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PubMed1990

MR imaging of thoracic and abdominal wall infections: comparison with other imaging procedures.

Infections of the chest and abdominal wall are rare but potentially fatal disorders that can occur spontaneously or in association with diabetes mellitus, immunosuppression, or trauma. The condition (either in the form of necrotizing fasciitis and/or pyomyositis) is difficult to diagnose clinically because of poor localizing signs. Prognosis depends on early recognition, extent of disease, and type of causative organism. Pathologically, the infections can manifest as cellulitis, abscess, and/or granulation tissue formation. To determine the value of MR imaging in the assessment of these infections, we compared the findings of MR with those of CT, sonography, scintigraphy, and plain radiography in 13 patients with proved thoracic and/or abdominal wall infection. The imaging findings were correlated with microbiological, pathologic, and/or surgical data. The isolated pathogens were Staphylococcus aureus (n = 6), Klebsiella pneumoniae (n = 1), Mycobacterium tuberculosis (n = 4), and Streptomyces somaliensis (n = 2). In 10 of 13 patients, MR imaging and CT were comparable and proved accurate in detecting the nature and extent of the inflammatory process. In seven of the patients, CT also was useful in guiding percutaneous biopsy and/or partial drainage procedures. Coronal and sagittal MR images were helpful for planning surgery. Rib osteomyelitis was missed with both techniques in one patient; in two other patients who did not have CT, MR imaging missed osteomyelitis of the ribs, the spinous process of a vertebral body, and the iliac bone. Sonography underestimated the extent of the disease in all 13 patients, but detected fluid collections in six. Findings on scintigraphy and plain radiography were the least contributory to the diagnosis and treatment of these patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Muscles↗
PubMed2002

Rheumatic disorders in Sub-saharan Africa.

OBJECTIVE: To review prevalence of rheumatic disorders in Sub-saharan Africa and in the context of current medical practice in the region assess the need for service and educational provision. DATA SOURCES: Medline, (English, French). Pre-Medline literature review from the 1950's (Current contents). Various conference reports including attendance at all three AFLAR (African League Against Rheumatism) congresses in the 1990's. Author's personal database. All cited references read in full. CONCLUSIONS: The evidence shows rheumatoid arthritis and systemic lupus erythematosus to be increasing in frequency in the indigenous populations of East, Central and South Africa but remaining rare in West Africans. Gout is now more prevalent than ever throughout the subcontinent. HIV has spawned a variety of previously rare spondyloarthropathies (reactive arthritis, psoriatic arthritis, enthesopathy) and changed the epidemiology of pyomyositis and osteomyelitis. Osteoarthritis is a universal problem. Juvenile chronic arthritis is not rare and rheumatic fever is common. Acute and chronic locomotor problems associated with diverse entities such as leprosy, brucellosis, meningococcus, alpha viruses, parasites, fluorosis, rickets and haemoglobinopathies enhance diagnostic diversity and therapeutic and educational requirements. Suggestions made to address the challenge posed by the burden of rheumatic disorders.

Adult↗
PubMed2003

Purulent pericarditis complicating septicaemia: report of two cases.

Intrapericardial (Pericardial) abscess is quite rare as a complication of sepsis and as a cardiac complication of typhoid septicaemia. It is rapidly fatal if untreated. We report two cases of a schoolboy eight years old with septicaemia from pyomyositis of the right thigh and another of nine and a half years with typhoid perforation and typhoid septicaemia that developed pericardial abscesses. In well-developed centres, computerised tomography, ultrasonography and other radiological investigations are employed for both diagnosis and therapy. We emphasise that these can be accomplished by good clinical examination, radiography of chest and the use of 18-G intra-venous cannula for percutaneous pericardiocentesis without aggressive surgical intervention.

Bacteremia↗
PubMedDate not supplied

Musculoskeletal manifestations of human immunodeficiency virus infection.

Musculoskeletal manifestations of the human immunodeficiency virus (HIV) are common and are sometimes the initial presentation of the disease. Knowledge of the conditions affecting muscle, bone, and joints in HIV-infected patients is essential for successful management. Myopathies may be caused by pyogenic infection (eg, pyomyositis), idiopathic inflammation (eg, polymyositis), or drug effect (eg, AZT myopathy). Characteristic skeletal infections, such as tuberculosis and bacillary angiomatosis, require a high index of suspicion for accurate diagnosis. Neoplastic processes, such as non-Hodgkin's lymphoma and Kaposi's sarcoma, occur more frequently as the immune system deteriorates. Inflammatory and reactive arthropathies are more prevalent in HIV-positive than HIV-negative individuals and include Reiter's syndrome, psoriatic arthritis, HIV-associated arthritis, painful articular syndrome, acute symmetric polyarthritis, and hypertrophic osteoarthropathy. Patients with atypical musculoskeletal complaints and a suspected history of exposure should be tested for HIV.

Angiomatosis, Bacillary↗
PubMed1998

[Tropical myositis].

Tropical pyomyositis (TP) is a microbial infection involving one or more skeletal muscles that rapidly leads to abscess. The most common infectious agent is Staphylococcus aureus. Since muscle tissue is highly resistant to infection, occurrence of TP is contingent upon one or more compromising factors such as trauma, skin lesions, parasitosis, or malnutrition. HIV infection is currently a major factor in the occurrence of TP. While Staphylococcus aureus accounts for 80% of cases, other microbial agents have been identified including gram-positive cocci and gram-negative bacilli. TP is endemic in intertropical zones of Africa and Latin America and in island areas of the Pacific Ocean. However a growing number of non-tropical cases have been reported in association with AIDS. The most frequent presentation is single-muscle involvement in the thighs, calves, and buttocks. The symptomatic phase or suppurative phase is almost always associated with hyperthermia. The infected muscle indurates prior to development of characteristic fluctuance. Hemocultures are seldom positive but needle aspiration may confirm diagnosis. Ultrasound imaging can allow early detection. Severe sepsis or cardiovascular, renal, or pleuropulmonary complications are observed in 10% of cases. Treatment is antibiotic therapy with penicillin M and surgical drainage or needle puncture of abscess cavities. Prognosis is generally favorable even in HIV-infected patients.

Diagnosis, Differential↗
PubMed1999

[Serious bacterial and fungal infections in intravenous drug addicts].

Invasive infections caused by bacteria and fungi are common complications of intravenous drug abuse. Various vital organs and structures may be affected, e.g. the cardiac valves, the larger arteries, the bones, the joints and the central nervous system. However, due to the high frequency of low-virulent microbes of skin and oral origin, the clinical picture may be atypical with subacute course and few focal signs and symptoms. The complexity of this problem is illustrated by eight cases of serious bacterial and fungal infections recently diagnosed at our hospitals. All patients were HIV negative intravenous heroin addicts. The clinical spectrum was wide and included skin abscesses, pyomyositis, spondylodiscitis, septic arthritis, costal osteomyelitis, infective endocarditis, recurrent bacteraemia, and multiple brain abscesses.

Abscess↗
PubMed1999

Painful swelling of the thigh in a diabetic patient: diabetic muscle infarction.

A 44-year-old woman with a 5-year history of poorly controlled Type 1 diabetes mellitus presented with a painful, firm and warm swelling in her right thigh. Pain was severe but the patient was not febrile, and had no history of trauma or abnormal exercise. Laboratory tests showed ketoacidosis, major inflammation (erythrocyte sedimentation rate (ESR) = 83 mm/h), normal white blood cell count and normal creatine kinase level. Plain radiographs were normal, and there were no signs of thrombophlebitis at Doppler ultrasound. Magnetic resonance imaging (MRI) showed diffuse enlargement and an oedematous pattern of the adductors, vastus medialis, vastus intermedius and sartorius of the right thigh. The patient's symptoms improved dramatically, making biopsy unnecessary, and a diagnosis of diabetic muscular infarction was reached. Idiopathic muscular infarction is a rare and specific complication of diabetes mellitus, typically presenting as a severely painful mass in a lower limb, with high ESR. The diabetes involved is generally poorly controlled longstanding Type 1 diabetes with established microangiopathy. Differential diagnoses include deep vein thrombosis, acute exertional compartment syndrome, muscle rupture, soft tissue abscess, haematoma, sarcoma, inflammatory or calcifying myositis and pyomyositis. In fact, physician awareness should allow early diagnosis on the basis of clinical presentation, routine laboratory tests and MRI, thereby avoiding biopsy and its potential complications as well as unnecessary investigations. Rest, symptomatic pain relief and adequate control of diabetes usually ensure progressive total recovery within a few weeks. Recurrences may occur in the same or contralateral limb.

Adult↗
PubMed2000

Musculoskeletal infections in adolescents.

Musculoskeletal infections are uncommon disorders in adolescents and represent unique diagnostic and therapeutic challenges to the clinician. The pathogenesis, treatment, and prognosis of many musculoskeletal infections vary markedly in children compared to adults based in part on behavioral differences, bone growth, and changing vascularity patterns. Since adolescents can exhibit manifestations of infection common to either age range, a familiarity with the differences is essential for successful management. This article reviews common musculoskeletal infections affecting normal adolescent population, but also includes special considerations. Hematogenous osteomyelitis and suppurative arthritis are reviewed in detail, including pathogenesis, etiology, signs and symptoms, diagnosis, laboratory tests, radiologic imaging, and treatment. Also discussed are contiguous osteomyelitis with and without vascular insufficiency, puncture wound osteomyelitis, vertebral osteomyelitis, osteomyelitis with sickle cell disease, chronic osteomyelitis, pyomyositis, acute bacterial myositis, and nonstreptococcal myonecrosis.

Adolescent↗
PubMed2001

[Infectious myopathies].

Infectious myopathies are rare acquired affections which have, generally, a good prognostic. Many types of viral infections can cause transient inflammatory myopathies. HIV myopathy may be present early in the HIV infection, but more often it is a complication of fully developed AIDS. Influenza virus myositis tend to be more severe in adults than in children. Group B coxsackie virus has been isolated from striated muscle of patients with epidemic myalgia. Parasitic infections of muscle include trichinosis, toxoplasmosis, and cysticercosis. Trichinosis is the most frequent parasitic myositis. The ocular, lingual or pharyngeal weakness and/or hypereosinophilia suggest the diagnosis. Pyomyositis, is a located zone of suppuration of muscle due to staphylococcus in 90% of the cases. It is a common occurrence in tropical climates, but has been recognized increasingly in temperate climates.

Bacterial Infections↗
PubMed2001

Musculoskeletal manifestations in patients positive for human immunodeficiency virus: correlation with CD4 count.

OBJECTIVE: To determine the relationship between the CD4+ lymphocyte count and musculoskeletal manifestations of human immunodeficiency virus (HIV) infection. METHODS: All patients from 1991 to 1998 who were positive for HIV with osteoarticular manifestations were reviewed retrospectively. HIV positivity was confirmed by ELISA and Western blot. CD4 count was performed by flow cytometry. RESULTS: We studied 74 patients with osteoarticular manifestations. The study group comprised 61 men (82.4%) and 13 women (17.5%) with a mean age of 34.2 years (range 17-62). Fifty-two patients were iv drug users (70.3%). Septic arthritis was present in 20 cases (23.0%), soft tissue infections in 9 cases (12.2%), spondyloarthropathies in 6 cases (8.1%), lymphomas in 9 cases (12.2%), osteomyelitis in 6 (8.1%), and 24 miscellaneous cases (32.4%). The mean CD4 count was as follows: septic arthritis 164.7 cells/mm3, soft tissue involvement 127.1 cells/mm3, spondyloarthropathies 245.8 cells/mm3, lymphoma 132.8 cells/mm3, and osteomyelitis 233.6 cells/mm3. CONCLUSION: Osteoarticular manifestations in the setting of HIV infection tend to be predominantly infectious. S. aureus is the microorganism most frequently involved. Ostearticular infections always appeared when the CD4 count was < 200 and pyomyositis and lymphoma appeared when CD4 was < 150. CD4 counts may be useful predictors to determine the type of musculoskeletal manifestation.

Adolescent↗
PubMedDate not supplied

A five year analysis of death in accident and emergency room of a semi-urban hospital.

A 5 year retrospective survey of deaths at the Accident and Emergency Unit was carried out to determine the demographic pattern, causes and time spent before demise. There were 475 deaths, annual rate of 95 cases. Males in 279 (58.8%) and 186 females (41.2%), age ranged from 15-90 years, mean 44 SD +/- 21 years. Medical diseases in 354 (74.5%), trauma in 72 (15.2%) and surgical conditions 49 (10.3%) patients There were 135 (38%) cases of cardiovascular diseases and pulmonary diseases 115 (32.6%) patients. Tuberculosis and pneumonia were the most common of pulmonary conditions. Central nervous diseases and gastro-intestinal diseases in 46 (13%) and 40 (11.2) respectively, mainly infectious conditions. Road Traffic Accident caused death in 51 (70.5%), assaults in 8 (11.4%) cases, gunshot and poison 5 (6.8%) each, and snake bites in only 3 (4.5%) cases of trauma. Surgical acute abdomen with peritonitis occurred in 18 (36%) cases, pyomyositis with septicaemia in 7(133%), gastrointestinal bleeding 5 (10%) and burns in only 3 (6.7%) cases In conclusion, over two-thirds of deaths in accident and emergency unit were due to medical problems. The means of the age were in late thirties- mid forties, there was no significant difference in the mean age of those who died of medical, trauma and surgical problems. Trauma victims spent the shortest mean time in accident and emergency before death, the longest staying were the victims of medical diseases.

Adolescent↗
PubMed1992

Imaging of the skeleton and soft tissues in children.

Sonographic applications to osteomyelitis, myositis ossificans, tropic pyomyositis, child abuse, synovitis, and slipped capital femoral epiphyses; MR imaging (including gadolinium-enhanced MR scans) in osteomyelitis, the normal and abnormal physis, physeal bars, normal marrow, Gaucher disease, cancer, dysplasia epiphysealis hemimelica, myositis, tenosynovitis, arthritis, and clubfoot; nuclear imaging in osteomyelitis, tibia valga, limp, and unexplained lower extremity pain; and CT in osteomyelitis, are reviewed. Routine long-bone radiography for patients with congenital syphilis is not recommended. Tibia valga after fracture has not been fully explained; tibia valga also follows treatment of renal failure. Nonsupracondylar humerus fractures in infants and femoral shaft fractures in the first year of life may suggest child abuse.

Bone Marrow↗
PubMed1992

Rheumatic fever and disorders of the musculoskeletal system.

New information provided on the pathogenesis and management of rheumatic fever is of current interest. Invasive disease by group A streptococci has been shown to be due to production of toxin A. The natural history and immunopathologic basis for chronic Lyme arthritis are reported. Attention is drawn to pyomyositis and clinical presentation of chronic fatigue syndrome in children. Patients with Sweet's syndrome often have antineutrophil cytoplasmic autoantibodies. Biopsy specimens of panniculitis should be taken to aid treatment. Long-term outcome in chronic osteomyelitis is favorable; recommendations on the rational use of imaging have been reported.

Child↗
PubMed2004

Human immunodeficiency virus-associated rheumatic disorders in the HAART era.

OBJECTIVE: To define the frequency and characteristics of human immunodeficiency virus (HIV)-associated rheumatic manifestations in patients receiving highly active antiretroviral therapy (HAART) referred to a rheumatology clinic. METHODS: A total of 75 patients with HIV infection receiving HAART were prospectively evaluated for the presence of rheumatic complaints. Diagnosis of HIV infection was performed by ELISA and confirmed by Western blot, and all HIV patients were classified according to the US Centers for Disease Control criteria. RESULTS: Seventy-five individuals with HIV infection and musculoskeletal manifestations were evaluated: 65 (86%) men and 10 (14%) women. Mean age was 32 +/- 4.5 years (range 21-58). The group included 40 (53%) heterosexuals, 30 (40%) intravenous drugs users, 9 (12%) homosexuals, 3 (4%) who had received blood transfusion, and 2 (2.6%) with unknown risk factors. Septic manifestations were the most common complications seen in 31 (41%) out of 75, and included septic arthritis, cellulitis, osteomyelitis, diskitis, and pyomyositis. Fibromyalgia was present in 13 (17%), seronegative symmetric polyarthritis in 4, oligoarthritis in 4, psoriatic arthritis in 2, carpal tunnel syndrome in 2, and enthesitis in 2. Mutifocal bone non-Hodgkin's lymphoma was present in 7 (9.3%) and Kaposis's sarcoma of bone in 2 (2.6%) patients. Hypertrophic osteoarthropathy in 3 (4%) and aseptic bone necrosis of multiple bones was seen in 3 (4%) patients. Ten patients exhibited only arthralgias. Most patients had moderately elevated erythrocyte sedimentation rate and C-reactive protein. Mean CD4 cell count was 250 mm3 (range 20-450), and mean HIV viral load was 5210 (range 0-75,300) copies/ml. CONCLUSION: Rheumatic manifestations were highly frequent in HIV patients receiving HAART referred to a rheumatology clinic, although the clinical spectrum differed from the pre-HAART era with septic and malignant complications being the most common manifestations seen.

Adult↗
PubMed2006

Soft tissue infections in children: a retrospective analysis of 242 hospitalized patients.

Pediatric soft tissue infections (STIs) are frequently seen disorders that represent one of the most common indications for antimicrobial therapy. We conducted a retrospective analysis of 242 patients who were hospitalized with STIs during the period from January 2000 to January 2004. The ages of the patients ranged from 1 month to 180 months (mean 44.33 +/- 36.92 months). The STIs were distributed as cellulitis in 96 (39.7%) patients, cervical lymphadenitis in 62 (25.6%), cervical abscess in 49 (20.2%), subcutaneous abscess in 25 (10.3%), pyomyositis in 6 (2.5%) and necrotizing fasciitis in 4 (1.6%). In 103 (42.2%) patients, a predisposing factor was found. Blood cultures yielded positive results in 18 (7.4%) cases. The responsible microorganisms were identified in 74 (30.6%) patients. The initial therapy consisted of ampicillin/sulbactam in 166 (68.6%) patients, ceftriaxone or cefotaxime in 58 (24.0%), and ceftriaxone plus clindamycin in 18 (7.4%). Surgical drainage was performed in 65 (86.7%) patients with abscesses. White blood cell count, C-reactive protein, and erythrocyte sedimentation rate returned to normal in mean periods of 3, 7 and 10 days, respectively. The mean duration of parenteral antibiotic therapy was 10 days, and the duration of treatment was found to increase with increasing C-reactive protein and erythrocyte sedimentation rate on admission (P = 0.001 and P < 0.001). Complications developed in 12 (4.8%) patients; there was no mortality.

Adolescent↗
PubMed1991

Septic arthritis and other infections of rheumatologic significance.

Bacterial arthritis has been reported rarely in patients with human immunodeficiency virus infection and generally is associated with other risk factors such as intravenous drug use. Septic arthritis may be caused by opportunistic organisms and may be more common in hemophiliacs when associated with human immunodeficiency virus infection. Pyomyositis and osteomyelitis have also been reported more commonly.

Arthritis, Infectious↗
PubMed1975

Diplococcus pneumoniae. Cellulitis in drug addicts.

Cellulitis caused by Diplococcus pneumoniae was diagnosed in two heroin users. To our knowledge, this medical emergency, clinically indistinguishable from deep fasciitis of pyomyositis, has not previously been reported as having been caused by the agent identified in these two patients.

Adult↗