Gas Gangrene

There are several infections which produce gas and need to be differentiated from clostridial myonecrosis.

Gas Producing Soft Tissue Infections - Finegold et al, Upjohn 1972

	Anerobic Cellulitis	Infected Vascular Gangrene	Clostridial Myonecrosis	Streptococcal Myositis
Incubation	> 3 days	> 5 days	< 3 days	3-4 days
Organism	C perfringens	mixed - gram(-), bacteriodes,	C perfringens	anerobic strep (peptostreptococci)
Onset	Gradual	Gradual	Acute	Subacute, insidious
Toxemia	Minimal	Minimal	Very severe	Severe after some time
Pain	Absent	Variable	Severe	Usually severe
Swelling	Minimal	Marked	Marked	Marked
Skin	Little change	Discolored, black, desiccated	Tense, often very white	Tense, often with coppery tinge
Exudate	Nil or slight	Nil	Variable, may be profuse , serous, blood stained	Very profuse
Gas	Abundant	Abundant	Rarely pronounced except terminally	Very slight
Smell	Foul	Foul	Variable, may be slight, often sweetish	Very slight, often sour
Muscle	No change	Dead	Marked change	At first little change, but edema

The treatment is surgical debridement plus Penicillin G and Clindamycin or Ceftriaxone.