Clostridial Gas Gangrene Workup

Updated: Jan 18, 2017
  • Author: Shahab Qureshi, MD, FACP; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Workup

Laboratory Studies

The white blood cell count may be normal or elevated. Immature forms are usually increased.

Elevated liver function test results may indicate progressive hepatic dysfunction.

Elevated blood urea nitrogen and creatinine may indicate azotemia, renal insufficiency, or renal failure.

Myonecrosis may elevate serum aldolase, potassium, lactate dehydrogenase, and creatine phosphokinase levels.

Profound anemia may result from severe intravascular hemolysis.

Arterial blood gas determinations and chemistry panel analysis may reveal .

Disseminated intravascular coagulation may result from exotoxin release.

A Gram stain of the wound discharge reveals gram-positive rods and an absence of polymorphonuclear cells. Other organisms are also present in up to 75% of cases. This test is essential for rapid diagnosis.

An assay for sialidases (neuraminidase) produced by clostridia also may be performed on serum and wound discharge. These tests provide rapid (< 2 h) confirmation of Gram stain results.

Most clinical microbiology laboratories use a combination of fermentation reactions and detection of short-chain fatty acid end-products for definitive identification of Clostridium species.

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Imaging Studies

Radiographs reveal fine gas bubbles within the soft tissues, dissecting into the intramuscular fascial planes and muscles. Other necrotizing soft tissue infections produce abundant gas, in contrast to the paucity of gas of clostridial gas gangrene.

Intra-abdominal clostridial gas gangrene is evaluated most readily with CT scanning, which demonstrates extraluminal gas.

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Other Tests

Blood and bullous fluid cultures reveal clostridia but take at least 48 hours to perform. They are not useful because the delay almost certainly results in death.

Although not widely used at present by clinical microbiology laboratories, rapid polymerase chain reaction methods for identification of C perfringens are available. [8]

In the future, methods such as matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry will likely be used for rapid identification of organisms, including Clostridium species. [9, 10, 11, 12]

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Histologic Findings

Histologic analysis reveals necrotic muscle, clostridia, and a minimal inflammatory infiltrate.

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