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Martucci JA, Riemer K. Gas-Producing Infections in the Foot at a Large Academic Medical Center: A 10-Year Retrospective Review. J Foot Ankle Surg 2023; 62:360-364. [PMID: 36270882 DOI: 10.1053/j.jfas.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 09/09/2022] [Accepted: 09/19/2022] [Indexed: 02/03/2023]
Abstract
Gas-producing infections, such as clostridial and nonclostridial gas gangrene, crepitant cellulitis, and necrotizing fasciitis, are characterized in the literature by a variety of initial presentations, microbial burdens and surgical outcomes-ranging from debridement to amputation to death. The primary aim of this study was to identify the organisms cultured in gas-producing infections of the foot in patients that presented to a large academic medical center over a 10-year period. Our secondary aims were to report the prevalence of sepsis in this population upon presentation, and patient outcomes upon discharge. After a retrospective chart review of 207,534 procedures, 70 surgical cases met inclusion criteria. The most common organisms that grew in operating room cultures were Staphylococcus aureus, Group B Beta Streptococcus, and Enterococcus species. Just over half of the population presented with sepsis. After an average of 2 or more operations, 64% of patients underwent amputation. One death occurred. Gas-producing infections, or "gas gangrene," are primarily polymicrobial infections, rarely due to Clostridium perfringens, that warrant surgical exploration for optimal outcomes.
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Affiliation(s)
- John A Martucci
- Former Chief Resident, Podiatric Medicine and Surgery, Division of Podiatric Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Clinical Fellow, Harvard Medical School, Boston, MA.
| | - Kevin Riemer
- Clinical Instructor of Surgery, Harvard Medical School; Associate, Division of Podiatric Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
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Christen SM, Gruenert JG, Winsauer S. Benign subcutaneous emphysema: a rare and challenging entity a case report and review of the literature. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2021; 8:153-157. [PMID: 34621914 PMCID: PMC8491730 DOI: 10.1080/23320885.2021.1984922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report the case of a craftsman who developed a rapidly progressive subcutaneous emphysema of his forearm after a minor stab injury into the palm of his hand. Based on our case report we discuss differential diagnosis and management of acute subcutaneous emphysema.
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Affiliation(s)
- Samuel M Christen
- Department of Hand, Plastic and Reconstructive Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Joerg G Gruenert
- Department of Hand, Plastic and Reconstructive Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Stefan Winsauer
- Department of Hand, Plastic and Reconstructive Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Abstract
Blood serum from immunized humans or animals (e.g., horses) contains relevant antibodies and has been used as serum therapy to treat many diseases or envenomation events. The effectiveness of blood serum was initially discovered in 1890 when Kitasato and von Behring observed the effectiveness of this type of therapy against diphtheria and tetanus. Serum therapies played an important role in the advancement of modern medicine prior to the development of penicillin and steroids. At present, several types of serum therapy remain in clinical use. However, some physicians have a limited understanding of the nature and the benefits of serum therapy and the factors that require particular attention. In this review, we set out to clarify the benefits, cautions, and potential applications of serum therapy in the context of conditions such as gas gangrene, diphtheria, botulism, and tetanus and bites from three snake species (mamushi, habu, and yamakagashi) and the redback spider. It is hoped that this review will help clinicians to learn about clinical serum therapies and become familiar with their applications.
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Iwata H, Sawada R, Mizutani S, Yamanishi Y. Systematic drug repositioning for a wide range of diseases with integrative analyses of phenotypic and molecular data. J Chem Inf Model 2015; 55:446-59. [PMID: 25602292 DOI: 10.1021/ci500670q] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Drug repositioning, or the application of known drugs to new indications, is a challenging issue in pharmaceutical science. In this study, we developed a new computational method to predict unknown drug indications for systematic drug repositioning in a framework of supervised network inference. We defined a descriptor for each drug-disease pair based on the phenotypic features of drugs (e.g., medicinal effects and side effects) and various molecular features of diseases (e.g., disease-causing genes, diagnostic markers, disease-related pathways, and environmental factors) and constructed a statistical model to predict new drug-disease associations for a wide range of diseases in the International Classification of Diseases. Our results show that the proposed method outperforms previous methods in terms of accuracy and applicability, and its performance does not depend on drug chemical structure similarity. Finally, we performed a comprehensive prediction of a drug-disease association network consisting of 2349 drugs and 858 diseases and described biologically meaningful examples of newly predicted drug indications for several types of cancers and nonhereditary diseases.
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Affiliation(s)
- Hiroaki Iwata
- Division of System Cohort, Multi-Scale Research Center for Medical Science, Medical Institute of Bioregulation, Kyushu University , 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka 812-8582, Japan
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Brucato MP, Patel K, Mgbako O. Diagnosis of gas gangrene: does a discrepancy exist between the published data and practice. J Foot Ankle Surg 2013; 53:137-40. [PMID: 24345706 DOI: 10.1053/j.jfas.2013.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Indexed: 02/03/2023]
Abstract
The Infectious Disease Society of America has defined gas gangrene as an infection caused by Clostridium species. However, in many clinical settings, soft tissue infections that produce subcutaneous gas have been diagnosed as gas gangrene without identification of the presence of Clostridium species. Instead, the diagnosis was based on clinical and radiographic findings. A chart review was performed of 25 consecutive patients treated at the Atlantic Health System for infections of the lower extremity that were diagnosed as gas gangrene. Wound cultures from the 25 patients grew 31 different species of bacteria. The most prevalent organism was Staphylococcus aureus, which accounted for 17 of 31 (54.84%) different organisms identified and 19.77% of 86 separate aerobic or anaerobic cultures. The most prevalent genus was Streptococcus, which accounted for 20 (64.52%) of the organisms identified and 23.26% of the cultures. The most prevalent anaerobic genus was Peptostreptococcus, which accounted for 8 (25.81%) of the organisms identified and 9.3% of the cultures. None of the cultures grew Clostridium species. These findings showed that gas-forming soft tissue infections of the lower extremity, commonly diagnosed as gas gangrene, are rarely caused by Clostridium species.
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Affiliation(s)
| | - Krupa Patel
- Foot and Ankle Specialists of New Jersey, Rahway, Westfield, and Union, NJ
| | - Obinna Mgbako
- Foot and Ankle Specialists of New Jersey, Rahway, Westfield, and Union, NJ
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Zalavras CG, Rigopoulos N, Ahlmann E, Patzakis MJ. Hip disarticulation for severe lower extremity infections. Clin Orthop Relat Res 2009; 467:1721-6. [PMID: 19277805 PMCID: PMC2690754 DOI: 10.1007/s11999-009-0769-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Accepted: 02/16/2009] [Indexed: 01/31/2023]
Abstract
UNLABELLED Hip disarticulation is rarely performed for infections and variable mortality rates have been reported. We determined the number of deaths following hip disarticulation for severe lower extremity infections in 15 patients. Indications for hip disarticulation were necrotizing soft tissue infections in seven patients and persistent infections of the proximal thigh in eight patients. The most common microorganism was Staphylococcus aureus, present in eight patients. Hip disarticulation was performed emergently in seven patients and electively in eight patients. All patients survived the operation and at 1 month postoperatively 14 of 15 patients were alive. Hip disarticulation for these severe infections had high survival, even when performed emergently for life-threatening infections. We believe hip disarticulation is a reasonable option treating severe infections of the lower extremity and should be part of the armamentarium of the orthopaedic surgeon. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Charalampos G. Zalavras
- Department of Orthopaedic Surgery, LAC+USC Medical Center, University of Southern California, Keck School of Medicine, 1200 N. State St., GNH-3900, Los Angeles, CA 90033 USA
| | - Nick Rigopoulos
- Department of Orthopaedic Surgery, LAC+USC Medical Center, University of Southern California, Keck School of Medicine, 1200 N. State St., GNH-3900, Los Angeles, CA 90033 USA
| | - Elke Ahlmann
- Department of Orthopaedic Surgery, LAC+USC Medical Center, University of Southern California, Keck School of Medicine, 1200 N. State St., GNH-3900, Los Angeles, CA 90033 USA
| | - Michael J. Patzakis
- Department of Orthopaedic Surgery, LAC+USC Medical Center, University of Southern California, Keck School of Medicine, 1200 N. State St., GNH-3900, Los Angeles, CA 90033 USA
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Ghosh S, Bal AM, Malik I, Collier A. Fatal Morganella morganii bacteraemia in a diabetic patient with gas gangrene. J Med Microbiol 2009; 58:965-967. [PMID: 19502368 DOI: 10.1099/jmm.0.008821-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We report a case of a 60-year-old lady with a history of a heel ulcer that had not responded to antibiotic therapy. This progressed to involve the right leg, which was swollen and erythematous. Radiological imaging revealed the presence of gas within the fascial planes. Blood cultures on admission yielded Morganella morganii. Due to the extent of the gas gangrene and her co-morbidities the patient was not suitable for surgical intervention and was treated conservatively with antibiotics. She deteriorated and died within 72 h of presentation. Non-clostridial gas gangrene is relatively rare, and diagnosis is frequently delayed and often missed. Early aggressive surgical intervention combined with appropriate antibiotic therapy is essential. Bacterial species other than Clostridium should be considered in all cases of gas gangrene.
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Affiliation(s)
- Sujoy Ghosh
- Department of Diabetes and Endocrinology, Ayr Hospital, NHS Ayrshire and Arran, Ayr KA6 6DX, Scotland, UK
| | - Abhijit M Bal
- Department of Medical Microbiology, Ayr Hospital, NHS Ayrshire and Arran, Ayr KA6 6DX, Scotland, UK
| | - Iqbal Malik
- Department of Diabetes and Endocrinology, Ayr Hospital, NHS Ayrshire and Arran, Ayr KA6 6DX, Scotland, UK
| | - Andrew Collier
- Department of Diabetes and Endocrinology, Ayr Hospital, NHS Ayrshire and Arran, Ayr KA6 6DX, Scotland, UK
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Pereira de Godoy JM, Vasconcelos Ribeiro J, Caracanhas LA. Mortality and diabetes mellitus in amputations of the lower limbs for gas gangrene: a case report. INT J LOW EXTR WOUND 2008; 7:239-40. [PMID: 18829608 DOI: 10.1177/1534734608324123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to examine any association between the presence of diabetes in patients with gas gangrene of the legs and mortality following major lower limb amputation. In a retrospective study, patients submitted to amputation of lower limbs for anaerobic infections were evaluated in the period from January 2005 to January 2007 in the University Hospital de Base in Sao Jose do Rio Preto. All the patients were hospitalized for the treatment of ulcerated lesions of the leg. The study sample consisted of 30 men and 10 women aged between 46 and 87 years (mean 69 years) suffering from anaerobic infections. During treatment, the presence of crepitation in the skin was observed as was gas by radiological examination. Amputation was performed within 2 to 6 hours after diagnosis. Diabetes was identified in 33 patients and death occurred within the perioperative period in 12 cases. Diabetes is associated with the necessity of amputation for gas gangrene resulting in a high mortality rate.
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Affiliation(s)
- José Maria Pereira de Godoy
- Cardiology and Cardiovascular Surgery Department, Medical School in São José do Rio Preto, São Paulo, Brazil.
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Tsokos M, Schalinski S, Paulsen F, Sperhake JP, Püschel K, Sobottka I. Pathology of fatal traumatic and nontraumatic clostridial gas gangrene: a histopathological, immunohistochemical, and ultrastructural study of six autopsy cases. Int J Legal Med 2007; 122:35-41. [PMID: 17370083 DOI: 10.1007/s00414-007-0163-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Accepted: 02/20/2007] [Indexed: 10/23/2022]
Abstract
We prospectively investigated six fatal cases of clostridial gas gangrene using autopsy, histology, immunohistochemistry, microbiology, and scanning electron microscopy. The causative pathogen was Clostridium perfringens in four cases, C. sordellii in one case, and a mixed infection with both C. perfringens and C. sordellii in one case. According to the previous medical history and autopsy findings, clostridial infection was related to trauma in three cases. Characterized by extensive tissue necrosis and total absence of an accompanying leukocyte infiltration and tissue inflammatory response, the histopathological picture of clostridial gas gangrene is distinctly different from other bacterial infections. In medicolegal casework, the proof of the source of infection and the portal of entry of the responsible pathogen is not always an easy task, especially in the absence of trauma.
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Affiliation(s)
- Michael Tsokos
- Institute of Legal Medicine and Forensic Sciences, Charité-Universitätsmedizin Berlin, Turmstr. 21 (Haus L), 10559, Berlin, Germany.
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