at term, which was diagnosed by antenatal computed tomography (CT) imaging. Case Report: A 23-year-old primiparous woman, who did not undergo any prenatal health checks until term, developed hypertension, proteinuria, and clouding of consciousness, and experienced intrauterine fetal death. A single, mature fetus with voluminous gas bubbles was observed on CT, which was consistent with a diagnosis of fetal gas gangrene. Following the induction of labor, a dead, malodorous infant was delivered, along with foul-smelling and frothy amniotic fluid. The patient's condition deteriorated, and intensive care support was required to treat the patient for septic shock and disseminated intravascular coagulation during the postpartum period. She died on the 2nd postpartum day. Conclusion: Fetal gas gangrene is a very rare and potentially lethal event in pregnant women. To our knowledge, this is the first report on the antenatal diagnosis of fetal gas gangrene in a term pregnancy through CT. CT was useful for evaluating the extent of emphysematous change in the fetal and maternal organs.

Gas gangrene is a rare but often fatal soft-tissue infection. Because it is uncommon and the classic symptom of crepitus does not appear until the infection is advanced, prompt diagnosis requires a high index of suspicion. We present a case report of a middle-aged man who presented with acute onset lower-extremity pain that was initially thought to be due to deep vein thrombosis. After undergoing workup for pulmonary embolism, he was found to have massive gas gangrene of the lower extremity secondary to an occult colon adenocarcinoma and died within hours of presentation from multisystem organ failure.

Clostridial perfringens is a bacteria commonly found on skin flora. Due to the optimal growth environment intramuscular epinephrine injections predispose patients to the rapid development of clostridial myonecrosis. There have been only four cases, including this one, reported in the last 60 years of pediatric Clostridium perfringens infections post-epinephrine injection. We detail the successful management of a 16 year old, immunocompetent female who developed gas gangrene and necrotizing fasciitis on her thigh secondary to clostridial infection after utilization of an Epinephrine Auto-Injector and review the pediatric literature of patients with Clostridial perfringens secondary to epinephrine injection. We define common clinical signs and symptoms of clostridial infection from the review of the literature. The relevance of our findings is to raise awareness among emergency physicians when patients present following an injection in order to reduce diagnostic delay that could result in amputation or death.

A 39-year-old male with a history of cocaine abuse presents to the emergency room with pain in the right leg and fever (39 C) 6 days after injecting himself in the thigh with midazolam pills diluted in tap water to control symptoms of withdrawal. Physical examination revealed rubor, swelling and tenderness of the thigh without crepitation, suggestive of cellulitis. Laboratory findings consisted of a WBC of 10.700x106/L (86% Neutrophiles) and CRP of 170 mg/dL. An X-ray of the leg was performed, revealing a feathering pattern of gas within the soft tissue of the thigh indicative of gas gangrene. Intraoperatively, we found wide necrosis of the muscles and fatty tissue of the posterior thigh without substantial quantities pus. An extensive debridement was performed and penicillin and clindamycin were administered for two weeks. Cultural exams revealed the presence of aerobic (Streptococcus mitis and Streptococcus oralis) and anaerobic bacteria (Clostridium clostridioforme and Prevotella oralis). The infection was controlled after further daily debridement and the wound was closed with the assistance of a negative-pressure wound therapy device. The patient was discharged from the hospital to a physical rehabilitation facility and regained most of his functional capacity. Gas gangrene is a life-threatening condition, misdiagnosis and failure of recognition in its early stages can prove fatal. Plain X-ray films are readily available in most hospitals and can provide significant information in patients with soft tissue infections where 'time is tissue.'

The objective of the study was to perform a comparative analysis of phenotypic and genetic similarity, determination of resistance profiles, detection of toxin-encoding genes and molecular typing of Clostridium perfringens isolates originating from patients with gas gangrene. The study encompassed three patients with a clinical and microbiological diagnosis of gas gangrene who were hospitalized in one of the hospitals of the Kujawsko-Pomorskie province in the same period of time between 8th April 2015 and 20th April 2015. The three C. perfrin­gens isolates studied had identical biochemical profiles. Two isolates had identical resistance patterns, while the third presented a different profile. Using the multiplex PCR method, all isolates showed the presence of cpa gene encoding α-toxin; furthermore, the presence of the cpb2 gene encoding β2-toxin was confirmed in two isolates. Genotyping with the use of pulsed field gel electrophoresis (PFGE) indicated that the isolates originating from the three studied patients represent three genetically different restrictive patterns which correspondedto three different clones – clone A, clone B and clone C. As a result of the study, it is possible to conclude that the studied patients simulta­neously hospitalized in a single Department of Orthopedics and Traumatology developed three different endogenous infections.

Gas gangrene is an invasive anaerobic infection, usually found in deep wounds with injury to large muscle masses that are contaminated with germs from the group of anaerobic clostridia. It is characterized by massive, acute progressive muscle necrosis and severe intoxication of the organism. The importance of gas gangrene is in its rapid evolution and high mortality. Untreated gas gangrene is fatal. This paper presents a patient in whom, after an open fracture of the femur and tibia, gas gangrene of the lower leg developed. Injury occurred during processing of agricultural land with a tiller, when cutter blades cut the bones of the leg and contaminated the wound with the soil in which clostridium microorganisms were present. After being admitted to hospital, due to lesions of the femoral vessels, hemostasis was performed, followed by the primary surgical treatment of the wound and external skeletal fixation. In the postoperative period, in the first 48 hours, there was a development of gas gangrene in the right calf with a bad general condition. For vital reasons, the patient underwent femoral amputation. Early amputation stump, after meticulous hemostasis was left open and was closed with the delayed secondary suture. After healing of the amputation stump, the patient was referred to physical therapy for prosthesis and gait training.

Hyperbaric oxygen therapy (HBOT) is the use of 100% oxygen at pressures greater than atmospheric pressure. Today several approved applications and indications exist for HBOT. HBOT has been successfully used as adjunctive therapy for wound healing. Non-healing wounds such as diabetic and vascular insufficiency ulcers have been one major area of study for hyperbaric physicians where use of HBOT as an adjunct has been approved for use by way of various studies and trials. HBOT is also indicated for infected wounds like clostridial myonecrosis, necrotising soft tissue infections, Fournier′s gangrene, as also for traumatic wounds, crush injury, compartment syndrome, compromised skin grafts and flaps and thermal burns. Another major area of application of HBOT is radiation-induced wounds, specifically osteoradionecrosis of mandible, radiation cystitis and radiation proctitis. With the increase in availability of chambers across the country, and with increasing number of studies proving the benefits of adjunctive use for various kinds of wounds and other indications, HBOT should be considered in these situations as an essential part of the overall management strategy for the treating surgeon.

Myonecrosis remains one of the severest manifestations of skin and soft tissue infections. Clostridia (C. perfringens, C. novyi, C. septicum, C. sordellii, C. histolyticum) are dominant and Staphylococcus aureus, Streptococcus pyogenes, Bacillus cereus, and Bacteriodes fragilis are much less in the etiology of myonecrosis. Cases of gas gangrene have recently become more frequent among injection drug users all over the world. Russia has become the largest opiate market in Europe and consumption of these narcotic drugs is annually growing. In the Russian Federation, a larger number of injection drug users uniquely results in a rise of cases of Clostridium- and mixed flora-induced myonecrosis. Gas gangrene in HIV-positive drug abusers seems to rapidly progress to multiple organ failure and to show high death rates, rather than to develop a localized form. The analyzed case of mixed flora-induced gas gangrene is of interest to physicians of any specialties who can encounter this wound infection in HIV-positive patients.

Necrotizing fasciitis is one of the rare complications of misdiagnosed appendicitis with the mortality rate of over 25%.We report a 47-year old diabetic man admitted with necrotizing fasciitis of flank and abdominal wall secondary to acute appendicitis. The patient, with primary diagnosis of gas gangrene and necrotizing fasciitis, underwent surgical operation and after 3 months, elective appendectomy was performed. After that, he was discharged in good conditions.

Necrotizing fasciitis is a severe, rare, potentially lethal soft tissue infection that develops in the scrotum and perineum, the abdominal wall or the extremities. The infection progresses rapidly, and septic shock may ensue; hence, the mortality rate is high (median mortality 32.2%). Prognosis becomes poorer in the presence of co-morbidities, such as diabetes mellitus, immunosuppression, chronic alcohol disease, chronic renal failure and liver cirrhosis. Necrotizing fasciitis is classified into four types, depending on microbiological findings. Most cases are polymicrobial, classed as type I. The clinical status of the patient varies from erythema, swelling and tenderness in the early stage to skin ischemia with blisters and bullae in the advanced stage of infection. In its fulminant form, the patient is critically ill with signs and symptoms of severe septic shock and multiple organ dysfunction. The clinical condition is the most important clue for diagnosis. However, in equivocal cases, the diagnosis and severity of the infection can be secured with laboratory-based scoring systems, such as the LRINEC score or FGSI score, especially in regard to Fournier’s gangrene. Computed tomography or ultrasonography can be helpful, but definitive diagnosis is attained by exploratory surgery at the infected sites.Management of the infection begins with broad spectrum antibiotics, but early and aggressive drainage and meticulous debridement constitute the mainstay of treatment. Postoperative management of the surgical wound is also important for the patient’s survival, along with proper nutrition. The vacuum-assisted closure system has proved to be helpful in wound management, with its combined benefits of continuous cleansing of the wound and the formation of granulation tissue.

We report a case of gas gangrene in a non diabetic HIV sero negative young male who succumbed to death within 60 hours following an intramuscular injection in rural India. Occurrence of GG after intramuscular injection is rare and only a few cases has been reported so far in the literature

Clostridium perfringens is a major cause of histotoxic and intestinal infections of humans and other animals. This Gram-positive anaerobic bacterium can produce up to three sialidases named NanH, NanI, and NanJ. The role of sialidases in histotoxic infections, such as gas gangrene (clostridial myonecrosis), remains equivocal. However, recent in vitro studies suggest that NanI may contribute to intestinal virulence by upregulating production of some toxins associated with intestinal infection, increasing the binding and activity of some of those toxins, and enhancing adherence of C. perfringens to intestinal cells. Possible contributions of NanI to intestinal colonization are further supported by observations that the C. perfringens strains causing acute food poisoning in humans often lack the nanI gene, while other C. perfringens strains causing chronic intestinal infections in humans usually carry a nanI gene. Certain sialidase inhibitors have been shown to block NanI activity and reduce C. perfringens adherence to cultured enterocyte-like cells, opening the possibility that sialidase inhibitors could be useful therapeutics against C. perfringens intestinal infections. These initial in vitro observations should be tested for their in vivo significance using animal models of intestinal infections.

Clostridium perfringens is a spore-forming, commensal, ubiquitous bacterium that is present in the gastrointestinal tract of healthy humans and animals. This bacterium produces up to 18 toxins. The species is classified into five toxinotypes (A–E) according to the toxins that the bacterium produces: alpha, beta, epsilon, or iota. Each of these toxinotypes is associated with myriad different, frequently fatal, illnesses that affect a range of farm animals and humans. Alpha, beta, and epsilon toxins are the main causes of disease. Vaccinations that generate neutralizing antibodies are the most common prophylactic measures that are currently in use. These vaccines consist of toxoids that are obtained from C. perfringens cultures. Recombinant vaccines offer several advantages over conventional toxoids, especially in terms of the production process. As such, they are steadily gaining ground as a promising vaccination solution. This review discusses the main strategies that are currently used to produce recombinant vaccines containing alpha, beta, and epsilon toxins of C. perfringens, as well as the potential application of these molecules as vaccines for mammalian livestock animals.

Injection site abscess is an iatrogenic infection. Intramuscular (IM) injection is a common route to administer medication. Microorganisms known to cause injection site abscess are Staphylococcus aureus, Pseudomonas, Klebsiella, Escherichia coli commonly, Atypical mycobacteria, Clostridium species rarely. Gas gangrene is a necrotic infection of soft tissue with high mortality, often necessitating amputation in order to control the infection. Here, presenting a case of gas gangrene in a 19-year-old healthy male, who developed a life-threatening infection after IM injection of sodium diclofenac. Prompt clinical diagnosis, laboratory support, and timely surgical intervention saved the patient’s life.

To determine which organisms most commonly cause infection after natural disasters, we cultured specimens from injured earthquake survivors in Wenchuan, China, 2008. Of 123 cultures, 46 (59%) grew only 1 type of pathogenic bacteria. Smear was more effective than culture for early diagnosis of gas gangrene. Early diagnosis and treatment of wounds are crucial.

La gangrena gaseosa de la mama es una enfermedad rara y potencialmente mortal descrita como consecuencia de un traumatismo, por complicaciones infecciosas de la cirugía o por una trombosis venosa. También se ha relacionado ocasionalmente con otras causas tales como la diabetes mellitus, el envenenamiento con monóxido de carbono o la cirugía plástica. Presentamos un caso de gangrena gaseosa de mama en una mujer diabética de 74 años. Esta rara infección representa una emergencia médico-quirúrgica.

Our objective is to report a case of a patient with necrosis limited to the pre-peritoneal fascia and fat tissue of the abdomen and pelvis. A 34-year-old female presented with fever, chills, nausea, diarrhea and abdominal pain. She denies history of trauma, diabetes mellitus, use of immunosuppressive drugs, smoking, and drug dependence. Laboratory tests revealed hematocrit of 28.7%, white blood count of 12.200/mm3 with 49% of bands, platelets of 317.000/mm3, and sedimentation rate of 65 mm/hr. She was subjected to an abdominal ultrasonography and computed tomography that showed hepatosplenomegaly and muscular thickening on the left flank. Surgical debridment was performed. There was necrosis limited to the pre-peritoneal fascia and fat tissue extending from the pelvis to the left flank. The fascia of the superficial muscles and the subcutaneous fat were normal. The pathologic examination showed suppuration and necrosis of the tissues. Antibiotics were administered and ten debridments were performed. The patient was discharged 30 days after the admission.