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Twenty-five cases of diabetes with non-clostridial gas gangrene have been reported since 1893. In the present report, we describe two cases of diabetes with non-clostridial gas-producing infec tions. Both cases died, and the severity of these infections is emphasized. The clinical findings are discussed.<BR>Case 1, a 45-year-old man, had been controlled on oral agents for 4 years. One day a fish bone became stuck in his anal region. He developed an egg-sized induration and redness in the left perianal region. Antibiotics and insulin were given. However, 10 days later, an ulcer was present with subcutaneous emphysema in the left perianal region. The subcutaneous emphysema extended to the scrotum, bilateral inguinal region, left abdomen, and left breast. He rapidly deteriorated, and died on the 11th hospital day. Aerobic and anaerobic cultures of specimens of pus obtained from the left perianal gangrenous tissue yielded a growth of <I>E. coli</I>. Clostridia were not isolated.<BR>Case 2, a 41-year-old man, had suffered from thirst and emaciation for one year. One day some cutting pliers dropped and injured his right foot. Ten days later he developed fever and pain in the right foot. In spite of treatment with antibiotics and insulin, high fever continued. The right foot became swollen, and subcutaneous emphysema was palpable beneath the inflamed area, but there was no ulcer. Aerobic and anaerobic cultures from the foot, CSF, and blood yielded Klebsiella. Clostridia were not isolated. The patient died on the 8th hospital day.<BR>It is important to distinguish between clostridial infections and non-clostridial infections. Differentiation is effected primarily on clinical grounds, but it may be helpful to undertake bacteriological and radiological examinations. The mortality rate from these infections is high. Multiple incisions and debriedments to free the tissues of gas and pus, and administration of antibiotics are the treatments of choice. However, the condition of these infectios can be such that prompt and extensive surgical treatment appears necessary.
- 一般社団法人 日本糖尿病学会の論文
一般社団法人 日本糖尿病学会 | 論文
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