Miscellaneous Uncommon Infections

Gas gangrene This is usually a complication of deep dirty wounds (especially in battlefields). Gas can be seen on soft tissue X-rays. A variety of bacteria can cause it but the most severe is Clostridia. Mixed infection is not uncommon. It presents in deep wounds involving muscle. Swelling and oedema occur around a discharging wound. Severe toxaemia may be present but the patient is often afebrile. Mottling and subsequent black necrosis of wound occurs. Crepitation may be felt. Diagnosis is based on the clinical findings, wound swabs, and X-rays. Treatment - IV penicillin and metronidazole. Clostridia needs extensive surgical debridement.

 

Mycetoma (‘Madura foot’) This is caused by fungi (eumycetoma) or actinomycetes bacteria (actinomycetoma) from soil or plants. It starts as firm nodule, typically on the foot or lower leg, which then develop grains, abscesses and sinuses with invasion of skin, subcutaneous tissue and bone. Treatment is with surgery or systemic antifungals/antibiotics.

 

Chromoblastomycosis This fungus is usually derived from wood or soil. A warty papule becomes a plaque with or without ulceration. Haematogenous spread is rare but may lead to lymphatic stasis and elephantiasis. Treat with systemic anti-fungals (Itraconazole).