Differential diagnosis and treatment of gas-producing infections

During an 8-year period, 30 patients with gas-producing infections were admitted for treatment of hyperbaric oxygen. Infection was a consequence of trauma and operation in 26 cases and a complication of other diseases in 4 cases. The definitive diagnoses were clostridial myositis in 12 cases, clostridial cellulitis in 7, non-clostridial cellulitis in 9 (mainly E. coli infections); in 2 cases the diagnoses were uncertain. Six cases of E. coli infection were misinterpreted as myositis and were treated with hyperbaric oxygen at 3 atm. abs. without effect. Five of these cases were cured by antibiotic therapy and surgical drainage. The risk of hyperbaric oxygen at 3 atm. abs. necessitates a strong indication for this kind of treatment. Thirteen cases of clostridial infections (2 with cellulitis, 11 with myositis) were successfully treated with hyperbaric oxygen except in 2 cases of myositis. Helpful data for the plausible diagnosis clostridial myositis in the acute stage were: a typical clinical picture with rapid progress of the local necrosis and inflammatory reaction, roentgenographically demonstrable intramuscular gas, and abundance of gram-positive rods in exudate from the inflammation. Laboratory data had a limited value. In some cases of clostridial myositis, a fall of hemoglobin to low values (less than 7.5 g%) was seen in the first 24 hours and high values of hemoglobin/plasma were noted in 4 cases. Incidents of side-effects from hyperbaric oxygen treatment were frequent but only a few were serious and these subsided during a short interruption of the treatment.