Non-Clostridial Gas-Forming Infections in Diabetic Patients

Abstract

Mitwalli, Non-Clostridial Gas-Forming Infections in Diabetic Patients. 1995; 15(1): 71-73 The ability of microorganisms to produce gas in infected tissue has long been recognized. Although this was originally linked to Clostridium perferingens and other clostridial species, 1 subsequent reports indicated that other bacteria including facultative coliforms, staphylococci, streptococci and other anaerobes are capable of causing gasforming infections.2,3 These infections range from mild disease with no gangrene to extensive disease with widespread tissue destruction that may lead to death. Most gas-forming infections in diabetics occur in association with diabetic foot ulcers.3 Other sites are less frequently involved. We report gas-forming infection due to Escherichia coli in two diabetic patients with involvement of the knee joint in one patient and the vertebral body and epidural space in the other. To the best of our knowledge, involvement of these sites in diabetic patients were not previously described. Case Reports Case 1A 70-year-old Saudi male with a history of noninsulin-dependent diabetes mellitus for six years and longstanding osteoarthritis of the right knee presented to the orthopedic clinic with painful swelling of the right knee of four days' duration and exacerbation of osteoarthritis was diagnosed. Therapeutic aspiration was performed and he was sent home on nonsteroidal anti-inflammatory drugs and cloxacillin. Next morning, he returned to the emergency room complaining of severe pain in the right knee, fever and shortness of breath. On examination, he was ill-looking and confused. Temperature was 39.8°C, blood pressure 100/60 mm/Hg, pulse rate 117/min and respiratory rate 26/min. The right knee was swollen, painful and warm. There was diffuse crepitus in the region of the right knee and the adjacent areas.

Emphysematous osteomyelitis: a case report and review of the literature

“…There are 25 cases of emphysematous osteomyelitis (including our case) reported in the literature 1,2,[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] (see Table 1). There is no gender association, with 13 of the 25 cases occurring in females.…”

Emphysematous osteomyelitis of the spine

“…Surgical methods could be performed by removing pus using incision and drainage, [ 5 , 7 ] or by debriding necrotic tissue extensively, followed by fusion and instrumentation if necessary. [ 13 , 14 ] In this case, an abscess was also identified around the facet joint and spinal canal. Therefore, laminectomy and facetectomy were performed, and instrumentation and posterolateral fusion were carried out subsequently.…”

Spontaneous emphysematous osteomyelitis of spine detected by computed tomography: Report of two cases

“…[1] Most common causative organisms include an anerobe or member of Enterobacteriaceae family. [14] Our cases are examples of hematogenous spread and can be considered spontaneous as there was no source of infection elsewhere or any surgery. [2]…”