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From January 1988 to December 1999, 43 adults with pyomyositis were managed at Ahmadu Bello UniversityTeaching Hospital, Zaria, Nigeria. Staphylococcus aureuswas the most commonly cultured organism (92.5%). All the 41 patients responded well to incision and adequate drainage, antibiotics and partial thickness skin grafting in 10 patients (23.2%).Two patients (4.65%) died from septicaemia, while being resuscitated.
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A 40-year-old man was hospitalized due to fever, muscular swelling and pain. He had poorly controlled diabetes with many dental caries and repeated periodontitis. CT revealed multiple intramuscular abscesses; administration of antibiotics and pus drainage were performed. Intraoral infection was suspected as the route of infection of pyomyositis, and a total of six teeth was extracted. In the clinical treatment of diabetic patients, it is important to instruct patients to routinely check for the presence of traumatic injuries of the lower extremities, and to have routine check-ups and dental care to check for dental caries or periodontitis.
OBJECTIVE: The purpose of this report is to describe the role of MR imaging in the diagnosis of focal pyomyositis surrounding the sciatic nerve in children. CONCLUSION: In the absence of joint effusion on sonography, MR imaging should be considered in pediatric patients who present with a febrile illness and incapacitating pelvic pain.
A case of tropical pyomyositis in a 24-year-old Greek is reported. The patient presented with high fever and swelling of the left thigh, generalized lymphadenopathy and multiple infiltrations in both lung fields on X-ray of the chest. Multifocal muscle abscesses were detected by CT scan of the left thigh and gluteal area. Staphylococcus aureus was identified in cultures of the purulent material which was surgically drained. The patient was subsequently treated with appropriate antibiotics. Lack of familiarity with this disease caused diagnostic confusion and delayed the initiation of treatment.
A case of pneumococcal pyomyositis of the brachial and shoulder region is presented. A bacteremic right lower lobe pneumonia was the source of infection. The spread of pneumococci was presumed to be blood-borne, presenting with cellulitis over the right shoulder region, progressing over 5 days to abscess formation in the right biceps muscle and right shoulder joint despite adequate antibiotic treatment.
Severe staphylococcal pneumonia developed secondary to pyomyositis of the buttock in an adult male Melanesian in East New Britain, Papua New Guinea. Penicillin-resistant Staphylococcus aureus was cultured from the abscess, and S. aureus, together with Gram-negative organisms, were cultured from sputum. Despite treatment with high dose cloxacillin together with supportive chemotherapy, progressive deterioration of lung function occurred and acute respiratory failure developed. As suitable ventilators were unavailable, tracheal intubation was performed, and manual assisted ventilation was carried out for 4 days. Progressive improvement in ventilation and general status resulted, and the patient recovered without sequelae.
Ten cases of pyomyositis of the iliacus muscle are described in otherwise healthy young Samoans. The correct diagnosis was frequently delayed. Staphylococcus aureus was the most common pathogen isolated from drained abscesses. Preference for hip flexion was seen in six patients, and localized pain or induration at the anterior superior iliac spine were found in seven patients. These clues may help expedite a correct diagnosis.
This report describes a case of tropical pyomyositis in a 25-year-old man in which gray scale ultrasound played a critical role in the diagnosis and management. A review of relevant literature is provided, and a recommended approach to the diagnosis of this disease is given.
Pyomyositis tropicans is a rare disease in non-tropical climates and thus presents diagnostic difficulties. Two children with single staphylococcal psoas muscle abscesses were recently successfully treated. Computerized axial tomography was found to be a useful diagnostic aid, allowing exact localization of the lesion. The diagnosis and therapy of these abscesses are discussed.
OBJECTIVE: Tropical pyomyositis (TP), a disease of varied aetiology, has been reported frequently from Africa and Latin America. However there are only a few reports from India. MATERIAL AND METHODS: Between January 1992 to June 1999, 26 patients with TP were admitted to Post Graduate Institute of Medical Education and Research Chandigarh, a tertiary care centre in north-west India and formed the study material. RESULTS: The disease was more common in young adults with male to female ratio being 5:2. In majority, presenting features were muscle pains (100%) and fever (81%). The diagnosis was confirmed by aspirating pus from the involved muscle. The pus grew organisms in 41.7% patients and methicillin sensitive Staphylococcus aureus was the commonest causative organism. Blood cultures were positive in 14.3% of cases. The common complications were bronchopneumonia (23.1%), empyema (19.2%) and venous thrombosis (15.4%). In three patients, the disease occurred in association with tuberculosis of dorsal-lumbar spine. The overall mortality was low (7.7%). CONCLUSIONS: TP is not an uncommon disease in India. Though the presenting features were similar to earlier studies, complications varied and mortality was low. An early recognition and aggressive treatment helps in decreasing morbidity and mortality.
A 5-year-old girl sought treatment for pyrexia of unknown origin. Despite prompt surgical drainage of a streptococcal septic arthritis of the ankle joint, her condition deteriorated. Multifocal pyomyositis was subsequently diagnosed. This was complicated by acute compartment syndrome in three extremities. With aggressive surgical and medical management, the child made a complete recovery. Orthopaedic clinicians in nontropical areas must familiarize themselves with this rare, potentially life-threatening, but eminently curable disease.
Pyomyositis is common in the tropics but rarely reported in temperate climates. This disease may give rise to obscure, non-specific, or misleading signs and symptoms. Delayed diagnosis and treatment may lead to death. The most common pathogen is Staphylococcus aureus. We analyzed 8 cases treated in the Tri-Service General Hospital between 1989 and 2001. There were 3 males and 5 females with age ranging from 2 to 66 years. Fever was found in all patients. The mean time lag between the onset of minor symptoms and diagnosis was 10 days. The imaging tools used included sonography, gallium-67 scan, computed tomography, and magnetic resonance imaging. Early application of sonography to any suspected lesions can help to establish diagnosis. All 8 patients recovered smoothly without complications after incision, drainage, and administration of adequate antibiotics for 2 to 4 weeks.
A 16-year-old girl from Guadeloup developed paresis of the flexors of the right foot, associated with edema and acute pain located in the upper anterior tibialis muscle. Electromyography confirmed mononeuritis of the right peroneal nerve, with severe reduction of potential amplitude. Computed tomography of the right leg showed a heterogeneous mass involving the upper segment of the anterior tibialis muscle, close to the location of peroneal nerve. Muscle biopsy confirmed pyomyositis. Muscle culture was negative. Paresis improved soon after antibiotic therapy was started.
A 30-year-old Thai woman with piriformis pyomyositis presented with sciatica. Computed tomography showed swelling and enhancement of the right gluteus medius and piriformis muscles. She made a complete recovery after a course of intravenous antibiotics. This condition has only been reported three other times and is often diagnosed with difficulty. It could be erroneously dismissed as a lumbar disc prolapse. If untreated, it could lead to prolonged hospital stay and death. A high index of suspicion, early diagnosis and appropriate antibiotic or surgical treatment leads to full recovery.
Although rare, tropical pyomyositis can result from staphylococcal bacteremia and should be considered in the different diagnosis of fever associated with extremity pain. The diagnosis is readily made with a CT scan. Treatment is primarily medical with surgery reserved for refractory abscesses.
Tropical pyomyositis (TP) is an acute bacterial infection of skeletal muscles characterized by rapid formation of abscesses. Since the beginning of the AIDS epidemic, interest in TP has increased because of its rising incidence in association with HIV infection and of the problems that it poses for differential diagnosis. Occurrence of TP is a criterion for classification of HIV infected patients in WHO disease stage III. The purpose of this report is to describe two HIV-infected patients who presented TP simulating septic arthritis of the hip and knee respectively. Medical imaging was particularly useful in establishing accurate topographic diagnosis and needle drainage in decreasing the duration of hospitalization and avoiding the need for surgical debridement. Needle puncture must be guided by ultrasound or scan imaging.
Although pyomyositis is uncommon in North America, it may be difficult to distinguish clinically from inflammatory myositis. We describe 2 cases of infectious myositis that were initially diagnosed as inflammatory myositis. As illustrated by these cases, infectious myositis is often a challenging diagnosis and requires a high degree of suspicion.