PDF(Pubmed)
Abstract：
BACKGROUND: Clostridium species are known to be the primary causative organism of gas gangrene. Non-clostridial gas gangrene (NCGG) is another rare necrotizing entity often associated with an underlying disease, particularly diabetes mellitus, and has a high mortality rate.
METHODS: A 16-year-old, immunocompetent male was referred to us after four days, following a roadside accident, with a degloving injury over the thigh and knee along with fractures around the knee. Although clinico-radiologically suspicious of gas gangrene, the initial smear report was negative for any Gram-positive bacilli. On the same day, he underwent aggressive debridement with an external fixator spanning the knee to salvage the limb. On post-operative day one, due to deteriorating general clinical condition and a strong clinical suspicion of gas gangrene, he underwent above-knee amputation (open stump) after discussion with microbiologists and physicians.
RESULTS: Polymicrobial non-clostridial infection was seen in culture reports taken serially at different stages of management. The latest follow-up showed a healed amputation stump following split skin grafting.
CONCLUSIONS: Although rare, polymicrobial infections can present as non-clostridial gas gangrene even in an immunocompetent patient. A high index of clinical suspicion with a multi-disciplinary approach helps in early decision-making to avoid a devastating outcome.
METHODS: A 16-year-old, immunocompetent male was referred to us after four days, following a roadside accident, with a degloving injury over the thigh and knee along with fractures around the knee. Although clinico-radiologically suspicious of gas gangrene, the initial smear report was negative for any Gram-positive bacilli. On the same day, he underwent aggressive debridement with an external fixator spanning the knee to salvage the limb. On post-operative day one, due to deteriorating general clinical condition and a strong clinical suspicion of gas gangrene, he underwent above-knee amputation (open stump) after discussion with microbiologists and physicians.
RESULTS: Polymicrobial non-clostridial infection was seen in culture reports taken serially at different stages of management. The latest follow-up showed a healed amputation stump following split skin grafting.
CONCLUSIONS: Although rare, polymicrobial infections can present as non-clostridial gas gangrene even in an immunocompetent patient. A high index of clinical suspicion with a multi-disciplinary approach helps in early decision-making to avoid a devastating outcome.
摘要：
背景：已知梭状芽孢杆菌是坏疽的主要致病生物。非梭菌坏疽（NCGG）是另一种罕见的坏死性实体，通常与潜在疾病相关。特别是糖尿病，死亡率很高。
方法：16岁，有免疫能力的男性在四天后被转诊给我们，在一次路边事故之后,大腿和膝盖上有脱套伤，膝盖周围有骨折。尽管临床放射学怀疑有气体坏疽，初次涂片报告对革兰氏阳性杆菌均为阴性.在同一天,他用横跨膝盖的外固定器进行了积极的清创术，以挽救肢体。术后第一天,由于总体临床状况恶化和强烈的临床怀疑为气坏疽，在与微生物学家和医生讨论后，他接受了膝盖以上截肢（开放性树桩）。
结果：在不同管理阶段连续采集的培养报告中发现了多微生物非梭菌感染。最新的随访显示，在裂开的皮肤移植后，截肢的残端愈合。
结论：虽然罕见，即使在有免疫能力的患者中，多微生物感染也可以表现为非梭菌气坏疽。多学科方法的高临床怀疑指数有助于早期决策，以避免破坏性结果。
方法：16岁，有免疫能力的男性在四天后被转诊给我们，在一次路边事故之后,大腿和膝盖上有脱套伤，膝盖周围有骨折。尽管临床放射学怀疑有气体坏疽，初次涂片报告对革兰氏阳性杆菌均为阴性.在同一天,他用横跨膝盖的外固定器进行了积极的清创术，以挽救肢体。术后第一天,由于总体临床状况恶化和强烈的临床怀疑为气坏疽，在与微生物学家和医生讨论后，他接受了膝盖以上截肢（开放性树桩）。
结果：在不同管理阶段连续采集的培养报告中发现了多微生物非梭菌感染。最新的随访显示，在裂开的皮肤移植后，截肢的残端愈合。
结论：虽然罕见，即使在有免疫能力的患者中，多微生物感染也可以表现为非梭菌气坏疽。多学科方法的高临床怀疑指数有助于早期决策，以避免破坏性结果。
