In puerperal infections, and especially in cases of septic abortion, the organisms may gain access from faeces-contaminated perinea] skin to necrotic or devitalized tissues in the uterus or adnexa and set up a dangerous pelvic infection or invade the blood stream to produce intravascular haemolysis and anuria. Clostridium welchii may also be involved in infections occurring as a result of extension of the organism from the alimentary tract, as in cases of appendicitis or intestinal obstruction.
If a preparation of adrenalin used for injection is contaminated with clostridial spores, the combination of an infective focus with the local ischaemia that follows the injection may be catastrophic. Gas gangrene is well recognized as a complication of surgical operations on the lower limb or hip area of patients in whom the blood supply may be inadequate and this is discussed below.
Other less severe forms of clostridial infection may occur without the typical toxaemia, such wounds having a foul odour and showing evidence of gas formation. Moreover, potentially pathogenic anaerobes may be cultivated from a wound that never shows any signs of gas gangrene. In 1943, MacLennan classified anaerobic infections on clinical grounds and he recognizes:-
(a) Simple contamination of a wound with clostridia.
(b) Anaerobic cellulitis, in which muscle is not involved.
(c) Anaerobic: myositis, which includes clostridial gas gangrene but may also, be caused by anaerobic streptococci.
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