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J Foot Ankle Surg 2020 Jul - Aug;59(4):869-872

Professor, Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC. Electronic address:

The staged approach to below knee amputation has proven to be an effective method of achieving functionality after amputation and reducing risk for postamputation complications. Transtibial or "guillotine" amputations are often used as the first-stage amputation. Disarticulation at the ankle joint is an alternative method that can be used with favorable results and benefits. Read More

Acta Chir Belg 2020 Jul 1:1-3. Epub 2020 Jul 1.

Department of General, Visceral and Transplantation Surgery, University Hospital, Tübingen, Germany.

Abdominal gas gangrene caused by Clostridium perfringens is a rare differential diagnosis to pneumoperitoneum caused by bowel perforation. There are only a handful of case reports on this topic. We present the case of a 58 year old cirrhotic patient who represented to our ER after complicated surgery for retroperitoneal liposarcoma. Read More

mSphere 2020 Jun 17;5(3). Epub 2020 Jun 17.

California Animal Health and Food Safety Laboratory System, School of Veterinary Medicine, University of California, Davis, San Bernardino, California, USA

type A is involved in gas gangrene in humans and animals. Following a traumatic injury, rapid bacterial proliferation and exotoxin production result in severe myonecrosis. alpha toxin (CPA) and perfringolysin (PFO) are the main virulence factors responsible for the disease. Read More

Lancet Infect Dis 2020 Jun;20(6):754

Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Electronic address:

BMC Gastroenterol 2020 May 27;20(1):163. Epub 2020 May 27.

The Mater Hospital, Townsville, Australia.

Background: Colonoscopy is a routine procedure in diagnosis and treatment of colonic disease. While generally regarded as a safe procedure, potentially fatal complications can occur. Gas gangrene is one such complication, with very high mortality. Read More

J Transl Int Med 2020 03 9;8(1):54-56. Epub 2020 May 9.

Intensive care Departement, Brugmann University Hospital, Brussels, Belgium.

Gas gangrene (GG) remains a life-threatening and deadly disease. Early recognition together with daily surgical debridement remains the mainstay of therapy. We sought to describe a fatal case of necrotizing soft tissue infection, which was a gas gagrene in this case. Read More

IDCases 2020 5;20:e00784. Epub 2020 May 5.

Division of Plastic Surgery, Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA.

is an anaerobic, gram-positive bacillus known to cause myonecrosis, also known as gas gangrene, a life-threatening necrotizing soft tissue infection. Though it accounts for just 1 % of all infections attributable to spp., is a highly virulent and aggressive pathogen. Read More

Am J Ther 2020 May 1. Epub 2020 May 1.

Division of Internal Medicine, Rutgers Robert Wood Johnson Medical School, Saint Peter's University Hospital, New Brunswick, NJ.

Abdom Radiol (NY) 2020 Apr 27. Epub 2020 Apr 27.

Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada.

Fournier gangrene is an emergency condition that is associated with a high mortality rate. It is defined as a rapidly progressing infective necrotizing fasciitis of the perineal, perianal, and genital regions. Early diagnosis, broad-spectrum antibiotic coverage, and adequate surgical debridement are crucial and lead to better prognosis and patient survival. Read More

CEN Case Rep 2020 Apr 22. Epub 2020 Apr 22.

Department of Nephrology, Saiyu Soka Hospital, 1-7-22 Matsubara, Soka, Saitama, Japan.

Recently, postmortem imaging is sometimes used as an alternative to conventional autopsy. However, there are few case reports of postmortem imaging of dialysis patients. Here, we report a fatal case of gas gangrene involving a 76-year-old man who underwent dialysis. Read More

Acta Biomed 2020 03 19;91(1):44-46. Epub 2020 Mar 19.

Occupational therapist, Professor of Postgraduate in Medicine School in São José do Rio Preto-FAMERP-Brazil.

Purposes: The aim of the current study was to evaluate epidemiological data on amputations of upper extremities.

Methods: The main causes of upper extremity amputations performed in the period from January 1998 to January 2008 in Hospital de Base, São José do Rio Preto were retrospectively evaluated in a descriptive and quantitative cross-sectional study. Data, including the age of the patient, gender and the reason for surgery, were obtained from hospital records identified by the international classification of diseases (ICD) code for amputation. Read More

Front Pharmacol 2020 28;11:179. Epub 2020 Feb 28.

Cadre's Ward, The First Hospital of Jilin University, Jilin University, Changchun, China.

() type A strains are the main cause of gas gangrene in humans and animals. Treatment of this lethal disease is limited, and the prognosis is not good. Alpha-toxin (CPA) and perfringolysin O (PFO) secreted by play irreplaceable roles in cytotoxicity to host cells, persistence in host tissues, and lethality of gas gangrene pathology. Read More

Surg J (N Y) 2020 Jan 3;6(1):e37-e41. Epub 2020 Mar 3.

Department of Internal Medicine and Medical Gastroenterology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India.

Hepatic portal venous gas (HPVG), a rare radiological finding, is historically considered an ominous sign with 100% mortality rates. The dictum that HPVG warrants surgical intervention is challenged in the recent literature. This is because of the identification of various causes of HVPG other than bowel gangrene. Read More

J Biol Regul Homeost Agents 2020 Feb 27;34(1). Epub 2020 Feb 27.

Department of Orthopedic and Traumatology, Foundation "University Polyclinic Agostino Gemelli IRCSS Catholic University of Sacred Heart, Rome, Italy.

Anaerobe 2020 Apr 15;62:102177. Epub 2020 Feb 15.

Université Lille, INRA, ISA, Université d'Artois, Université Littoral Côte d'Opale, EA 7394-ICV Institut Charles Viollette, F-59000, Lille, France. Electronic address:

Eleven strains of clostridia were isolated from chickens suffering from necrotic enteritis (NE) disease, and were identified by 16S rDNA sequencing as C. perfringens (Clin1, ICVB079, ICVB080, ICVB081, ICVB082, ICVB083, ICVB085, ICVB088, ICVB089, ICVB090), C. sporogenes (ICVB086) and C. Read More

J Vet Diagn Invest 2020 Mar 21;32(2):175-183. Epub 2020 Feb 21.

Veterinary School, Federal University of Minas Gerais, Brazil (Oliveira Junior, Silva, Lobato).

Gas gangrene is a necrotizing infection of subcutaneous tissue and muscle that affects mainly ruminants and horses, but also other domestic and wild mammals. type A, type A, and are the etiologic agents of this disease, acting singly or in combination. Although a presumptive diagnosis of gas gangrene can be established based on clinical history, clinical signs, and gross and microscopic changes, identification of the clostridia involved is required for confirmatory diagnosis. Read More

IDCases 2020 20;19:e00687. Epub 2019 Dec 20.

Department of Emergency Medicine, Shin Yurigaoka General Hospital, 255 Furusawatuko Asou-ku, Kawasaki, Kanagawa, 247-8581 Japan.

An 83-year-old man visited an orthopedic hospital for his lower back pain. A compression fracture was noted in his second lumbar vertebra. He had taken pain medication for approximately five weeks, but the pain had worsened and he was unable to walk by himself. Read More

Can Assoc Radiol J 2020 Feb 28;71(1):30-39. Epub 2020 Jan 28.

Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.

Fournier gangrene (FG) is a genitourinary necrotizing fasciitis that can be lethal if not promptly diagnosed and surgically debrided. The diagnosis is often made by physical examination paired with an appropriate clinical suspicion and supporting laboratory values. Imaging, particularly computed tomography (CT), plays a role in delineating involved fascial planes for operative debridement and occasionally in diagnosing FG. Read More

J Vet Diagn Invest 2020 Mar 13;32(2):239-245. Epub 2020 Feb 13.

California Animal Health and Food Safety Laboratory System, University of California-Davis, San Bernardino (Nyaoke, Navarro, Fresneda, Moore, Uzal) and Davis (Diab) branches, CA.

Enteric disease in horses may be caused by a variety of microorganisms, including several clostridial species. (previously ) has been frequently associated with gas gangrene in humans and several animal species, including horses. However, its role in enteric diseases of animals has not been fully determined. Read More

Injury 2020 Mar 1;51(3):597-601. Epub 2020 Feb 1.

Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK. Electronic address:

Sir Martin Frobisher (ca 1535-1594), the famous Elizabethan explorer and privateer, sustained a bullet to the outer plate of his ilium from a low-velocity bullet wound fired at close range from an arquebus, an early form of musket. The bullet was removed, but he subsequently died from gas gangrene. This paper looks at the management of this injury in Tudor times and compares it to current practice. Read More

Dtsch Arztebl Int 2020 01;117(3):38

Front Cell Infect Microbiol 2019 10;9:462. Epub 2020 Jan 10.

State Key Laboratory of Veterinary Etiological Biology, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China.

is an important human and animal pathogen that is the primary causative agent of necrotizing enteritis and enterotoxemia in many types of animals; it causes traumatic gas gangrene in humans and animals and is associated with cases of food poisoning in humans. produces a variety of toxins as well as many enzymes, including three sialidases, NanH, NanI, and NanJ. Sialidases could be important virulence factors that promote the pathogenesis of . Read More

BMC Biotechnol 2020 01 28;20(1). Epub 2020 Jan 28.

Istituto Zooprofilattico Sperimentale dell'Umbria e delle Marche "Togo Rosati", Via G. Salvemini 1, 06126, Perugia, Italy.

Background: Clostridium perfringens is the causative agent of several diseases and enteric infections in animals and humans. The virulence of C. perfringens is largely attributable to the production of numerous toxins; of these, the alpha toxin (CPA) plays a crucial role in histotoxic infections (gas gangrene). Read More

Int J Med Microbiol 2020 Feb 17;310(2):151398. Epub 2020 Jan 17.

Infection and Immunity Program, Monash Biomedicine Discovery Institute and Department of Microbiology, Monash University, Clayton 3800, Australia. Electronic address:

Clostridium perfringens is the causative agent of human clostridial myonecrosis; the major toxins involved in this disease are α-toxin and perfringolysin O. The RevSR two-component regulatory system has been shown to be involved in regulating virulence in a mouse myonecrosis model. Previous microarray and RNAseq analysis of a revR mutant implied that factors other than the major toxins may play a role in virulence. Read More

Natl Med J India 2019 Mar-Apr;32(2):123

Department of General Surgery, Institute of Post-Graduate Medical Education and Research (IPGMER), Kolkata, West Bengal, India.

Handchir Mikrochir Plast Chir 2020 Apr 13;52(2):132-134. Epub 2020 Jan 13.

Surg Infect (Larchmt) 2020 Jun 7;21(5):411-415. Epub 2020 Jan 7.

Department of Surgery, Division of Trauma, Burns, Acute and Critical Care, Division of Medical Ethics, Weill Cornell Medicine, New York, New York, USA.

The United States is in the midst of an opioid crisis. Injection drug use is a major risk factor for necrotizing soft tissue infections (NSTI) by introducing bacteria into the soft tissues. Repetitive infection and atypical pathogens may be tangible manifestations of the opioid crisis. Read More

Pol J Microbiol 2019 Sep 3;68(3):323-329. Epub 2019 Sep 3.

Department of Molecular Medical Microbiology, Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College , Krakow , Poland.

This study conducts a comparative phenotypic and genetic analysis of strains isolated from two patients hospitalized at the same time in 2017 in the surgical ward of the Provincial Specialist Hospital in Włocławek (Kujawsko-Pomorskie Province) who developed necrotizing soft tissue infections (NSTI). To explain the recurring cases of this infection, a comparative analysis was performed for these strains and the ones originating from infections recorded at the same hospital in three patients with gas gangrene in 2015. The two isolates studied in 2017 (8554/M/17 from patient No. Read More

Jpn J Infect Dis 2020 May 25;73(3):177-180. Epub 2019 Dec 25.

Department of Emergency and Critical Care Medicine, St. Luke's International Hospital.

Clostridium species are gram-positive, spore-forming, anaerobic rods normally found in the soil and gastrointestinal tract of humans and animals. Spontaneous sepsis due to C. perfringens is not caused by injury, which sets it apart from the classical gas gangrene that typically follows trauma. Read More

BMJ Case Rep 2019 Dec 17;12(12). Epub 2019 Dec 17.

Clinical Physiology, King Saud University, Riyadh, Riyadh Province, Saudi Arabia.

A 51-year-old diabetic man diagnosed with prostatic abscess underwent its drainage twice. Following surgery he developed fever and right-sided painless visual loss due to endophthalmitis. To rule out its endogenous source CT scan was done which showed multisystem aetiology and complications. Read More

Pol Przegl Chir 2019 Oct;91(6):1-5

II Klinika Chirurgii Ogólnej i Gastroenterologicznej, Uniwersytet Medyczny w Białymstoku.

In this paper the authors would like to present a correct procedure in both surgical and hyperbaric treatment of patients with gas gangrene admitted to a surgical department during ER. Gas gangrene is not very common these days, but when it comes to dealing with gangrenous infection in the emergency it is quite likely to make errors in both diagnostic and therapeutic manners. When there is a gas gangrene in a patient at the emergency time plays crucial role and the proper application of procedures is vital for the patient's survival. Read More

J Vasc Surg 2020 May 13;71(5):1781-1788. Epub 2019 Dec 13.

Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio. Electronic address:

Background: Clostridium septicum is an anaerobic, motile, spore-forming, toxin-producing gram-positive bacillus that can lead to rapidly progressive gas gangrene due to the release of alpha toxin. Aortic aneurysm secondary to C. septicum infection is a rare condition with 60 cases reported in the literature; however, we have recently treated several patients with the condition in our large tertiary care and aortic center. Read More

Protein Expr Purif 2020 03 4;167:105550. Epub 2019 Dec 4.

Department of Bacterial Biologics, China Institute of Veterinary Drug Control, Beijing, China.

The Clostridium perfringens alpha toxin (CPA), encoded by the plc gene, is the causative pathogen of gas gangrene, which is a lethal infection. In this study, we used an E. coli system for the efficient production of recombinant proteins and developed a bicistronic design (BCD) expression construct consisting of two copies of the C-terminal (247-370) domain of the alpha toxin (CPA-C) in the first cistron, followed by Cholera Toxin B (CTB) linked with another two copies of CPA-C in the second cistron that is controlled by a single promoter. Read More

Infect Dis (Lond) 2020 03 28;52(3):196-201. Epub 2019 Nov 28.

Institute of Clinical Microbiology, University of Szeged, Szeged, Hungary.

and other gas gangrene-forming clostridia are commensals of the human gut and vaginal microbiota, but can cause serious or even fatal infections. As there are relatively few published studies on antibiotic susceptibility of these bacteria, we decided to perform a 10-year retrospective study in a South-Eastern Hungarian clinical centre. A total of 372 gas gangrene-forming spp. Read More

J Am Podiatr Med Assoc 2019 Jul;109(4):305-307

is a known human pathogen and member of the group. is a known bacterial cause of soft-tissue abscesses and bacteremia and is an increasingly prevalent pathogen in infections in patients with cystic fibrosis. We describe a rare case of as an infectious agent in a case of nonclostridial myonecrosis with soft-tissue emphysema. Read More

Antibiotics (Basel) 2019 Nov 8;8(4). Epub 2019 Nov 8.

Animal Biosciences and Biotechnology Laboratory, United States Department of Agricultural (USDA), Agricultural Research Service, Baltimore Avenue, Beltsville, MD 10300, USA.

is a bacterial pathogen that causes necrotic enteritis in poultry and livestock, and is a source of food poisoning and gas gangrene in humans. As the agriculture industry eliminates the use of antibiotics in animal feed, alternatives to antibiotics will be needed. Bacteriophage endolysins are enzymes used by the virus to burst their bacterial host, releasing bacteriophage particles. Read More

Front Microbiol 2019 25;10:2406. Epub 2019 Oct 25.

Department of Bacterial Pathogenesis, Infection and Host Response, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.

() is Gram-positive anaerobic, spore-forming rod-shaped bacterial pathogen that is widely distributed in nature. This bacterium is known as the causative agent of a foodborne illness and of gas gangrene. While the major virulence factors are the α-toxin and perfringolysin O (PFO) produced by type A strains of , the precise mechanisms of how these toxins induce the development of gas gangrene are still not well understood. Read More

Intern Med 2020 02 31;59(4):591. Epub 2019 Oct 31.

Department of Internal Medicine, Suwa Central Hospital, Japan.

Mil Med 2020 Jun;185(5-6):e900-e903

Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708.

Testicular pain has a wide differential and the nonspecific presentation should be triaged rapidly for urgent diagnosis and treatment. Scrotal pyoceles are uncommon collections of purulent fluid between the visceral and parietal tunica vaginalis, usually secondary to acute epididymo-orchitis, intra-abdominal infection, or trauma. Epididymitis and epididymo-orchitis are generally secondary to sexually transmitted infections or urinary tract pathogens. Read More

J Vet Diagn Invest 2020 Mar 4;32(2):246-251. Epub 2019 Oct 4.

Veterinary Sciences Institute of Litoral and Morphological Sciences Department, Veterinary Sciences School, National University of Litoral, Santa Fe, Argentina (Sacco).

Gas gangrene occurs in several animal species and is caused by one or more clostridial species. In horses, the disease is most often caused by type A. Although has been associated with gas gangrene in ruminants and humans, cases of the disease associated with this microorganism have not been described in horses, to our knowledge. Read More

Acta Chir Orthop Traumatol Cech 2019 ;86(4):290-293

Klinika plastickej, rekonštrukčnej a estetickej chirurgie Lekárskej fakulty Univerzity Komenského v Bratislave a Univerzitnej nemocnice Bratislava.

Vascularized bone grafting was for the first time described in the 1970s. It has become a crucial component in the reconstruction of long bone defects and non-unions in a poorly vascularised environment. Although the vascularized bone is well described for the lower extremity and mandibular reconstructions, it started to be used for the upper extremity bone defects only recently. Read More

Toxins (Basel) 2019 09 11;11(9). Epub 2019 Sep 11.

Australian Institute for Bioengineering and Nanotechnology (AIBN), The University of Queensland, Brisbane, QLD 4072, Australia.

is a broad genus of anaerobic, spore-forming, rod-shaped, Gram-positive bacteria that can be found in different environments all around the world. The genus includes human and animal pathogens that produce potent exotoxins that cause rapid and potentially fatal diseases responsible for countless human casualties and billion-dollar annual loss to the agricultural sector. Diseases include botulism, tetanus, enterotoxemia, gas gangrene, necrotic enteritis, pseudomembranous colitis, blackleg, and black disease, which are caused by pathogenic . Read More

Dose Response 2019 Jul-Sep;17(3):1559325819871757. Epub 2019 Aug 28.

Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA.

Necrotizing fasciitis (NF) is a rapidly spreading bacterial infection causing extensive tissue necrosis and destruction. Despite appropriate therapy, the disease results in significant morbidity/mortality and substantial treatment costs. Several studies published in the early 1900s demonstrated the effective use of low-dose X-ray radiotherapy (RT) for the treatment of many diverse inflammatory conditions and diseases (eg, gas gangrene, sinus infections, arthritis, tendonitis, and serious inflammatory lung conditions). Read More

BMC Infect Dis 2019 Sep 5;19(1):777. Epub 2019 Sep 5.

Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Genève 14, Switzerland.

Background: Splenic abscess usually arises from hematogenous spread. Causative pathogens are various and anaerobic pathogens are rarely reported.

Case Presentation: We report the case of a 50-year-old male patient who was admitted for sepsis due to gangrenous necrosis of the spleen associated with bacteremia. Read More

Toxins (Basel) 2019 08 30;11(9). Epub 2019 Aug 30.

Department of Microbiology, Faculty of Pharmaceutical Sciences, Tokushima Bunri University, Yamashiro-cho, Tokushima 770-8514, Japan.

type A causes gas gangrene characterized by myonecrosis and development of an effective therapy for treating affected patients is of clinical importance. It was recently reported that the expression of granulocyte colony-stimulating factor (G-CSF) is greatly up-regulated by infection. However, the role of G-CSF in -mediated myonecrosis is still unclear. Read More

J Surg Res 2020 01 23;245:516-522. Epub 2019 Aug 23.

Trauma Unit, Amsterdam UMC location AMC, Amsterdam, the Netherlands.

Background: A necrotizing soft-tissue infection (NSTI) is a rare but severe infection with a high mortality rate of 12%-20%. Diagnosing is challenging and often delayed. Treatment consists of surgical debridement of all necrotic tissue and administration of antibiotics. Read More

Intensive Care Med 2019 09 22;45(9):1241-1251. Epub 2019 Aug 22.

Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.

Purpose: Necrotising soft-tissue infections (NSTI) are characterised by necrosis, fast progression, and high rates of morbidity and mortality, but our knowledge is primarily derived from small prospective studies and retrospective studies.

Methods: We performed an international, multicentre, prospective cohort study of adults with NSTI describing patient's characteristics and associations between baseline variables and microbiological findings, amputation, and 90-day mortality.

Results: We included 409 patients with NSTI; 402 were admitted to the ICU. Read More

BMC Infect Dis 2019 Aug 15;19(1):719. Epub 2019 Aug 15.

Department of Emergency Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 596-8686, Japan.

Background: Clostridium perfringens can cause various infections, including food poisoning, gas gangrene, cellulitis and fasciitis. C. perfringens septicemia is rare, but is a known cause of hemolysis by damaging red blood cell, and often proves rapidly fatal in emergency department (ED) situations. Read More

Microbiol Spectr 2018 08;6(4)

Infection and Immunity Program, Monash Biomedicine Discovery Institute and Department of Microbiology, Monash University, Clayton, Victoria 3800, Australia.

The pathogenesis of clostridial myonecrosis or gas gangrene involves an interruption to the blood supply to the infected tissues, often via a traumatic wound, anaerobic growth of the infecting clostridial cells, the production of extracellular toxins, and toxin-mediated cell and tissue damage. This review focuses on host-pathogen interactions in -mediated and -mediated myonecrosis. The major toxins involved are α-toxin, which has phospholipase C and sphingomyelinase activity, and α-toxin, a β-pore-forming toxin that belongs to the aerolysin family. Read More