Analysis index

Muscle tissue (from the margins to necrosis), swabs and puncture specimen from suspicious lesions, especially deeper regions, pus, exudate (pathogen demonstration)

Quickest possible transport in transport medium (anaerobic conditions). Please call at once in case of clinical suspicion of gas gangrene!

Pathogen demonstration: Muscle tissue (from the margins to necrosis), swabs and puncture specimen from suspicious lesions, especially deeper regions, pus, exudate (pathogen demonstration)

Quickest possible transport in transport medium (anaerobic conditions). Please call at once in case of clinical suspicion of gas gangrene!

Clinical suspicion of gas gangrene: Deep, dirty wounds with sudden onset of severe pains, gas development (crepitus); less common: abdominal infections (bowel gangrene) with identical rapid progress and gas development, i.e. after bowel perforations (endogenous infection), as clostridia are normal intestinal bacteria.

Due to the rapid course of the illness, clinical diagnosis is key. To support diagnosis please phone the laboratory prior to sending the sample material. Initially, a microscopy for the detection of thick, gram-positive rods will be carried out as quickly as possible.

Incubation time: 4 – 72 hours

In case of gas gangrene earliest possible extensive cleaning of wound / opening of the wound area and supply of oxygen! Antibiosis with high dosed penicillin G in combination with metronidazole, and tetracycline or clindamycin. Hyperbaric oxygen therapy. In case of unclear findings, i.e. difficult differentiation with cellulitis, necrotizing fasciitis or gas phlegmon (see below), a combination of ciprofloxacin plus clindamycin plus penicillin G can be tried. Interpretation of the detection of clostridium perfringens should always be in connection with the clinical presentation. The actual gas gangrene is rare but lethality high.

Differential diagnosis:

• Gas gangrene: Mono infection, myonecrosis, gas bubbles, hardly any leucocytes, gram-positive plump rods mainly without spores, toxinemia
• Anaerobic cellulitis: Mono- or mixed infection, muscles without pathological changes, numerous leucocytes, gram-positive rods in prefascial connective tissue, no toxinemia
• Gas phlegmon: Aerobic-anaerobic mixed infection or infection with gas-producing aerobe, numerous leucocytes, gram-positive and gram-negative rods and cocci
• Necrotizing fasciitis: Infection by beta-hemolysing group A streptococcus, often in the context of a streptococcus toxic shock syndrome (STSS), gram-positive cocci in chains, spread in the subcutaneous tissue, gas development, reddening of skin, severe pains

Enteritis by clostridium perfringens: Enterotoxin-producing strains of clostridium perfringens are the second-common cause, following staphylococcus aureus, of food poisoning. In this case, symptomatic therapy is usually sufficient, a special antibiotic therapy is not required.