Clostridial soft-tissue infections

[Ernesto]

Clostridial soft-tissue infections include cellulitis, myositis, and clostridial myonecrosis. They usually occur after trauma. Symptoms may include edema, pain, gas with crepitation, foul-smelling exudates, intense coloration of the site, and progression to shock, renal failure, and sometimes death. Diagnosis is by inspection, smell, and Gram stain and is confirmed by culture. Treatment is with penicillin and surgical debridement. Hyperbaric oxygen is sometimes beneficial.
(See also Overview of Anaerobic Bacteria and Overview of Clostridial Infections.)
Clostridial infections of soft tissues may occur after an injury or spontaneously. Infection typically results in gas in soft tissues.
Clostridium perfringens is the most common species involved.
Clostridial soft-tissue infections usually develop hours or days after an extremity is injured by severe crushing or penetrating trauma that devitalizes tissue, creating anaerobic conditions. The presence of foreign material (even if sterile) markedly increases risk of clostridial infection. Infection may also occur in operative wounds, particularly in patients with underlying occlusive vascular disease.
Rarely, spontaneous cases occur, usually caused by C. septicum bacteremia originating from occult colon perforation in patients with colon cancer, diverticulitis, or bowel ischemia. Because C. septicum is aerotolerant, infection can spread widely to normal skin and soft tissues. Concurrent neutropenia, regardless of cause, predisposes to C. septicum bacteremia, which results in a poor prognosis; the prognosis is worse if intravascular hemolysis occurs.
In suitable conditions (low oxidation-reduction potential, low pH), as occur in devitalized tissue, infection progresses rapidly, from initial injury through shock, toxic delirium, and death within as little as 1 day.