Gangrene

Gangrene refers to the death of the tissue in any particular area of the body caused by the loss of blood supply. Though gangrene can occur in any part of the body, it normally affects toes, fingers, feet and hands. Infections, vascular disease, diabetes, injury and weakened immunity are some of the causes of gangrene.

Types of gangrene

Dry gangrene: Dry gangrene involves lack of blood supply due to cell death and necrosis. This condition is not associated with infection and develops gradually over a period of time. Patients with diabetes, atherosclerosis and other blood vessel diseases are most likely to develop dry gangrene. Those suffering from injuries, burns, frostbite and any other arterial trauma are also prone to dry gangrene.

Symptoms of dry gangrene

• Affected area feels numb and cold.
  
• Does not show any signs of healing due to interrupted blood supply and necrosis (un programmed cell death).
  
• Patients may or may not have pain.
  
• Color changes gradually from red to brownish red and eventually becomes black.
  
• Skin becomes dry, scaly, shriveled and finally falls off the body if not treated in time.
  
• On very rare occasions, the onset of dry gangrene may be sudden which may be caused by an immediate loss of arterial blood supply. In such a case, the affected area turns pale or bluish and then starts withering away.

Wet gangrene: Bacterial infection, loss of blood supply due to swollen tissues and gas production are some of the causes of wet gangrene. Wet gangrene spreads very quickly and in no time turns into sepsis. It restricts the white blood cells from reaching affected area, allowing the bacteria to feed on the surrounding muscles. Hence wet gangrene is a medical emergency and requires immediate treatment.

There are few variations to wet gangrene and one of them is gas gangrene. The bacterial organism called Clostridium perfringens causes gas gangrene. The bacteria present in the site releases toxins and produces gas bubbles in the dead tissues affecting not only the local site, but adjoining tissues and muscles. Though gangrene normally occurs on external parts of the body like hands, toes and legs, it can also attack internal organs like gallbladder, intestines and appendix. This condition is called internal gangrene. Internal organs may develop hernia, get strangulated and as a result do not receive sufficient blood supply causing gangrene.

Fournier gangrene is the gangrene that occurs in the male genital area due to an infection or urinary tract infection. Red skin, swelling, tenderness associated with pain are some of the symptoms of Fournier gangrene.

Necrotizing fasciitis is a type of wet gangrene that is caused by bacterial infection, affecting the deep layers of skin. It progresses rapidly and starts eating up the flesh in the body.

Symptoms of wet gangrene

• The site at which gangrene has occurred becomes swollen and painful. The skin in that area gets discolored.
  
• Pus, oozing of fluid and foul smell in the affected area.
  
• Fever indicating sepsis.
  
• If it is a gas gangrene, along with above mentioned symptoms, patient may experience increased heartbeat and vigorous breathing as toxins enter the blood stream. When the wound is pressed, there will be a slight crackling noise as there is a gas beneath the skin.

Causes of gangrene

The first and the primary cause of gangrene is complete loss or insufficient supply of blood to the tissue. When there is no blood supply, the required oxygen does not reach the cells allowing them to decay and die. Bacterial infections, trauma, damaged blood vessels, and blood vessel disease like atherosclerosis are some of the causes that restrict the blood supply leading to gangrene. Surgery wounds, frost bites, severe burns are typical breeding sites for bacteria causing infection and gangrene.

Diagnosing gangrene

Doctor will conduct a thorough physical examination and look for the symptoms like discoloration, pus, shrinking of skin, odor to determine the type of gangrene. If it is a wet gangrene, further tests like blood test, blood culture and tissue cultures are carried on to find out about the white blood cell count and the kind of bacteria causing the issue. This helps the doctors to decide on the right course of antibiotics. Imaging studies like X-ray, MRI and CT scan are done to determine the spread of gangrene.

Gangrene Treatment

Treatment approach varies depending upon the type of gangrene. However, whatever be the type of gangrene; it should be brought to the notice of the medical practitioner at the earliest to prevent it from spreading. In case of dry gangrene, firstly, doctor will remove the dead tissues from the affected area surgically. Next, he will try to correct the destroyed blood vessels to smoothen the blood flow. Patient will be administered antibiotics to curtail the spread and will also be given some anti blood clotting drugs.

Wet gangrene is a medical emergency and once diagnosed, treatment should start as quickly as possible. Debridement procedure is normally adopted to treat wet gangrene. Debridement refers to the removal of dead and decaying tissues from the affected site. Antibiotics are administered to control the infection and pain killers are given to relieve the patient from pain. In worst cases surgeon may have to amputate, where the affected limb will be separated from the body to prevent further deterioration. Gas gangrene is a deadly disease. Though it is treated in the same way as mentioned above, it necessitates swift action when compared to all other gangrenes. The infection can spread and enter the blood stream very quickly causing organ failures.

There is also an alternate therapy called hyperbaric oxygen therapy that is gaining momentum to treat gas gangrene. This process involves exposing the patient to 100% oxygen at inflated pressure for 90 to 120 minutes, three times a day for 2 days. Then the frequency will be brought down as per the patient's requirements. This therapy stimulates the cell growth, enhances the white blood cell count thereby regulating the infection and increasing the blood flow to areas affected by the arterial blocks.

Preventing gangrene

• Seek prompt treatment for any kind of external wound, cut or injury before the site is attacked by infection.
  
• Diabetics should keep their sugar levels under control as they are at higher risk. Those with vascular diseases and low immunity levels should be extremely cautious and vigilant about the signs of infection like pus, oozing, discoloration, swelling and pain. They should take good care of their fingers, toes and feet and go for frequent health checkups to rule out any adverse health condition.

Dry gangrene is easily treatable provided there is no infection associated with it. Chances of recurrence are higher in diabetes patients. The outlook for wet gangrene is poor and patients with severe infection and sepsis may also lose their life, if treatment is not initiated in time. It requires an aggressive treatment and patients with wet gangrene may end up with amputation.

Urinary Tract Infection

Under normal circumstances, the urinary system and its structure helps ward off infection. Immune defenses also play a part. The urinary tract is the body's filtering system for removal of liquid wastes. Women may be more susceptible to UTI because their urethral opening is near the source of bacteria. Women who are newly sexually active or have a new sexual partner may be at increased risk of contracting Urinary Tract Infection.

Causes for UTI infection in women

• The female urethra is shorter and this makes it easier for bacteria to travel
  
• If the bladder is not completely emptied, it may lead to infection.
  
• Pregnant women and diabetic women are more likely to develop UTI
  
• Stones or tumor in the urinary tract can cause urinary tract
  
• Urinary catheters and nephrostomy tubes are also likely causes of UTI in women

UTI treatment

UTI treatment involves a course of antibiotics. Treatment of UTI is done with amoxicillin, trimethoprim-sulfamethoxazole or fluoroquinolones. Treating UTI caused by bladder outlet obstructions may necessitate surgery and hospitalization. Drinking plenty of water and fluids will aid in flushing away the bacteria from the urinary system. Some doctors recommend Vitamin C as it will make the urine acidic and thereby hostile to bacteria. The most important tip to prevent urinary tract infections, bladder infections, and kidney infections is to practice good personal hygiene.

Cause of Urinary Tract Infection

E. coli is the most common cause of UTI. When the infection is limited to the urethra, it is called urethritis. A bladder infection is called cystitis. If the UTI is not treated in time, the infection will travel up and infect the kidneys. Other microorganisms called Chlamydia and Mycoplasma are also known to cause UTI infection. Other causes of UTI are bladder outlet obstructions or suppressed immune system. Certain blood types enable bacteria to attach more easily to cells that line the urinary tract, causing recurrent infections.

Osteomyelitis

Osteomyelitis is a medical condition that results from bone infection. The bacteria Staphylococcus aureus is usually the cause of Osteomyelitis. Other possible causes for Osteomyelitis are streptococcus and E. coli. Infection is caused either through the bloodstream or direct bone infection through open wounds or fractures. Surgery, fungal infection, injury or boils can be the source for contamination and infection. Typically the infection results in the formation of pus and abscess in the bone. The blood supply to the bone is affected and Osteomyelitis sets in. Osteomyelitis can affect adults and children. While the long bones of the limbs are usually affected in children, the pelvic or back bone of adults is affected. Chronic Osteomyelitis sets in when there is prolonged loss of blood supply to the affected bone tissue. This can happen in diabetics, dialysis patients and those who abuse drugs intravenously. Persons whose spleen has been removed may be at higher risk for Osteomyelitis.

Osteomyelitis can attack more than one bone at a time. Symptoms of Osteomyelitis are localized swelling and redness in the affected bone area. The patient feels ill and nauseous. There might be fever and pain too. In some cases, Osteomyelitis also results in swelling of feet and ankles or lower back pain. The nagging joint pain fails to respond to pain medications and there is intense pain on touching. There is weight loss and severe fatigue. Tests to diagnose this condition include bone scans and MRI of infected bones. Blood tests and cultures can help identify the type of bacterial infection so that the right course of treatment can be adopted. Blood tests will reveal higher ESR and elevated WBC count in those affected by Osteomyelitis. X-rays can reveal the extent of infection in the affected bone. A biopsy of affected bone tissue can also help identify the bacterial infection.

With early diagnosis, this infection can be treated with antibiotics. Often the antibiotics are given intravenously. Treatment for Osteomyelitis involved hospitalization and bed rest. But newer forms of oral antibiotic therapy have been successful in penetrating bone tissue. This has drastically reduced the need for prolonged hospitalization. In chronic cases of Osteomyelitis, surgical removal of dead bone tissue is required. Bone grafting is done to promote growth of new bone tissue. In rare cases, Osteomyelitis can lead to blood poisoning (septicemia) and destruction of the bone.