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Diabetic Gangrene


Presentation

  • He had previously suffered from cerebral infarction resulting in right hemiplegia and his right foot was amputated because of right femoral lesion presenting diabetic foot gangrene 5 years previously.[ncbi.nlm.nih.gov]
  • Edema and crepitus are usually present at the time of diagnosis; however, some references state that as many as 50% of cases may not have discernable crepitus or gas on radiographs on initial presentation [ 9 ].[intjem.springeropen.com]
Gangrene
  • The foot gangrene itself and the local circulation around the gangrene lesion were remarkably improved after treatment with LDL-apheresis. We present here the first case of diabetic foot gangrene improved by LDL-apheresis.[ncbi.nlm.nih.gov]
Pain
  • By then the pain score decreased to 2 and no further pain medication was needed.[ncbi.nlm.nih.gov]
  • Gangrene Dry gangrene no infection little tissue liquefaction In early stages, dull, aching pain, extremely painful to palpate, cold, dry and wrinkled.[slideshare.net]
  • Both his calves were painful to touch. No other site of infection was found. The patient was classified as Fontaine stage IV. Osteomyelitis was not found on the radiographs.[rrnursingschool.biz]
  • Symptoms and signs of diabetic leg, foot are changed color to blue and burning pains even during sleep at night from knee to foot.[altera.si]
  • A diabetic patient complains of pain in the toes while lying down (rest pain) which is often relieved or diminished by hanging the foot over the side of the bed.[reversegangrene.com]
Fever
  • She suffered from diabetic foot gangrene in her right foot with high-grade fever when she visited our hospital.[ncbi.nlm.nih.gov]
  • Wet Gangrene And Sepsis A 65-year-old male patient who had type 2 diabetes since the age of 45 years and was being treated with sulfonylureas, was brought to the emergency clinic suffering from a fever.[rrnursingschool.biz]
  • Other symptoms diabetics should watch out for include a change in skin color (generally from red to brown or black), pus being discharged from the blisters and a fever.[advancedtissue.com]
  • The patient had symptoms and signs of sepsis, such as tachycardia, fever, and leucocytosis; but the procalcitonin level was not elevated.[jgid.org]
Intravenous Administration
  • She was immediately admitted to our hospital and received intensive insulin treatment, along with intravenous-administration of antibiotics.[ncbi.nlm.nih.gov]
Toe Pain
Jaundice
  • Open air Past History H/o Typhoid in childhood H/o Appendicectomy in 1962 H/o Jaundice in 1963 Amputation of great toe of (Lt) foot in 1998 Cataract operated in 2002 both eyes (Lt) to (Rt) Investigations Random BSL – 200-mg/100 ml. 06.06.2005 : BSL (F[hompath.com]
Skin Discoloration
  • Bullae and the bluish skin discoloration are classic findings of gas gangrene and were noted have begun to show at the time of presentation of this case (Figures 1 and 2 ).[intjem.springeropen.com]
  • Gas gangrene is marked by a high fever, brownish pus *, gas bubbles under the skin, skin discoloration, and a foul odor. It is the rarest form of gangrene, and only 1,000 to 3,000 cases occur in the United States each year.[humanillnesses.com]
  • Gas gangrene is marked by a high fever, brownish pus*, gas bubbles under the skin, skin discoloration, and a foul odor. It is the rarest form of gangrene, and only 1,000 to 3,000 cases occur in the United States each year.[encyclopedia.com]
Agalactia
  • Repeated aerobic and anaerobic cultures of wound tissue grew only Streptococcus agalactiae, Staphylococcus aureus and corynebacteria (unspeciated).[omicsonline.org]
Paresthesia
  • She does not feel paresthesia or numbness in her feet. She also had continuous fever and decreased appetite 3 weeks prior. The patient suffered diabetes and hypertension since a year ago, but she seldom took medicines.[jgid.org]
Polyneuropathy
  • […] complication E10.4 Type 1 diabetes mellitus with neurological complications E10.40 Type 1 diabetes mellitus with diabetic neuropathy, unspecified E10.41 Type 1 diabetes mellitus with diabetic mononeuropathy E10.42 Type 1 diabetes mellitus with diabetic polyneuropathy[icd10data.com]
Aura
  • Preventive recommend to all, which have diabetes and disease of blood vessels our preventive examination of the entire body with the system AURA GDV where disease are visible well before the creation in the physical form, when the first signs and symptoms[altera.si]
Uremia
  • Mortality resulted mostly from mixed causes (cardiopulmonary failure, uremia, sepsis, diabetic coma).[ncbi.nlm.nih.gov]

Workup

  • […] conditions in the operating room is the preferred way to identify the causative pathogen Important pathogens include Bacteroides fragilis, E coli, Proteus mirabilis, and Klebsiella pneumoniae; Pseudomonas aeruginosa is usually not the causative organism See Workup[emedicine.medscape.com]

Treatment

  • Topical application of a mixture of PBMC and bFGF appears to be a useful, non-invasive and convenient method for the treatment of diabetic gangrene.[ncbi.nlm.nih.gov]
  • Thrombosis leg requires immediate treatment with anticoagulants.[altera.si]
  • In practical terms, HBO treatment drastically reduced leg amputations in patients so treated in the last 3 yr compared with earlier and current figures for patients not receiving HBO treatment.[care.diabetesjournals.org]

Prognosis

  • Given this ominous prognosis, it’s logical to take every possible precaution against amputation. Image Source: IDF.org Foot Problems Are Preventable.[sterishoe.com]
  • While gas-forming infections may be caused by Clostridium species, those in the diabetic foot are more often associated with mixed aerobic (and sometimes anaerobic bacteria) and usually have a more gradual progression and better prognosis.[omicsonline.org]
  • Immediate diagnosis and management are critical in the prognosis. 3,4 As seen in this case, high rate of IV fluids along with hemodynamic stabilization and broad-spectrum antibiotics (with aerobic and anaerobic coverage) are imperative, but urgent surgery[touchendocrinology.com]
  • What is the prognosis for gangrene ? Prognosis of ischaemic gangrene depends on the extent of disease, the underlying cause and the timing of appropriate treatment.[dermnetnz.org]
  • A study revealed that the prognosis of P. putida bacteremia has been shown to be good, with 93% of cases being cured. [2] In contrast to previous reports, another study found that the mortality rate in P. putida bacteremia was high, where mortality rate[jgid.org]

Etiology

  • Conclusion The diagnosis of congenital gangrene in this child was purely clinical and maternal diabetes with associated hypertension an etiological possibility.[njssjournal.org]
  • A previous report suggested that acute septic vasculitis is an important etiological factor ( 4 ).[care.diabetesjournals.org]
  • […] is an anal/perineal abscess in patients with underlying uncontrolled diabetes, but has also been described to be secondary to thrombosed hemorrhoids or strangulated inguinal hernia. 3–5 Many of the cases remain of unknown etiology and the postoperative[touchendocrinology.com]
  • Research indicates that when present in Staphylococcus aureus, the prophage ROSA-like inhibits the bacterium from infecting diabetic foot ulcers and also prevents S aureus from replicating inside osteoblasts, diminishing cell damage to these lesions. [8] Etiology[emedicine.medscape.com]
  • Etiologic diagnosis of chronic osteomyelitis: a prospective study. Arch Intern Med. 2006;166(1):95–100. 20. Hirsch AT, Haskal ZJ, Hertzer NR, et al.[aafp.org]

Epidemiology

  • Neurology and Neurosurgery Czech and Slovak Ophthalmology Czech and Slovak Psychiatry Czech Geriatric Review Czech Gynaecology Czech Rheumatology Czech Dental Journal Czech Urology Czech-Slovak Dermatology Czecho-Slovak Pathology Czech-Slovak Pediatrics Epidemiology[prolekare.cz]
  • Epidemiology of diabetic foot problems and predictive factors for limb loss. #F084-2. Presented at the 15th Triennial Congress of the Asia Pacific Orthopaedic Association. Sept. 9-13, 2007. Seoul.[healio.com]
  • Epidemiology and economic impact of foot ulcers and amputations in people with diabetes. In: Bowker JH, Pfeifer MA, editors. Levin and O'Neal's the diabetic foot. 7th ed. Philadelphia: Mosby; 2008. pp. 3-22.[synapse.koreamed.org]
  • Morganella morganii : epidemiology of bacteremic disease. Infect Control 5, 131 –137. [Google Scholar] Owada, R., Kanamori, A., Hirai, N. & Yajima, Y. ( 1994 ; ).[jmm.microbiologyresearch.org]
  • The investigators also searched PubMed, Google Scholar, EMBASE, and EBSCOhost to identify case reports and epidemiologic studies reporting on Fournier gangrene in SGLT2 inhibitor therapy.[infectiousdiseaseadvisor.com]
Sex distribution
Age distribution

Pathophysiology

  • The major foot complications include foot ulceration, cellulitis, abscess, wet gangrene, dry gangrene, and necrotizing fasciitis, with different pathophysiological concepts behind each of them.[dovepress.com]
  • Discussion Fournier’s gangrene pathophysiology usually begins with microthrombosis of the small subcutaneous vessels that leads to gangrene of the skin, and subsequent rapid spread of bacteria along the muscular fascia taking advantage of the relatively[touchendocrinology.com]
  • It has long been taught that the pathophysiology of diabetic foot ulcer (DFU) is neuropathy and loss of protective sensation 9. In the modern era, it is evident that the majority of foot ulcers also have an ischemic element.[onlinelibrary.wiley.com]
  • Pathophysiology In chronic osteomyelitis, a sequestrum and involucrum form; these represent islands of infected bone. Bone fragments that are isolated have no blood supply.[emedicine.medscape.com]
  • A 3, 5, 7, 8 Pathophysiology Patients with diabetes are particularly susceptible to foot infection primarily because of neuropathy, vascular insufficiency, and diminished neutrophil function. 3 Peripheral neuropathy has a central role in the development[aafp.org]

Prevention

  • Proper wound care of diabetic ulcers may help prevent the development of wet gangrene.[advancedtissue.com]
  • Prevention of gangrene is possible; just because you are diabetic does not mean you need to succumb to the condition. Tips to prevent gangrene include: Care for your diabetes and ensure blood sugar is well managed. Lose weight. Don’t smoke.[belmarrahealth.com]
  • Preventive recommend to all, which have diabetes and disease of blood vessels our preventive examination of the entire body with the system AURA GDV where disease are visible well before the creation in the physical form, when the first signs and symptoms[altera.si]
  • While the number of amputations and deaths have gone down in recent years, it’s still a cause for great concern because these extreme outcomes are often preventable.[sterishoe.com]

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