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PubMed1987

Pyomyositis in south Indian children.

Thirty-two children with pyomyositis were studied. In 28 children, 23 boys and 5 girls, Staphylococcus aureus was the aetiological agent. The strains isolated were resistant to penicillin. The muscles of the thigh, back and upper arm were most frequently involved. Eight children had infections in other parts of the body, namely pneumonia, empyema, pericarditis, meningitis, osteomyelitis and arthritis. Two children died. At follow-up one child had chronic osteomyelitis. In four neonates, beta haemolytic streptococcus was the causative organism. All were septicaemic. One infant died.

Abscess↗
PubMed1999

Pyomyositis in children: analysis of 31 cases.

In a 10-year period, 31 children with 35 pyomyositis were managed in Zaria, northern Nigeria. Twenty-two (71%) were less than 10 years of age, with a peak incidence at between 5 and 9 years. The leg muscles, mainly the quadriceps, were most frequently involved (51.4%), followed by the trunk muscles (25.7%), predominantly those of the anterior abdominal wall. Arm and shoulder girdle muscles were less frequently affected (11.4% each). Staphylococcus aureus was the most frequently cultured organism (75%) and was usually sensitive to cloxacillin and, to a lesser degree, to erythromycin and chloramphenicol. Incision and adequate drainage was usually very effective with recurrence at only one site. Antibiotics were used routinely. Involvement of the heart and lungs occurred in two children respectively, the former causing the only death. The average duration of hospital stay was 20 days.

Adolescent↗
PubMedDate not supplied

Pyomyositis in children and adolescents: report of 12 cases and review of the literature.

Pyomyositis initially was observed more commonly in the developing world but now is reported with increasing frequency in the United States. The presentation is nonspecific and the differential diagnoses are many. We found the clinical history, laboratory findings, and response to treatment similar to those observed in different areas of the world. Magnetic resonance imaging (MRI) with gadolinium injection, in addition to helping to make the diagnosis, may help differentiate between early and late stages that help guide treatment. Coexisting bone changes (58%) may represent either the sensitivity of MRI to reactive inflammatory changes or the presence of a coexisting osteomyelitis. All patients responded to antibiotics and drainage if abscesses were present. Although the optimal duration of antibiotic therapy remains unclear, a shorter course should be considered in patients with a good clinical response, even when MRI shows nonspecific bony abnormalities. Percutaneous drainage was successful in five cases and may represent an alternative to the traditional surgical approach.

Adolescent↗
PubMedDate not supplied

MRI of tuberculous pyomyositis.

PURPOSE: The purpose of this article is to describe the findings of MRI in tuberculous pyomyositis (PM). METHOD: The MR images of four proven cases of tuberculous PM were retrospectively reviewed and analyzed with clinical and laboratory findings. The location, signal intensity on T1- and T2-weighted spin echo images, presence of abscess, signal intensity of peripheral rim, patterns of contrast enhancement, and associated findings were evaluated. RESULTS: On MR images, all cases demonstrated low signal intensity on T1-weighted images and high signal intensity on T2-weighted images in a single muscle. Abscess was seen in all cases. Peripheral rim showed subtle hyperintensity on T1-weighted images and hypointensity on T2-weighted images. After gadolinium infusion, peripheral rim enhancement was observed in all cases. Cellulitis was associated in one case. The patients clinically presented with a palpable mass of long duration. CONCLUSION: Tuberculous PM shows characteristic findings of a well demarcated abscess with rim enhancement at MRI and can be distinguished from other soft tissue masses.

Abscess↗
PubMed2001

Pneumococcal pyomyositis.

Pyomyositis is most commonly caused by Staphylococcus aureus. A 25-month-old child developed infection of the biceps brachialis muscle caused by Streptococcus pneumoniae. The child had no underlying immune or anatomic defect.

Child, Preschool↗
PubMed2004

Pneumococcal psoas pyomyositis associated with complement deficiency.

A 4.5-year-old boy with complement deficiency developed infection of the psoas caused by Streptococcus pneumoniae. Pyomyositis of the psoas muscle is uncommon but should be included in the differential diagnosis of fever and lameness. The most useful diagnostic test is computed tomography guided needle aspiration, and underlying conditions should be sought.

Anti-Bacterial Agents↗
PubMed2000

Pyomyositis of the leg with early neurologic compromise.

Pyomyositis, although uncommon, is being reported with greater frequency in temperate climates. The presentation is similar to a number of infectious processes, and when associated with a traumatic event, the clinical picture may be confused with that of a musculoskeletal injury. This, coupled with an unfamiliarity of the disease, may result in a delay in diagnosis. Early antibiotic therapy may obviate surgery. Progression to the suppurative stage requires surgical drainage along with antibiotics. CT guided drainage may be accomplished in certain cases. In immunocompromised patients, progression to the septicemic stage is associated with high morbidity and mortality.

Ankle Injuries↗
PubMed2004

Right arm pyomyositis and necrotizing fasciitis complicated with subcutaneous emphysema and pneumomediastinum in a patient with diabetes mellitus and iatrogenic Cushing syndrome.

We report a case of subcutaneous emphysema and pneumomediastinum secondary to pyomyositis and necrotizing fasciitis over the right arm of a woman with underlying diabetes mellitus and iatrogenic Cushing syndrome. Gas produced by the culprit pathogen extensively dissected the subcutaneous fat and fascia of the patient's right arm and distantly spread to her face, neck, back, and thoracic wall and penetrated the soft tissue cephalically bordering her sternum, resulting in pneumomediastinum. The patient improved-with antimicrobial therapy and localized debridement and fasciotomy over her right arm.

Anti-Bacterial Agents↗
PubMedDate not supplied

Three cases of staphylococcal pyomyositis in adolescence, including one patient with neurologic compromise.

Pyomyositis is rarely reported in the United States and is not easily recognized. In a 4-year period, we treated three adolescents from our vicinity with muscle infection resulting from Staphylococcus aureus. One was an insulin-dependent diabetic patient. Two patients had deep infections about their pelvis, one of which resulted in acute loss of bowel and bladder function. In all three cases, the patient did not recover until the abscess was operatively drained. Diagnosis was delayed because of lack of awareness of the condition, the deep muscles involved, and clinical presentation before formation of a localized abscess. Indium scan may be a very useful initial diagnostic test.

Abscess↗
PubMed1993

Pyomyositis in a patient with myeloma responding to antibiotics alone.

Pyomyositis is a rare purulent infection of skeletal muscle with striking clinical features. It usually occurs in patients living in the tropics but is increasingly being reported in immunosuppressed patients. The traditional approach to management has been surgical with drainage and debridement of the multiple muscle abscesses. We report a patient with myeloma who developed multiple muscle and lung abscesses associated with a Staphylococcus aureus septicaemia. The case was successfully managed with intravenous antibiotics alone with no recurrence of the abscesses during a later episode of neutropenia. The advantages of avoiding surgical intervention in immunosuppressed and thrombocytopenic patients are obvious.

Abscess↗
PubMed1997

Disseminated pyomyositis with high creatine phosphokinase levels.

Pyomyositis is a rare purulent infection of skeletal muscle caused predominantly by Staphylococcus aureus. We report a patient who presented with high fever, widespread muscle pain and high creatine phosphokinase levels. He also developed multiple muscle and lung abscesses associated with a S. aureus septicaemia.

Adolescent↗
PubMed1975

Tropical pyomyositis.

Six cases of tropical pyomyositis occurring in Australian, New Zealand and British soldiers in Malaysia and Singapore are described.

Abscess↗
PubMed1983

Trioleoylglycerol lipolysis by Staphylococcus aureus strains from recurrent furunculosis, pyomyositis, impetigo and osteomyelitis.

Staphylococcus aureus strains isolated from 94 patients with recurrent furunculosis, chronic osteomyelitis, tropical pyomyositis and impetigo were investigated for lipase activity after growth 1, 2 and 5 days in aerated casein hydrolysate-yeast extract. As substrate for lipase activity a tri-3H-oleoylglycerol emulsion was used. Phage group II staphylococci isolated from furunculosis had the highest lipase activity and on day 5 these strains differed significantly in activity from strains isolated from the other infections. Strains isolated from impetigo had a remarkably low lipase production. The quantitative difference in lipase production of various S. aureus strains may reflect the localization of the lesion.

Furunculosis↗
PubMed1995

Tropical Pyomyositis in a Patient From St. Croix.

A 70-year-old man living in St. Croix, developed persistent swelling of his right leg approximately 1 year after undergoing pelvic lymph node dissection and irradiation in the United States for locally invasive adenocarcinoma of the prostate. Approximately 1 month prior to admission, he had noticed slow, painful swelling of his right groin associated with erythema and increased warmth. He reported no history of trauma. A computed tomography (CT) scan demonstrated an intramuscular soft tissue mass in the right iliopsoas, obturator, and adductor magnus muscles. A 19-day course of corticosteroids provided symptomatic improvement; however, cessation of this medication resulted in the rapid return and distal extension of the swelling. In addition, edema and a firm, "woody" mass developed in the lateral aspect of the right thigh, although there were no constitutional symptoms. Because of the recrudescence of symptoms, the patient was again placed on corticosteroids. After noting no improvement in 48 hours, the patient sought treatment in the United States, where he was diagnosed with tropical pyomyositis. Imaging studies demonstrated copious purulent material distributed in and between the anterior femoral muscles (Fig. 1). Culture of the pus drained intraoperatively yielded Streptococcus anginosus and Bacteroides vulgaris. The patient recovered after repeated surgical drainage and treatment with intravenous penicillin and metronidazole.

Journal Article↗
PubMed2003

Analysis of a viridans group strain reveals a case of bacteremia due to lancefield group G alpha-hemolytic Streptococcus dysgalactiae subsp equisimilis in a patient with pyomyositis and reactive arthritis.

Streptococcus dysgalactiae is classified by a combination of phenotypic and genotypic characteristics into Lancefield group C alpha-hemolytic Streptococcus dysgalactiae subsp. dysgalactiae and Lancefield group C, group G, and group L beta-hemolytic Streptococcus dysgalactiae subsp. equisimilis. In this study, we report the isolation of a catalase-negative, alpha-hemolytic, optochin- and bacitracin-resistant viridans group strain, which does not grow in 10 or 40% bile, on MacConkey agar or bile esculin agar, or in 6% NaCl, from the blood culture of a 73-year-old woman with pyomyositis and poststreptococcal reactive arthritis. Lancefield grouping revealed that the strain was a group G streptococcus. The Vitek system (GPI) showed that it was unidentified, and the API system (20 STREP) showed that it was 95.7% S. dysgalactiae subsp. dysgalactiae. 16S rRNA gene sequencing showed that it was a strain of S. dysgalactiae. Based on phylogenetic affiliation with 16S rRNA gene or GroEL amino acid (another bacterial gene, in addition to 16S rRNA gene, that is highly conserved) sequences, the strain is most closely related to Lancefield group C beta-hemolytic S. dysgalactiae subsp. equisimilis. PCR amplification and sequencing of the streptolysin S structural gene (sagA) and M protein gene (emm) hypervariable region showed the presence of these suspected primary virulence factors. Further studies would delineate whether the isolate is just a hemolysin-deficient variant of group G beta-hemolytic S. dysgalactiae subsp. equisimilis or a novel type of S. dysgalactiae. The present case showed that group G alpha-hemolytic S. dysgalactiae subsp. equisimilis can be associated with serious invasive infection and poststreptococcal sequelae.

Aged↗
PubMed2004

Tropical pyomyositis (myositis tropicans): current perspective.

Tropical pyomyositis, a disease often seen in tropical countries, is characterised by suppuration within skeletal muscles, manifesting as single or multiple abscesses. The most common organism implicated is Staphylococcus aureus. In 20%-50% of cases there is a history of trauma to the affected muscles. Commonly involved muscles are quadriceps, glutei, pectoralis major, serratus anterior, biceps, iliopsoas, gastrocnemius, abdominal and spinal muscles. Early diagnosis is often missed because of lack of specific signs, unfamiliarity with the disease, atypical manifestations, and a wide range of differential diagnosis. Diagnostic techniques like ultrasound and computed tomography/magnetic resonance imaging are very useful in diagnosis. The diagnosis is confirmed either by biopsy or aspiration of pus from the affected muscles. The initial antibiotic of choice is cloxacillin. Incision and drainage are important components of management. Treatment for Gram negative or anaerobic organisms should be instituted, whenever indicated. Physicians should become more familiar with this potentially life threatening but curable infective disease entity.

Diagnosis, Differential↗
PubMed1995

Pyomyositis: characteristics at CT and MR imaging.

PURPOSE: To establish imaging criteria for pyomyositis (PM). MATERIALS AND METHODS: Twenty-seven computed tomographic (CT) scans and 11 magnetic resonance (MR) images obtained in 32 patients with PM were reviewed. Images in 10 patients with PM and 16 with soft-tissue masses were evaluated blindly. RESULTS: At CT, all 27 patients had muscle enlargement with heterogeneous attenuation; 26 patients had a focal fluid collection, with rim enhancement in all 18 patients who underwent contrast material-enhanced CT. Twenty-four patients had cellulitis. At MR imaging, all 11 patients had both a subtle increase in signal intensity in the affected muscle(s) on T1-weighted images and cellulitis. Nine patients had a focal fluid collection, which had high signal intensity and a hypointense rim on T2-weighted images. In six patients, a rim of increased signal intensity was seen around the collection on T1-weighted images. Six gadolinium-enhanced examinations demonstrated rim enhancement. Eight patients had fluid in the distal joint. All patients with PM were correctly identified when evaluated with the control subjects; however, there were four false-positive results. CONCLUSION: CT and MR imaging can help characterize changes that are suspicious for PM.

Adolescent↗