Anaerobic infection

Anaerobic infection (synonym: gas gangrene, gas cellulitis, malignant swelling) - a severe complication of wound process called anaerobic microflora, characterized by necrosis of tissues with the formation of these bubbles of gas or heavy occur sero-bloody liquid and heavy General intoxication. Pathogens anaerobic infection - Cl. perfringens, Cl. oedematiens, Cl. histolyticum, Vibrio septicus (see Anaerobes). They all form sporesthat survive boiling for hours. Microbes are found in rotting organic matter in the earth, especially analoginiai in the intestines of animals and humans. Vnedrivšis ' tissue, they quickly causing their death, in the presence of Cl. perfringens with the formation of gases, in the presence of Cl. oedematiens - edema. In most cases, anaerobic infections is caused not by one, but by a combination of two or three of microorganisms. Prevalence in the tissues of one or another agent and determines the peculiarity of the clinical picture.
There are gas, or emphysematous, swollen and combined forms. Emphysematous form anaerobic infection is characterized by the formation of gas bubbles in the tissues; in edematous form of gas is not formed, there was abundant soaking fabrics bloody-serous fluid. A mixed form of anaerobic infections swelling combined with emphysema. When each of these forms there comes a tissue necrosis (anaerobic gangrene). The clinical course there are anaerobic infection lightning (with fast fatal), acute and subacute.
Anaerobic infection affects mainly the wound with a large area of tissue damage, as its development is important presence in the injury of a large number of non-viable tissue deprived of blood and hence oxygen. In such tissues pathogens anaerobic infection freely reproduce, releasing toxinscausing severe General reaction of the body. Most susceptible anaerobic infection wounds areas rich in muscle tissue (buttock, thigh). The process is especially rapidly in the muscles and in the course of the vascular bundles can jump with legs on the trunk. With gunshot wounds to the development of anaerobic infection is facilitated by the presence in the wound tract pieces of clothing, shoes and so on, carried away by a bullet or shell splinters. The development of anaerobic infections also promote blood loss, exhaustion, a tourniquet on the wounded extremity. Anaerobic infection in peacetime possible with extensive torn contused wounds, heavily contaminated land. There are complications anaerobic infection after criminal abortions.
Initial symptoms of anaerobic infection are fever, severe arching pain in the wound, and in the course of blood pressure, swelling, pallor of the skin. During examination of the affected area are seen clearly expressed subcutaneous veins, blue spots or bronze stripes on the skin. Common symptoms are caused severe intoxication: the patient pale, pointed face, the skin is yellowish color. Marked anxiety and fear, sweat, increased blood pressure, small and frequent pulse. The patient remains conscious, but is in a state of complete apathy, sometimes euphoria. While touching the affected area, there is a sense of snow is crackling" (crepitus). This symptom is caused by the presence of gas bubbles in the tissues. The skin may appear blisters filled with fluid (edema fluid enters the epidermal layer and lifts it). When the incision wound almost no bleeding, vessels trombirovania, the muscle looks boiled veal. With deep cuts stand out from the wound ohoronno-bloody liquid and gas bubbles. When x-rays are visible gas accumulation in the tissues.
To highlight agents anaerobic infection is taken from the wounds of the pieces of damaged tissues, wound fluid (remove the syringe), blood from a vein (not more than 5-10 ml). Of all the materials taken prepare smears and staining of a gram. Detection of smear-negative gram-positive bacilli with rounded ends indicates the possibility of anaerobic infection. To confirm the presence of pathogens anaerobic infection grow crops within 1-4 days at temperature of 37 degrees. For this tissue pound in a mortar, bred equal volume of physiological solution, and divide into two parts - one warm up for 15 minutes at a temperature of 80 degrees, other leave unheated. Both portions produce a crop on meat l casein environment enrichment under vaseline oil with 1% solution of glucose, boiled for 15 minutes, and dense medium - blood and benzidine the agars, environment Wilson - Blair. Grown culture mikroskopiruyut. Growth, toxicobrain at Cl. perfringens observed after 6 to 18 hours, Cl. oedematiens-through lasts for 48-96 hours, Vibrio septicus and Cl. histolyticum - 20 - 36 hours.
The General principle of treatment anaerobic infection is its complexity: surgical treatment is combined with conservative. Surgical treatment is wide cut wounds (the entrance gate infection); make deep skin incisions in the form of stripes to tendon aponeurosis with the opening, excised necrotic tissue. After production cuts wound is treated with a solution of potassium permanganate, hydrogen peroxide, dressings with hypertonic solution of sodium chloride. In severe cases, produce amputation or the exarticulation.
Non-specific General and local treatment includes the following events. With the aim of detoxification give plenty of fluids (isotonic solution of sodium chloride, 5% glucose solution), produce transfusion of blood and protein drugs, given plenty of water. The patient needed rest, high-calorie food. According to the testimony appoint heart funds. The specific treatment of General and local include the appointment of sera, bacteriophages. Anti-gangrenous the serum is administered to the patient after surgery (in the state of narcosis) intravenous (50 000 - 75 000 AE, diluted in 500 ml izotoniceski solution of sodium chloride) drip with preliminary desensitization on Besedka, and then again to the disappearance of toxemia. Prevention of anaphylactic shock intravenous 10 ml of 10% solution of chloride calcium, antihistamines (pipolfen, diphenhydramine) intramuscularly or intravenously.
Anaerobic bacteriophage and difer injected 50-75 ml 500 ml izotoniceski solution of sodium chloride daily for three days. In addition, their local applied to the wound.
Prevention. The main method of preventing anaerobic infection is timely and complete primary processing of the Russian Academy of Sciences (see the Wounds, the wounds) with local and General use of antibiotics. If the injuries of the upper and lower extremities, accompanied by fractures and crushing of soft tissues and contaminated land, pieces of clothing, and if the blind wounds, injuries, damage to a major blood vessels shown preventive introduction protivomigrenoznoe serum intramuscularly 20 000 AE (against Cl. perfringens - 10 000 AE, against Cl. oedernatiens - 5000 AE, against Vibrio septicus - 5000 AE).

Anaerobic infection is the most severe of wound infections caused by pathogenic anaerobes, manifested in the form of gas gangrene, gas phlegmon or malignant swelling. Often develops at gunshot wounds of the limbs, mainly lower (printing. Fig).

anaerobic infection Shin
Anaerobic infection Shin - gas form

Agents of anaerobic infections are mainly four pathogenic gone anaerobic: Cl. perfringens, Cl. oedematiens, Cl. septicum, Cl. histolyticum. Each of them separately, in combination with each other or with other agents of both aerobic and anaerobic some may call any form of anaerobic infection. Pathogenic anaerobes are widely distributed in nature; they are the permanent citizens of the intestine of humans and animals; as a rule, contained in the soil, contaminated or soiled by dirt (arable, garden).
Often anaerobes are on the skin (especially the lower half of the body), linen and clothing. Every bullet wound, especially blind, contaminated land, scraps of linen and clothes, initially infected anaerobes. The development of pathogens in the wound depends on a number of conditions. The best breeding ground for anaerobes are dead or damaged tissue exposed to oxygen starvation, located in closed pockets and cavities. Especially favorable conditions for anaerobes in damaged devoid of nutrition of the muscle tissue. Any weakening of the body is blood loss, shock, cooling, fatigue - contributes to the development and spread of infection. Quickly multiply in the tissues with the broken food, anaerobes penetrate into the healthy parts, violate the power in them toxins, and then eventually destroy the muscles, resulting in complete paralysis.
Local infection may be accompanied by pain in the wound, swelling and flatulence. The latter especially pronounced in the presence of Cl. perfringens (gas cellulitis, gas gangrene). An infection caused by Cl. oedematiens, can proceed without any noticeable gassing. Anaerobic infection has the ability to very rapid spread per continuitatem. Heavy common phenomenon when it is associated with intoxication decay products of tissue and bacterial toxins from the lesion.
Clinic, diagnostics, treatment and prevention of anaerobic infections - see the Wounds, the wounds.