The incubation period is short, usually less than 3 days. The most common presenting complaints in early gas gangrene are pain out of proportion to physical findings, as well as a sensation of "heaviness" of the affected part. On examination, the area may demonstrate a brawny edema with crepitance. The skin will develop a bronze or brownish discoloration with a malodorous serosanguineous discharge, and bullae may be present. Systemic manifestations include a low-grade fever with tachycardia out of proportion to the fever. The patient may be confused or irritable and have a rapid deterioration of the sensorium. Laboratory evaluation may reveal any or all of the following: metabolic acidosis, leukocytosis, anemia, thrombocytopenia, coagulopathy, myoglobinemia and myoglobinuria, and liver or kidney disfunction. Gram stain of the bullae often shows pleomorphic gram-positive bacilli with or without spores, red blood cells, but very few white blood cells. Radiologic studies may demonstrate gas within soft tissue fascial planes and possibly gas within the peritoneal or retroperitoneal space.
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