This is part of our House MD Project series.
Click here to read the connection to the episode (spoiler alert!)
On episode 9 of season 2, called “Deception”, A woman named Anica has a seizure and arrives at the hospital. She also has a bruise on her stomach. She has had Cushing’s syndrome in the past, caused because she was faking it (she has Munchausen syndrome – a condition in which people fake diseases to get attention). After House smells a fruity smell in her bed, he arrives at the conclusion that she has an infection with a bacteria called clostridium perfringens, that used her stomach bruises as a safe house in which to grow.
Danger level: High
What is it?
Gas gangrene is a life-threatening infection of muscle. It’s usually caused by a germ called clostridium perfringens.
Who gets it?
In the US, about 3000 of these infections occur each year. Estimates are that outside the US it is more common.
What causes it?
Gas gangrene is an infection of the muscle caused by a germ named clostridium perfringens (although it may be caused by other bacteria as well).
It usually occurs at the site of an injury in the body, or in a surgical wound. Clostridium perfringens is a type of bacteria that belongs to the anaerobic type, which means it lives best when the level of oxygen is low. This makes deep wounds, in which there isn’t much oxygen, an excellent area for them to grow and prosper.
Clostridium perfringens. These guys cause all the trouble.
The bacteria then produce toxins. These eventually cause the death of the tissue (hence the name gangrene = tissue death). As a result of the toxins gas is produced, and it becomes trapped in the infected tissue.
The time between the infection and the symptoms is very short, since these bacteria grow very fast. The average time is less than 24 hours.
As a result of this process, tissue destruction occurs rapidly – muscle and fat in the area are destroyed, and blood vessels get clogged. The whole process affects the whole body pretty fast, causing destruction of blood cells, possible kidney failure, and then shock. Eventually, death can occur if the condition isn’t treated.
How does it feel?
The infected area will be very painful. At the beginning it may be swollen and pale, but it then turns red, then bronze, and then a blackish green. Large blisters also appear in the area.
Gas bubbles may be felt under the skin, as a result of the gas produced by the bacteria.
As mentioned above, without treatment death can occur pretty fast, usually within 48 hours.
Behind this link is an image showing a leg with gas gangrene. Please be warned – the image is very graphic. (photo by Engelbert Schröpfer, Stephan Rauthe and Thomas Meyer).
How is it discovered?
Usually a doctor suspects the condition just by seeing the patient and the infected area. X-rays can be used to confirm the suspicion, as well as CT or MRI images. The images will show gas inside the muscle tissue.
To make sure this is gas gangrene, though, fluids from the wound have to be examined under a microscope to show the bacteria there (like in the picture above). Most times, when the condition is suspected, there isn’t much time for that, and sometimes the diagnosis is done in surgery.
How is it treated?
When gas gangrene is suspected, high doses of antibiotics are immediately given.
Then a procedure called debridement is performed, in which all dead and infected tissue is removed surgically. About 1/5 of people with the infection in a limb will have to undergo amputation.
What happens after treatment?
Even with treatment, about 1/8 of people with an infected limb, and about 2/3 of those with infection in the torso will die.
The bottom line – How do I prevent this?
Any skin injury should be cleaned thoroughly. If you see any signs of infection (such as redness, pain, drainage, or swelling around a wound) consult your health care provider promptly.