Emergency amputation necessitated within 24 hours by a human bite: a case report

Clostridial Catastrophe in Orthopedics - A Case Report

Introduction

We present a case of a 51-year-old gentleman admitted to the emergency department with a 2-day history of severe left forearm symptoms following a Gustillo-Anderson type II left both bone fracture sustained during a bicycle accident. Initially managed conservatively at an outside facility with an above-elbow backslab, his condition rapidly deteriorated, necessitating transfer to our institution. Adding complexity to his clinical presentation was his history of poorly controlled type 2 diabetes mellitus.

Case Report

On arrival, the patient exhibited fever and pronounced limb abnormalities, including extensive swelling, brownish skin with oozing blisters, and subcutaneous crepitus spanning from wrist to elbow. Radiological imaging unequivocally identified gas within the forearm compartments, signifying a severe infection. A provisional diagnosis of gas gangrene was made, later confirmed by culture report through intraoperative sampling.

Conclusion

Gas gangrene was definitively diagnosed, prompting immediate emergency surgery. Extensive necrosis was discovered during the procedure, necessitating an above-elbow amputation for limb salvage. Unfortunately, postoperatively, the infection continued to advance, extending to the chest and neck regions. Expert consultations in cardiothoracic and general surgery led to further extensive surgical interventions, including complete glenohumeral disarticulation and fasciotomy over chest for surgical emphysema. Microbiological analysis identified Clostridium perfringens, Escherichia coli, and Enterococcus as causative organisms. Aggressive antibiotic therapy, repeated surgical debridement, and meticulous wound management ultimately resulted in a successful recovery. The patient was discharged 20 days after initial presentation, underscoring the critical importance of prompt recognition and multidisciplinary management in severe gas gangrene cases, particularly in patients with underlying medical comorbidities.

A novel detection method for the pathogenic Aeromonas hydrophila expressing aerA gene and/or hlyA gene based on dualplex RAA and CRISPR/Cas12a

Aeromonas hydrophila is an emerging waterborne and foodborne pathogen with pathogenicity to humans and warm water fishes, which severely threatens human health, food safety and aquaculture. A novel method for the rapid, accurate, and sensitive detection of pathogenic A. hydrophila is still needed to reduce the impact on human health and aquaculture. In this work, we developed a rapid, accurate, sensitive, and visual detection method (dRAA-CRISPR/Cas12a), without elaborate instruments, integrating the dualplex recombinase-assisted amplification (dRAA) assay and CRISPR/Cas12a system to detect pathogenic A. hydrophila expressing aerA and/or hlyA virulence genes. The dRAA-CRISPR/Cas12a method has high sensitivity, which can rapidly detect (about 45 min) A. hydrophila with the limit of detection in 2 copies of genomic DNA per reaction, and has high specificity for three pathogenic A. hydrophila strains (aerA⁺hlyA⁻, aerA⁻hlyA⁺, and aerA⁺hlyA⁺). Moreover, dRAA-CRISPR/Cas12a method shows satisfactory practicability in the analysis of the spiked human blood and stool and fish samples. These results demonstrate that our developed pathogenic A. hydrophila detection method, dRAA-CRISPR/Cas12a, is a promising potential method for the early diagnosis of human A. hydrophila infection and on-site detection of A. hydrophila in food and aquaculture.

Necrotizing fasciitis and gas gangrene due to Aeromonas hydrophila in an immunocompetent host: A rare entity

Aeromonas hydrophila, widely distributed in various aquatic environments, is recognized as emerging opportunistic pathogens mainly causing gastrointestinal and wound infections. Necrotizing fasciitis and gas gangrene attributable to A. hydrophila are believed to develop mainly in immunocompromised hosts and have required amputation as a life-saving measure in many of these individuals. The present case re-emphasizes the virulent nature of this organism requiring amputation even in an immunocompetent host and hence, the critical need for early recognition and appropriate targeted therapy, especially after minor traumatic injuries which usually tend to get neglected.