They may develop by spread from a contiguous bone or soft tissue infection or from a hematogenous route. It is common in many tropical areas and affects both children and adults, especially the malnourished. Hematogenous seeding is thought to be the mechanism. Presumably, bacteremia leads to localized infection in a muscle damaged by previous, often unrecognized, trauma. The initial symptoms are cramping pain followed by edema, worsening discomfort, and mild fever.
Leukocytosis is common.
Occasional cases are due to Streptococcus pyogenes or Escherichia coli. Treatment is with a penicillinase-resistant penicillin. The extent of involvement at surgery is frequently much greater than anticipated from clinical evaluation. All rights reserved.