What is Hyperbaric Treatment of Clostridial Myositis and Myonecrosis?
Clostridial myositis and myonecrosis, also known as gas gangrene, are severe infections caused by a type of bacteria called Clostridium perfringens. This bacteria doesn’t need oxygen to grow, forms protective spores, and produces harmful toxins. Gas gangrene is very serious and can cause death if not detected and treated promptly. Therefore, if gas gangrene is suspected, quick identification and treatment are crucial to save the patient’s life.
What Causes Hyperbaric Treatment of Clostridial Myositis and Myonecrosis?
Gas gangrene is a kind of infection caused by a type of bacteria called Clostridia, most commonly a specific kind known as Clostridium perfringens. These bacteria, which are surrounded by a protective layer and grow without the need for oxygen, are very common. They can be found in many places, including the environment around us and even inside our own bodies. However, these bacteria are known to cause infections especially when wounds come into contact with soil particles.
Risk Factors and Frequency for Hyperbaric Treatment of Clostridial Myositis and Myonecrosis
In the United States, around 3000 cases of a particular infection are reported each year. These infections could be a result of trauma, surgery, or occur spontaneously. Most cases (around 60%) arise from physical injuries like car accidents. It’s worth noting that anyone can get this infection, regardless of gender. There are even some isolated cases of women getting infected during certain gynecological conditions or procedures.
- Each year in the United States, there are roughly 3000 cases of this infection.
- The infections can happen because of three main reasons: after an injury (post-traumatic), after surgery (post-surgical), or out of the blue (spontaneous).
- Most of these cases (about 60%) are post-traumatic, often related to car accidents.
- There are no gender preferences for this infection, it affects both men and women equally.
- Occasionally, the infection can occur after certain gynecological events or procedures, like amniocentesis, cordocentesis, molar pregnancy, vaginal delivery, cesarean section, medical/spontaneous abortion, ablation, and cervical procedures.
Signs and Symptoms of Hyperbaric Treatment of Clostridial Myositis and Myonecrosis
Gas gangrene is a type of infection that can happen after a significant injury, particularly when the injury involves vascular damage and soil contact. It is usually present in situations like bowel surgeries, gunshot or knife wounds, open bone fractures, certain situations during childbirth (like retained placenta or ruptured membranes), or after an injection into a muscle.
This infection typically starts with severe pain in the injured area, usually within 24 hours of the incident. How quickly symptoms appear can also depend on how much bacteria got into the wound and how severe the vascular damage is. Initially, the skin over the infection might look pale, but it changes to a bronze color, then to shades of purple, red, or black. The skin could also develop dark fluid-filled blisters and excessively swell. Sometimes, you may notice a crackling sensation under the skin due to gas being produced by the bacteria, but this depends on how much swelling is present. An unusual sweet smell may accompany the wound, along with fever and a rapid heartbeat.
- Severe pain in the injured area
- Skin discoloration (from pale to bronze to purple, red or black)
- Dark fluid-filled blisters
- Excessive swelling
- Crackling sensation under the skin
- Unusual sweet smell
- Fever
- Rapid heartbeat
Testing for Hyperbaric Treatment of Clostridial Myositis and Myonecrosis
When diagnosing clostridial myonecrosis, a type of severe bacterial infection, doctors rely heavily on physical symptoms and patient’s experiences. If a patient has severe pain at the site of a recent injury, along with whole-body signs such as fever and a rapid heart rate, and the doctor can feel or see evidence of gas in the tissue around the wound, it might suggest clostridial myonecrosis.
However, the only way to confirm the diagnosis is by taking a sample from the wound and examining it under a microscope. If the sample shows the presence of large bacteria that can change their shape (called gram-variable rods), and these bacteria turn a certain color (gram-positive) in a lab culture, this can confirm the diagnosis of clostridial myonecrosis.
It’s also worth noting that the fluid coming out from the wound (exudate) doesn’t look like pus and doesn’t have a type of white blood cell called neutrophils. These details might seem minor, but they’re part of the unique pattern of symptoms and signs that helps doctors diagnose clostridial myonecrosis.
Treatment Options for Hyperbaric Treatment of Clostridial Myositis and Myonecrosis
Early treatment with a method known as hyperbaric oxygen therapy is vital for reducing the severity of an illness and the risk of death, as well as saving as much healthy tissue as possible. Hyperbaric oxygen therapy involves breathing pure oxygen in a pressurized room or tube. Some studies have shown that adding hyperbaric oxygen therapy to surgery and antibiotic treatment can decrease death rates by 50%.
Clostridium perfringens is a type of bacteria that can’t grow well when there are high levels of oxygen pressure. High oxygen tension also stops the production of a harmful toxin (alpha-toxin) produced by the bacteria and helps the body fight the bacteria in other ways. This includes stopping bacteria from multiplying, encouraging the creation of molecules called free radicals that can damage the bacteria, and boosting the function of a type of white blood cell called a neutrophil that kills bacteria.
This bacteria and the toxin it produces can spread quickly — up to six inches in an hour. This is why it’s so important to start hyperbaric oxygen treatment right away. Not only does it stop the disease from spreading further, but it also helps doctors see the difference between healthy tissue and tissue that has been damaged by the disease, making it easier to remove the damaged tissue and keep as much healthy tissue as possible.
Recommended treatment involves receiving oxygen at high pressure for 90 minutes. This is done three times in the first 24 hours of treatment, and twice per day for the next two to five days. The length of the treatment should be adjusted based on the patient’s response.
Surgical removal of damaged tissue should be performed in between rounds of hyperbaric oxygen therapy. Using the proper antibiotics is also essential. Research in animals suggests that a combination of penicillin and clindamycin, delivered via an intravenous drip, should be used.
What else can Hyperbaric Treatment of Clostridial Myositis and Myonecrosis be?
When trying to diagnose gas gangrene, doctors must be careful to distinguish it from other similar medical conditions. These can include:
- Infections caused by Group A Streptococcus
- Infections caused by Vibrio vulnificus
- Pyomyositis, which is usually a result of Staphylococcus aureus
- Viral myositis
- Rhabdomyolysis
Given the serious nature of these conditions, accurate diagnosis is essential.
What to expect with Hyperbaric Treatment of Clostridial Myositis and Myonecrosis
Generally seen as having a serious outlook, the death rate can vary a lot. Recent studies have shown mortality rates to be at 25%. However, if treatment is delayed, these rates can reach nearly 100%.
Possible Complications When Diagnosed with Hyperbaric Treatment of Clostridial Myositis and Myonecrosis
Systemic toxicity from clostridial myonecrosis, also known as a severe bacterial infection in the muscles, can develop quickly, evidenced by an elevated heart rate (tachycardia) and fever. These symptoms can lead to shock and eventually cause multiple organs to fail. About 15% of the patients may also experience bacteremia, which is the presence of bacteria in the blood and can cause rapid destruction of red blood cells (intravascular hemolysis).
Here are other complications that can arise from clostridial myonecrosis:
- Jaundice – a yellowing of the skin and eyes due to excessive bilirubin in the body
- Renal failure – the loss of kidney function
- Hypotension – abnormally low blood pressure
- Liver necrosis – death of liver cells
It should be noted that renal failure in these cases is often a result of multiple factors working together, including low blood pressure (hypotension), the presence of excess hemoglobin in urine (hemoglobinuria), and the presence of an excess muscle protein in urine (myoglobinuria). Additionally, bacterial toxins might target and damage renal tubular cells, which are a specific type of cell in the kidneys.