Types of anaerobic intestinal infection. Anaerobic infection

“5” (excellent) – absence of errors in the technique of performing the manipulation and a complete, detailed justification of the sequence of its implementation

“4” (good) – no more than 2 minor errors were made in the technique of performing the manipulation. Provides a complete, detailed justification for the sequence of its implementation. Mistakes made do not lead to complications and do not threaten the vital functions of the patient’s body.

“3” (satisfactory) – When performing the manipulation technique, more than 2 minor errors were made (violation of technique), which could lead to complications. The student eliminates them with the help of the teacher

“2” (unsatisfactory) – When performing the manipulation technique, gross (more than 2) errors were made. The student cannot correct them with the help of the teacher.

GENERAL ISSUES OF SURGICAL INFECTION, OSTEOMYELITIS. GENERAL PURULENT INFECTION

Surgical infections include diseases caused by the introduction of pyogenic microbes into the body, accompanied by purulent-inflammatory and purulent-necrotic processes in organs and tissues that require surgical treatment. The development of purulent-inflammatory diseases depends on 3 reasons: 1. On the state of the macroorganism (the body's defenses, immunity); 2. From virulence, i.e. the body’s ability to cause purulent-inflammatory diseases; 3. From timely preventive measures (asepsis and antiseptics), the absence of entry points for infection.

The main causative agents of purulent surgical infection are staphylococci, streptococci, Pseudomonas aeruginosa, various types of Proteus and Escherichia coli. Microbes that enter the body cause purulent inflammation, which has local and general manifestations: local symptoms of inflammation - swelling or dense formation - infiltration, redness, local increase in body temperature, pain and dysfunction of the affected organ. The main component in the source of inflammation is pus, the components of which are leukocytes, destroyed tissue and bacteria. With a staphylococcal infection, the pus is yellow, thick, odorless, with a staphylococcal infection it is liquid, mucous-looking, and light in color. Pseudomonas aeruginosa gives various shades - from bluish to greenish with a sweetish odor. E. coli is brown pus with a fecal odor.

General symptoms:

1. The general reaction is clinically manifested by an increase in body temperature, which depends on the general reactivity, on the other hand, on the severity of the manifestation of purulent inflammation.

2. General intoxication: weakness, headache, chills, increased heart rate.

3. In blood tests: leukocytosis (increased band forms) and neutrophils, with a shift of blood to the left, a decrease in red blood cells, accelerated ESR. Urine analysis shows protein.

Principles of treatment: 1. Local treatment: 1. Creation of functional rest of the affected area. 2. Opening the abscess. 3.Drainage of the wound. 4.Rinse the wound with antiseptic solutions and apply a hypertonic bandage to the wound. After the appearance of granulations, apply ointment dressings.

General treatment: 1. Antibiotic therapy and chemotherapy. 2. Infusion therapy and detoxification therapy (hemodez, neocompensan, polyvinylpyrramidone, etc.)

3. Stimulation of immunity (gemostimulin, vitamin B 12, ATP, vitreous, aloe, antistaphylococcal gamma globulin, leukocyte mass, thymosin, T-activin, levomisol, decaris 1 tablet per day for 3 days, thymalin in/ m 5-10 mg for 5-10 days, ultraviolet irradiation of blood.

SPECIFIC TYPES OF LOCAL PURULENT DISEASES:

FURUNCLE is an acute purulent-necrotic inflammation of the hair follicle and surrounding tissue. Localization: back of the neck, forearm, back of the hand, buttocks, face, etc. Pathogen: staphylococcus. Furuncle, purple in color, painful, cone-shaped nodule with tissue infiltration around it. At the apex there is an area of ​​purulent necrosis (size from 0.5 -1.5-2). Furunculosis is the appearance of several boils simultaneously or sequentially. Treatment: outpatient in the initial stages, the skin around the boil is treated with alcohol, ether, 2% salicylic alcohol. Dry heat, UHF, UV irradiation, novocaine blockades with 0.25% solution around the lesion and under it. General treatment - vitamin therapy, autovaccine, autohemotherapy, physiotherapy, ultraviolet radiation.

CARBUNCLE is an acute purulent-necrotic inflammation of several hair follicles and adjacent sebaceous glands, spreading throughout the entire thickness of the skin and underlying tissues. The inflammatory process spreads to the lymphatic vessels and nodes. Necrotic rods within 3-5 days are combined into a single purulent-necrotic conglomerate, which is rejected. A wound is formed, which granulates and scars within 3-4 weeks. General symptoms of intoxication: fever, chills,

HYDRADENITIS- this is a purulent inflammation of the apocrine sweat glands. The infection penetrates through the excretory ducts of the sweat glands (armpits, inguinal folds, mammary glands, perianally). Clinic: the appearance of a dense, painful, cone-shaped formation of a reddish, purple color, 1-3 cm in size. An abscess appears on the 2-3rd day - melting of the sweat glands. Treatment: local - bandages with levomikol. In case of abscess - opening. Antibiotic therapy, sulfonamides, immunotherapy.

ABSCESS- this is a limited form of purulent inflammation, which is characterized by the formation of a cavity filled with pus. (Pathogens - staphylococcus, streptococcus, E. coli, etc.) Causes - complications of a boil, carbuncle, wound, microtrauma, foreign bodies, after injections, hematoma infection. Metastatic abscesses, with a general purulent infection, enter organs and tissues through the blood. Abscesses may be not specific purulent, putrefactive, specific and anaerobic. Diagnostics - during a diagnostic puncture, air can be injected through the needle - pneumoabscessography or a radiopaque substance - radiopaque abscessography. Treatment is surgery, opening the abscess. Antibiotic therapy.

PHLEGMON- this is an acute, unlimited, diffuse inflammation of the cellular spaces. M.b. phlegmon is superficial (epifascial), deep (subfascial), often putrefactive and anaerobic flora. The clinical picture shows an acute onset of local and general inflammation. With a superficial location. sharply increasing pain, swelling, hyperemia, increased body temperature, chills with sweat, impaired function of the affected area. On palpation – infiltrate, + sm “fluctuations”. Treatment is surgery under general anesthesia, opening of cavities, drainage. Antibiotic therapy, sulfonamides, infusion therapy.

erysipelas– is an acute serous-purulent inflammation of the skin and mucous membranes (pathogen is streptococcus). Entrance gate - violation of the integrity of the skin, contact path of transmission through tools, material, hands; The infection occurs secondarily if there is a streptococcal infection. Localization - on the lower extremities, face, torso, scalp. There are 4 forms of erysipelas: 1. erythematous, 2. bullous, 3. necrotic, 4. phlegmonous. Clinic: general symptoms of intoxication: increased temperature to 38-40, nausea, vomiting, confusion, rapid pulse, against this background, sharply limited redness of the skin appears in the form of “tongues of flame” with swollen edges. Regional lymph nodes are enlarged, painful, stripes of hyperemic nodes (lymphangitis) are often visible - erythematous form. Bullous f-ma - blisters appear filled with serous, serous-hemorrhagic exudate. Necrotic - areas of necrosis are noted against the background of changed skin. Phlegmonous - (pyogenic flora is attached to streptococcus), an unlimited form of purulent inflammation of the skin and subcutaneous tissue. Treatment: inpatient, local treatment of the skin 2-3 times with antiseptic solutions (96% ethyl alcohol + 20% ammonia 2:1). IV antibiotics. For phlegmonous disease - opening of abscesses, for necrotic - excision of areas of dead skin - necrectomy, antiseptic ointment dressings with 10% hypertonic sodium chloride solution, levomikol.

ERYZYPELOID- this is an erysipelas-like disease caused by the pig's erysipelas, affecting the skin of the fingers and, less often, parts of the hand (contingent - butchers, cooks, housewives, tanners), the infection penetrates through the skin, microtraumas. Clinic – serous inflammation of all layers of the skin with swelling and redness. The incubation period is from 2-5 days. Skin itching, hyperemia from one finger spreads to neighboring areas, the phenomenon of lymphadenitis and lymphangitis is noted. T-ra is normal. Treatment: a/b (penicillin 250 thousand units - 4-5 times), novocaine blockade 0.25% novocaine solution, ultraviolet irradiation.

FELON- purulent inflammation of the fingers (with an abrasion, injection, scratch, splinter). The structural features of the skin and subcutaneous tissue of the fingers, which have a large number of connective tissue partitions, determine the specificity. 1. Cutaneous panaritium - an accumulation of pus under the epidermis, easily displaced by pressure, moderate pain. Treatment: the exfoliated epidermis is cut off with scissors. Apply an ointment bandage with antibiotics to the wound. 2. Subcutaneous panaritium - increased pain as a result of compression of the nerve endings. Treatment: initially conservative, warm baths, alcohol compresses, novocaine blockades. The operation is performed under local anesthesia according to Oberst-Lukashevich, on both sides at the base of the finger with a pre-applied tourniquet, anesthetize with 1% 10 ml novocaine solution (or IV anesthesia - barbiturates), two parallel incisions are made along the edge of the phalanx. For better drainage of pus, the incisions are connected and drainage is installed.3. Subungual panaritium - the cause is trauma to the periungual bed, manicure. Clinic: pain, pus under the nail plate. Surgery: the nail and ointment bandage are removed under anesthesia. 4. Paranychia is an abscess under the root of the nail. Clinic: pain, swelling, hyperemia of the skin at the base of the nail. Operation - two parallel incisions are made at the base of the nail on the rear of the terminal phalanx along the edges of the periungual ridge, separated and pulled back. 5. Tendon panaritium (purulent tendovaginitis), a complication of other forms, in case of wounds. The finger is bent, thickened, pain when moving, intoxication. Pus accumulates in the tendon synovial sheaths, from where it breaks into the soft tissues, forming deep phlegmons of the hand and forearm.

Treatment: surgery for tendon felons of 2-4 fingers, two parallel incisions are made on the lateral surface of the main and middle phalanges, drainage. For fingers 1-5, incisions are made on the palmar surface in the area of ​​the eminence. Immobilization with a dorsal plaster splint: the hands are placed in a semi-flexed position. Antibiotics. 6. Bone felon - primarily when the infection penetrates deep under the periosteum, secondary - advanced subcutaneous felon. Necrosis of the bone area - sequestrum - occurs. Clinic - severe pain, purulent fistulas, necrosis of the entire phalanx of the finger. The sequestra are separated within 8-10 days. Treatment: under anesthesia, a wide lateral or arcuate incision is made in the soft tissue to the bone. The sequesters are removed, the wound is washed with H2O2, drainage, and a tampon with Vishnevsky ointment. Immobilization of the finger and hand with a plaster splint. In case of necrosis, amputation of fingers. 7. Articular panaritium - half-bent position of the finger, pain in the joint, pathological mobility, as a result of destruction of the ligaments and joint capsule. Treatment: open with two lateral incisions, washed with solutions of antiseptics, antibiotics, immobilization with a plaster cast. Disability due to impairment of the function of 1 finger.

Thrombophlebitis- acute inflammation of the vein wall with the formation of a thrombus (blood clot) in its lumen. The reasons are a violation of the integrity of the inner lining of the vein, a slowdown in blood flow, and an increase in blood clotting. Clinic: thrombophlebitis of the superficial veins of the lower extremities, the cause is varicose veins of the lower extremities. acute onset, the appearance of intense pain, hyperemia along the veins, sharply painful cords under the skin. Swelling of the limb, difficulty moving, increased body temperature. With purulent thrombophlebitis, we see general intoxication, dense infiltrate along the vein, suppuration, abscesses, phlegmon. Deep vein thrombophlebitis is a serious disease, sudden severe pain, swelling of the entire limb. A complication is embolism (blockage) of the pulmonary arteries, which can lead to death. Septic thrombophlebitis and sepsis are dangerous. Treatment: conservative - a/b and anti-inflammatory therapy, hospitalization.

OSTEOMYELITIS- purulent inflammation of the bone marrow, usually spreads to the compact, spongy bone and periosteum. The causative agents are pyogenic microbes (Staphylococcus aureus 80%). There are 2 ways of spread: 1. The infection enters the bone through damaged skin and mucous membranes (exogenous route); 2. The infection is introduced into the bone through the bloodstream from another purulent source (endogenous path); Predisposing moment, a decrease in the general defenses of the body, injury, local and general cooling, vitamin deficiencies, infections. The tubular bones and metaphysis are affected. Once the infection enters the bone, it causes inflammation of the bone marrow, with the development of serous and then purulent exudate. The dead area of ​​the bone is called a sequestrum, a foreign body; a demarcation shaft is formed around the sequestrum; it separates living tissue from dead tissue. Pus breaks into the soft tissues (purulent leaks) outward, forming purulent fistulas. Sequesters also support the existence of the fistula. Gradually, the granulation tissue around the sequestrum is replaced by bone and the sequester is delimited. Fistulas can close, and during exacerbation they open again (the disease becomes a chronic process). Clinic: sudden onset, increased body temperature, pain in the affected limb. the condition worsens, breathing becomes more frequent, tachycardia 100-120 beats. per minute The pain is bursting and intensifies with palpation, active or passive movement. Swelling of soft tissues appears, lymph nodes are enlarged, skin hyperemia and local increase in body temperature. The appearance of edema of the limb indicates the formation of a subperiosteal abscess. There is hyperemia and fluctuation in the center. When the pus breaks through, the condition improves. M.b. purulent metastases.

Changes in the bone are observed on the radiograph after 2-3 weeks. hospitalization and treatment in a hospital: transportation with immobilization of the limb and administration of analgesics. Operation: opening of subperiosteal abscesses with bone trepanation.

SEPSIS– a severe pathological condition, CTR is caused by a variety of microorganisms and their toxins (0.1% - 0.15%). Reason – pathogenic, opportunistic bacteria: staphylococcus, streptococcus, Pseudomonas aeruginosa, Escherichia coli, Proteus vulgaris, anaerobes, etc. development mechanism (3 factors): 1. Microbial (monoinfection, polyinfection, mixed, virulence; 2. Type of input gate (the nature of the destroyed tissues, the size of the purulent focus, its location, the state of the blood circulation); 3. The reactivity of the body (the state of the immune system);

Classification of sepsis: 1. According to the type of pathogen - staphylococcal, streptococcal, coli-bacillary, non-clostridial, clostridial, mixed; 2. According to the location of the entrance gate of infection - surgical, urological, gynecological, otogenic, etc.; 3. Based on the presence or absence of a visible focus of infection - primary (cryptogenic - sepsis, with CTP the primary focus of purulent inflammation cannot be recognized for reasons), secondary; 4. By the presence or absence of purulent metastases - septicemia, septicopyemia; 5. According to the clinical picture – fulminant, acute, subacute, chronic.

Clinic: septicemia is characterized by a sharp deterioration of the condition, chills, T-ra 40-41C; hemodynamic dis-vatachycardia, rapid Ps, drop in blood pressure, muffled heart sounds, Ps - soft, not counted, rapid breathing 25-30 per minute, cyanosis, acrocyanosis. On the part of the nervous system – excitement, inhibition, hallucinations, anxiety. The skin and sclera are jaundiced, there are rashes on the skin (vasculitis). the spleen is enlarged, painful on palpation, subcutaneous hemorrhages, temperature in the terminal state decreases to normal, pulse is 120-140 beats. per minute (“scissors effect”, there are discrepancies between temperature and pulse, then this is a bad prognostic sign). Sepsis lasts 1-2 days and has a high mortality rate. Septicopyemia is characterized by an acute and subacute course: bacteriemia, purulent metastases, high temperature of the body, with periodic remission (during the day the temperature drops within 2-4 C, when measuring temperature every 2 hours - a remitting type curve ). The duration of the course is from several weeks to several months. Symptoms of intoxication, pain in muscles, joints, headaches, tachycardia, pulse rate corresponds to the temperature. UAC - anemia, leukocytosis (15.0 - 25.0 x 10 9 / l, shift to the left, rods, accelerated ESR. OAM - anuria, decreased amount of urine, protein, renal epithelium, cylinders. The spleen is enlarged, rashes on the skin The skin and mucous membranes are jaundiced. Metastases to the liver, kidneys, lungs, brain - death (subacute - 2-3 weeks, chronic - months). , kidneys, brain (cerebral coma). Renal and liver failure develops, with impaired thrombus formation and intravascular coagulation (hyper- and hypocoagulation). Treatment: in intensive care and intensive care. Treatment principles: 1. Active surgical treatment of primary and secondary purulent foci. ; 2. General intensive care: antibiotics, detoxification therapy, immunocorrection, specific immunization, correction of blood clotting, maintenance of cardiovascular system, respiration, liver, kidneys.

ACUTE ANAEROBIC SURGICAL INFECTION. GAS GANGRENE.

Anaerobes are microorganisms that can reproduce in the absence of oxygen.

Gas gangrene- pathogens Cljstridium perfringens, Cl. Septicus, Cl. Oedematiens, Cl. Histolyticum. Gas gangrene develops with extensive crushed tissues (gunshot, lacerations, lacerations and bruises), contaminated with earth; the more tissue is destroyed (especially muscles), the more favorable the conditions. Clinical features depend on the type of bacteria: Clostridium perfringens - toxic-hemolytic, fibrinolytic, necrotic effect. Clostridium septicum causes bloody-serous swelling of tissues and hemolysis of red blood cells. Clostridium oedematiens - rapidly growing edema with the release of large amounts of gas. Clostridium hystoliticum - dissolves living tissue, melts muscles, connective tissue.

Local symptoms of gas gangrene are swelling, the presence of gas in the tissues, muscle breakdown and the absence of symptoms characteristic of inflammation.

General symptoms: incubation period (2-3 days), tachycardia, low blood pressure, patient agitation, talkativeness, depressed mood, insomnia. Temperature - 38-39C, intoxication, dehydration, rapid breathing, R-120-140 beats per minute, in the blood - hemolysis of erythrocytes, anemia, hemoglobin - 70-100 g/l, erythrocytes - 1-1.5x10 12 / l, leukocytosis-15-20x10 9 /l, shift of the leukocyte formula to the left, p/i and juvenile forms, in the urine - oliguria, anuria, hematuria. If treatment is not started within 2-3 days, death occurs.

Prevention: primary surgical treatment of the wound - excision of non-viable tissue under anesthesia and local anesthesia.

Treatment: surgical-PHO: non-viable tissue is excised using wide parallel (lamp-shaped) incisions, fascia and soft tissue are dissected to the full depth, the wounds are drained and left open. Antibiotics are injected into the wound. Hyperbaric oxygenation (3 atm) is prescribed, the patient is placed in a chamber with high atmospheric pressure: on the 1st day - 3 times for 2-2.5 hours, then once a day. If gangrene spreads, then amputation or disarticulation of the limb. Intensive infusion therapy is prescribed: albumin, plasma, electrolytes, proteins, transfusion of freshly prepared whole blood, red blood cells. Antigangrenous serum is prescribed (if the pathogen is identified, monovalent, if the pathogen is not identified, polyvalent) intravenously at a dose of 150 thousand AE (active units). The whey is dissolved in an isotonic sodium chloride solution and heated to 36-37C. Care for patients: patients must be isolated, linen, instruments are processed in a dry-heat oven at T-150C, in a steam sterilizer - 2 atm. Dressings are done with gloves, the dressing material is burned.

TETANUS- an acute specific anaerobic infection caused by the introduction into the body of a virulent tetanus bacillus (Clostridium tetani). The rod is common in nature, on the surface of the body (spores), soil, in street dust, clothing, soil, in the intestines of humans and animals. Entrance gate – mouth, foreign bodies. The causative agents of tetanus produce toxins that are characterized by a neurotropic effect and act on the central nervous system, causing convulsive contractions of striated muscles.

Clinic: the incubation period is from 2 days to 3 weeks or more. Headache, sweating, increased body temperature, photophobia, then tension and rigidity of the masticatory muscles (trismus) quickly appear, which does not allow opening the mouth, and involuntary convulsive contraction of the facial muscles “sardonic smile”. The occipital muscles, back and abdominal wall are also involved in the process, clonic convulsions of all skeletal muscles appear. The attacks are accompanied by severe pain. Light, sound, and mechanical irritations lead to an attack of convulsions. The patient's head is thrown back, the spine is bent anteriorly, the patient rests on the back of his head and on his heels (opisthotonus). The abdominal wall muscles are tense. Consciousness is completely preserved, the duration of the attack is 1-2 minutes (in severe conditions, the attack is repeated after 30 minutes - 1 hour). The transfer of spasms to the muscles of the larynx creates a threat of suffocation; spasms of the intercostal muscles are dangerous, which makes it difficult to exhale. The spread of spasms to the diaphragm leads to respiratory arrest. Severe attacks. lead to rib fractures and muscle tears.

Prevention- wound treatment, immunization (passive): administration of antitoxic serum. All patients with damage are given Bezredko 3000 AU (active units) of antitetanus serum. Before administering the entire dose, an intradermal test of 1:100 serum is placed in the forearm area and the patient is observed for 20 minutes. In case of a “negative” reaction, undiluted serum is administered subcutaneously in an amount of 0.1 ml; if there is no reaction, the entire dose of serum is administered after 30 min-1 hour. For active immunization, tetanus toxoid is used subcutaneously (1 ml; after 3 weeks - 1.5 ml; after another 3 weeks - 1.5 ml of toxoid). Early immunized persons who have the appropriate certificate are administered 0.5 ml of toxoid. The serum must be administered separately from the toxoid.

Treatment. It is necessary to administer large doses of anti-tetanus serum - 100-150 thousand AE for adults, 20-80 thousand AE for older children; to neutralize toxins it is administered intramuscularly, intravenously, into the spinal canal.

At the same time, active immunization is carried out: 2-3 hours before the start of the serum infusion, 2 ml of toxoid is injected under the skin. A week later, the administration of toxoid is repeated. Toxoid is administered 3 times (every week) at a dose of 4 ml. The patients are in the intensive care unit. Sound, light, and mechanical stimuli are excluded. Muscle rigidity and convulsive attacks are relieved by the introduction of substances that reduce the excitability of the nervous system: 10 ml of 20% magnesium sulfate solution, sleeping pills, bromides; IV drip preparations of barbituric acid: sodium thiopental, hexenal, pentothal; muscle relaxants.

Anaerobic infection is a pathology caused by bacteria that can grow and multiply in the complete absence of oxygen or its low voltage. Their toxins are highly penetrating and are considered extremely aggressive. This group of infectious diseases includes severe forms of pathologies, characterized by damage to vital organs and a high mortality rate. In patients, manifestations of intoxication syndrome usually prevail over local clinical signs. This pathology is characterized by predominant damage to connective tissue and muscle fibers.

Anaerobic infection is characterized by a high rate of development of the pathological process, severe intoxication syndrome, putrid, foul-smelling exudate, gas formation in the wound, rapid necrotic tissue damage, and mild inflammatory signs. Anaerobic wound infection is a complication of injuries - wounds of hollow organs, burns, frostbite, gunshot, contaminated, crushed wounds.

Anaerobic infection in origin can be community-acquired and; by etiology – traumatic, spontaneous, iatrogenic; by prevalence - local, regional, generalized; by localization - with damage to the central nervous system, soft tissues, skin, bones and joints, blood, internal organs; along the flow - lightning, acute and subacute. According to the species composition of the pathogen, it is divided into monobacterial, polybacterial and mixed.

Anaerobic infection in surgery develops within 30 days after surgery. This pathology is hospital-acquired and significantly increases the patient’s time in hospital. Anaerobic infection attracts the attention of doctors of various specialties due to the fact that it is characterized by a severe course, high mortality and disability of patients.

Reasons

The causative agents of anaerobic infection are inhabitants of the normal microflora of various biocenoses of the human body: skin, gastrointestinal tract, genitourinary system. These bacteria are opportunistic due to their virulent properties. Under the influence of negative exogenous and endogenous factors, their uncontrolled reproduction begins, bacteria become pathogenic and cause the development of diseases.

Factors causing disturbances in the composition of normal microflora:

1. Prematurity, intrauterine infection,
2. Microbial pathologies of organs and tissues,
3. Long-term antibiotic, chemotherapy and hormonal therapy,
4. Radiation, taking immunosuppressants,
5. Long-term hospital stays of various profiles,
6. Prolonged stay of a person in a confined space.

Anaerobic microorganisms live in the external environment: in the soil, at the bottom of reservoirs. Their main characteristic is lack of oxygen tolerance due to insufficiency of enzyme systems.

All anaerobic microbes are divided into two large groups:

Pathogenicity factors of anaerobes:

1. Enzymes enhance the virulent properties of anaerobes and destroy muscle and connective tissue fibers. They cause severe microcirculation disorders, increase vascular permeability, destroy red blood cells, promote microthrombosis and the development of vasculitis with generalization of the process. Enzymes produced by bacteroids have a cytotoxic effect, which leads to tissue destruction and the spread of infection.
2. Exotoxins and endotoxins damage the vascular wall, cause hemolysis of red blood cells and trigger the process of thrombus formation. They have nephrotropic, neurotropic, dermatonecrotizing, cardiotropic effects, disrupt the integrity of epithelial cell membranes, which leads to their death. Clostridia secrete a toxin, under the influence of which exudate is formed in the tissues, the muscles swell and die, become pale and contain a lot of gas.
3. Adhesins promote bacterial attachment to the endothelium and its damage.
4. The anaerobic capsule enhances the virulent properties of microbes.

Exogenous anaerobic infection occurs in the form of clostridial enteritis, post-traumatic cellulite and myonecrosis. These pathologies develop after the penetration of the pathogen from the external environment as a result of injury, insect bites, or criminal abortion. Endogenous infection develops as a result of the migration of anaerobes within the body: from their places of permanent residence to foreign loci. This is facilitated by operations, traumatic injuries, therapeutic and diagnostic procedures, and injections.

Conditions and factors that provoke the development of anaerobic infection:

• Contamination of the wound with soil, excrement,
• Creation of an anaerobic atmosphere by necrotic tissues deep in the wound,
• Foreign bodies in the wound,
• Violation of the integrity of the skin and mucous membranes,
• Penetration of bacteria into the bloodstream,
• Ischemia and tissue necrosis,
• Occlusive vascular diseases,
• Systemic diseases
• Endocrinopathies,
• Oncology,
• Great blood loss
• Cachexia,
• Neuropsychic stress,
• Long-term hormone therapy and chemotherapy,
• Immunodeficiency,
• Irrational antibiotic therapy.

Symptoms

Morphological forms of clostridial infection:

Non-clostridial anaerobic infection causes purulent inflammation of internal organs, the brain, often with abscess formation of soft tissues and the development of sepsis.

Anaerobic infection begins suddenly. In patients, symptoms of general intoxication prevail over local inflammation. Their health deteriorates sharply until local symptoms appear, the wounds become black in color.

The incubation period lasts about three days. Patients feel feverish and chills, they experience severe weakness and weakness, dyspepsia, lethargy, drowsiness, apathy, blood pressure drops, heart rate increases, and the nasolabial triangle turns blue. Gradually, lethargy gives way to excitement, restlessness, and confusion. Their breathing and heart rate increase. The condition of the gastrointestinal tract also changes: patients' tongue is dry, coated, they experience thirst and dry mouth. The skin of the face turns pale, acquires an earthy tint, and the eyes become sunken. The so-called “mask of Hippocrates” – “fades Hippocratica” - appears. Patients become inhibited or sharply agitated, apathetic, and depressed. They cease to navigate space and their own feelings.

Local symptoms of pathology:

• Severe, unbearable, increasing pain of a bursting nature, not relieved by analgesics.
• Swelling of the tissues of the limb progresses quickly and is manifested by sensations of fullness and distension of the limb.
• Gas in affected tissues can be detected using palpation, percussion and other diagnostic techniques. Emphysema, soft tissue crepitus, tympanitis, slight crackling, box sound are signs of gas gangrene.
• The distal parts of the lower extremities become inactive and practically insensitive.
• Purulent-necrotic inflammation develops rapidly and even malignantly. If left untreated, soft tissues are quickly destroyed, which makes the prognosis of the pathology unfavorable.

Diagnostics

Diagnostic measures for anaerobic infection:

• Microscopy of smears from wounds or wound discharge makes it possible to determine long polymorphic gram-positive “rough” rods and the abundance of coccal microflora. Bacteriods are polymorphic, small gram-negative rods with bipolar coloring, mobile and immobile, do not form spores, strict anaerobes.
• In the microbiological laboratory they carry out bacteriological examination of wound discharge, pieces of affected tissue, blood, urine, liquor. The biomaterial is delivered to the laboratory, where it is inoculated on special nutrient media. The dishes with the crops are placed in an anaerostat, and then in a thermostat and incubated at a temperature of +37 C. In liquid nutrient media, microbes grow with rapid gas formation and acidification of the environment. On blood agar, colonies are surrounded by a zone of hemolysis, and in air they acquire a greenish color. Microbiologists count the number of morphologically different colonies and, after isolating a pure culture, study the biochemical properties. If the smear contains gram+ cocci, check for the presence of catalase. When gas bubbles are released, the sample is considered positive. On Wilso-Blair medium, clostridia grow in the form of black colonies in the depths of the medium, spherical or lenticular in shape. Their total number is counted and their belonging to clostridia is confirmed. If microorganisms with characteristic morphological signs are detected in the smear, a conclusion is made. Bacteriodes grow on nutrient media in the form of small, flat, opaque, grayish-white colonies with jagged edges. Their primary colonies are not reseeded, since even short-term exposure to oxygen leads to their death. When bacteriodes grow on nutrient media, a disgusting smell attracts attention.
• Express diagnostics – study of pathological material in ultraviolet light.
• If bacteremia is suspected, the blood is inoculated onto nutrient media (Thioglycolate, Sabouraud) and incubated for 10 days, periodically inoculating the biomaterial onto blood agar.
• Enzyme immunoassay and PCR help to establish a diagnosis in a relatively short time.

Treatment

Treatment of anaerobic infection is complex, including surgical treatment of the wound, conservative and physical therapy.

During surgical treatment, the wound is widely dissected, non-viable and crushed tissue is excised, foreign bodies are removed, and then the resulting cavity is treated and drained. The wounds are loosely packed with gauze swabs with a solution of potassium permanganate or hydrogen peroxide. The operation is performed under general anesthesia. When decompressing edematous, deeply located tissues, a wide fasciotomy is performed. If an anaerobic surgical infection develops against the background of a limb fracture, it is immobilized with a plaster splint. Extensive tissue destruction can lead to amputation or disarticulation of the limb.

Conservative therapy:

Physiotherapeutic treatment consists of treating wounds with ultrasound and laser, conducting ozone therapy, hyperbaric oxygenation, and extracorporeal hemocorrection.

Currently, specific prevention of anaerobic infection has not been developed. The prognosis of the pathology depends on the form of the infectious process, the state of the macroorganism, the timeliness and correctness of diagnosis and treatment. The prognosis is cautious, but most often favorable. Without treatment, the outcome of the disease is disappointing.

Anaerobic infection is one of the types of wound infection and is one of the most severe complications of injuries: compartment syndrome, frostbite, wounds, burns, etc. The causative agents of anaerobic infection are gram-negative bacteria (anaerobic gram-negative bacilli, AGOB), living in conditions of severely limited or completely absent oxygen access. The toxins released by anaerobic bacteria are very aggressive, highly penetrating and affect vital organs.

Regardless of the localization of the pathological process, anaerobic infection is initially considered as generalized. In addition to surgeons and traumatologists, doctors of various specialties encounter anaerobic infection in clinical practice: gynecologists, pediatricians, dentists, pulmonologists and many others. According to statistics, anaerobes are found in 30% of cases of the formation of purulent foci, but the exact proportion of complications caused by the development of anaerobes has not been determined.

Causes of anaerobic infection

Anaerobic bacteria are considered opportunistic and are part of the normal microflora of the mucous membranes, digestive and genitourinary systems and skin. Under conditions that provoke their uncontrolled reproduction, an endogenous anaerobic infection develops. Anaerobic bacteria that live in decomposing organic matter and soil, when introduced into open wounds, cause exogenous anaerobic infection.

With respect to oxygen, anaerobic bacteria are divided into facultative, microaerophilic and obligate. Facultative anaerobes can develop both under normal conditions and in the absence of oxygen. This group includes staphylococci, E. coli, streptococci, Shigella and a number of others. Microaerophilic bacteria are an intermediate link between aerobic and anaerobic; oxygen is necessary for their life, but in small quantities.

Among obligate anaerobes, clostridial and non-clostridial microorganisms are distinguished. Clostridial infections are exogenous (external). These are botulism, gas gangrene, tetanus, food poisoning. Representatives of non-clostridial anaerobes are causative agents of endogenous purulent-inflammatory processes, such as peritonitis, abscesses, sepsis, phlegmon, etc.

The development of anaerobic infection is facilitated by tissue damage that allows the pathogen to enter the body, a state of immunodeficiency, massive bleeding, necrotic processes, ischemia, and some chronic diseases. Invasive manipulations (tooth extraction, biopsy, etc.) and surgical interventions pose a potential danger. Anaerobic infections can develop due to contamination of wounds with soil or the entry of other foreign bodies into the wound, against the background of traumatic and hypovolemic shock, irrational antibiotic therapy, which suppresses the development of normal microflora.

Characteristics (species), pathogens

Strictly speaking, anaerobic infections include pathological processes caused by the vital activity of obligate anaerobes and microaerophilic organisms. The mechanisms of development of lesions caused by facultative anaerobes are somewhat different from typically anaerobic ones, but both types of infectious processes are clinically very similar.

Among the most common pathogens of anaerobic infection are;

• clostridia;
• propionibacteria;
• bifidobacteria;
• peptococci;
• peptostreptococci;
• sarcins;
• bacteroides;
• fusobacteria.

In the vast majority of anaerobic infectious processes occur with the joint participation of anaerobic and aerobic bacteria, primarily enterobacteria, streptococci and staphylococci.

The most complete classification of anaerobic infections, optimally suitable for use in clinical practice, was developed by A. P. Kolesov.

According to microbial etiology, clostridial and non-clostridial infectious processes are distinguished. Non-clostridial ones, in turn, are divided into peptococcal, fusobacterial, bifidobacterial, etc.

Based on the source of infection, anaerobic infections are divided into endogenous and exogenous.

According to the species composition, infectious agents are divided into monobacterial, polybacterial and mixed. Monobacterial infections are quite rare; in the vast majority of cases, a polybacterial or mixed pathological process develops. Mixed infections are defined as infections caused by an association of anaerobic and aerobic bacteria.

Based on the location of the lesions, infections of bones, soft tissues, serous cavities, bloodstream, and internal organs are distinguished.

Based on the prevalence of the process, the following are distinguished:

• local (limited, local);
• regional (unlimited, prone to distribution);
• generalized or systemic.

Depending on the origin, the infection may be community-acquired or hospital-acquired.

Due to the occurrence of anaerobic infections, spontaneous, traumatic and iatrogenic infections are distinguished.

Symptoms and signs

Anaerobic infections of various origins have a number of common clinical signs. They are characterized by an acute onset accompanied by an increase in local and general symptoms. Anaerobic infections can develop within several hours, the average incubation period is 3 days.

In anaerobic infections, the symptom of general intoxication is characterized by a predominance of symptoms over the manifestations of the inflammatory process at the site of infection. Deterioration of the patient's condition due to developing endotoxemia often occurs before visible signs of the local inflammatory process appear. Symptoms of endotoxicosis include:

• headache;
• general weakness;
• inhibition of reactions;
• nausea;
• tachycardia;
• fever;
• chills;
• rapid breathing;
• cyanosis of the extremities;
• hemolytic anemia.

Early local symptoms of wound anaerobic infection:

• bursting severe pain;
• soft tissue crepitus;
• emphysema.

The pain that accompanies the development of anaerobic infection is not relieved by analgesics, including narcotics. The patient's body temperature rises sharply, the pulse quickens to 100-120 beats per minute.

Liquid purulent or hemorrhagic exudate emerges from the wound, heterogeneously colored, with gas bubbles and fatty inclusions. The smell is putrid, indicating the formation of methane, nitrogen and hydrogen. The wound contains gray-brown or gray-green tissue. As intoxication develops, disorders of the central nervous system occur, including coma, and blood pressure decreases. Against the background of anaerobic infection, the development of severe sepsis, multiple organ failure, and infectious-toxic shock, leading to death, is possible.

Non-clostridial pathological processes are indicated by the release of brown pus and diffuse tissue necrosis.

Clostridial and non-clostridial anaerobic infections can occur in fulminant, acute or subacute form. Fulminant development is said to occur if the infection develops within the first 24 hours after surgery or injury; An infectious process that develops within 4 days is called acute; the development of the subacute process is delayed by more than 4 days.

Diagnostics

The peculiarities of the development of anaerobic infections often leave doctors no choice but to diagnose the pathology based on clinical data. The diagnosis is supported by a foul odor, tissue necrosis, as well as the localization of the infectious focus. It should be noted that with subacute development of the infection, the smell does not appear immediately. Gas accumulates in the affected tissues. The ineffectiveness of a number of antibiotics indirectly confirms the diagnosis.

The sample for bacteriological examination must be taken directly from the source of infection. It is important to exclude contact of the taken material with air.

Biological materials obtained by puncture (blood, urine, cerebrospinal fluid) and tissue fragments obtained by puncture conicotomy are suitable for identifying anaerobes. The material intended for research must be delivered to the laboratory as quickly as possible, since obligate anaerobes die when exposed to oxygen and are replaced by microaerophilic or facultative anaerobes.

Treatment of anaerobic infection

The treatment of anaerobic infection requires a comprehensive approach, including surgery and conservative treatment methods. Surgical intervention when an anaerobic pathological process is detected should be performed without delay, since the chances of saving the patient’s life are rapidly decreasing. Surgical treatment consists of opening the infectious focus, excision of necrotic tissue, and open drainage of the wound with rinsing with antiseptic solutions. Depending on the further course of the disease, the need for repeated surgery cannot be ruled out.

In the most severe cases, it is necessary to resort to disarticulation or amputation of the affected limbs. This is the most radical method of combating anaerobic infection and is used in extreme cases.

Conservative general therapy is aimed at increasing the body's resistance, suppressing the vital activity of the infectious agent, and detoxifying the body. The patient is prescribed broad-spectrum antibiotics and intensive infusion therapy. If necessary, anti-gangrenous antitoxic serum is used. Extracorporeal hemocorrection, hyperbaric oxygenation, and ultraviolet therapy are performed.

Forecast

The prognosis is cautious, since the outcome of anaerobic infection depends on the timeliness of detection and initiation of treatment, as well as the clinical form of the pathology. In some forms of anaerobic infection, death occurs in more than 20% of cases.

Prevention

Preventive measures include the removal of foreign bodies from the wound, strict implementation of antiseptic and aseptic measures during operations, and timely postsurgical treatment of the wound appropriate to the patient’s condition. If there is a high risk of anaerobic infection, the patient is prescribed antimicrobial and immune-strengthening treatment in the postoperative period.

Which doctor should I contact?

The main treatment for anaerobic pathologies is surgical. If you suspect an anaerobic infection, you should immediately contact a surgeon.

Traditionally the term "anaerobic infection" applied only to infections caused by clostridia. However, in modern conditions, the latter are involved in infectious processes not so often, in only 5-12% of cases. The main role is given to non-spore-forming anaerobes. What both types of pathogens have in common is that they produce pathological effects on tissues and organs under conditions of general or local hypoxia using the anaerobic metabolic pathway.

Anaerobic infection occupies a special place due to the exceptional severity of the disease, high mortality (14-80%), and frequent cases of profound disability of patients.

By and large, anaerobic infections include infections caused by obligate anaerobes, which develop and exert their pathogenic effects under conditions of anoxia (strict anaerobes) or at low oxygen concentrations (microaerophiles). However, there is a large group of so-called facultative anaerobes (streptococci, staphylococci, Proteus, E. coli, etc.), which, when exposed to hypoxic conditions, switch from aerobic to anaerobic metabolic pathways and are capable of causing the development of an infectious process clinically and pathomorphologically similar to a typical anaerobic one.

Anaerobes are ubiquitous. More than 400 species of anaerobic bacteria have been identified in the human gastrointestinal tract, which is their main habitat. The natural habitat of clostridia is soil and the large intestine of humans and animals.

Anaerobic endogenous infection develops when opportunistic anaerobes appear in places unusual for their habitat. Penetration of anaerobes into tissues and the bloodstream occurs during surgical interventions, during injuries, invasive manipulations, tumor disintegration, during translocation of bacteria from the intestine during acute diseases of the abdominal cavity and sepsis.

However, for the development of infection, it is not enough for bacteria to simply enter unnatural places of their existence. For the introduction of anaerobic flora and the development of an infectious pathological process, the participation of additional factors is necessary, which include large blood loss, local tissue ischemia, shock, starvation, stress, overwork, etc. Concomitant diseases (diabetes mellitus, collagenosis, malignant tumors, etc.) play an important role. ), long-term use of hormones and cytostatics, primary and secondary immunodeficiencies due to HIV infection and other chronic infectious and autoimmune diseases.

For all anaerobic infections, regardless of the location of the outbreak, there are a number of very characteristic clinical signs):

• erasure of local classical signs of infection with a predominance of symptoms of general intoxication;
• localization of the source of infection in the usual habitat of anaerobes;
• unpleasant putrid odor of exudate, resulting from anaerobic oxidation of proteins;
• the predominance of processes of alterative inflammation over exudative inflammation with the development of tissue necrosis;
• gas formation with the development of emphysema and crepitus of soft tissues due to the formation of poorly soluble products of anaerobic metabolism of bacteria (hydrogen, nitrogen, methane, etc.) in water.

Various types of anaerobes can cause both superficial and deep purulent-necrotic processes with the development of serous and necrotic cellulitis, fasciitis, myositis and myonecrosis, combined lesions of several structures of soft tissues and bones.

Most anaerobic infections have a rapid onset. Symptoms of severe endotoxicosis usually come to the fore (high fever, chills, tachycardia, tachypnea (rapid breathing), lack of appetite, lethargy, etc.), which are often 1-2 days ahead of the development of local signs of the disease. In this case, some of the classic symptoms of purulent inflammation (swelling, hyperemia, pain, etc.) disappear or remain hidden, which complicates timely pre-hospital, and sometimes in-hospital, diagnosis of anaerobic phlegmon and delays the start of surgical treatment. It is characteristic that patients themselves often do not associate their “disease” with the local inflammatory process until a certain time.

In the treatment of anaerobic infections, surgery and complex intensive care are of primary importance. Surgical treatment is based on radical COGO, followed by repeated treatment of an extensive wound and its closure using available plastic methods.

The time factor in organizing surgical care plays an important, sometimes decisive role. A delay in surgery leads to the spread of infection over large areas, worsening the patient's condition and increasing the risk of the intervention itself. In patients with septic shock, surgical intervention is possible only after stabilization of arterial pressure and resolution of oligoanuria (manifestations of acute renal failure).

Clinical practice has shown that it is necessary to abandon the so-called “lamps” incisions without necrectomy, which were widely accepted several decades ago and have not yet been forgotten by some surgeons. Such tactics lead to the death of patients in almost 100% of cases.

During surgical treatment, it is necessary to perform a wide dissection of tissues affected by infection, with incisions extending to the level of visually unaltered areas. The spread of anaerobic infection is characterized by pronounced aggressiveness, overcoming various barriers in the form of fascia, aponeuroses and other structures, which is not typical for infections that occur without the dominant participation of anaerobes.

With COGO, it is necessary to remove all non-viable tissue, regardless of the extent of the lesion. After radical HOGO, the edges and bottom of the wound should be visually unchanged tissue. The area of ​​the wound after surgery can occupy from 5 to 40% of the body surface. There is no need to be afraid of the formation of very large wound surfaces, since only complete necrectomy is the only way to save the patient’s life. Palliative surgical treatment inevitably leads to the progression of phlegmon, systemic inflammatory response syndrome, the development of sepsis and a worsening prognosis of the disease.

The Department of Purulent Surgery of the City Clinical Hospital29 has accumulated global experience in the treatment of this nosology. Timely diagnosis and adequate surgical intervention are the basis for a favorable outcome in the management of patients with anaerobic infection. Considering the severity of the patients’ condition, specialists from the intensive care unit provide enormous assistance in treatment. The presence of modern antibacterial drugs, dressings, qualified nursing and junior medical personnel, as well as a competent attending physician as the head of the treatment process - create the conditions for a comprehensive and adequate fight against this formidable disease. The department also performs the entire range of reconstructive plastic surgeries after stopping the purulent process.

Pale skin

Muscle pain

Purulent discharge with an unpleasant odor

Thirst

Recession of the eyeball

Fever

Presence of fresh wounds on the body

Gas formation in the wound

Formation of necrosis

Swelling of the limbs

Low blood pressure

Blue discoloration of the nasolabial triangle

Loss of sensation

Anaerobic infection is a disease of a bacteriological nature, caused by the growth and reproduction of bacteria without access to oxygen or with an acute lack of oxygen. The causative agent is anaerobic bacteria. Their toxins penetrate into the body and are considered very dangerous. Bacteria mainly affect muscle and connective tissue. Patients more often develop symptoms of body poisoning than local signs. In women, this pathology occurs due to an incorrectly performed abortion or severe injuries to the genital organs.

Anaerobic infection has distinctive clinical features, namely:

• heavy;
• putrid discharge with an unpleasant odor;
• formation of gas in the wound;
• rapid death of surrounding tissue;
• mild inflammatory process.

But anaerobic wound infection is a complication of the injuries received. Therefore, the main routes of transmission are wounds, burns, and frostbite. In other words, open wounds, especially if dirt gets in there.

Etiology

The main causative agents of anaerobic infection are bacteria from the microflora of the human body. They are called opportunistic bacteria. If exposed to negative factors, they begin to multiply uncontrollably. During this process, they degenerate into pathogenic ones, which leads to the development of a pathological process.

The factors causing pathogenic bacteria are as follows:

• infection of the fetus during intrauterine development;
• birth ahead of schedule;
• long-term hormonal, chemotherapy, and antibiotic therapy;
• use of immunosuppressants;
• irradiation;
• long-term hospital stay;
• long stay indoors;
• contamination of an open wound with soil or excrement;
• violation of the integrity of the skin or mucous membrane.

Acute anaerobic surgical postoperative infection may also occur. This can happen not only after surgery, but also be a consequence of puncture, biopsy, or tooth extraction.

Also, the development of pathology is influenced by chronic and congenital diseases that affect the immune system.

Classification

In medicine, the classification of anaerobic developing infections has several forms of pathology.

Depending on the course of the disease, the following forms are distinguished:

• lightning;
• rapidly progressing;
• slowly progressing.

Depending on local changes, it happens:

• gas anaerobic developing infection;
• with a predominance of edema;
• mixed.

Depending on the depth of the lesion:

• deep;
• superficial.

The disease is also divided depending on its origin:

• nosocomial infection;
• out-of-hospital.

Depending on the reasons for the development:

• traumatic;
• spontaneous;
• Iatrogenic.

By prevalence:

• local;
• regional;
• generalized.

By affected area:

• with damage to the nervous system;
• soft fabric;
• skin;
• bones;
• joints;
• blood;
• internal organs.

Anaerobic infection is severe, so treatment should begin immediately. Otherwise, serious complications may develop.

Symptoms

Depending on the form of infection, its symptoms appear.

So, clostridial anaerobic developing infection has the following symptoms:

• Myonecrosis and inflammation of one muscle, while subcutaneous fat and skin are not affected. Patients feel severe pain. It is this that is the first symptom of this disease. The skin over the affected area becomes bronze. Gas and purulent exudate are formed.
• Fasciitis is a condition characterized by inflammation of the muscle sheaths. It is classified as complications after wounds, abrasions and operations. Tissue necrosis develops.

Non-clostridial anaerobic infection affects the development of purulent inflammation of the brain, soft tissues and internal organs. In mixed forms, damage to the skin, subcutaneous fat and muscles also occurs. Most often, the muscles of the legs and pelvis become inflamed.

As mentioned earlier, acute anaerobic developing infection occurs suddenly. Patients experience symptoms of poisoning. Signs of inflammation are mild. The patient's condition quickly deteriorates, local signs of pathology begin to appear, and the wound becomes black.

During the incubation period, which lasts three days, the following symptoms appear:

• fever;
• chills;
• lethargy;
• drowsiness;
• blood pressure decreases;
• heart rate increases;
• the nasolabial triangle becomes blue.

In addition, the patient's consciousness becomes confused, thirst and dry mouth appear, the skin becomes pale, and the eyes become sunken.

Local signs of anaerobic infection:

• severe pain that cannot be relieved with painkillers;
• swelling of the limb, which feels similar to distension;
• gas formed in the affected areas;
• the affected areas of the limbs lose sensitivity.

The purulent-inflammatory process, in which tissue necrosis occurs, develops rapidly. If effective treatment is not started in time, the tissue will quickly collapse. Because of this, the prognosis of the disease is unfavorable.

Diagnostics

The first signal of infection is pain in the wound. After contacting a doctor, he prescribes an examination.

Diagnosis of a possible anaerobic infection may include the following:

• microscopic examination of smears from a wound or examination of discharge from it;
• bacteriological examination of discharge from a wound - the same analysis is carried out with the affected tissue, blood and urine;
• express diagnostics - this type involves studying the obtained material in the light of an ultraviolet lamp;
• enzyme immunoassay and PCR - with their help you can make a diagnosis in a short time.

X-rays are used as hardware methods. It will help determine the presence of gases in the affected area.

Such putrefactive infection should be differentiated from other pathologies, such as soft tissue, perforation of hollow abdominal organs.

Treatment

Comprehensive treatment of anaerobic infection is prescribed.

It includes:

• surgical treatment of ulcers;
• methods of conservative therapy;
• physiotherapeutic procedures.

During surgical treatment, necrotic bodies are excised and foreign bodies are removed, then the wound cavity is treated and drainage is installed. Tamponation is performed with gauze swabs. Before this, they are impregnated with hydrogen peroxide or potassium permanganate. To perform this operation, the patient is given general anesthesia. If the lesion is extensive, then amputation of the limb is performed.

Conservative treatment is as follows:

• drugs are used to detoxify the body;
• antibacterial treatment is prescribed;
• antitoxic anti-gangrenous serum is administered intravenously and intramuscularly;
• immunotherapy is used (plasma transfusion);
• painkillers;
• anabolic hormones;
• anticoagulants;
• vitamin and mineral complexes.

Physiotherapeutic procedures include wound treatment with ultrasound and laser. Ozone therapy and other effective procedures are also prescribed.

Prognosis and prevention

The prognosis of the disease with anaerobic pathogenic bacteria will depend on the clinical form of the pathology, as well as on the timeliness of diagnosis and effective treatment. Unfortunately, this disease has a high risk of death.

Prevention of possible anaerobic infection is as follows:

• carrying out timely and effective primary surgical treatment of the wound is the most important and decisive circumstance in prevention;
• removal of foreign bodies trapped in soft tissues;
• compliance with the doctor's recommendations for wound care.

If tissue damage is extensive and the risk of developing this infection is high, special immunization and preventive antimicrobial measures should be carried out.

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