Etiology

Bacterial inoculation is usually of external and traumatic origin -involving telluric germs. The well-known ecology of Clostridia relates to this: devitalised and bruised wounds; soiled with earth; inadequately disinfected; retained foreign bodies. Usually inoculation is extensive (road traumatology involving very severe injuries) and occurs jointly with lesions promoting anaerobic microbial proliferation (vascular disruption, open fractures, etc...)21.

Etiology can also be of medical origin by contamination of cutaneous ulcers20,22. Diabetic foot lesions currently make up nearly 40 % of the lesions present when gas gangrene develops. Iatrogenic causes such as intramuscular or intra-articular injections are less frequent causes - mostly involving injections of corticosteroids or non steroidal anti-inflammatory drugs24-25. Contamination can also be surgical - particularly after amputations in vascular surgery or in diabetic patients. There have been rare cases occurring after "aseptic" procedures such as hip surgery26.

Unlike anaerobic necrotizing fasciitis, contamination from endogenous intestinal or genitourinary flora is rare. When this does occur, colic or rectal cancer must be suspected27.

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