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PubMed2004

Bacterial pyomyositis in the United States.

The incidence of reported bacterial pyomyositis is increasing in the United States, especially among immunocompromised persons. This review summarizes all reported cases of pyomyositis among human immunodeficiency virus (HIV)-infected persons worldwide and HIV-negative persons in the United States since 1981. During the era of combination antiretroviral therapy, bacterial pyomyositis among HIV-infected persons typically occurred in those with end-stage acquired immunodeficiency syndrome. Among non-HIV-infected patients, about half have a serious underlying medical problem, most commonly diabetes mellitus, malignancy, or a rheumatologic condition. These patients are more likely to have a gram-negative infection, a normal white blood cell count, multifocal involvement, or higher mortality than those without an underlying medical condition. The characteristics of cases in temperate areas are similar to tropical cases, except that the former occurs more often in immunocompromised persons; this may change with the HIV epidemic in tropical regions.

AIDS Serodiagnosis↗

PubMed2004

Multifocal pyomyositis in an immunocompetent patient.

Pyomyositis is defined as suppurative infection of the skeletal muscle and usually occurs in immunocompromized patients. We managed a 23-year-old man admitted for myalgia and evidence of infection, with onset after a strenuous physical activity. Numerous muscles were involved. Multiple abscesses were visualized by ultrasonography and computed tomography, with predominant involvement of the pelvic muscles. Examination of the aspirate from a forearm abscess recovered Staphylococcus aureus. No factors associated with immunodeficiency were found. Appropriate antimicrobial therapy ensured complete resolution of the infection. Pyomyositis is rare in immunocompetent individuals. Myalgia, fever, and rhabdomyolysis should suggest pyomyositis. Computed tomography and magnetic resonance imaging are the best investigations for confirming the diagnosis.

Abscess↗

PubMed2003

Anterior tibial compartment syndrome due to the pyomyositis in a patient with rheumatoid arthritis. A case report.

Anterior tibial compartment syndrome was developed due to pyomyositis in a 33-year-old male patient with rheumatoid arthritis while receiving steroid therapy during the follow-up period. The preoperative physical examination, laboratory findings, MRI images, intraoperative observation and postoperative histopathological examinations confirmed the association with pyomyositis. The surgical drainage and antibiotic treatment were effective, and in the follow-up period, neuromuscular dysfunctions disappeared completely within 6 months. The patient has been asymptomatic for 4 years of follow-up. To date, anterior tibial compartment syndrome due to pyomyositis in a case with rheumatoid arthritis has not been reported.

Adult↗

PubMed2005

[The non-tropical pyomyositis--a rare disease in the moderate climate zone].

Pyomyositis is in the moderate climate zone a rare and acute bacterial infection of the skeletal muscles without an obvious origin of infection. Initial symptoms contain muscle pain and localized swelling and tension. As different causes are taken into account first, the diagnosis of a pyomyositis is often delayed. We report on three cases of pyomyositis and discuss diagnosis and therapy against the background of the available and recent literature.

Abscess↗

PubMedDate not supplied

Gram-negative bacterial pyomyositis: unique case and review.

Bacterial pyomyositis in tropical or temperate climates is usually associated with gram-positive organisms, and Staphylococcus aureus has been recovered most often. In contrast, skeletal muscle infection due to aerobic gram-negative bacteria is an acknowledged rarity, even in tropical areas. A literature review revealed only five organisms implicated in gram-negative pyomyositis in the United States; to this list, we add a unique case of pyomyositis caused by Serratia marcescens that occurred in a patient with multiple myeloma. Although the data are limited, it appears that lower leg muscles are more likely to be involved and that clinical cure is often achieved following appropriate drainage and antibiotic therapy.

Aged↗

PubMedDate not supplied

Pyomyositis in patients with diabetes mellitus.

Pyomyositis is a pyogenic infection of skeletal muscle that is endemic in the tropics and is being recognized with increasing frequency in temperate climates. We report two cases of nonendemic pyomyositis in patients with diabetes mellitus. A review of the literature suggests that diabetes mellitus may be an important risk factor for the development of pyomyositis. Possible mechanisms of this association are discussed.

Adult↗

PubMed1995

Salmonella pyomyositis in patients with the human immunodeficiency virus.

Pyomyositis is a common disease in the tropics, mostly due to Staphylococcus aureus. We report two patients infected with the human immunodeficiency virus (HIV) who presented with fever and unilateral limb swelling and in whom pyomyositis was diagnosed in quadriceps and gluteus major, respectively. Salmonella enteritidis was isolated in both, with recurrent episodes of muscle involvement and secondary osteomyelitis in one case. Non-typhi Salmonella pyomyositis may occur in HIV + patients with a relapsing and aggressive clinical course in some cases.

Adult↗

PubMed1998

Streptococcal pyomyositis: case report and review.

Pyomyositis is most often associated with Staphylococcus aureus infections after trauma. We describe an unusual presentation of pyomyositis of the chest wall secondary to group A betahemolytic streptococcus infection in a 15-month-old child with acute abdominal symptoms. In addition, the patient had no history or evidence of trauma to the affected area. Pyomyositis presenting in this manner secondary to group A beta-hemolytic streptococcus infection in the absence of a primary varicella infection has not been previously reported.

Abdomen, Acute↗

PubMed2005

Nontropical pyomyositis in an immunocompetent host.

Pyomyositis is a primary infection of the striated muscle. We describe the clinical and imaging features of 2 cases with nontropical pyomyositis in immunocompetent hosts. Staphylococcus aureus was the causative agent; the treatment included antibiotics and either computed tomography or magnetic resonance-guided percutaneous needle drainage, avoiding open drainage. This treatment modality was successful with complete recovery of movement. Because of the rarity of pyomyositis in temperate climates, the common lack of specific signs or symptoms, and the frequent negative blood cultures, considerable delay precedes the diagnosis. Fever, elevated erythrocyte sedimentation rate, and muscle stiffness are diagnostic clues. Increased awareness, especially in immunocompetent hosts, should lead to earlier diagnosis and treatment with improved outcomes. Diagnosis and treatment can be reached at the same time in some cases by image-guided percutaneous drainage.

Adult↗

PubMed1989

Non-tropical pyomyositis in children--with report of severe neurological complications.

Pyomyositis appears to occur rarely in temperate climate areas, compared with the incidence of the disease in the tropics. Three young adults with pyomyositis have previously been described in Israel, two of them were newly arrived Ethiopian immigrants. We report three Israeli children with pyomyositis, who presented initially with nonspecific abdominal pain; in one child the course was complicated by spinal cord compression due to extension of the infected mass into the spinal canal. All three patients attained full recovery after antibiotic therapy and surgical drainage. Computed tomography was most valuable in establishing the diagnosis and defining the extent of the process.

Abscess↗

PubMed1980

Bacterial pyomyositis in a patient with aplastic anaemia.

Bacterial pyomyositis is common in the tropids but is rare in temperate climates. A patient with aplastic anaemia who had never left the continental United States developed bacterial pyomyositis secondary to Staphylococcus aureus which responded to antibiotics and surgical drainage. Bacterial pyomyositis should be considered in the differential diagnosis of fever and myalgias in the immunocompromised patient.

Adult↗

PubMed1996

Pyomyositis in a renal transplant patient with Kyrle's disease.

Pyomyositis, an endemic disease of tropical origin, is increasingly reported in temperate zones, especially in patients with diabetes mellitus and in the immunocompromised. A 28-year-old renal transplant recipient presented with perforating skin lesions (Kyrle's disease), thigh pain, and swelling associated with fever. A gallium scan of the thigh led to surgical exploration and a diagnosis of pyomyositis. To our knowledge, the association of Kyrle's disease with pyomyositis has not been reported before. The significance of this combination of conditions in our patient remains unexplained.

Adult↗

PubMed1996

Pyomyositis: report of three patients and review of the literature.

Pyomyositis is the primary infection of skeletal muscles, accompanied by abscess formation in the suppurative phase but may be without a focal fluid collection in the presuppurative phase. We describe three patients, one with insulin-dependent diabetes mellitus, another with sickle cell disease, and the third a previously healthy child with varicella infection who developed pyomyositis. Ultrasound or magnetic resonance imaging suggested the diagnosis in each case. The patients were treated with intravenous antibiotic therapy and two required abscess drainage. The infection in the third resolved without surgical drainage. None of our patients had residual functional limitations. We believe that a high index of suspicion and prompt diagnosis can prevent complications from pyomyositis.

Abscess↗

PubMed2004

Osteomyelitis complicating pyomyositis in HIV disease.

Pyomyositis has previously been described in association with human immunodeficiency virus (HIV) and as a discrete entity in HIV seronegative patients from tropical climates (tropical pyomyositis). Pyomyositis and osteomyelitis are usually considered a late complication of advanced HIV disease. We describe a patient with well-controlled HIV and both types of musculoskeletal infection. The case highlights an unusual presentation, the utility of MRI in soft tissue infection and an excellent outcome from prolonged antimicrobial therapy following surgical debridement.

Anti-Bacterial Agents↗

PubMed2001

Pyomyositis of the iliacus muscle in a child.

Pyomyositis is rarely seen in temperate climates. Typically, it presents with the formation of an abscess requiring surgical drainage and it has been reported as a differential diagnosis for septic arthritis of the hip. We describe the occurrence of pyomyositis of the iliacus muscle in a ten-year-old girl which was diagnosed by MRI and blood culture. Formation of an abscess did not occur despite marked focal inflammation and swelling of the muscle. Conservative treatment with antibiotics alone led to complete clinical and radiological resolution of the infection. We could find no previous description of pyomyositis in a child in the British orthopaedic literature. Orthopaedic surgeons, particularly those with a paediatric interest, should be aware of this condition and its presentation, diagnosis and treatment.

Child↗

PubMedDate not supplied

Visceral larva migrans and tropical pyomyositis: a case report.

We report a case of tropical pyomyositis in a boy who presented with a severe febrile illness associated with diffuse erythema, and swelling in many areas of the body which revealed on operation extensive necrotic areas of various muscles that required repeated débridement. The patient gave a history of contact with dogs, and an ELISA test for Toxocara canis was positive. He also presented eosinophilia and high serum IgE levels. Staphylococcus aureus was the sole bacteria isolated from the muscles affected. We suggest that tropical pyomyositis may be caused by the presence of migrating larvae of this or other parasites in the muscles. The immunologic and structural alterations caused by the larvae, in the presence of concomitant bacteremia, would favour seeding of the bacteria and the development of pyomyositis.

Adolescent↗

PubMed1991

Pyomyositis complicating the acquired immunodeficiency syndrome. A report of two cases with coexistent neutropenia.

OBJECTIVE: To identify some factors contributing to the development of pyomyositis in patients with the acquired immunodeficiency syndrome (AIDS) by a report of two cases and a review of the literature. CLINICAL FEATURES: A 36-year-old man with AIDS presented with tenderness of the left adductor longus muscle; a 28-year-old man with AIDS presented with fever and left leg pain. Both men had a history of severe neutropenia induced by drug treatment and opportunistic infections requiring treatment in hospital. The pyomyositis was defined by a gallium-67 scan (and, in one case, by a computed tomography scan). In one case Staphylococcus aureus was cultured from blood; in the other it was cultured from pus from the pyomyositic abscess. INTERVENTIONS: Both patients had their abscesses drained. The first patient was treated with flucloxacillin (2 g every four hours, given intravenously) and rifampicin (450 mg by mouth each day). The second patient was treated with flucloxacillin (2 g every four hours, given intravenously) and ticarcillin (3 g every six hours, given intravenously). OUTCOME: After their symptoms abated, both patients were discharged from hospital, taking flucloxacillin by mouth as ongoing treatment. CONCLUSIONS: Staphylococcal infections are increasingly common in neutropenic patients. Neutropenia is likely to have contributed to the development of pyomyositis in these patients.

Acquired Immunodeficiency Syndrome↗

PubMed2001

[Adductor muscle pyomyositis simulating acute appendicitis: CT and MR imaging findings].

Pyomyositis is a primary bacterial infection of skeletal muscle. This infection tends to occur in the large muscles of the lower extremity. Pyomyositis of the proximal muscles of the thigh can simulate acute abdominal disease. Early diagnosis improves the outcome. Delayed diagnosis may lead to septicemia and shock. We report the CT and MRI findings in a patient with pyomyositis of the proximal muscles of the thigh.

Adult↗