Mephitic gangrenes

Description:

Mephitic gangrene (wound) — the infectious process caused by anaerobe bacterias. It is characterized by quickly arising and progressing necrosis of fabrics with formation in them of gases and lack of the expressed inflammatory phenomena, heavy intoxication.

Symptoms of Mephitic gangrenes:

azvity a mephitic gangrene, both klostridialny, and neklostridialny, can be fulminant (to 1 days from the moment of an injury or operation), acute (within 3 — 4 days) and subacute (more than 4 days).

At gas gangrene at the beginning of a disease excitement, concern are noted. Complaints to arching pains in a wound or feeling of completeness in an extremity are characteristic. Pains often are not killed by narcotic analgetics. Pulse becomes frequent to 100 — 120 blows in 1 min., body temperature increases to 39 0C. There is a yellowness of scleras later, euphoria increases. The expressed intoxication leads to dysfunctions of TsNS (up to a deep coma), respiratory insufficiency, disturbances of a hemodynamics (decrease in arterial and venous pressure), and also hepatonephric insufficiency. Often infectious and toxic shock develops. In blood anemia and decrease in a hematocrit, a moderate leukocytosis, a sharp deviation to the left, increase in SOE come to light. At survey of a wound are defined the expressed hypostasis of fabrics, at a palpation and percussion — crepitation and a tympanic sound. Coloring of skin in a defeat zone at a klostridialny infection pale, bluish or bronze, and its temperature is reduced. A characteristic sign is spread of hypostasis, and then and a necrosis on long distance from a wound. The wound discharge usually has serous and bloody character, can be scanty and foamy.

Neklostridialny anaerobe bacterias often come to light at various purulent diseases: purulent pleurisy, abscesses of lungs, brain, liver, spleen, peritonitis, puerperal or post-abortion sepsis, septic thrombophlebitis, etc. Plentiful release of pus of brown color with a pungent fetid smell, the diffusion necrosis of soft tissues, existence of vials of gas and droplets of fat in wound separated, fervescence to 39 °C, a fever, increase of pulse to 100 — 120 blows in 1 min., the expressed intoxication, accession of hepatonephric insufficiency are characteristic signs of a neklostridialny infection of an open wound.

At inspection the bacterioscopy wound separated with coloring of drugs across Gram has a certain value: existence of "rough", unevenly reinforced sticks confirms the diagnosis of a klostridialny infection, and the abundance of coccal microflora is peculiar to a neklostridialny infection, the association of anaerobe bacterias with aerobic microorganisms is Quite often observed that comes to light as a result of crops of material on mediums. For planned bacteriological control the studied environment (pieces of the struck fabrics, a wound secret, etc.) is sent to laboratory, carrying out special rules: after a puncture the received material is delivered in the syringe or in special transport environments, having forced out from them air.

Reasons of Mephitic gangrenes:

Distinguish two groups of microorganisms — activators of a mephitic gangrene. Spore-forming anaerobe bacterias, or clostridiums carry to the first group (Clostridium perfringens, Cl., septicum, Cl., oedematiens and Cl. his-tolyticum). The wound fever caused by these microorganisms often is designated as gas gangrene or gas phlegmon. The second group — asporous, or neklostridialny, anaerobe bacterias (bacteroids, fuzobakteriya, peptostreptokokk, peptokokk, etc.).

Treatment of Mephitic gangrenes:

Basis of treatment of a wound at a klostridialny and neklostridialny infection is an operative measure: a wide section of the center of defeat and excision of nekrotizirovanny fabrics with processing by antiseptic agents and adequate drainage. An operative measure is carried out, as a rule, under the general anesthesia.

The leading role in treatment after operation belongs to antibacterial therapy which cornerstone use of antibiotics, usually a broad spectrum of activity is: semi-synthetic penicillin, cephalosporins, aminoglycosides, etc., and also the drugs which are selectively operating on anaerobe bacterias (clindamycin, metronidazole, etc.). In hard cases, as a rule, appoint the maximum daily doses of drugs. Besides, apply the antiseptic agents which are selectively operating on anaerobe bacterias: dioxidin, Dimexidum, etc. Are widely used infusional therapy (introduction of blood preparations, plasmas, blood substitutes, solutions of amino acids, etc.), modern methods of a detoxication (hemosorption and a plazmosorbtion), immunostimulators (levamisole), anabolic hormones, anticoagulants, etc.

At a klostridialny wound fever apply polyvalent antigangrenous serum (enter intravenously kapelno). Medical dose of 150 000 ME; before use serum is dissolved by 3 — 5 times with isotonic solution of sodium chloride. Introduction not less than 1 dose of serum a day is recommended.