Gangrene pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Edzel Lorraine Co, D.M.D., M.D.
Overview
There are three types of gangrene and they have different pathophysiology. A reduced arterial perfusion is observed in dry gangrene which results in the compensatory arteriolar dilation , which eventually results in distal edema, and damage of the endothelial tissue. [1] Saprogenic microorganisms such as Clostridium perfringens and Bacillus fusiformis are the most common organisms observed in wet gangrene which are responsible for infecting the tissues, thereby producing a putrid smell and edema. [2] Group A Steptococcus and exotoxins from Clostridium perfringens are responsible for the local and systemic infection found in gas gangrene.[3]
Pathophysiology
There are three types of gangrene and they have different pathophysiology.
Dry Gangrene
- A reduced arterial perfusion is observed in dry gangrene which results in the compensatory arteriolar dilation, which eventually results in distal edema, and damage of the endothelial tissue. [1]
- It is a type of coagulative necrosis which occurs in ischemic tissue.
Wet Gangrene
- Saprogenic microorganisms such as Clostridium perfringens and Bacillus fusiformis are the most common organisms observed in wet gangrene. They are responsible for infecting the tissues, thereby producing a putrid smell and edema. [2]
- The pooling and accumulation of blood in the affected tissue promotes proliferation of bacteria.
- An edematous, putrid, soft, and dark tissue is observed.[2]
Gas Gangrene
- Group A Steptococcus and exotoxins from Clostridium perfringens are responsible for the local and systemic infection found in gas gangrene. [3]
- Clostridium perfringens produces a Clostridium- lecithinase called Alpha-toxin that contributes to tissue necrosis and systemic hemolysis.[4][5]
- Rapid progression to shock is usually observed.
References
- ↑ 1.0 1.1 "StatPearls". 2022. PMID 32809387 Check
|pmid=value (help). - ↑ 2.0 2.1 2.2 Al Wahbi A (2018). "Autoamputation of diabetic toe with dry gangrene: a myth or a fact?". Diabetes Metab Syndr Obes. 11: 255–264. doi:10.2147/DMSO.S164199. PMC 5987754. PMID 29910628.
- ↑ 3.0 3.1 Lehner PJ, Powell H (1991). "Gas gangrene". BMJ. 303 (6796): 240–2. doi:10.1136/bmj.303.6796.240. PMC 1670510. PMID 1884064.
- ↑ Yang Z, Hu J, Qu Y, Sun F, Leng X, Li H; et al. (2015). "Interventions for treating gas gangrene". Cochrane Database Syst Rev (12): CD010577. doi:10.1002/14651858.CD010577.pub2. PMC 8652263 Check
|pmc=value (help). PMID 26631369. - ↑ Sakurai J, Nagahama M, Oda M (2004). "Clostridium perfringens alpha-toxin: characterization and mode of action". J Biochem. 136 (5): 569–74. doi:10.1093/jb/mvh161. PMID 15632295.