Myonecrosis

Another important necrotizing skin and soft tissue infection is clostridial myonecrosis (gas gangrene). Clostridial myonecrosis can develop spontaneously but most often occurs after trauma. Clostridium perfringens is the most common causative pathogen. 

Tens of thousands of Americans, including 1 of every 12 persons with spinal cord injury, die each year as a result of complications relating to pressure sores.41 Most complications are infectious. The most common is osteomyelitis, which is present in approximately 38% of infected pressure sores.37 Less frequently, NF, clostridial myonecrosis, and sepsis can occur. 

Clostridial gas gangrene (myonecrosis) should be treated with clindamycin and penicillin. 

Incubation period is 6 hours to 1 day. Symptoms of exposure include the development of gas gangrene (anaerobic destruction of tissue with the production of gas) and myonecrosis (muscle destruction). Naturally-occurring gas gangrene usually involves rapid invasion, liquefaction (changing solids to liquids), and necrosis of muscles, with gas formation followed by clinical signs of toxicity. 

Toxicoses from pine needles have been reported in field cases, but are rare and have only occurred in pregnant cattle. No toxicity other than abortion in cattle has been demonstrated from ICA or ICA derivatives. However, the abietane-type resin acids in ponderosa pine needles (concentrated in new growth pine tips) have been shown to be toxic, but not abortifacient at high doses, when administered orally to cattle, goats, and hamsters. Pathological evaluations of intoxicated animals includes nephrosis, edema of the CNS, myonecrosis, and gastroenteritis (Stegelmeier et al., 1996). While abietane-type resin acids may contribute to the occasional toxicoses reported in the field, they do not contribute to the abortions. Most cow losses in the field are associated with difficult parturition or post abortion toxemia due to retained fetal membranes. 

In some instances, epinephrine can be a cause of a blood condition involving the leukocytes and known as neutrophilia. In very rare cases, an intramuscular injection of epinephrine can be a cause of clostridial myonecrosis (gas gangrene). 

Suhler, E., W. Lin, H.L. Yin, and W.M. Lee. 1997. Decreased plasma gelsolin concentrations in acute liver failure, myocardial infarction, septic shock, and myonecrosis. Crit Care Med. 25 594—8. 

Chen W-H, Lee P-Y Ng W, et al, Aspirin resistance is associated with a high incidence of myonecrosis after non-urgent percutaneous coronary intervention despite clopidogrel pretreatment. J Am Coll Cardiol 2004 43 1 122-1 126. 

Claeys MJ, Van der Planken MG, Bosmans JM, et al. Does pretreatment with aspirin and loading dose clopidogrel obviate the need for glycoprotein llb/llla antagonists during elective coronary stenting A focus on peri-procedural myonecrosis. Eur Heart J 2005 26(6) 567-575. 

Chang SM, Yazbek N, Lakkis NM. Use of statins prior to percutaneous coronary intervention reduces myonecrosis and improves clinical outcome. Catheter Cardiovasc Interv 2004 62(2)4 93-197. 

Wolf, E. (1994). Carbon monoxide poisoning with severe myonecrosis and acute renal failure. Am. J. Emerg. Med. 12 347-9. 

Myonecrosis developed in a 22-year-old man who presented with dark smoky urine and calf tenderness, with progressive weakness and difficulty in walking, after treatment with aminocaproic acid for several weeks for traumatic hematuria after withdrawal he recovered over 3 weeks (61). 

Johnstone BR, Syme RR. Myonecrosis complicating epsilon aminocaproic acid treatment of traumatic haematuria. Br J Urol 1987 60(l) 81-2. 

Strieker BH, van Kasteren BJ. Diclofenac-induced isolated myonecrosis and the Nicolau syndrome. Ann Intern Med 1992 117(12) 1058. 

C. perfringens is the most important of the histotoxic clostridia that cause tissue infections in humans, especially of the muscle tissue (clostridial myonecrosis or gas gangrene). The organism is more aerotolerant than most other anerobes. In addition to toxins and enzymes, many of which have lethal, cell-destroying and hemolytic properties, a number of nonlethal enzymes are also produced and apparently contribute to the invasiveness of the organism in the tissue. These include collagenase, deoxyribonuclease, and hyaluronidase. 

Anteroseptal versus inferolateral MI prognostic implications. It is known that the MI involving LAD presents for similar area of necrosis, increased myonecrosis, reduced early and late left-ventricular function and high mortality compared with infarction in other vascular territories. However, the mechanisms underlying a worse prognosis are not completely characterised. Recently, it has been demonstrated (Kandzari et al, 2006) that prognosis after primary PCI in patient with ACS, the majority with ST-segment elevation, is different in patients with LAD occlusion than in RCA or LCX. Acute myocardial infarction due to LAD is associ-... 

Clostridial myonecrosis is a necrotizing infection that involves the skeletal muscle. Gas production and muscle necrosis are prominent features of this infection, which readily explains why this infection is commonly referred to as gas gangrene. ° The infection advances rapidly, often over a matter of a few hours." Most infections occur after surgery or trauma, with Clostridium perfringens identified as the most common etiologic agent. 

Without appropriate intervention, the infection will evolve rapidly into a frank cutaneous gangrene, sometimes with myonecrosis (involvement of skin and muscle). 

Unlike necrotizing fasciitis, clostridial myonecrosis shows little inflammation on histologic examination. 

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