The main cause of the severe form of gangrene known as gas gangrene is the bacterium

Clostridium perfringens which is frequently found in contaminated wounds and soil. People with

compromised blood supply to the affected area such as those with diabetes are more likely to

experience it. Gas production in the affected tissues causes a crepitus feeling when touched. Gas

gangrene can advance quickly, causing extensive tissue loss and septic shock within a short

amount of time. The affected area develops swelling, excruciating pain, and visible tissue

discoloration.

A type of gangrene called wet gangrene is characterized by bacterial infection and tissue

decomposition and it usually involves a variety of different bacteria. Typically, areas with

excessive moisture, such as open wounds that become infected or places with poor drainage, will

experience wet gangrene. Compared to gas gangrene, wet gangrene tends to advance more

slowly, but it can eventually cause significant tissue damage. There is no gas production in the

tissues, in contrast to gas gangrene (Tsutsumi, 2020).

Multicellular organisms experience apoptosis, a highly regulated and uncontrolled type of

programmed cellular death. Apoptosis is a well-planned process that involves several

biochemical occurrences. To preserve tissue homeostasis and control cell populations, damaged,

unwanted, or old cells are naturally eliminated through this process. Numerous internal and

external signals regulate apoptosis tightly. It can be brought on by internal factors such as DNA

damage, cellular factors, or lack of growth factors. External factors such as immune system

signals and activation of death receptors also trigger apoptosis. Necrosis is an unplanned type of

cell death that happens as a result of damage to the cell or extrinsic factors such as toxins,

infections, or lack of blood flow. Cellular swelling and loss of membrane integrity are symptoms

of necrosis, which is followed by cell rupture and the release of the contents of the cell into the
extracellular space. Unlike apoptosis which is governed by particular genetic pathways, necrosis

is not. It is brought on by physical harm, an infection, toxins, or lack of oxygen (Tiwari et al.,

2022).

The effects of Clostridial myonecrosis, also known as gas gangrene, are most likely the cause

of cellular damage (Leiblein et al., 2020). The bacteria can enter the body through a wound or an

injury in diabetic people with a compromised blood supply and poor wound healing. Toxins

produced by Clostridium perfringens include theta- and alpha-toxins among others. One

important virulence factor that results in tissue destruction is alpha-toxin. The Clostridium

perfringens toxin-producing organism causes extensive tissue necrosis in the afflicted area.

Vascular complications from diabetes include diabetic microangiopathy and peripheral artery

disease. This leads to decreased blood flow to the extremities which creates an ideal environment

for Clostridium perfrigens to grow anaerobically. A small wound or injury that serves as an entry

point for Clostridium perfringens may go unnoticed by the patient due to diabetic neuropathy,

allowing the bacteria to enter the body and cause infection. Uncontrolled diabetes can deteriorate

the immune system, increasing the risk of infection. Angiogenesis and the typical inflammatory

response, two crucial steps in the healing of wounds, can be hampered by elevated blood glucose

levels. As a result, even small wounds have the potential to develop into chronic infections that

invite Clostridium perfringens growth and lead to gas gangrene (Polk et al., 2021).
 References

Leiblein, M., Wagner, N., Adam, E. H., Frank, J., Marzi, I., & Nau, C. (2020). Clostridial gas

gangrene ‐ a rare but deadly infection: Case series and comparison to other necrotizing

soft tissue infections. Orthopaedic Surgery, 12(6), 1733-

1747. https://doi.org/10.1111/os.12804

Polk, C., Sampson, M. M., Roshdy, D., & Davidson, L. E. (2021). Skin and soft tissue

infections in patients with diabetes mellitus. Infectious Disease Clinics of North

America, 35(1), 183-197. https://doi.org/10.1016/j.idc.2020.10.007

Tiwari, S. K., Sivasailam, A., Maliakkal, R. T., Pillai, P. R., Surabhi, S. V., Prasad, T., &

Santhoshkumar, T. R. (2022). Quantitative analysis of Apoptosis and necrosis in live

cells using flow Cytometry. Methods in Molecular Biology, 57-

69. https://doi.org/10.1007/978-1-0716-2553-8_6

Tsutsumi, Y. (2020). Pathology of gangrene. Pathogenic

Bacteria. https://doi.org/10.5772/intechopen.93505