Pathology of fatal traumatic and nontraumatic clostridial gas gangrene: a histopathological, immunohistochemical, and ultrastructural study of six autopsy cases

• Published in: International journal of legal medicine Vol. 122; no. 1; pp. 35 - 41
• Main Authors: Tsokos, Michael, Schalinski, Sarah, Paulsen, Friedrich, Sperhake, Jan P., Püschel, Klaus, Sobottka, Ingo
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01-01-2008; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Arteriosclerosis - complications; Brain - microbiology; Brain - pathology; Clostridium - isolation & purification; Clostridium - ultrastructure; Female; Forensic Medicine; Forensic Pathology; Gas Gangrene - pathology; Hemorrhage - microbiology; Hemorrhage - pathology; Humans; Immunohistochemistry; Kidney - microbiology; Kidney - pathology; Liver - microbiology; Liver - pathology; Lung - microbiology; Lung - pathology; Male; Medical Law; Medicine; Medicine & Public Health; Microscopy, Electron, Scanning; Middle Aged; Muscle, Skeletal - pathology; Necrosis - microbiology; Necrosis - pathology; Original Article; Pancreatitis - complications; Prospective Studies; Skin Diseases, Vesiculobullous - microbiology; Skin Diseases, Vesiculobullous - pathology; Spleen - microbiology; Spleen - pathology; Wounds and Injuries - complications; Clostridial myonecrosis; Forensic pathology; Autopsy; Gas gangrene
• ISSN: 0937-9827; 1437-1596
• DOI: 10.1007/s00414-007-0163-9

We prospectively investigated six fatal cases of clostridial gas gangrene using autopsy, histology, immunohistochemistry, microbiology, and scanning electron microscopy. The causative pathogen was
Clostridium perfringens
in four cases, C.
sordellii
in one case, and a mixed infection with both
C. perfringens
and C.
sordellii
in one case. According to the previous medical history and autopsy findings, clostridial infection was related to trauma in three cases. Characterized by extensive tissue necrosis and total absence of an accompanying leukocyte infiltration and tissue inflammatory response, the histopathological picture of clostridial gas gangrene is distinctly different from other bacterial infections. In medicolegal casework, the proof of the source of infection and the portal of entry of the responsible pathogen is not always an easy task, especially in the absence of trauma.