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PubMed1989

Disseminated Fusarium infections in patients following bone marrow transplantation.

Intensive immunosuppressive therapy and broad spectrum antibiotics predispose cancer patients to opportunistic fungal infections. Fusarium has rarely been reported as a pathogen in immunocompromised patients, but is almost uniformly fatal. Only six cases of disseminated Fusarium infection have been described in patients following bone marrow transplantation (BMT). We report here two additional cases. Fusarium infection initially presented with pyomyositis in one patient and with embolic skin lesions in another following T cell-depleted BMT. Both patients died with active Fusarium infection despite an extensive course of amphotericin B, rifampicin and granulocyte transfusions. From this experience and from a review of the literature, Fusarium infections appear to be increasing in prevalence as significant pathogens in immunocompromised hosts and are resistant to many conventional forms of therapy.

Adult↗
PubMed1985

[Acute suppurative myositis. 4 cases].

Four cases of acute pyomyositis are reported. They were diagnosed at an advanced stage, and the different complementary examinations were of uneven value. The responsible pathogen was Staphylococcus aureus in 3 cases and a strain of Streptococcus in 2 cases (one patient had both germs). Cure was obtained in 3 patients, including one who required amputation; the 4th patient died. In this disease only the finding of purulent fluid at surgery or by needle aspiration has a diagnostic value. Management consists of antibiotic therapy associated with surgical drainage.

Acute Disease↗
PubMed1987

The status of cardiovascular surgery in West Africa.

This report reviews the present status of cardiovascular surgery in West Africa and highlights some of the constraints of development in this field.Rheumatic heart disease is still endemic in the tropics, where it constitutes about 20 percent of all cases of cardiovascular disease (CVD) in Nigeria. Endomyocardial fibrosis is a disease of unknown etiology accounting for 10 to 20 percent of cases. Purulent pericarditis is a common complication of pyomyositis and osteomyelitis found in 5 percent of patients. Chronic constrictive pericarditis is a sequela of infective pericarditis found in 5 percent of all cases of CVD. Calcification is found in 30 percent of cases and pericardiectomy can be performed successfully without cardiopulmonary bypass. Infective endocarditis is equally rare, occurring in 2.5 percent of cases; it is a common source of septic emboli to coronary artery and a very difficult disease to treat in the West African environment.Ischemic heart disease is relatively uncommon, accounting for less than 0.5 percent of patients. The rarity of the disease in black Africans has been attributed to dietary habits and environment rather than to racial and psychosocial factors. Congenital heart disease accounts for 5 percent of all cases of CVD in this review. Ventricular septal defect and patent ductus arteriosus are the most common acyanotic defects, while tetralogy of Fallot and transposition of the great arteries are the most common cyanotic defects.Vascular diseases are uncommon in this series, with traumatic injuries accounting for most of the cases. Abdominal aortic aneurysms, peripheral occlusive vascular disease, and atherosclerotic aortic aneurysms are quite rare. This review further confirms the rarity of deep venous thrombosis and pulmonary embolism in Africans.

Adolescent↗
PubMed1979

Skin and soft tissue polymicrobial infections from intravenous abuse of drugs.

Skin and soft tissue infections were studied in 21 seriously ill narcotic addicts who had been admitted to hospital. Subcutaneous abscesses were present in 14 patients; cellulitis was noted in 3, pyomyositis in 2 and necrotizing fasciitis in 2. In four patients there was septicemia. Infections in 14 patients (66.6 percent) were associated with anaerobic bacteria, which were the exclusive isolates in 6 patients. In seven patients (33.3 percent) isolates were exclusively aerobic bacteria and in eight both aerobes and anaerobes were present. The anaerobic isolates were clostridia (six), peptostreptococci (five), bacteroides (five), peptococci (three), and one of each of Veillonella, Propionibacterium, Eubacterium, Fusobacterium and Actinomyces. Staphylococcus aureus, generally thought to be the most common cause of subcutaneous infections in addicts, was found only in four (19 percent) patients. The other aerobic isolates were Klebsiella (five) and Enterobacter (four) species. When clinical features or the Gram stain of pus suggest that anaerobic bacteria may be present, antibiotic therapy should be directed against both aerobic and anaerobic bacteria until culture results are available.

Abscess↗
PubMed1979

Staphylococcal pericarditis with pyopericardium.

Seven previously well patients with acute staphylococcal pericarditis and purulent pericardial effusion are described. All had a septicaemic illness in which worsening heart failure with signs of cardiac tamponade became the major problems of management. Tropical pyomyositis was probably the predisposing illness in four patients. This number of proven cases within an 18-month period suggests that staphylococcal pyopericardium is in a tropical environment probably commoner than realised.

Adolescent↗
PubMed1983

Clinical trial of bacampicillin in acute bacterial infections.

A clinical trial of bacampicillin was carried out in 20 patients. The antibiotic was found to be effective in acute lobar pneumonia, pyogenic meningitis, acute and chronic bronchitis, acute pharyngitis, acute tonsillitis, cellulitis, furunculosis, and pyomyositis caused by such ampicillin-sensitive organisms as Neisseria meningitidis, Diplococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, Streptococcus pyogenes, Klebsiella pneumoniae, and Escherichia coli. Rash in three patients was the only side effect encountered. It is concluded that while bacampicillin may have overcome some of the disadvantages of ampicillin, it retains its main attributes and some shortcomings.

Adolescent↗
PubMed1981

Penicillin resistant Staphylococcus aureus in Port Moresby.

Since 1971, over 90% of cultures of Staphylococcus aureus isolated from pus specimens obtained in Port Moresby General Hospital have been resistant to penicillin, Since 1979 the percentage has risen to 98% and in addition chloramphenicol resistance has been noted in 26% of isolates since that year. Cases of methicillin or gentamicin resistance have not yet been detected. Even when the possibility of staphylococcal infection is suspected, penicillin or penicillin and chloramphenicol continue to be the initial treatment prescribed in 90.6% of subjects with pyomyositis, 88.5% with acute osteomyelitis, 88.2% with pneumonia and 90% with bacteraemia. Appropriate initial treatment of patients in Port Moresby who are suspected or proven to have serious S. aureus infection should include a beta-lactamase resistant penicillin or suitable alternative bacteriocidal antibiotic.

Chloramphenicol↗
PubMed1978

Pattern of thoracic surgical diseases in Nigeria: experience at the University College Hospital, Ibadan.

A prospective study of 595 patients treated by the Thoracic Surgical Unit (TSU) at the University College Hospital (UCH), Ibadan between July 1975 and December 1977 was carried out to determine the pattern of thoracic surgical diseases in Nigeria and to prove or disprove the rarity of certain cardiopulmonary diseases in tropical Africa. This review shows that pyogenic infections of the lung and pleura constitute the largest percentage (38.5) of the thoracic surgical diseases in Nigeria. Although pulmonary tuberculosis accounts for only 23.4 percent of our total inpatient load, it constitutes about 60 percent of our outpatient clinic practice. Cardiovascular diseases form 12.9 percent, notably congenital and acquired valvular heart diseases. An interesting finding was the occasional association of pyomyositis with pyogenic pericarditis and empyema thoracis. This triad is being investigated. Chest trauma was the most common thoracic surgical emergency accounting for 9.2 percent of the total thoracic surgical pathology. The most common causes of dysphagia are strictures from corrosive esophagitis, achalasia, and carcinoma of the esophagus. Present experience confirms the rarity of hiatus hernia, reflux esophagitis, atherosclerotic cardiovascular disease, and, perhaps, carcinoma of the lung among Nigerians.

Adolescent↗
PubMed1981

Purulent pericarditis: a continuing surgical challenge.

This report presents a prospective series of 12 patients with a diagnosis of purulent pericarditis who were treated between April 1978 and September 1979 by the cardiothoracic surgical unit at the University College Hospital, Ibadan, Nigeria. These patients were studied to determine the adequacy of a therapeutic protocol consisting of systemic antibiotics and pericardiostomy tube drainage. All patients were in the pediatric age group with an average age of 6¾ years. Bronchopneumonia was the antecedent focus of sepsis in eight patients, with pyomyositis in four (33 percent). Two patients expired prior to surgery.No mortality or significant morbidity occurred in the ten patients who underwent pericardiostomy.The results of this series combined with the initial experience reported in 1978 by the same authors confirm the described protocol as the treatment of choice in their environment.

Anti-Bacterial Agents↗
PubMed1995

Staphylococcus aureus infections in diabetic patients.

Staphylococcus aureus infections may occur with greater frequency among patients with diabetes mellitus. This article reviews the available literature as it pertains to diabetes and S. aureus in three categories: colonization/carriage, bacteremia with or without metastatic complications, and dialysis-related infections. The clinical entity of pyomyositis is also discussed.

Bacteremia↗
PubMedDate not supplied

[Tropical myositis].

The authors describe six cases of tropical myositis or pyomyositis treated in the Department of Internal Medicine of the University of São Paulo between 1985 and 1992. Staphylococcus aureus was the causative agent. It was isolated from the muscular abscess in four cases and blood cultures in two cases. The treatment with appropriate antibiotics and drainage of the abscess(es) determined satisfactory evolution without mortality or residual deformity.

Adult↗
PubMed1993

Surgical management of pyopericardium.

Forty three patients with pyopericardium were managed over a six year period. Pyomyositis and septic arthritis were the most common associated conditions and Staphylococcus aureus the commonest microorganism isolated. Mycobacterium tuberculosis was isolated in only three of the cases. Pericardiocentesis and various forms of pericardial windows were found to be associated with high rates of recurrences, inadequate drainage and subsequent constrictive pericarditis. Pericardiectomy should be done as an initial form of surgical treatment where the general condition of the patient permits, since this procedure is not associated with the adverse sequelae of aspiration and pericardial window procedures.

Adolescent↗
PubMed1993

Infections other than AIDS.

Neurologic manifestations of severe infectious complications of drug abuse and chronic alcoholism are reviewed in this article. Portals of entry from cutaneous postinjection infections and multiple vascular injection sites may lead to pyomyositis, tetanus, infective endocarditis, meningitis, brain abscesses, and vertebral osteomyelitis. Chronic intranasal abuse of cocaine may be followed by frontal osteomyelitis, botulism, brain abscess, and visual loss. Problems of hepatitis, malaria, and syphilis in drug abusers are discussed also.

Humans↗
PubMedDate not supplied

[Myosonographic findings in inflammatory muscular diseases].

Inflammatory myopathies are rare diseases with an annual incidence of about 1-8 per 1 million persons. However, they are of special importance in myology as they can be treated successfully. There are auto-immune mediated and infectious forms of myositis. From the clinical and myopathological view, one can distinguish acute and chronic forms: the former presenting with distinct inflammatory reactions in the muscle tissue and often causing myalgia. Muscle atrophy, the latter presenting with marked muscle weakness, often with clear muscle atrophy and mesenchymal abnormalities in the biopsy. Ultrasound well documents muscle atrophy, sometimes compensatory hypertrophy, as well as mesenchymal abnormalities such as lipomatosis and fibrosis. In very acute myositis, as in pyomyositis muscle edema and abscesses can be depicted. Typical findings in autoimmune mediated myositis are reported based on our own experiences in 75 patients and according to the literature. The degree and distribution of muscle atrophy and mesenchymal abnormalities visualized by ultrasound can give clues to the type and prognosis regarding muscle function. Additionally, ultrasound can be used for searching the optimal biopsy site.

Diagnosis, Differential↗
PubMed1996

Spinal infections in the immunocompromised host.

There is an increasing population of immunocompromised patients with HIV, IV drug abuse, organ transplantation, and long-term steroid treatment developing spinal infections. Delayed diagnosis because of blunted host immune response and lack of outward signs and symptoms places the treating physician at a disadvantage in the treatment of this type of disease, which presents at a later stage of development. Immunocompromised patients are infected by a different group of pathogens than their healthier cohorts (e.g., Pseudomonas, gram-negative bacteria and fungal infections) because their host defenses are diminished. Osteomyelitis with or with out pyomyositis and epidural abscess may occur. The overriding symptom is back pain. Radiculopathy, myelopathy, and sensory loss may accompany local pain and tenderness. Plain film radiography, CT scan, MR image, and bone scan is invaluable in the diagnosis of these infections. The cornerstone of treatment is identification of the responsible pathogen, appropriate medical therapy, immobilization of the affected segment of the spine, and physical therapy to combat physical deconditioning. Psoas abscesses may require surgical debridement if they cannot be adequately drained by CT-guided percutaneous catheterization. Epidural abscesses with neurologic compromise require surgical drainage. Impingement of the spinal cord or cauda equina by collapsed osteomyelitic vertebral bodies requires surgical debridement by anterior vertebrectomy, with an autologous tricortical iliac crest strut and immobilization of the spine using external bracing or posterior instrumentation as dictated by the disease.

Abscess↗
PubMed1997

Arthropathies and inflammatory conditions of the elbow.

MR imaging of arthropathies and inflammatory conditions affecting the elbow are presented. Noninfectious conditions discussed include osteoarthritis, disorders characterized by synovial proliferation, pigmented villo- nodular synovitis, synovial osteochondromatosis, crystal deposition disorders, and neuropathic osteoarthropathy. Infectious conditions discussed include septic olecranon bursitis, septic arthritis, osteomyelitis, and pyomyositis. Clinical aspects of these entities are discussed, including utility of MR imaging for diagnosis and clinical management.

Arthritis↗
PubMed1997

Septic arthritis of lumbar facet joints. A review of six cases.

Hematogenous infection of the facet joints by pyogenic organisms is exceedingly rare. We report six cases of lumbar facet joint septic arthritis due to hematogenous spread of a pyogenic organism. A review of the literature identified ten anecdotal reports of similar cases. An analysis of these 16 cases showed that the diagnosis was based mainly on imaging study findings and that clinical data failed to discriminate between facet joint septic arthritis and infectious discitis. Increased uptake on the radionuclide bone scan was an early finding and the pattern of uptake was different from that seen in discitis. Computed tomography was the investigation that best delineated the facet joint lesions. Magnetic resonance imaging of the lumbar spine was superior over computed tomography in demonstrating spread of the infection to the epidural space and/or soft tissues and in some instances demonstrated enhancement of the infected facet joint on T1 images after gadolinium injection. Aspiration of the facet joint under fluoroscopic guidance was required only when blood cultures were negative or when the diagnosis of the septic nature of the arthritis was in doubt. Blood cultures yielded a Staphylococcus aureus in the six cases in our series. Appropriate antimicrobial therapy was successful in most cases. In our series, four of the six patients had posterior epiduritis, pyomyositis, or an abscess in the paraspinal muscles or psoas muscle, suggesting that some epidural infections or psoas muscle abscesses believed heretofore to be primary may in fact be complications of facet joint septic arthritis. Facet joint septic arthritis is a new aspect of pyogenic spinal infections that deserves to be considered in patients with febrile spinal syndromes not explained by discitis.

Abscess↗
PubMed1998

[A swelling in the distal part of the thigh].

A swelling in the distal thigh may be caused by a tumour of bone or soft tissues, an aneurysm or an inflammation. Signs of inflammation may render interpretation more difficult. Four males aged 60, 48, 15 and 81 years had had a swelling in the popliteal space or above the knee, in some cases with pain. Supplementary examinations, especially MRI scanning and arteriography did not always result in a diagnosis. The diagnosis could be made, however, during operation: an empyemic thrombosed popliteal artery aneurysm, a liposarcoma, pyomyositis and suture dehiscence of a plastic prosthesis of the popliteal artery. After treatment, consisting of or started during the operation, uneventful recovery occurred.

Adolescent↗