I am writing this because it is a risk of abortions, and I want women to know the truth that abortion kills and it has the risk of also killing them:
Clostridium Difficile infections are raging everywhere it seems since it was in the BBC news early this am and has been reported in several hospitals in the US also.
Therefore this 'lesson' is about clostridium in its various forms and what could be done about it. Bacteria or germs as those with medical training call them, are categorized by infection specialists in a variety of ways. The categories are sorted to begin with by the shape of the bacteria or bacillus, then by the type, then by the morbidity [how often it causes death or serious damage to humans]. Clostridium is an anaerobic meaning it survives without oxygen present, and it is gram positive spore-bearing bacilli. Clostridium occurs everywhere in nature,in the soil and garbage, and in the intestinal tracts of animals. Under conditions favorable to the 'germ' it could attack almost any part, or type of tissue of the human body. But remember it is an anaerobe, meaning that sunlight kills it.Therefore it thrives where there is not sunlight like in puncture wounds, or the intestinal tract of humans where it is not supposed to be. The manifestations of a clostridium infection therefore require certain clinical conditions to develop and become life-threatening. To combat these infections the practices of the clinicians must be examined, including the sterilization of equipment, the integrity of the sterile gloves e.g. was there a break in them, or a break in technique for surgical sterility? Were proper disinfectants used and in timely fashion? Did the autoclave reach the necessary temperature for the prescribed amount of time to kill all bacteria from the previous patient the surgical instruments were used upon?
Clostridia is divided into two main groups, 1) those that are neurotoxic, i.e. they produce neurotoxins, which produce toxins that affect the brain and nervous system, which includes botulus and tetanus, and those 2) that are histotoxic meaning they produce toxins that affect parts of the body other than the nervous system or brain. However it is possible for both types of bacteria to thrive/grow/multiply in the same human and that complicates the outcome greatly. Clostridium botulism, resulting in gas gangrene of limbs, is particularly a risk in war-time where soldiers were treated and sometimes surgically in less than ideal situations on the battleground, where makeshift operating rooms may be all that is available to save the life of a soldier bleeding to death. Then the triage team determines that saving the life by stopping the outpouring of the patient's blood is the most important task, and realizging that they will deal with the infection that may arise later in a clinical setting. Sometime that is the right thing to do. The traumatized tissues develop infection more easily and therefore that is a risk in dirty wounds. Wounds contaminated with dirt, or having shrapnel, or pieces of fabric that the soldier was wearing driving into the flesh deep down and closed over is a huge risk for clostridium botulinum.
Clostridium perfringens is found in the gastrointestinal tracts of humans and introduced there in several ways, either by direct contact with a contaminated human or direct contact with a contaminated instrument. It is one of the group that is capable of causing severe and fatal infection. The other clostridium bacteria are: c. septicum, c. histolyticum, c. novyi, and c. bifermentans [sordellii] . All of these are histotoxic, producing potent [powerful] poisons which is what the word 'toxic' means. All except one of these produce a toxin that is specific to only that type of bacteria. That means that the treatment for one type of clostridium will not affect another type of clostridium. C. Perfringens produces twelve different toxins, c. novyi produces six different toxins, and C.histolyticum produces three different toxins. However, in each group there is one toxic produced that is more deadly than the others and it is against that one,that the anti-toxins are prepared. C. Perfringens and also c.novyi have been subclassified also into A,B,C,D,E,and F for c.perfringens and into A,B,and C for c.novyi, but of these subcategories, the groups that affect humans are: c.perfringens A,D,F and c.novyi A, and B.
The point to remember in developing a plan to eradicate any of the Clostridium bacterias is that they multiply and thrive only in places where there is little or no oxygen. Therefore look for them in these situations:
-when a tourniquet was applied,
- if there is a too tight plaster cast restricting blood flow
-if there was trauma that introduced a puncture wound where flesh closed in on itself and/or the weapon/instrument was contaminated with soil, feces, or bacteria from another,
-the presence of necrotic tissues [tissues that were so compromised as to be in a dying state, from less than needed oxygen to tissue]
- the occurrence of foreign bodies introduced into a human body tract such as the gastrointestinal tract;
-shell fragments or fragments of clothing appearing
-if a surgical autoclave did not reach the temperature set by the manufacturer for the amount of time specified to kill clostridia bacterias,
Any of these is enough to cause the clostridia bacteria that was introduced to grow and produce spores and then toxins. The toxins poison the tissues and organs if not stopped. The process by which clostridia kills a human is rather straightforward once the toxins are produced. The toxins flow out [diffuse into the tissue sort of like sugar dissolves in water, kill the cells, and then the dead cells are more culture for the more production of toxins and the process repeats itself gaining momenturm and severity with every cell destroyed. When they invade muscle they become very dangerous. It is a rapid descent of the patient in that situation,from life to death. When muscle is infected the toxins cause production of lecithinase, which readily kills the tissue by attacking the lecithin present in the cell wall. Diffusion of the bacteria is then accomplished by the production of collagenase, a hyaluronidase and a fibrolysin which break down bindings of the elements in the cells. It is possible to stop the disease after it advances to the muscle, but surgeons know that death is the usual outcome if gas gangrene exists in the muscle and is not aggressively treated. if the clostridium bacterias invade the blood supply the outcome of the patient [prognosis] is grim. There is what is called the "crush syndrome' if human tissue has been crushed that tends to lead to these type of infections.
The pathological and clinical features of clostridia infections are sorted into ; simple contamination, anaerobic cellulitis, and anaerobic myositis.
Simple contamination means the clostridia bacteria was found in a wound by culture but there is no manifestation yet of infection. Anaerobic cellulities means that infection was found and that the bacteria found suitable conditions for mulitplying and had invaded the cells producing gas in the tissues, both of a protoeolytic, and a saccharolytic process, but had not invaded muscle tissue. This occurs 3-6 days after injury and is notable in that pain is absent usually, but there is the presence of gas in the tissues, a foul odor and a thin, brownish-seropurulent discharge. Anaerobic myositis means the infection has spread to the muscle and is what is meant when the diagnosis of 'gas gangrene' is decided. It is far more acute and severe and rapidly fatal if left untreated. The onset of symptoms could be in as little a time as six hours, and up to three days after injury. Usually there is pain in the affected area that escalate, and it may be accompanied by tachycardia, [rapid heart beat], tachypnea, [rapid breathing] and a fall in blood pressure. There may be a slight elevation in temperature but it is not a marked elevation usually i.e. the lack of high fever is not an indication that infection does not exist. The skin of the infected part may be pale in color compared to the rest of the body, and may be tense [tight to the touch] with fluid under skin, and shiny. The wound may exude a brownish or blood-tinged serous discharge with a foul odor. If left untreated the skin becomes bronze in color and/or a bluish color and if the patient survives long enough may show vesicles [fluid filled tiny sacs] filled with dark red liquid which tend to run together as they multiply. Muscle may herniate through the wound. If left untreated, the patient becomes prostrate [unable to get up] and apathetic, indifferent to the surroundings and if left untreated delirium, stupor, and coma result. The muscle changes consist of swelling, reduced contractility to stimuli, and changed color from healthy pink to bluish or bronze colored. Bubbles of gas may be pushed out by manipulating the muscle.
The most common form of gas gangrene in civilian practices [apart from war zones] is clostridium perfringens of the uterus, that result from criminal or so-called legal abortions where instruments were not properly sterilized, or sterile gloves were not used, and there was a sloppy technique by the abortionist. The course of the infection is as already described but the widespread blood poisoning [bacteremia] and massive hemolysis [break down of blood cells] also occurs. Intravascular hemolysis [blood breaks down inside the blood vessels and becomes watery, less effective at providing oxygen and therefore causing the heart to fail] occurs in many cases, and that in turn causes acute renal failure as the kidneys try to cope with excreting the extra cells caused by the massive breakdown of the blood. Shock anuria [the total cessation of the kidneys producing urine secondary to reduced blood pressure and depleted circulating blood flow], and hemolysis could occur even in the absence of demonstrable by culture findings of clostridia bacteria. The fatality rate if shock anuria occurs is high because the blood flow to the kidneys is reduced and it causes a sequalae of events sort of like a chain reaction that lead to death.
Other bacterias also cause gas in the tissues and those that do are of the genus Aerobacter or Escherichia. Seeing gas in the tissues on xray is not definitive of gas gangrene because of the other types of bacteria that cause gas production. Therefore cultures must be taken from the wound and tissues to get a precise diagnosis for treatment. Xrays do help determine how far advanced the infection is since they show the gas gangrene advancing and therefore are helpful.
Almost always a surgeon is necessary to treat clostidia infections. Fasciotomies [releasing the fascia holding the muscle] and multiple incisions are necessary to allow drainage of the infection. Amputation of affected parts is often the only solution to prevent death. In the case of abortion, the uterus is scraped and sometimes removed to prevent the spread of infection to the blood stream. In spite of hysterectomy in patients affected with clostridium botulinum in the reproductive organs there is a high morbidity rate [patient dies often] because the uterus and fallopian tubes are drained are intimately connected to the other systems because they were designed to nurture life and their blood vessels and hormones are in rapid response because of the interrupted pregnancy.
Clostridial gastroenteritis is caused by clostridium perfringens and ranges from mild gastroenteritis that is commonly called 'food poisoning' to the enteritis necroticans, that causes gas gangrene of the small intestine. The latter produces large amounts of toxin that is hemolytic, necrotizing [killing cells] and lethal. The clostridia perfringens group D is the cause of enterotoxemic infection in sheep and may cause disease in humans if infected sheep, or certain foods including infected canned meat or preserved fish; but it may also result if the lower bowel was damaged by other causes.
Clostridium tetani is the clostridium bacillus that causes tetanus. It is a neuromuscular disease commonly called 'lockjaw". C. Tetani is a strict anaerobe and produces a characteristic 'drumstick' or 'squash' looking appearance to the cells where it invades. The spores of this bacertia are not killed by boiling water nor by raising the temperature alone.The best method is autoclaving to 120 centigrade and maintaining that temperature for at least 15 minutes. Next to the botulinum toxin the toxin produced by C Tetani is the most powerful poison known and produces nitrogen. It is found in nature commonly in the soil and the gastrointestinal tracts of humans, and in some animals. It has also been isolated from the mouths of humans. It has also been isolated from the floors of operating rooms presumably coming into the OR on the shoes of the staff. Plaster of Paris for casts and also surgical dusting powders for making it easy for sterile gloves to be put on, have also been found to have it in some places. The infection of it almost always results from injury to a body part first. Sometimes it may seem like a trivial injury at first. Tetanus has resulted in these cases: war wounds, highway accidents, burns, major trauma, after hyerdermic injections, after smallpox vaccination, hen pecks, insect bites, and other causes, sometimes with no apparent wound visible. If the spores of the C Tetani were distributed the patient becomes infected. If there is a situation where there is little or no oxygen to the area [no open flow of air to it] then the potential is there for the spores to multiply and produce toxins. Tetanus once started remains remarkably localized to the original site. The toxin it produces acts on the central nervous system and the motor cells of the spinal cord. The exact mechanism of it is unknown but it is believed that the toxin it produces is similar to strychnine-like poisons. Tetanus causes spasms of the muscles and may be so intense as to cause fractures of bone. The incubation period is 3 days to four weeks after injury. When the onset of disease occurs in less than a week, it runs a more severe course and become fulminating more quickly and leads to death. The symptoms are spasm of muscle at the site of injury, and spasms that may be protracted lasting weeks. Also, restlessness, irritability, and difficulty swallowing occur. The spasm of the masseter muscle of the jaw interferes with the opening of the jaws [trismus] and is always considered a red flag that tetanus may be present. As it progresses, stiffness and rigidity of the neck occurs, and also of the back, abdomen, and extremities. If left untreated the face of the patient may take on a grosteque looking grin from the spasm of the facial muscles. That is called risus sardonicus. The teeth may also be tightly clenched and the neck and back arched [opisthotonus] with the abdomen taut and the extremities rigidly extended. These spasms are initiated by even the slightest stimuli like a sound or a draft of cold air, or brushing against patient, and in some cases they occur spontaneously. They are severe enough to cause decreased respirations and anoxia [not enough oxygen to the brain] and cyanosis [blueness of lips and nail beds of fingers and toes] and then death if not interrupted. The sensorium remains clear and the patient remains conscious throughout spasms. There is usually a fever of 103 Farenheit, upwards, and also elevated pulse and respirations. The beginning manifestations are disease are: chills, fever, headache, stiffness of gait, abdominal pain caused by muscle spasm, difficulty swallowing, pain in back and neck and biting of the tongue. Isolating the c.tetani bacteria is necessary to be certain of diagnosis and is only possible 2-3 days after contamination. Once the disease has developed it is 'regrettably simple" and causes death about fifty percent of the time. In the early stages it may be confused with other diseases that cause similar manifestations such as meningitis and encephalitis. The indications that the patient may be moribund are rapid onset of symptoms [i.e. short incubation period] and rapid progression of symptoms. Those patients who develop the clinical symptoms after a ten day incubation period are more likely to survive. Antifoxin should be given my manufacturer's specifications if patient is not allergic, but remember it does not affect or neutralize the toxins already produced and bound by the nervous system tissues. Penicillin has been shown to eliminate c. tetani rapidly in most if not all cases. It is necessary to maintain airways and provide nutrition and fluid intake until patient recovers. Medication must be continued until spasms and rigidity are gone. Sedation and muscle relaxants may be necessary for some patients. Cortisone is of no use in tetanus. In all cases of tetanus, a tracheotomy is performed as a way of providing emergency ventilation to the patient in cases of extreme seizure or spasm of respiratory muscles, to prevent respiratory arrest and death. Forced ventilation or positive pressure breathing may be indicated. The muscle spasms are usually accompanied with profuse sweating that tends to disturb the acid-base balance and must be compensated for with replacement of fluids and electrolytes. In some cases a naso-gastric tube may be necessary to feed the patient until recovery. IV fluids with glucose, amino acids,and electrolytes are essential to control/prevent shock. Tetanus as a disease does not confer immunity against reinfection. Temporary immunity may be acquired through prompt administration of tetanus antitoxin when an injury occurs, and tetanus prophylaxis is more readily and safely achieved with tetanus toxoid and may require three injections since examination proved that antibodies did not develop after only one toxoid injection.
The treatment with anti-microbials if necessary for any clostridium bacterial infection, and either penicillin or a new generation drug is used to treat the clostridia bacteria and kill it, hopefully. In more advanced nations, penicillin may not be the first "drug of choice" because of tendencies of pharmaceutical companies to promote more expensive drugs, but penicillin is a very effective drug and should be given in doses of one million units every three hours preferably by intramuscular administration. Also tetracycline drugs should also be given with the minimal dose being 0.5 gm every 12 hours also by parenteral route. Also the administration of 40,000 Units of antitoxin intravenously should be given every six hours provided the patient is not allergic to these drugs.
Of course, it goes without saying, that tourniquets must only be applied in life-threatening situations or when surgeon is present, and must be released intermittently to allow blood flow, that plaster casts should be inspected frequently when wet as they are drying to make sure they are not impeding circulation to a limb, and wounds must be assessed frequently for discharge, odor, and visual appearance. Also for hospitals there must be a person appointed to watch the stats for autoclaves, to monitor the temperature they reach and the amount of time the heat and pressure is on the surgical instruments. And the circulating nurse in the operating room should have eyes like an eagle to watch every detail of the procedure for any break in technique and call them on it immediately to prevent contamination.
I referred to the medical textbook 'A Textbook of Medicine" by Cecil and Loeb, for this information, and from my RN experience as an Infection Control Nurse for an ambulatory surgery center.
/s/ Gloria Poole, RN [aka gloriapoole®©]
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