ACUTE ANAEROBIC NONSPECIFIC AND SPECIFIC INFECTION

Anaerobic an infection is various illnesses which, as a rule, come up in a wound, attributable to microbes which develop throughout anaerobic situations. The standard options of this an infection: weak inflammatory response, tissue hypostasis, lifeless tissue, formation of gasoline in tissue, important intoxication.

Extra usually this an infection is a complication of battle wounds. In the midst of its historical past it had totally different interpretations, described in literature as “hospital gangrene”, “gasoline gangrene,” “malignant hypostasis”, “bronze mallow”, “blue gangrene”, and so on.

In regards to the scientific image of open fractures Hyppocrates gave the outline of a deadly complication with sturdy hypostasis of tissue and jaundice and, as a rule, with deadly consequence.

Describing the loss of life of prince Romadanovsky in a letter to Alexander Menshikov, his son represented this complication as follows: “Yesterday prince Romadanovsky died from print illness. Anton’s hearth appeared on the leg. Huge fever was upon the entire physique and the leg started to swell, the swelling nearly reached the moon inside two days”. Dupuytren (1815), Velpeau (1844), Pyrogov (1848) described this illness in particulars within the XIX century.

In 1835 Mezanov allotted this illness into an unbiased sickness and named it a lightning gangrene. It’s recognized that anaerobic infections is extra usually noticed in the course of the warfare. In keeping with Terebinsky’s knowledge in the course of the World Battle I the gasoline an infection affected 7– 8% of the wounded. Within the English military right now, about 1,115 amputations have been executed. Within the Russian military, there are 200,000 of individuals suffered from this an infection, in keeping with Burdenko’s knowledge. Through the Nice Patriotic Battle — 0.2–0.3% of the wounded had gasoline an infection. Within the peace time this complication can be noticed however a lot much less usually.

Sources of the causative agent of anaerobic infections are the intestines of mammals and folks, microbes excrete into the atmosphere, find within the higher layers of floor and might seem with the air pollution of the wound. Various situations are needed for his or her growth, to begin with oxygen-free house, shaped throughout “blind” wounds, lacerations, and in addition the presence of glycogen; due to this anaerobic an infection seems extra usually with harm to muscular tissues. It’s recognized that 90% of wounds include anaerobic brokers. Nevertheless, with the absence of situations for his or her progress scientific indicators usually are not noticed.

Immediately it’s thought-about that brokers of anaerobic an infection are micro organism of the genus Clostridium, so-called clostridium anaerobic infections. Representatives of the genus Clostridium, harmful and pathogenetic for persons are the next: Cl. Perfringens (varieties A, B, C, and so on.), Cl. Edematiens (varieties A, B, C, and so on.), Cl. Septicum, Cl. Hystoliticum.

Every sort of an agent of anaerobic infections has qualitative and structural options, and in addition has a sure motion on an individual’s organism.

Cl. Perfringens are noticed extra usually, inflicting gasoline formation. The agent’s toxins have proteolytic, haemolytic, glycogenolytic motion. The pathoanatomical image seems as necrosis of tissue, particularly muscular, porosis of vessels and expressive interstitial hypostasis of the connective tissue, oppression of pink blood progress.

Immediately the next classifications are used:

1. After the pace of spreading:

lightning;

acute.

2. After the pathoanatomical image:

emphysemic;

hydropic;

phlegmonous;

necrotic;

combined.

3. After the depth of the method:

epifascial;

subfascial.

From the second of getting into the wound to the scientific shows of anaerobic infections, as a rule, a number of hours or 1–2 days as much as 7 days move.

The incidence of varied has a variety. The hydropic kind is noticed in 37.7%, combined types — in 29.2%, emphysemic types — in 19.7%, the necrotic kind — in 9.3% of the circumstances,  phlegmonous — in 7.1%.

Extra usually the anaerobic an infection is attributable to harm to the muscular tissues of the extremities. In due time, M. I. Pyrogov described the event of this an infection: “the broken half with none attributes of response dies inside first 24–28 h after the harm. The pores and skin is flushed, gases rapidly develop, a rattle throughout palpation. The wounded weakens, and generally doesn’t complain of ache, he’s pale with a yellowish shade, anxious, cloudy eyes, chilly sweat, small, quivering, frequent pulse and hiccups, which reveals that loss of life is shut”.

Immediately within the scientific image of anaerobic an infection native indicators are distinguished — rising bursting ache within the wound, edema, which spreads upwards on the legs. First the pores and skin is pale, after which it will get a dark-purple. The wound is dry; insignificant secretion, disagreeable odour, pronounced necrosis of the muscular tissues (shade of cooked meat), a crunch of the tissue in locations the place gasoline (crepitation) has gathered is decided throughout palpation. The final image seems as paleness, accentuation of options of the face, frequent pulse (120–140 beats per minute), excessive temperature. Arterial strain decreases. Sufferers are euphoric. Lower in haemoglobin and erythrocytes is noticed; diuresis decreases.

Many scientific physicians describe a attribute particular putrefactive odour which spreads via the air. Victor Hugo describes his go to to Onore Balzac. It’s recognized that O. Balzac suffered from hydrops: having wounded his leg with a desk, he felt aid, as a result of from the wound numerous tissue liquid flew out. Nevertheless, later anaerobic an infection developed within the wound. Having visited the affected person, Victor Hugo described his situation: “I known as, a home maid appeared and lead me to the living-room, we got here to Balzac’s bed room. I heard ominous loud night breathing. An insupportable odour got here from the mattress. I lifted the blanket and took Balzac’s hand. It was moist from sweat. He didn’t reply my handshake. Once I arrived dwelling, I discovered just a few males and advised them: Sirs, Europe is now shedding a genius”.

Apart from of the scientific image, the prognosis is predicated on radiological examination, which reveals the presence of gasoline within the tissue. Extra usually bacteriological strategies are used.

Smear-prints, generally inoculation of wound excretion on the Package—Taroci medium is used, and in addition hyaluronidase and lecithinase are decided within the wound excretion. Nevertheless, all of the strategies of prognosis lag behind scientific shows by the hour issue, that’s the reason within the clinic therapy is began when anaerobic an infection within the wound is suspected, with out ready for laboratory affirmation.

Aggression of clostridium toxins has been investigated in particulars by workers of the college of microbiology of our college. The important contribution was made by the works of prof. S. N. Minevrina, A. V. Tselukha, and so on. It’s proved that aggression of clostridium toxins will increase in the course of the mixture of a number of sorts of brokers each anaerobic and cardio. That’s the reason it’s essential to not permit the event of purulent course of within the wound.

Remedy of anaerobic an infection contains some parts. It’s particular remedy. Antigangrenous serums, containing 30,000 IU (10,000 IU in opposition to Cl. Perfringens, Cl. Edematiens and Cl. Septicum) are utilized. The dose — 30,000 IU is utilized for preventive measures, throughout therapy 10–15 preventive doses are used. Serum is entered intravenously. Just lately it’s thought-about that quite a few problems of serotherapy make it inexpedient to enter antigangrenous serum. Nevertheless, being based mostly upon expertise of the clinic, we contemplate this concept to be inaccurate. The applying of hyperbaric oxygenation is efficient. Periods of hyperbaric oxygenation are carried out 2–4 instances a day with the strain of two.5–3.0 atm. It’s needed to use additionally antibiotics (penicillin group) and to mix them with tetracyclin and erythromycin.

Surgical therapy consists of duly surgical processing of the wound with the opening of blind pockets, removing of lifeless tissues, washing of the wound with hydrogen peroxide, kalium permanganate, boric acid. Sufferers ought to be remoted in case of the event of anaerobic an infection. The fabric which is utilized for dressings, is burnt, the wound is extensively opened (incisions). Extra usually amputation of the extremities is carried out. With anaerobic an infection, the amputation is finished within the “guillotine” kind, i.e. don’t kind a stump and don’t sew up the wound. It’s essential to actively perform nonspecific remedy which consists within the strategies of detoxing and stimulations of the parenchymatous organs perform. They transfuse blood, blood substitutes, stimulate diuresis, perform vitamin remedy, and apply cardiac medication.

Sadly, trendy complicated remedy not all the time offers optimistic outcomes, and right now the speed ranges from 20 as much as 30%.

Final years, on account of M. I. Kuzin’s and B. M. Kostyuchenko’s works, microbiologists established that anaerobic an infection is prompted not solely by clostridia but in addition by a complete group of non-clostridium anaerobes: gram-negative bacilli of the bacteroid household and fusobacteria, gram-positive cocci of the peptococcum and peptostreptococcus household, gram-positive asporous bacilli.

Underneath typical situations these brokers are within the oral cavity, intestines. For a very long time they may not be launched, as a result of after they collide with air they rapidly perish. In clinic non-clostridium pathogenic organisms continuously complicate the wound course of and trigger various illnesses: phlegmons of the subcutaneous fats with harm foci, the tissues across the wound are saturated with serousbloody brownish liquid with an disagreeable odour. The method spreads extra deeply, damaging muscular tissues in opposition to a background of toxemia, rising edema and disintegration of muscular tissues. It will increase due to native thrombogenesis of fantastic vessels, inflammatory response is insignificant.

Prognosis is tough, nevertheless, lately due to gas-liquid chromatography it’s potential to seek out crotonic, oil, valerian and different fatty acids, within the surrounding tissue which kind throughout anaerobic infections and are absent throughout purulent. Remedy of anaerobic non-clostridium an infection contains surgical interventions similar to broad incisions (eradicating) necrotic tissue, antibiotics utilization: lincomycin, siptomisin, metronidazole, and so on. It’s needed to hold out detoxing. Sadly, lethality price is excessive throughout this an infection and ranges inside 16–60%.

ACUTE SPECIFIC ANAEROBIC INFECTION

Tetanus, anthrax, wound diphtheria and rabies belong to anaerobic an infection.

Tetanus is noticed extra usually in surgical follow. The illness was described in historical instances. Tetanus was recognized nonetheless by historical hindus. It was described by Hyppocrates, who misplaced his son due to tetanus, and solely in 1884 Monastirsky and Nicolaer discovered its causative brokers.

The agent of tetanus is revealed in warfare situations, however in peace time additionally it is noticed. Through the Nice Patriotic Battle tetanus was marked in 6–7 circumstances in 10,000 wounded. M. І. Pyrogov thought-about that in the course of the Crimean and Caucasian wars (1854–1858) the tetanus incidence ranges from 0.3 as much as 0.6%.

The brokers of tetanus — Cl. tetani — as saprophyte is within the intestines of animals (sheep, horned cattle) and folks. When excrements enter the bottom, it may be saved for a very long time within the surrounding atmosphere. With mud it will get to the pores and skin, after which to the wound. It doesn’t require particular situations and might develop beneath the blood crust from 4 days to 4–5 months.

Cl. tetani intensively divides and releases exotoxin, which accommodates tetanospasmin and tetanohemolysin. The toxin will get into the central nervous system via the perineural areas, damaging the anterior gray substance of the spinal wire, causes tonic and clonic muscle spasms. Tetanohemolysin destroys erythrocytes.

In keeping with the place of the an infection getting into totally different sorts of tetanus are distinguished:

— wound;

— burn;

— postinfection;

— postoperative; — postnatal, and so on.

In keeping with the character of spreading and localization:

— native tetanus

— generalized tetanus.

In keeping with the scientific course:

— acute tetanus;

— power tetanus;

— imprecise tetanus.

The scientific image of tetanus seems as basic weak point, rise within the physique temperature, unsure pains, after which convulsive muscular contraction follows on the wound website or outdated scars. Additional there’s harm to the chewing muscular tissues — masticatory spasm and mimic muscular tissues as a smile — “sardonic smile”, convulsive contractions spreads to muscular tissues which encompass the wound, after which to muscular tissues of the entire thorax — the affected person is curved as an arch, on occasion leaning on the mattress by the heals and occiput (opistotonus). The frequency of the convulsive assaults will increase. The method spreads to the respiratory muscular tissues, asphyxia happens, throughout this the muscular tissues can rupture, bones can fracture, atelectasis of the lungs can happen.

Remedy of sufferers with tetanus is carried out in specialised resuscitation division and accommodates the next measures: centralization of the tetanus toxin, elimination of spasms, lung air flow, as effectively strengthening and symptomatic remedy. The affected person is given intravenous or intralumbar antitetanic serum within the dose of 100,000–150,000 IU every day, in addition to muscle relaxants. Synthetic lung air flow is carried out by the strategy of tracheotomy or tracheostomy. Introduction of large amount of liquids — nutritional vitamins, parenteral diet are carried out.

Thus, surgeons throughout therapy of tetanus are consulting physicians, however they’re liable for preventive measures of this illness.

Preventive measures of tetanus could also be elective and emergency.

Elective preventive measures start at an early age with the observance of sure phrases. Immunization of kids is carried out with adsorbed diphtheria, tetanus toxoids and pertussis vaccine, and immunization of adults — tetanus anatoxin. Immunization is began at 6–7 months of age and continues until 15 years. Elective preventive measures for adults are carried out throughout excavations and for service males.

Emergency preventive measures are carried out with the infringement of the pores and skin, burns and frostbites, abortions and operations on the big intestines. Emergency preventive measures include the introduction of tetanus anatoxin 1.0 ml, 3,000 AO antitetanic serum. They enter by the scheme. Nonspecific preventive measures of tetanus are main surgical processing of wounds.

Anthrax is an acute particular pathology. It belongs to particularly harmful infections due to excessive contageousness. The illness is attributable to the anthrax bacillum which is able to forming spores. It is rather immune to situations of hostile atmosphere. It may be saved for many years within the floor. Supply: animals — sheep, cattle. Earlier this sickness was named sickness of furriers as a result of an individual may catch it from animal pores and skin and in addition by consuming their meat.

Remedy is carried out by doctors-infectionists. Nevertheless, it’s needed to recollect this illness as a result of in clinic it may possibly seem as a furuncule, and in addition harm the intestines and lungs, stimulate tumoural course of. Malignant carbuncle locates on open surfaces of the physique; the main focus is black, pronounce oedema, weak ache syndrome, however the prime is surrounded with two strains of fantastic blisters stuffed with an amber shade liquid. Any operative interventions are not possible. Remedy is carried out with particular serums and antibiotics.

Diphtheria. There will be diagnostic errors with acute illness for diphtheria. The pathogenic organism — the Löffler bacillus — can develop within the wound, thus, its toxin leads to important morphofunctional modifications within the cardiac muscle, cortex of the adrenal glands, kidneys. With therapy no antiseptics, apart from particular serum, work. That’s the reason it is very important do not forget that wound diphtheria presents within the wound gray movies, soldered with surrounding tissues. When making an attempt to take away them there are dot bleedings. Thus, in the course of the therapy of tetanus, diphtheria of wounds and sibirea surgeons usually are not the main docs, however for the introduction of preventive measures for tetanus and figuring out differential prognosis of sibirea and diphtheria surgeons have to have corresponding information.

Rabies. Surgeons are liable for preventive measures of yet another illness — rabies. It’s attributable to virus on account of a chew from a wild animal or pets with rabies. The illness is related to break to the CNS by the rabies virus. In clinic basic intoxication prevails, the affected person can not swallow, settle for meals and water on account of pharyngospasm, the event of spasms and paralyses is noticed. The prognosis is hostile, lethality reaches 100%.

Prophylaxis consists in gamma-globulin and antirabic vaccine in keeping with particular schemes.