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Molina B, Pogossian A, De Moreuil C, Rouvière B, Le Berre R. [Infectious myositis]. Rev Med Interne 2020; 41:241-249. [PMID: 32113637 DOI: 10.1016/j.revmed.2020.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 01/21/2020] [Accepted: 02/01/2020] [Indexed: 01/08/2023]
Abstract
Infectious myositis is a rare condition that can be caused by bacteria, viruses, parasites or fungi. Muscle pain or weakness are symptoms shared by all type of myositis. Diagnosis is made on clinical presentation: fever and poor general state is found in bacterial myositis, diffuse muscle pain with flu-like symptoms in viral causes, eosinophilia and a tropical travel history can be related to parasitic etiology, and immunocompromising condition suggests fungal infection. Rhabdomyolysis, leukocytosis and elevated C-reactive protein are common. Imaging (computed tomography or magnetic resonance imaging) can be useful to detect which muscle is affected. The causative organism can be identified on blood cultures, skeletal muscle biopsy, serology or any other pathogen specific test. Treatment depends on the causative organism. Open surgical or imaging-guided drainage is usually necessary in bacterial myositis.
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Affiliation(s)
- B Molina
- Service de médecine interne, vasculaire et pneumologie, hôpital de la Cavale Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France
| | - A Pogossian
- Service de médecine interne, vasculaire et pneumologie, hôpital de la Cavale Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France
| | - C De Moreuil
- Service de médecine interne, vasculaire et pneumologie, hôpital de la Cavale Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France; EA 3878, GETBO, université de Brest, Brest, France
| | - B Rouvière
- Service de médecine interne, vasculaire et pneumologie, hôpital de la Cavale Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France; UMR 1227 « Lymphocytes B et auto-immunité », université de Brest, Brest, France
| | - R Le Berre
- Service de médecine interne, vasculaire et pneumologie, hôpital de la Cavale Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France; Inserm, UMR 1078, université de Brest, Brest, France.
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Reichert JC, Habild G, Simon P, Nöth U, Krümpelmann JB. Necrotizing streptococcal myositis of the upper extremity: a case report. BMC Res Notes 2017; 10:407. [PMID: 28807000 PMCID: PMC5556997 DOI: 10.1186/s13104-017-2743-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 08/08/2017] [Indexed: 11/17/2022] Open
Abstract
Background Necrotizing myositis is a rare but life-threatening soft-tissue infection characterized by rapidly spreading inflammation and subsequent necrosis of the affected tissue. The myositis is often caused by toxin-producing, virulent bacteria such as group A β-hemolytic streptococcus and associated with severe systemic toxicity. It is rapidly fatal unless diagnosed promptly and treated aggressively. However, necrotizing myositis is often initially misdiagnosed as a more benign soft-tissue infection as such fulminant, invasive muscle infections are rare with no more than 30 cases reported over the last century. Case presentation We illustrate the case of a 74-year-old male Caucasian initially presenting with a progressing swelling and gradually oncoming pain of the upper right extremity. Rapidly, livid discolorations of the skin, blisters, hypoesthesia and severe pain resistant to analgesics treatment developed accompanied by disruption of the arterial blood flow. Due to a manifest compartment syndrome the patient was admitted to theater for fasciotomy of the arm. After multiple revision surgeries wound closure was achieved using a pedicled, fasciocutaneous parascapular flap and a free, ipsilateral anterolateral thigh flap. Microbiological analysis revealed group A β-hemolytic streptococcus, histology a bacterial interstitial myositis with necrotic muscular fibers. Conclusions A high degree of clinical suspicion is necessary to avert potentially disastrous consequences of necrotizing myositis. Timely diagnosis, broad-spectrum antibiotic therapy, and aggressive surgical debridement of affected tissue are keys to the treatment of this serious, often life-threatening infection.
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Affiliation(s)
- Johannes C Reichert
- Department of Orthopaedic and Trauma Surgery, Ev. Waldkrankenhaus Spandau, Stadtrandstr. 555, 13589, Berlin, Germany. .,Department of Orthopaedic Surgery, König-Ludwig-Haus, Center for Musculoskeletal Research, Julius-Maximilians-University, Brettreichstraße 11, 97074, Würzburg, Germany.
| | - Götz Habild
- Department of Orthopaedic and Trauma Surgery, Ev. Waldkrankenhaus Spandau, Stadtrandstr. 555, 13589, Berlin, Germany
| | - Paul Simon
- Department of Orthopaedic and Trauma Surgery, Ev. Waldkrankenhaus Spandau, Stadtrandstr. 555, 13589, Berlin, Germany
| | - Ulrich Nöth
- Department of Orthopaedic and Trauma Surgery, Ev. Waldkrankenhaus Spandau, Stadtrandstr. 555, 13589, Berlin, Germany
| | - Jan B Krümpelmann
- Department of Orthopaedic and Trauma Surgery, Ev. Waldkrankenhaus Spandau, Stadtrandstr. 555, 13589, Berlin, Germany
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Midha M, Rosenthal ME. Group G streptococcal myositis in a patient with myeloproliferative neoplasm. IDCases 2016; 5:54-6. [PMID: 27500083 PMCID: PMC4971150 DOI: 10.1016/j.idcr.2016.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 07/12/2016] [Accepted: 07/12/2016] [Indexed: 12/05/2022] Open
Abstract
While many cases of streptococcal infection are due to Lancefield groups A and B, there has been a rise in reported cases of infections due to group G streptococcus. We present a case of an individual with a hematologic malignancy who developed myositis secondary to group G streptococcus, with no clearly identifiable source of infection. The patient was managed with antibiotic therapy rather than surgical intervention due to high surgical risk related to severe thrombocytopenia. Targeted antibiotics initiated early in the course of disease may prevent the need for surgical intervention. Early diagnosis and treatment are critical to avoid the high morbidity and mortality of life-threatening infections caused by group G streptococcus.
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Affiliation(s)
- Monica Midha
- Department of Medicine, Jersey Shore University Medical Center, 1945 State Route 33, Neptune, NJ, 07753, United States
| | - Marnie E Rosenthal
- Division of Infectious Diseases, Jersey Shore University Medical Center, 1945 State Route 33, Neptune, NJ, 07753, United States
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Nicola H, Morgan DJR. Necrotising myositis presenting as multiple limb myalgia. Med J Aust 2016; 204:157-8. [PMID: 26937672 DOI: 10.5694/mja15.00815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 01/07/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Henrique Nicola
- Intensive Care Unit, St John of God Subiaco Hospital, Perth, WA
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Schnürer S, Beier JP, Croner R, Rieker RJ, Horch RE. [Pathogenesis, classification and diagnosis of necrotizing soft tissue infections]. Chirurg 2013; 83:943-52. [PMID: 23011149 DOI: 10.1007/s00104-012-2281-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Necrotizing soft tissue infections are caused by a variety of pathogens and may affect different types of soft tissue. Even today mortality and lethality are very high. The primary symptoms of necrotizing soft tissue infections are local pain out of proportion, swelling, erythema and crepitation in cases of subcutaneous gas. A systemic inflammatory response syndrome (SIRS) is often associated. During the last decades early recognition and initiation of an adequate therapy were able to reduce lethality to an average of 20%. The physical examination remains the diagnostic gold standard and may be supported by typical findings of imaging technologies, e.g. subcutaneous gas on x-rays and laboratory tests. After diagnosis an adequate antibiotic and surgical therapy should be performed immediately.
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Affiliation(s)
- S Schnürer
- Plastisch- und Handchirurgische Klinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland.
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Silva SR, Bosch P. Intramuscular air as a complication of pulse-lavage irrigation. A case report. J Bone Joint Surg Am 2009; 91:2937-40. [PMID: 19952258 DOI: 10.2106/jbjs.h.01431] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Selina R Silva
- Department of Orthopaedics, University of New Mexico Hospital, MSC10 5600, Albuquerque, NM 87131, USA.
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Bharathi RS, Sharma V, Sood R, Chakladar A, Singh P, Raman DK. Management of necrotizing myositis in a field hospital: a case report. Scand J Trauma Resusc Emerg Med 2009; 17:20. [PMID: 19374768 PMCID: PMC2674589 DOI: 10.1186/1757-7241-17-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2009] [Accepted: 04/18/2009] [Indexed: 11/10/2022] Open
Abstract
Necrotizing myositis is a rare and fatal disease of skeletal muscles caused by group A beta hemolytic streptococci (GABHS). Its early detection by advanced imaging forms the basis of current management strategy. Paucity of advanced imaging in field/rural hospitals necessitates adoption of management strategy excluding imaging as its basis. Such a protocol, based on our experience and literature, constitutes: i. Prompt recognition of the clinical triad: disproportionate pain; precipitous course; and early loss of power- in a swollen limb with/without preceding trauma. ii. Support of clinical suspicion by 2 ubiquitous laboratory tests: gram staining- of exudates from bullae/muscles to indicate GABHS infection; and CPK estimation- to indicate myonecrosis. iii. Replacement of empirical antibiotics with high intravenous doses of sodium penicillin and clindamycin. iv. Exploratory fasciotomy: to confirm myonecrosis without suppuration- its hallmark. v. Emergent radical debridement. vi. Primary closure with viable flaps - unconventional, if need be.
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Madhusudhan TR, Sambamurthy S, Williams E, Smith IC. Surviving streptococcal toxic shock syndrome: a case report. J Med Case Rep 2007; 1:118. [PMID: 17967190 PMCID: PMC2174498 DOI: 10.1186/1752-1947-1-118] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2007] [Accepted: 10/29/2007] [Indexed: 01/04/2023] Open
Abstract
Streptococcal toxic shock syndrome and associated myositis caused by group A beta-hemolytic streptococcus pyogenes generally have a poor outcome despite aggressive operative treatment. Frequently the diagnosis is missed initially as the clinical features are non-specific. The progression to a toxic state is rapid and unless definitive treatment measures are initiated early, the end result can be catastrophic. We report a previously healthy patient who had features of toxic shock syndrome due to alpha haemolytic (viridans) streptococcus mitis which was treated successfully with antibiotics, aggressive intensive care support including the use of a 'sepsis care bundle', monitoring and continuous multidisciplinary review. Life and limb threatening emergencies due to streptococcus mitis in an immune-competent person are rare and to our knowledge, have not previously been described in the English scientific literature. Successful outcome is possible provided a high degree of suspicion is maintained and the patient is intensively monitored.
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Dalal M, Sterne G, Murray DS. Streptococcal myositis: a lesson. BRITISH JOURNAL OF PLASTIC SURGERY 2002; 55:682-4. [PMID: 12550125 DOI: 10.1054/bjps.2002.3953] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Streptococcal myositis is a rare, often fatal, acute infection of the muscle, caused by an invasive group A beta-haemolytic streptococcus. It is characterised by muscle necrosis without abscess formation, and, in contrast to necrotising fasciitis, does not primarily affect the subcutaneous tissue or skin. A young adult male presented with streptococcal myositis initially affecting the rectus femoris muscle of his left thigh. The symptoms, signs and management are discussed. Particular emphasis is given to the benefits of emergency CT scans to diagnose and delineate the extent of the disease. These scans may need to be repeated if the disease progresses. The four cornerstones of management are: early diagnosis using emergency CT scans; high-dose intravenous antibiotics; early aggressive surgical debridement; and intensive fluid and nutritional support. Published by Elsevier Science Ltd. All rights reserved.
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Affiliation(s)
- M Dalal
- Department of Plastic Surgery, Selly Oak Hospital, Birmingham, UK
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Tang WM, Wong JW, Wong LL, Leong JC. Streptococcal necrotizing myositis: the role of magnetic resonance imaging. A case report. J Bone Joint Surg Am 2001; 83:1723-6. [PMID: 11701798 DOI: 10.2106/00004623-200111000-00018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- W M Tang
- Department of Orthopedic Surgery, Queen Mary Hospital, Hong Kong, China.
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