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PubMed2004

Hemoglobinopathy and pattern of musculoskeletal infection in children.

BACKGROUND: The bacterial pathogens associated with osteomyelitis in patients with hemoglobinopathy (HbSS) are controversial. There is insufficient data on the common musculoskeletal (MSS) infections in patients with hemoglobinopathies and the associated bacterial pathogens in Nigeria. OBJECTIVES: To identify the common MSS infections in children and the associated bacterial pathogens, especially in those with abnormal hemoglobin genotypes. METHODS: A retrospective case review was done of pediatric and adolescent patients admitted with bone and soft tissue infections over a seven-year period in a Nigerian teaching hospital. RESULTS: One-hundred-nineteen patients were studied, with mean age 7.9+/-5.6 years and male-female ratio of 1.3:1. Out of 78 patients with known genotype, 62.8% had HbAA, 20.5% HbSS, 9% HbAS, and 7.7% HbAC. The most common MSS infections were osteomyelitis (64.7%), pyomyositis (17.6%), and septic arthritis (10.1%). Others were cellulitis (5.9%), tuberculous arthritis (0.8%), and necrotizing fasciitis (0.8%). Staphylococcus aureus (S. aureus) was isolated from 62% of chronic osteomyelitis (COM) and 58% of pyomyositis, while gram-negative bacilli accounted for 34% and 42%, respectively. S. aureus was isolated from 63% of patients with HbAA, 40% with HbSS, 58% with HbAS, and 58% with HbAC, while gram-negative bacilli accounted for 33%, 60%, 33%, and 33%, respectively. Osteomyelitis and pyomyositis appear to be similarly common in patients with and without HbSS (RR 1.29; 95% CI 0.47-3.50). Osteomyelitis and soft tissue infections in general also appear to be equally common in them (RR 1.16; 95% CI 0.39-4.11). However, osteomyelitis appears to be more common among patients with HbSS than those with HbAA (RR 2.29; 95% CI 0.58-8.99) and those with other hemoglobinopathies (RR 2.23; 95% CI 0.66-7.49) CONCLUSIONS: Osteomyelitis, pyomyositis and septic arthritis are common MSS infections in hospitalized pediatric and adolescent patients, while tuberculous arthritis is uncommon. The most common bacterial pathogen in these infections is S. aureus-even in patients with HbSS and other hemoglobinopathies. Gram-negative bacilli are important causes of MSS infections in hospitalized children with HbSS. HbSS may be an independent risk factor for osteomyelitis in these patients.

Adolescent↗
PubMed1994

Magnetic resonance imaging in adults presenting with severe acute infectious cellulitis.

BACKGROUND AND DESIGN: Early categorization of some acute soft-tissue infections, such as severe infectious cellulitis (IC) without or with secondary abscess formation, necrotizing fasciitis (NF) or pyomyositis, is frequently difficult. The first one requires only medical treatment, the remaining ones require either surgery or closed drainage. To determine the presence and the extent of these infections early, we have prospectively studied the value of magnetic resonance imaging in patients admitted for IC with local or general criteria of severity. Images were analyzed on a blind basis. Definite diagnosis was obtained by reviewing clinical records and, in most patients, the results of an invasive procedure. RESULTS: Twenty-six patients (56 +/- 23 years old) were included in this study. Among them, 13 received gadolinium-diethylene-triaminepenta-acetic acid intravenously. The final diagnosis was pyomyositis (five patients), NF (three patients), or IC with (seven patients) or without (11 patients) subcutaneous abscess. Images specific for these diseases were best outlined with T2-weighted sequences. In patients with pyomyositis or subcutaneous abscess(es), we observed spindle-shaped or round, well-defined areas of high signal intensity within the muscles or subcutis, respectively. Patients with NF exhibited numerous homogeneous, well-defined dome-shaped areas of hypersignal in the deep hypodermis. In patients with uncomplicated IC, these dome-shaped areas of hypersignal appeared ill-defined, heterogeneous, smaller, thinner, and less numerous than those in patients with NF. CONCLUSIONS: In patients presenting severe IC, magnetic resonance imaging provided an early clue in the diagnosis of pyomyositis, NF, and abscess-complicated IC. By precisely defining the extent of these infections, it helped to plan surgical treatment.

Abscess↗
PubMedDate not supplied

[Subcutaneous and soft tissue involvement associated with AIDS: ultrasonographic aspects. Apropos of 3 cases].

Subcutaneous and soft tissue involvement is frequent in AIDS patients. Although the relevant clinical characteristics have been extensively described in the literature, there has been little work on the radiological features. We therefore report three cases of AIDS with subcutaneous and soft tissue involvement: two cases of pyomyositis and one case of non-Hodgkin's lymphoma. All three were black African men and were aged 22, 28 and 41 years. They were diagnosed as suffering from AIDS and were HIV1 and HIV2 positive. Diagnosis was established using needle puncture and histological (lymphoma) and bacteriological (pyomyositis) examination. We report ultrasound scan findings. The features of the pyomyositis differed from those usually observed in immunocompetent patients. The lymphoma nodules were similar to those described in the literature. They were hypoechoic and homogeneous, with no necrotic center. We believe that subcutaneous and soft tissue infectious involvement, for example pyomyositis, is more frequent in tropical regions than tumors (Kaposi's sarcoma, lymphoma) which are more frequent in Europe. This soft tissue involvement can be considered to be part of the particular picture which is "tropical AIDS".

AIDS-Related Opportunistic Infections↗
PubMed1997

[Methi-resistant Staphylococcus aureus myositis].

INTRODUCTION: Pyomyositis are relatively rare in our countries. CASE REPORT: A 73-year-old-man presented with leg pains and septicemia. Diagnosis of pyomyositis was made and a large incision was performed after which the patient had a progressive improvement. DISCUSSION: Diagnosis of pyomyositis may be difficult in early stages. Diagnosis is greatly facilitated by magnetic resonance imaging. Responsibility of Staphylococcus aureus in cases of pyomyositis due to methi-resistant Staphylococcus aureus may be evocated even if patients was not hospitalized.

Aged↗
PubMed2006

Internal obturator muscle abscess caused by Klebsiella pneumoniae.

Obturator internus muscle abscess is an infrequent form of pyomyositis. To date, this disease has been described almost exclusively in children and young adults, and in most cases the causative agents are Gram-positive bacteria. We present the first report of obturator internus muscle abscess caused by a highly antibiotic resistant Klebsiella pneumoniae, in an elderly diabetic patient. Once considered very rare, Gram-negative pyomyositis is increasingly reported, and is an important concern in diabetic patients. Since pyomyositis can easily be missed if not considered, physicians should become familiar with this condition, and consider it in the differential diagnosis of septic diabetic patients.

Abscess↗
PubMedDate not supplied

Orthopaedic manifestations of invasive group A streptococcal infections complicating primary varicella.

The incidence of invasive group A streptococcal (GAS) infections in primary varicella appears to be increasing. GAS infections complicating varicella range from cellulitis, abscess, and septic arthritis to life-threatening necrotizing fasciitis and pyomyositis in association with GAS toxic shock syndrome (TSS). Four patients admitted in 1 year to the Children's Hospital and Medical Center in Seattle, whose care included evaluation and treatment by the Orthopaedic service, are presented to illustrate this spectrum. Three had a delay in diagnosis, including discharge from previous emergency department visits. One patient with polyarticular septic arthritis was treated with diagnostic aspiration and intravenous antibiotics. The remainder required urgent surgical debridement for treatment of deep infection. Patients with necrotizing fasciitis or pyomyositis had life-threatening complications of TSS, including hypotension, adult respiratory distress syndrome (ARDS), coagulopathy, and acute renal failure. These patients required aggressive fluid resuscitation and prolonged intensive care unit support. Diagnostic imaging studies were obtained in one patient with necrotizing pyomyositis but may have served only to delay definitive treatment. Recognition of the potential for secondary GAS infections and a high index of suspicion for the presence of necrotizing soft-tissue infection are essential in the evaluation of any child with fever and localized extremity pain with varicella.

Arthritis, Infectious↗
PubMedDate not supplied

MRI of musculoskeletal extraspinal tuberculosis.

PURPOSE: The aim of this study was to describe the MR findings in extraspinal musculoskeletal tuberculosis (EMT). METHOD: A retrospective review was conducted of the MR findings of 18 patients with microbiologically and/or pathologically proven EMT. All MR studies were performed using T1-and T2-weighted spin echo sequences. T1-weighted spin echo sequences after Gd-DTPA injection were obtained for 12 patients. The MR images were evaluated for abnormalities in joints, bones, and soft tissues, and the results were grouped by anatomic localization, frequency distribution of structures affected, and morphologic patterns of involvement. RESULTS: Isolated soft tissue tuberculosis was found in 10 (55.5%) patients and involvement of more than one structure in 8 (44.4%). Pyomyositis (n = 6) and arthritis with involvement of adjacent soft tissues (n = 7) were the most common forms of presentation. One patient presented with isolated fascial superficial tissue involvement in one leg. Isolated pyomyositis involving one (n = 3) or two (n = 3) muscles was homogeneous in six cases and showed intermediate (n = 6), low (n = 2), or high (n = 1) signal intensity on T1-weighted images and a high and very hyperintense signal on T2-weighted images. The tenosynovitis synovial fluid was homogeneous (n = 1) or heterogeneous with multiple tiny hypointense nodules (n = 1) on T2-weighted images. The subdeltoid bursitis fluid was characterized by homogeneous low signal intensity with a hyperintense rim (n = 2) on T1-weighted images and homogeneous (n = 1) or heterogeneous hyperintense signals with areas of low signal intensity (n = 1) on T2-weighted images. In tuberculous arthritis, the synovial joint fluid (n = 7) showed heterogeneous (n = 4) or homogeneous (n = 3) low signal intensity on T1-weighted images and high or very high signal intensity on T2-weighted images. Where involved, the adjacent muscle(s) (n = 8) were usually hypointense on T1-weighted images and very hyperintense on T2-weighted images. Associated cellulitis was found in arthritis with involvement of neighboring soft tissues (n = 5), pyomyositis (n = 2), and tenosynovitis (n = 1). The images obtained after Gd-DTPA showed peripheral (n = 10) or heterogeneous (n = 1) enhancement or no enhancement (n = 1). CONCLUSION: The MR findings for EMT are variable. Although diagnosis is dependent largely on prior presumption and clinical context, MRI provides valuable guidelines in defining the extent of the lesions to select the appropriate treatment and for follow-up of abnormalities.

Adolescent↗
PubMed1997

Increased prevalence of HIV-2 infection in hospitalized patients with severe bacterial diseases in Guinea-Bissau.

We studied the association between HIV-2 infection and bacterial pneumonia, sepsis or pyomyositis, as well as the influence of HIV-2 infection on the clinical outcome in patients with these bacterial infections. A total of 201 consecutive hospitalized patients were included at the Simao Mendes National Hospital in Bissau, Guinea-Bissau. Age- and sex-matched controls were selected from an ongoing census in a semi-urban area of Bissau. Among 201 cases with such bacterial infection the prevalence of HIV-1 was 5.4%, HIV-2, 27.9%, and both HIV-1 and HIV-2 reactivity 6.4%. Among controls, the corresponding prevalence rates were significantly lower, 1.5%, 9.0% and 1.0%, respectively. A total of 140, 31 and 30 cases of pneumonia, sepsis and pyomyositis were included, and the differences in prevalence of HIV-2 compared with the controls also remained significant for each diagnosis separately. Lymphocyte subsets were determined in 93 consecutive patients, and the CD4 cell counts and CD4/CD8 lymphocyte ratios were markedly suppressed in the HIV-2-seropositive group. Due to excess mortality in the seropositive groups with sepsis (75.0%) and pyomyositis (25.0%), the mortality during hospitalization was significantly higher among HIV-2 infected compared to HIV-negative patients. Among cases of pneumonia the mortality was low in the HIV-2-seropositive (2.9%) as well as in the HIV-seronegative (3.4%) group.

Adult↗
PubMed1994

The spectrum of myositis and rhabdomyolysis associated with bacterial infection.

OBJECTIVE: (1) To describe the clinical and radiographic features of 6 patients with myositis or rhabdomyolysis associated with bacterial infection. (2) To analyze the role of computed tomography (CT) in myositis associated with bacterial infection. METHODS: Review of cases treated by the authors with literature review. RESULTS: Two patients had classical pyomyositis with Staphylococcus aureus as the etiologic agent. One patient had pyomyositis with Enterobacter cloacae (the first reported to our knowledge), 2 had myositis/fasciitis (one due to Clostridium perfringens and one due to S. aureus), and one had fatal toxic rhabdomyolysis in association with C. perfringens bacteremia without evidence of gas gangrene. No patient had a completely normal CT scan of affected muscles, but CT scans in 3 patients failed to show abscesses that were subsequently discovered at surgery, while in another patient CT scanning falsely suggested a large abscess that was not present at surgery. CONCLUSION: Infection associated muscle involvement represents a spectrum of clinical manifestations that include pyomyositis, myonecrosis, fasciitis/myositis, and toxic rhabdomyolysis. Diagnosis may be delayed by the often mild clinical presentation. CT scanning alone may be unreliable in distinguishing muscle abscess from swollen muscle unless combined with CT guided needle biopsy.

Adult↗
PubMed2006

[Painful syndromes in diabetic patients due to skeletal muscle injuries].

Progressive painful syndromes due to skeletal muscle injuries rather than diabetic neuropathy are unusual complications of diabetes mellitus (DM). Two clinical cases are presented: Case 1 (pyomyositis: leg location) and Case 2 (muscle infarction: thigh location). Discussion on how to proceed the diagnosis based on clinical features are included as it is critical for early and proper treatment since approaches highly differ in the two situations. These complications can mimic thrombophlebitis, rhabdomyolyses or a neoplasm, therefore the diagnosis of a diabetes-related disorder may be overlooked. If pyomyositis is not correctly treated with antibiotics and in some cases with surgery, systemic infection and even death may occur, whereas muscle infarction only requires rest and analgesia. Image and laboratory investigations can be of help to differentiate these syndromes, although some findings can overlap. Thus, the present report emphasizes the importance to include these diseases when limb painful syndromes are to be investigated in a diabetic patient.

Adult↗
PubMed2006

Acute iliopsoas and adductor brevis abscesses presenting with proximal leg muscle weakness.

Pyomyositis is a bacterial infection of skeletal muscle. We describe the clinical case of a 77-year-old woman affected by gait disturbance, repetitive falls, low back pain and left thigh and groin pain, but without symptoms of systemic infection. Computed tomography and magnetic resonance imaging of the abdomen and pelvis showed abscesses in the left psoas and adductor brevis muscles. Investigations of urogenital tract and gastrointestinal system were normal. Systemic antibiotic treatment alone was not efficient, while surgical drainage improved the clinical picture. The aetiological organism, isolated from the abscess, was Staphylococcus aureus. We suggest that this patient had a primary pyomyositis rather than a secondary form. This is the first report of concomitant abscesses of psoas and adductor brevis muscles with early neurological involvement.

Aged↗
PubMed2006

[Paravertebral streptococcal myositis complicated by an epidural abscess in a 5-year-old girl].

CASE REPORT: A 5-year-old girl was hospitalised for fever, abdominal and lumbar pain, associated with general impairment state and a whitlow. One of the blood cultures and CSF grew A beta haemolytic Streptococcus, muscular echography and MRI showed paravertebral myositis, which was complicated by an epidural abscess. The outcome was good with medical treatment alone. DISCUSSION: Streptococcal myositis is a rare and severe skeletal muscle infection caused by A beta haemolytic Streptococcus. It is characterized by a muscle necrosis, without abscess formation. It has to be distinguished from pyomyositis, usually caused by Staphylococcus aureus, where a muscle abscess occurs, which must be treated by surgical drainage and antibiotics. Prognosis of this infection is poorer than other muscle infections such as pyomyositis, with a high mortality rate. The diagnosis is difficult and often delayed. Practitioners should keep in mind this diagnosis, even if symptoms are non specific, in front of an undetermined infectious syndrome associated with pain, and make an echography or nuclear magnetic resonance imaging to confirm the diagnosis.

Administration, Oral↗
PubMed2002

Tuberculosis pyomyosits of the soleus muscle in a fifteen-year-old boy.

Skeletal muscle infection caused by Mycobacterium tuberculosis is rare and usually caused by invasion from adjacent structures. We describe a 15-year-old male youth with tuberculous right inguinal lymphadenitis and right calf swelling who had tuberculous pyomyositis of the soleus, probably resulting from hematogenous seeding. Tuberculosis should be suspected as the cause of pyomyositis, especially if present elsewhere.

Adolescent↗
PubMed1987

Lipolytic activity of Staphylococcus aureus strains from disseminated and localized infections.

Lipase production of 425 S. aureus strains isolated from patients with different clinical diagnoses and healthy carriers were measured by a specific method, using emulsified trioleoylglycerol substrate. Strains isolated from patients with septicemia showed significantly higher lipase activity than osteomyelitis strains (p = 0.011), impetigo strains (p = 0.002) and strains isolated from healthy relatives of patients with recurrent furunculosis (p = 0.019). Recurrent furunculosis and pyomyositis strains had significantly higher (p = 0.002 and 0.032, respectively) lipase activity than septicemia strains. S. aureus strains isolated from patients with a significant antibody response in an antilipase ELISA did not show a higher lipase activity in culture supernatants than strains from patients without a significant antibody response. The lipase activity was significantly higher in strains isolated from deep or subcutaneous infections, i.e., septicemia, pyomyositis, osteomyelitis, aerobic and anaerobic furunculosis, than in strains from superficial infections, i.e. impetigo, or from nasal mucosa.

Furunculosis↗
PubMed1997

A case of muscle abscess presenting to an accident and emergency department.

A case is reported of a patient with acute primary muscle abscess who presented to the accident and emergency department with hip pain. Pyomyositis must be considered as a cause of muscle pain especially around the hip. A brief discussion of the diagnosis and management of pyomyositis is also presented.

Abscess↗
PubMed2001

Primary tuberculosis in the gluteal muscle of a patient with chronic renal failure. A rare presentation.

Patients suffering from chronic renal failure (CRF) are at increased risk for contracting tuberculosis (TB) due to their impaired immunity. In this patient group, extrapulmonary involvement is more common than the pulmonary form of TB, and symptoms tend to be milder and less distinctive than those seen in the general population. Pyomyositis secondary to TB is relatively rare. We report a case of TB pyomyositis in the setting of CRF. The nonspecific symptoms that are typical of CRF patients with TB make it particularly difficult to establish the diagnosis in this patient group. In order to avoid diagnostic delays, which may increase the risk of complications and mortality, TB should be kept in mind in any case of ongoing fever and infection that does not respond to seemingly appropriate therapy. In addition, TB should always be suspected in endemic areas, even in the absence of osseous involvement.

Abscess↗
PubMedDate not supplied

Obturator internus muscle abscess in children.

The authors describe four cases of obturator internus muscle (OIM) abscess in children, including their clinical presentations and treatment. This was a retrospective chart review. Children and adolescents younger than 18 years discharged between July 1, 1985, and September 30, 1998, from Brenner Children's Hospital with the diagnosis of muscle abscess or pelvic abscess were identified. A total of 56 patients were identified with the diagnosis of muscle abscess or pelvic abscess. OIM abscess was defined by radiologic findings of an inflammatory process with fluid collection in the OIM, along with the clinical findings suggestive of an OIM abscess. Four of the patients met the definition of OIM muscle abscess. The common presenting features were fever, limp, and hip pain. Computed tomography or magnetic resonance imaging was diagnostic in all four patients, and Staphylococcus aureus was the causative agent in each. All the patients recovered, one after surgical drainage and the other three after antimicrobial therapy alone or with needle aspiration. The presentation of OIM pyomyositis is similar to that of psoas muscle pyomyositis and other infectious processes of the pelvis and hip. The S. aureus is the most common etiologic agent but not the only one reported. Most patients can be managed without open surgical drainage, but needle aspirations may be helpful both therapeutically and diagnostically.

Abscess↗
PubMed2006

Infection and musculoskeletal conditions: Infectious myositis.

Infectious myositis, an infection of the skeletal muscle(s), is uncommon. This clinical entity may be caused by viral, bacterial, fungal, and parasitic pathogens. Viral etiologies typically cause diffuse myalgias and/or myositis, whereas bacteria and fungi usually lead to a local myositis which may be associated with sites compromised by trauma or surgery and are more common among immunocompromised patients. Localized collections within the muscles are referred to as pyomyositis. Other pyogenic causes of myositis include gas gangrene, group A streptococcal myonecrosis, and other types of non-clostridial myonecrosis. Early recognition and treatment of these conditions are necessary as they may rapidly become life-threatening.

Gas Gangrene↗