Gas Gangrene

What is gas gangrene?

Gas gangrene, also called clostridial myonecrosis, is a bacterial infection that destroys your tissues. It’s usually caused by Clostridium bacteria (most commonly, C. perfringens).

Clostridium bacteria release toxins that destroy blood cells, blood vessels and muscle tissue. This causes severe blisters, swelling and skin discoloration. The bacteria create gas that makes wounds smell bad when they open. The toxins also cause widespread inflammation.

Gas gangrene can be life-threatening within hours of symptoms starting.

How common is gas gangrene?

Gas gangrene is rare. Less than 1 in 100,000 people in the U.S. are diagnosed with it every year. Gas gangrene was common on the battlefields during the American Civil War and WWI, before modern methods for cleaning wounds and killing germs.

What’s the difference between gas gangrene and necrotizing fasciitis?

Gas gangrene and necrotizing fasciitis have similar symptoms and causes. They both destroy tissue and can be fatal. The main difference between them is in the types of tissue they typically affect. Necrotizing fasciitis destroys the fat under your skin and the connective tissues that support your body (fascia). Gas gangrene infects and destroys your blood cells, blood vessels and muscle tissue.

The same bacteria can cause both of them, but gas gangrene is usually caused by Clostridium and necrotizing fasciitis is usually caused by group A Streptococcus or Staphylococcus Aureus.

What are the symptoms of gas gangrene?

Gas gangrene causes discoloration, large blisters and swelling on your skin where you have a wound. It can also cause other symptoms, including:

• Pain near your injury. This might be severe, even if your wound doesn’t look serious.
• Fever.
• Fast heart rate (tachycardia).
• Sweating.
• Anxiety.
• Yellow skin (jaundice).
• Light-headedness.
• Low blood pressure (hypotension).

What does gas gangrene look like?

Gas gangrene destroys your skin and muscle. It leaves large areas of dead tissue and inflammation. The bacteria reproduce so fast that you might see changes in your skin over just minutes or hours. In the area of an injury, you might experience:

• Swelling.
• Skin discoloration. It might be pale, dark red or purplish.
• Large bubbles or blisters that are red, brown, dark green or black.
• Air pockets under your skin or in the fluid inside blisters.
• Foul-smelling fluid draining from blisters.
• A crackling feeling or sound when you touch the blisters (crepitus).

What does gas gangrene smell like?

Fluids draining from gas gangrene blisters is often described as foul, putrid or sickly sweet.

What causes gas gangrene?

The bacterium Clostridium perfringens causes most cases of gas gangrene. Other species (types) of Clostridium and group A Streptococcus bacteria can also cause it.

These bacteria live in dirt and in the intestines (GI tract) of people and animals. They release toxins that destroy your cells, including your blood cells, blood vessels and muscle tissue.

They reproduce best in areas with little oxygen. Destroying your blood cells means that less oxygen gets to your tissues. That makes it easier for them to keep reproducing and creating toxins, spreading the damage very quickly. Breaking down nutrients without oxygen (fermentation) is also what causes the pockets of gas.

How do you get gas gangrene?

The most common way to get gas gangrene is through a severe injury that goes deep into your body. These wounds are tougher to clean completely. They also aren’t exposed to oxygen in the air, which kills C. perfringens bacteria. An injury is at further risk for gas gangrene if:

• It goes into your muscle.
• It’s contaminated with dirt or debris.
• You can’t clean it out quickly after getting injured.

Traumatic injuries like this can happen as a result of car or motorcycle accidents (for instance, “road rash”). Gunshot and stab wounds are other examples of traumatic injuries.

Less common causes of gas gangrene include:

• Colon, gallbladder and other abdominal surgeries.
• Gynecological surgeries or procedures.
• Tumors or other conditions that can damage your GI tract (intestines).
• Childbirth.
• Miscarriage.
• Complications of diabetes or other conditions that reduce blood flow to your tissues. The lack of oxygen makes it easier for the bacteria that cause gas gangrene to grow.

What are the risk factors for gas gangrene?

Severe injuries and abdominal surgeries put you at higher risk for traumatic gas gangrene. You’re at higher risk for spontaneous gas gangrene — not caused by an injury — if you have certain underlying conditions, including:

• Colon cancer.
• Diverticulitis, which can damage your colon.
• Diabetes.
• Blood vessel disease, such as atherosclerosis.

Keep in mind that, even if you have one of these risk factors, it’s still extremely unlikely that you’ll ever be affected by gas gangrene.

What are the complications of gas gangrene?

Gas gangrene can quickly lead to life-threatening complications, including:

• Renal failure. Bacteria rapidly destroying your red blood cells can cause your kidneys (organs that filter your blood) to fail.
• Sepsis and septic shock. Clostridium bacteria cause an extreme immune system reaction. This leads to inflammation in your entire body. It can cause your blood pressure to drop dramatically (shock) and your organs to fail.

How is gas gangrene diagnosed?

A provider diagnoses gas gangrene based on your symptoms and the look of any wounds you have. They’ll confirm a diagnosis by looking at tissue or fluids from your wounds under a microscope. They might order imaging tests, such as X-rays, CT scans or MRIs to check for tissue damage.

What tests will be done to diagnose gas gangrene?

A provider may order or perform the following tests to confirm a gas gangrene diagnosis or to decide on treatment:

• Imaging. X-rays, CT scans or MRIs can show gas bubbles or changes in your muscle tissue.
• Bacterial staining or culture. A provider takes fluid from your wound and looks at it under a microscope for the types of bacteria that cause gas gangrene. They may also try to grow (culture) the bacteria.
• Biopsy. A provider takes a sample of the tissue from your wound to look for damage or changes.

How is gas gangrene treated?

Gas gangrene must be treated immediately. Your provider will give you high doses of antibiotics and surgically remove as much of the infected tissue as possible. You may need other treatments depending on the severity of your infection. You’ll need to stay in the hospital to be monitored throughout your treatment.

Medications and procedures used to treat gas gangrene

Your provider may treat you with the following medications or procedures:

• Debridement. A provider will surgically remove dead and damaged tissue or debris from your wound.
• Antibiotics. Providers often use a combination of penicillin and clindamycin to kill the bacteria causing the gas gangrene.
• Amputation. In some cases, the best way to prevent further damage and life-threatening illness is to remove the infected limb. About 1 in 5 people with gas gangrene need an amputation.
• Hyperbaric oxygen therapy. Hyperbaric oxygen therapy can help gas gangrene heal. A provider puts you in a special chamber that delivers 100% oxygen (about five times more than room air). This increases the amount of oxygen getting to your tissues, helping them to heal. It can also slow down the infection, since oxygen kills Clostridium bacteria.

Can gas gangrene be prevented?

Healthcare providers take precautions to prevent any infections during surgery and other procedures. This includes the bacterial infections that cause gas gangrene. Ways for you to reduce your risk of gas gangrene and other bacterial infections include:

• Clean out wounds with soap and water.
• Get medical attention immediately for any deep wounds. This includes wounds you’re unable to clean completely by washing with soap and water.
• Keep an eye on injuries. Let a provider know if you see changes in your skin or experience severe pain.
• Wear protective gear that covers your arms and legs when riding a motorcycle or bicycle.
• Work with a provider to treat underlying conditions that affect your blood vessels or circulation, or that weaken your immune system.

What can I expect if I have gas gangrene?

Gas gangrene is a life-threatening emergency. You can expect to stay in the hospital while providers treat you. There, providers will:

• Regularly treat and clean your wounds.
• Give you IV antibiotics.
• Monitor you closely for changes in your condition.
• Give you additional treatments and procedures depending on your specific case.

What’s the outlook for gas gangrene?

The outlook for gas gangrene depends on what caused it and where on your body it’s doing damage. People who have gas gangrene in their extremities (arms, legs, hands or feet) have a better prognosis (outlook) than those who have an infection in their abdomen or chest, or those with spontaneous gas gangrene.

Can you survive gas gangrene?

You can survive gas gangrene if you get treatment quickly. Between 20% and 30% of gas gangrene cases are fatal with treatment. Without treatment, gas gangrene is always fatal.

When should I see my healthcare provider?

See a healthcare provider if you have an injury that penetrates into your body. Deep wounds need to be cleaned right away and may need to be closed with stitches. A provider may prescribe antibiotics to prevent infection.

When should I go to the ER?

Go to the nearest emergency room if you have symptoms of gas gangrene, especially if you’ve recently had a deep injury or surgery. It can be fatal if not treated quickly.

What questions should I ask my doctor?

It might be helpful to ask your provider:

• How serious is my condition?
• What caused the infection?
• What treatments are available?

A note from Cleveland Clinic

Gas gangrene is a rare but life-threatening infection. It’s treatable if caught early. But it can get worse quickly — within minutes to hours of you noticing symptoms. Don’t wait to seek medical attention if you think you could have gas gangrene.