Gas gangrene diagnosed from culture of tissue

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A 65-year-old man with type 2 diabetes of 23 years' duration and chronic ischaemia developed four necrotic toes following an episode of infection which was treated in hospital with intravenous antibiotics. Vascular intervention was not feasible and the toes were treated conservatively, with treatment consisting of pain control with liberal analgesia, oedema control with diuretics, infection control with oral antibiotics, and wound control with

Fig. 6.17 (a) The proximal portion of this necrotic ulcer was wet and discharging pus. (b) The same ulcer 2 weeks later after debridement of wet necrosis, (c) 10 weeks after the first debridement the toe is healing well.

Fig. 6.17 (a) The proximal portion of this necrotic ulcer was wet and discharging pus. (b) The same ulcer 2 weeks later after debridement of wet necrosis, (c) 10 weeks after the first debridement the toe is healing well.

Fig. 6.18 Clostridium perfringens. A tissue sample was sent for culture from the necrotic area at the base of the 3rd toe.

regular debridement along the demarcation line between necrosis and viable tissue.

After 8 weeks (Fig. 6.18), a tissue sample was sent for culture and grew Clostridium perfringens from tissue and not from the swab. We recalled the patient to clinic: he had an X-ray which revealed gas in the tissues. He was admitted, underwent surgical debridement and was given benzylpenicillin 1.2 g qds intravenously. He was discharged after 1 week. Over the next 8 months the gangrene auto-amputated and the foot healed.

Key points

Diabetic patients with necrosis in the foot require close follow-up in the diabetic foot clinic and intense surveillance to detect infection

• Without regular microbiological investigations this serious infection would not have been diagnosed early

• Clostridium perfringens is best treated by high-dose intravenous penicillin.

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Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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