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PubMed2003

Pyomyositis of the vastus medialis muscle associated with Salmonella enteritidis in a child.

We describe a 23-month-old boy with pyomyositis of the vastus medialis muscle caused by Salmonella enteritidis. Such focal Salmonella infections are uncommon in soft tissue. It is noteworthy of this case that there were no antecedent signs of gastroenteritis and no underlying medical condition. MRI, in particular the fat-suppressed T2-weighted sequence, is helpful for establishing the diagnosis and differentiating pyomyositis from other pathological conditions.

Humans↗
PubMed1996

Tropical pyomyositis: imaging findings and a review of the literature.

Tropical pyomyositis is a rare cause of multiple abscesses of skeletal muscle. The entity is rare in temperate climates and, as its name suggests, is more common in areas such as the tropics and South Pacific. Staphylococcus aureus is the most common cause of infection. Therapy is aggressive, with surgical debridement and drainage followed by antibiotics. We report an unusual case of tropical myositis which simulated tumor recurrence in a patient without the typical risk factors associated with tropical pyomyositis.

Abscess↗
PubMed2002

Ultrasound and MRI features of pyomyositis in children.

Pyomyositis (PM) is an infectious disease of the skeletal muscle with a wide range of symptoms such as pain, fever or swelling, and is predominantly found in the tropics. In recent years PM has increasingly been diagnosed in Europe and in the U.S. Our objective is to describe the ultrasound and MRI features of PM in children. A retrospective analysis of 12 children with PM (2 girls and 10 boys; age range 1-13 years) admitted to our hospital between 1998 and 2002 was carried out. All children had a US exam and 8 children underwent MRI. Children with osteomyelitis and accompanying myositis were excluded from this study. In all patients who had MRI ( n=8) the infected muscles were found to have the following features: hyperintensity on the T2-weighted images, diffuse borders and contrast enhancement. In the pelvis ( n=4), only one PM could be detected with US, in the other 3 cases only US of the hip joint was performed based on the clinical symptoms. In the extremities ( n=8) US always revealed an altered echogenicity of the affected muscles as well as fluid collection in 5 cases. Both US and MRI reveal characteristic changes of the PM. Ultrasound should be the first imaging modality in the extremities. In the pelvis MRI is the imaging modality of choice. The MRI is needed to differentiate pyomyositis from osteomyelitis.

Adolescent↗
PubMed1981

Pyomyositis: tropical disease in a temperate climate.

Two cases of pyomyositis or bacterial abscess of striated muscle in adults are presented. One patient was initially diagnosed as having acute thrombophlebitis of the lower extremity. Computerized tomography was helpful in establishing the correct diagnosis. The other patient presented with a closed compartment syndrome following blunt trauma. Both patients responded to open drainage and antibiotic therapy, although the diagnosis was delayed for over three weeks in one patient. Although common in the tropics, pyomyositis is unusual in the temperate zone. Unfamiliarity with this entity remains the major obstacle to appropriate management.

Abscess↗
PubMed1987

Pyomyositis and hepatic abscess in association with Aeromonas hydrophila sepsis.

This report describes a patient with chronic liver disease in whom Aeromonas hydrophila sepsis developed following ingestion of fresh lake water. A hepatic abscess and bilateral calf pyomyositis, an extremely rare and previously fatal complication of A. hydrophila septicemia, subsequently developed. The patient recovered following bilateral fasciotomies and systemic antibiotic therapy with gentamicin and trimethoprim/sulfamethoxazole. No previous survivors of A. hydrophila pyomyositis secondary to metastatic infection have been described. A discussion of these rare sequelae of A. hydrophila septicemia and their effective management is included.

Adult↗
PubMed1990

Has lack of vitamin C any role in the aetiology of tropical pyomyositis?

The plasma concentration of vitamin C of 14 patients with tropical pyomyositis without clinical evidence of scurvy and that of II age and sex-matched controls was determined in order to ascertain whether or not there was a deficiency of the vitamin in this condition. The results show that the mean plasma concentrations of vitamin C of patients were slightly higher (15.9 +/- 6.4 g/l) than those of controls (12.0 +/- 4.5 g/l). The differences, however, were not statistically significant (P greater than 0.25). It is therefore concluded that lack of vitamin C does not play a part in the aetiology of tropical pyomyositis.

Ascorbic Acid↗
PubMed1996

[Pyomyositis in adults in central Tunisia. Apropos of 10 cases].

Ten adult patients treated for pyomyositis between 1988 and 1994 in Sousse's university hospital (Tunisia) were retrospectively reviewed. Due to the non specific symptoms, the diagnosis was often delayed (mean = 17 days) and other primary diagnoses were considered, mainly including synovitis. The muscles around hip and thigh were most commonly involved (ten patients), and Staphylococcus aureus was the most common pathogen (nine patients). Ultrasonography was very helpful in the accurate diagnosis of the infection. Incision, drainage, and antibiotic therapy eradicated the infection in all patients. No residual functional limitations and no residual symptoms were noted. Our study showed that pyomyositis is present in central Tunisia and not associated with HIV infection. Clinical features and prognosis are similar to those previously described in the literature.

Adult↗
PubMed1996

Pyomyositis in children, caused by anaerobic bacteria.

The author describes the microbiology and clinical features of six pyomyositis infections in children, which yielded anaerobic bacteria. Anaerobic bacteria alone were recovered in four instances, and they are mixed with facultative bacteria in two. There were 15 bacterial isolates (13 anaerobic, 2 facultative). The bacteria were Peptostreptococcus sp (5 isolates), Bacteroides fragilis (3), Clostridium sp (2), Fuso-bacterium nucleatum (1), Prevotella sp (1), Bateroides sp (1), Streptococcus pyogenes (1), and Escherichia coli (1). Recent trauma or injury had occurred in five cases; three such injuries were from penetrating objects. This study highlights the potential importance of anaerobic bacteria in children with pyomyositis.

Abscess↗
PubMed1987

Neutrophil cell function and migration inhibition studies in Nigerian patients with tropical pyomyositis.

We investigated polymorphonuclear neutrophil (PMN) cell function and migration inhibition factor (MIF) in Nigerian patients with tropical pyomyositis (TP) and in healthy Nigerians as control subjects. The nitroblue tetrazolium (NBT) reduction test revealed that the ability of PMN to form formazan in patients was similar to that of the control subjects. This observation was taken to indicate that there may not be any metabolic defect in PMN of these patients. The MIF assay showed that the lymphocytes of the patients were significantly inefficient in responding in vitro to Staphylococcus aureus as compared with controls (S.D. 26 +/- 8 for patients, 53 +/- 10 for controls; P less than 0.01). This observation suggested that lymphocytes, particularly T-cells, of the patients were probably not primed adequately against S. aureus during the course of infection in vivo. The implications of these findings as they relate to tropical pyomyositis are discussed.

Adolescent↗
PubMed1992

Tropical pyomyositis in a temperate climate in an immunocompetent adult.

Tropical pyomyositis, though common in Africa, South America, and the South Pacific, is relatively rare in North America. Reported is the case of a patient who developed chest wall muscle abscesses after sustaining minor chest wall muscle trauma and presented to the emergency department appearing acutely ill. He was treated surgically with irrigation and debridement of the abscesses as well as with antibiotics and recovered fully over a seven-month course. This case illustrates important aspects of tropical pyomyositis with a discussion of the natural history of this disease as well as diagnostic modalities and treatment options for this virulent infectious process that is usually caused by penicillin-resistant Staphylococcus aureus.

Adult↗
PubMed2000

Magnetic resonance imaging of pyomyositis in 43 cases.

PURPOSE: To describe the magnetic resonance imaging (MRI) findings in pyomyositis. METHODS AND MATERIALS: Forty-three patients with proven muscle infection (30 males, 13 females) ranging in age from 14 to 86 years (mean 42 years) were studied with MRI. The initial clinical diagnose were soft tissue infection (n=27), neoplasm (n=12), thrombophlebitis (n=3), and lymphedema (n=1). Spin-echo T1- and T2-weighted images were obtained in all cases and STIR sequence in 6. Spin-echo T1-weighted images after Gd-DTPA injection were obtained in 16 cases. The signal intensity findings, the extent of the abnormalities in the soft tissue (muscle, fascial and subcutaneous involvement), the presence of fluid collections, and the involvement of neighbouring bone and joint were reviewed retrospectively. RESULTS: A hyperintense signal on T2-weighted and STIR images were detected in all patients. Fluid collections were seen in 21 cases as localized areas of hypointensity on the T1-weighted images, and highly hyperintense areas on the T2-weighted images. In four patients a rim of high signal intensity was seen around the fluid collection on the T1-weighted images. On contrast-enhanced T1-weighted images there was diffuse enhancement in the patients without fluid collections that was heterogeneous in seven and homogeneous in two. After Gd-DTPA all fluid collections showed a central area without enhancement and a well-defined enhancing peripheral rim. Involvement of adjacent structures included subcutaneous tissue (n=25), bone marrow (n=14), fascial planes (n=15) and joints (n=11). CONCLUSION: MRI is useful in the assessment of pyomyositis and in determining the location and extension. A hyperintense rim on unenhanced T1-weighted images and peripheral enhancement after Gd-DTPA are useful for identifying the number, size, and location of soft-tissue abscesses.

Adolescent↗
PubMed1989

Pyomyositis in spinal cord injury patients.

Bacterial infections remain a major cause of morbidity and mortality among patients with longstanding spinal cord injury. Infection may occur in a number of different foci, often taxing the skill of the most accomplished diagnostician. Herein are described three patients with fever of unknown origin wherein extensive diagnostic workups ultimately led to the diagnosis of primary pyomyositis. These patients demonstrate the importance of repeated careful physician examination in determining the site of infection in patients with established sensorimotor deficits. Although primary pyomyositis is not a common occurrence in those with spinal cord injuries, it should be included as a potential cause of fever in this patient population.

Adult↗
PubMed2001

MRSA pyomyositis complicating sickle cell anaemia.

A patient being treated for sickle cell crisis developed swollen, painful, indurated, discoloured thighs after several days in hospital. Imaging revealed the presence of multiple small abscesses in the muscle and methicillin resistant Staphylococcus aureus (MRSA) was cultured from aspirated fluid. Pyomyositis usually occurs in association with damaged muscle and impaired host defences. Staphylococcus is the most frequent organism involved. It is not a common complication of sickle cell disease, although it may be under diagnosed. Availability of advanced imaging techniques facilitates early diagnosis of pyomyositis.

Adult↗
PubMed1989

Pyomyositis in patients with diabetes. Computed tomography as a key to diagnosis.

Pyomyositis rarely occurred in nontropical climates in the past but is becoming increasingly recognized in temperate climates. Nevertheless, this diagnostic possibility is often not immediately recognized. Pyomyositis should be considered in diabetic patients with lower-extremity cellulitis who do not respond to presumptively appropriate therapy. A high index of suspicion and documentation with appropriate imaging techniques, aggressive surgical intervention, and adjunctive antibiotic therapy are the keys to prompt resolution without sequelae. The patients in this report were diabetic adults who responded to appropriate therapy after computed tomographic scans, surgical exploration, and cultures established the diagnosis.

Adult↗
PubMed1998

Pyomyositis due to non-haemolytic streptococci.

We present a unique case of a multifocal non-tropical pyomyositis due to non-haemolytic streptococci in a 36-y-old woman. The initial infection was in an area of contused muscle in the left anterior thigh and spread to the contralateral femoral and gluteal musculature. There was a previous history of Staphylococcus aureus pyomyositis and colitis ulcerosa. The patient was treated successfully with surgical drainage and parenteral antibiotics.

Adult↗
PubMed1997

Pyomyositis of the anterior tibial compartment.

Five oncology patients developed bacterial pyomyositis involving the anterior tibial compartment and resulting in compartment syndrome with ischemia and abnormalities of neuromuscular function. All patients were neutropenic and thrombocytopenic, and four were receiving or had recently received cancer chemotherapy. Three infections were due to gram-negative bacilli and two to Staphylococcus aureus. Appropriate antimicrobial therapy and surgical drainage in four patients resulted in the resolution of these infections with good residual muscle function. To our knowledge, primary pyomyositis has never previously been known to cause compartment syndrome.

Adult↗
PubMed1990

Citrobacter freundii: a newly reported cause of pyomyositis.

Pyomyositis has been uncommonly reported in temperature climates, but is being recognized with increasing frequency. The most common etiologic agent is Staphylococcus aureus, although other pathogens have been rarely implicated. The authors describe the first case of pyomyositis caused by Citrobacter freundii. Because of the rarity of this disease in North America, it is often initially misdiagnosed. Neuromuscular sonography, a non-invasive imaging technique, identified the muscle abscess in this patient.

Aged↗