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Gangrene is a form of necrosis, which is the death of body tissue due to a lack of blood flow or a bacterial infection. It is characterised by dead skin that appears black and is beginning to rot. Gangrene can affect many parts of the body, including the arms, legs, fingers, toes, muscles, and internal organs. Gas gangrene is a type of gangrene that affects deep muscle tissue and can be caused by bacterial infections through wounds or surgical incisions. This type of gangrene is life-threatening and requires immediate medical attention.
| Characteristics | Values |
|---|---|
| Definition | Muscle necrosis is a potential clinical complication of snakebite envenomings, which in severe cases can lead to functional or physical sequelae such as disability or amputation. |
| Cause | Muscle necrosis is caused by factors external to the cell or tissue, such as infection, injury, trauma, extreme exertion, ischemia, or disease. |
| Types | Focal monophasic reactions, multifocal monophasic reactions, focal polyphasic reactions, multifocal polyphasic reactions, dry gangrene, wet gangrene, gas gangrene, internal gangrene, and necrotizing fasciitis. |
| Symptoms | Swelling, blistering, skin colour change, dryness, coldness, fever, tachycardia, hypotension, shock, foul odour, skin rot, pain, and low-grade fever. |
| Treatment | Antibiotics, oxygen therapy, surgery, operative procedures, endovascular interventions, hyperbaric oxygen therapy, amputation, or maggot therapy. |
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What You'll Learn
- Muscle necrosis is caused by snake venom proteins called myotoxins
- Gas gangrene is caused by bacterial exotoxin-producing clostridial species
- Gangrene is caused by a lack of blood flow or a bacterial infection
- Wet gangrene is a type of liquefactive necrosis with a bacterial infection
- Dry gangrene is a type of coagulative necrosis caused by a lack of blood supply
Muscle necrosis is caused by snake venom proteins called myotoxins
Muscle necrosis is the death of muscle tissue. It can occur due to injuries, infections, diseases, or lack of blood flow to the muscles. Snake bites are often associated with localized soft-tissue necrosis, and in some cases, victims may suffer extensive muscle damage leading to rhabdomyolysis and the loss of muscle-specific protein.
Snake venom proteins with the ability to directly damage skeletal muscle fibers are called myotoxins. Myotoxins are one of the three main types of snake venom proteins, the other two being cytolysins of the "three-finger toxin" protein family and the widespread secreted phospholipase A2 (sPLA2) molecules. Myotoxins induce a similar pattern of degenerative events in muscle cells. Myotoxic PLA2s bind to acceptors in the plasma membrane, which may be lipids or proteins.
The K49 proteins are a type of myotoxin that exerts several toxic activities, including myotoxicity, anticoagulation, and edema formation. The myotoxicity induced by K49 PLA2 proteins is histologically similar to that caused by D49 PLA2 myotoxins, with some muscle fiber types possibly more sensitive than others. The inflammatory events evoked by PLA2s are primarily associated with enzymatic activity and the release of arachidonic acid metabolites. However, catalytically inactive K49 PLA2s trigger inflammatory and nociceptive responses comparable to those of their catalytically active counterparts. This provides evidence that these proteins promote inflammation and pain through mechanisms unrelated to phospholipid hydrolysis or the mobilization of arachidonic acid.
The venom of the Australian taipan snake (Oxyuranus scutellatus) contains a myotoxin called taicatoxin, which specifically blocks L-type Ca2+ channels in selected tissues, including cardiac muscle and chromaffin cells. Another myotoxin, atrotoxin, found in the venom of the rattlesnake Crotalus atrox, prolongs the Ca2+ channel in the open state, causing necrosis and edema at the bitten area, as well as hemorrhage and hypotension. Elapid snake venoms (family Elapidae) induce predominantly neurotoxic envenomings, resulting in neuromuscular paralysis that, if untreated, may lead to respiratory paralysis. Some elapid venoms also induce local necrosis and systemic myotoxicity.
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Gas gangrene is caused by bacterial exotoxin-producing clostridial species
Gas gangrene, also known as myonecrosis, is a highly lethal infection of deep soft tissue caused by bacterial exotoxin-producing Clostridial species. It is characterised by gas in a gangrenous muscle group. The most common cause of gas gangrene is Clostridium perfringens, which produces at least 20 exotoxins. Other common Clostridial species that cause gas gangrene include Clostridium bifermentans, Clostridium septicum, Clostridium sporogenes, Clostridium novyi, Clostridium fallax, Clostridium histolyticum, and Clostridium tertium. Clostridium sordellii can also produce two major toxins: lethal toxin (TcsL) and haemorrhagic toxin (TcsH).
Clostridial species produce more toxins and exhibit higher virulence than any other bacterial taxon. They are true saprophytes and are commonly found in soil and dust. They are also found in the mucous membranes of humans, including the GI tract and the female genital tract. Clostridia may also colonise the skin, especially around the perineum. Clostridia are obligate anaerobes, but some species are relatively aerotolerant. Bacterial multiplication and the production of exotoxins require a low oxygen tension.
The infection typically occurs in immunocompromised patients and those with local tissue hypoxia due to trauma or poor vascular supply. It involves deeper tissue, such as muscle, which can lead to a rapidly spreading infection along tissue planes, and patients often present with sepsis. The typical incubation period for gas gangrene is less than 24 hours, but incubation periods ranging from one hour to six weeks have been reported. The infection causes extensive tissue damage and can result in a build-up of decomposing dead tissue and cell debris.
Gas gangrene gained recognition for its wartime incidence, and during World War I, it complicated 6% of open fractures and 1% of all open wounds. However, with improvements in wound care, antisepsis, and the use of antibiotics, the incidence has decreased significantly. Early intravenous antibiotics, surgical debridement of necrotic tissue, and hyperbaric oxygen therapy are critical for improving survival rates in patients with gas gangrene.
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Gangrene is caused by a lack of blood flow or a bacterial infection
Gangrene is a medical emergency that occurs when blood flow to a specific body part is interrupted, causing the tissue in that area to die. It can develop anywhere in the body but often starts in the foot or hand, commonly affecting the fingers, toes, arms, and legs. It can also occur in muscles and internal organs such as the gallbladder, intestines, or appendix.
Gangrene is caused by a lack of blood flow to the affected area, resulting in tissue death. This can be due to blocked blood vessels or underlying conditions such as diabetes, blood vessel disease, or atherosclerosis, which involves plaque buildup in the arteries. Additionally, traumatic injuries, car accidents, or severe trauma to the skin and tissues can lead to a sudden loss of blood flow, increasing the risk of gangrene.
Gangrene can also be caused by a bacterial infection, either through open wounds that allow bacteria into the body or untreated infections in the affected area. Fournier's gangrene, for example, is a severe bacterial infection affecting the genital area, usually occurring in males. Gas gangrene is another form caused by bacteria called Clostridium perfringens, which gather in wounds with no blood supply and release toxins that produce gas and cause tissue death.
The risk of developing gangrene is higher in individuals with underlying health conditions affecting blood vessels and arteries or those with a weakened immune system. Gangrene is a serious condition that requires prompt treatment to prevent complications or death. Treatment options include antibiotics, oxygen therapy, surgical procedures to restore blood flow and remove dead tissue, and, in severe cases, amputation of the affected body part.
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Wet gangrene is a type of liquefactive necrosis with a bacterial infection
Gangrene is a clinical condition of necrotic tissue, often circumferential around a digit or extremity. It is caused by a lack of blood flow or a bacterial infection. It is identified by discoloured or black tissue and associated sloughing of natural tissue planes. The three main types of gangrene are wet gangrene, dry gangrene, and gas gangrene. Wet gangrene is a type of liquefactive necrosis with a bacterial infection.
Wet gangrene occurs when tissue compromised by poor venous or arterial blood flow becomes infected. This is most commonly seen in areas prone to edema (lower extremities/feet), though it can also be seen in genitourinary and oral tissues. Diabetic patients are more susceptible to these infections due to poor wound healing and hyperglycemia. Wet gangrene may develop after a severe burn, frostbite, or injury. It is often seen in people with diabetes who unknowingly injure a toe or foot.
Wet gangrene is a type of liquefactive necrosis where the death of tissue due to a lack of blood supply occurs simultaneously with a bacterial infection. Liquefactive necrosis is characterized by the digestion of dead cells to form a viscous liquid mass. This is typical of bacterial or, sometimes, fungal infections because of their ability to stimulate an inflammatory response. The necrotic liquid mass is frequently creamy yellow due to the presence of dead leukocytes and is commonly known as pus. Wet gangrene needs to be treated immediately because it spreads quickly and can be deadly.
The diagnosis of wet gangrene is typically made clinically, but if gas or wet gangrene is suspected, Gram stain and wound cultures can help identify the bacterial cause to guide antibiotic therapy. Treatment may involve surgery to remove the dead tissue, antibiotics to treat any infection, and efforts to address the underlying cause. Surgical efforts may include debridement, amputation, or the use of maggot therapy. Efforts to treat the underlying cause may include operative procedures such as bypass surgery or endovascular interventions such as stenting or angioplasty. In certain cases, hyperbaric oxygen therapy may be useful.
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Dry gangrene is a type of coagulative necrosis caused by a lack of blood supply
Gangrene is a clinical condition of ischemic and necrotic tissue, often affecting a digit or extremity. It is identified by discoloured or black tissue and associated sloughing of natural tissue planes. The three main types of gangrene are wet gangrene, dry gangrene, and gas gangrene.
Coagulative necrosis is characterised by the formation of a gelatinous (gel-like) substance in dead tissues. The dead cells remain firm and look normal for days after death. Lack of blood flow or oxygen to any part of the body except the brain can cause coagulative necrosis.
Necrosis is the medical term for the death of body tissue. It is a form of cell injury that results in the premature death of cells in living tissue by autolysis. Necrosis is caused by factors external to the cell or tissue, such as infection, trauma, disease, or extreme environmental conditions. In contrast, apoptosis is a naturally occurring programmed and targeted cause of cellular death. While apoptosis often provides beneficial effects to the organism, necrosis is almost always detrimental and can be fatal.
Gangrene can lead to serious complications if left untreated. Bacteria can spread quickly to other tissues and organs, and amputation may be necessary to save a person's life.
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Frequently asked questions
Necrosis is the medical term for the death of body tissue. It is a form of cell injury that results in the premature death of cells within living tissue. It can be caused by illness, infection, injury, disease, or a lack of blood flow to the tissues.
Gangrene is a condition that occurs when a large area of tissue is affected by necrosis. It is caused by a critically insufficient blood supply or infection. It can affect various types of tissue, including skin and muscle.
The affected area may turn brown, then darken to black or purple. It may also become dry, shrivelled, and cold to the touch. There may be swelling, a foul smell, and fever.
Muscle necrosis can be caused by ischemia, trauma, inherited diseases, inflammatory myopathies, extreme exertion, or snakebite envenomings. It can lead to physical sequelae such as disability or amputation.
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