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Young BC, Earle SG, Soeng S, Sar P, Kumar V, Hor S, Sar V, Bousfield R, Sanderson ND, Barker L, Stoesser N, Emary KR, Parry CM, Nickerson EK, Turner P, Bowden R, Crook DW, Wyllie DH, Day NP, Wilson DJ, Moore CE. Panton-Valentine leucocidin is the key determinant of Staphylococcus aureus pyomyositis in a bacterial GWAS. eLife 2019; 8:42486. [PMID: 30794157 PMCID: PMC6457891 DOI: 10.7554/elife.42486] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 02/21/2019] [Indexed: 02/07/2023] Open
Abstract
Pyomyositis is a severe bacterial infection of skeletal muscle, commonly affecting children in tropical regions, predominantly caused by Staphylococcus aureus. To understand the contribution of bacterial genomic factors to pyomyositis, we conducted a genome-wide association study of S. aureus cultured from 101 children with pyomyositis and 417 children with asymptomatic nasal carriage attending the Angkor Hospital for Children, Cambodia. We found a strong relationship between bacterial genetic variation and pyomyositis, with estimated heritability 63.8% (95% CI 49.2–78.4%). The presence of the Panton–Valentine leucocidin (PVL) locus increased the odds of pyomyositis 130-fold (p=10-17.9). The signal of association mapped both to the PVL-coding sequence and to the sequence immediately upstream. Together these regions explained over 99.9% of heritability (95% CI 93.5–100%). Our results establish staphylococcal pyomyositis, like tetanus and diphtheria, as critically dependent on a single toxin and demonstrate the potential for association studies to identify specific bacterial genes promoting severe human disease. Certain bacteria that normally live on the skin or in the nose without causing problems can sometimes lead to diseases elsewhere in the body. For example, the bacterium Staphylococcus aureus can cause blood infections or a severe and painful infection of the muscle called pyomyositis, which is very common in children who live in the tropics. Scientists believe that pyomyositis happens when S. aureus bacteria in the blood stream infect the muscles. Some strains of this bacteria are more likely to cause such infections, but why is unclear. One potential cause is a toxin produced by some S. aureus bacteria called Panton-Valentine leucocidin (PVL). So far, studies looking at whether PVL-producing bacteria are more likely to cause pyomyositis have had conflicting results. Now, Young et al. show that the gene for PVL is always present in S. aureus strains that cause pyomyosistis in Cambodian children, but is rarely found in S. aureus taken from the noses of their healthy counterparts. In the experiments, bacteria were collected from 101 children with pyomyositis and from the noses of 417 healthy children at the Angkor Hospital for Children in Cambodia over a 5-year period. The DNA in these bacteria were compared using very sensitive genetic techniques. The comparisons showed having the gene for PVL increased the odds of having pyomyositis 130-fold, showing that this one toxin likely accounts for much of the risk of developing this disease. If more studies confirm the link between PVL and pyomyositis, developing vaccines that block the gene for PVL might be one way to protect children in the tropics from developing this infection. Treating children with pyomyositis with antibiotics that reduce the production of the PVL toxin may also be helpful.
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Research Support, Non-U.S. Gov't |
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Abstract
Myositis is inflammation especially of the voluntary muscles, characterized by localized or diffuse pain, tenderness on movement or palpation, swelling, and/or weakness. The two main categories of myositis include non-infectious and infectious. Infective myositis may be due to a wide variety of pathogens, including bacteria, fungi, viruses, and parasites. A brief account of the various pathogens causing infective myositis is discussed.
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Gonzalez Moran G, Garcia Duran C, Albiñana J. Imaging on pelvic pyomyositis in children related to pathogenesis. J Child Orthop 2009; 3:479-84. [PMID: 19806379 PMCID: PMC2782063 DOI: 10.1007/s11832-009-0206-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Accepted: 09/17/2009] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Pelvic pyomyositis in children is a rare infectious condition, although it is increasingly reported in temperate climates. Often considered a primary disease, new diagnostic methods are able to identify additional foci of infection. The purpose of this study is to review our patients and to analyze the imaging studies to determine its pathogenesis. METHODS A retrospective study of the clinical charts and imaging records of 11 patients was made, noting the number and location of muscles involved, as well as bone and joint involvement. RESULTS Besides the classical form of pelvic pyomyositis, i.e., iliopsoas pyomyositis, other muscular groups were frequently affected, often with multiple involvement. Bone involvement is also frequent. Magnetic resonance imaging (MRI) gives the most useful information. CONCLUSION MRI is the diagnostic procedure of choice for diagnosing pelvic pyomyositis in children. It may also have an elucidating role in the debated pathogenesis of this condition. In most of the cases, pelvic pyomyositis in children could be secondary.
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Ngor C, Hall L, Dean JA, Gilks CF. Factors associated with pyomyositis: A systematic review and meta-analysis. Trop Med Int Health 2021; 26:1210-1219. [PMID: 34407271 DOI: 10.1111/tmi.13669] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Pyomyositis, an acute bacterial infection of skeletal muscle usually resulting in abscess formation, is well recognised in tropical regions where it can account for up to 4% of adult surgical admissions. It is increasingly being reported from high-income temperate countries. Pyomyositis occurs across all ages and in both sexes. Mortality ranges from 1% to 23%. Many risk factors have been suggested. We aimed to identify factors associated with pyomyositis. METHODS We undertook a systematic review and meta-analysis, using PubMed, EMBASE, Scopus and the Cochran Library and hand-searching published papers. The random-effects model meta-analysis was used to calculate pooled estimated odd ratios with the corresponding 95% confidence interval. RESULTS All studies in the systematic review (n = 25) and the meta-analysis (n = 12) were hospital-based. Seven only included children. Relatively few studies have been published in the last decade, the majority of which are from high-income temperate settings. Staphylococcus aureus was the main organism isolated. Males under the age of 20 predominated, and mortality of up to 20% was reported. Factors associated with pyomyositis were HIV infection (OR = 4.82; 95% CI: 1.67-13.92) and fulfilling an AIDS surveillance definition (OR = 6.08; 95% CI: 2.79-13.23). CONCLUSIONS Our meta-analysis indicated significant associations between pyomyositis infection and HIV/AIDS. Major gaps in our understanding of the epidemiology, pathogenesis, clinical presentation, and outcome remain, highlighting the need for further research and more systematic studies. Pyomyositis merits consideration as a neglected tropical disease.
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Kumar MP, Seif D, Perera P, Mailhot T. Point-of-care ultrasound in diagnosing pyomyositis: a report of three cases. J Emerg Med 2014; 47:420-6. [PMID: 24725823 DOI: 10.1016/j.jemermed.2014.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 01/07/2014] [Accepted: 02/08/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Pyomyositis is a bacterial infection of skeletal muscle that often results in deep intramuscular abscesses. The absence of external dermatologic manifestations in the early stages of pyomyositis makes this a challenging diagnosis. In addition, physical examination findings can be difficult to distinguish from more common processes, such as soft-tissue cellulitis. Clinicians can fail to diagnose this serious disease in a timely manner, resulting in delayed treatment and potential clinical deterioration from sepsis. Although advanced imaging modalities, such as computed tomography (CT) and magnetic resonance imaging (MRI) provide excellent detail, ultrasound (US) can also be used to detect this disease. US can be performed expeditiously at the bedside and is less expensive than CT or MRI. It allows the clinician to examine the deeper tissue planes of muscle, in which purulent fluid collections will develop as pyomyositis advances. CASE REPORT Three patients presenting with leg pain were evaluated with point-of-care (POC) US and diagnosed with pyomyositis. The early diagnosis of this condition prompted rapid treatment with administration of appropriate antibiotics and involvement of orthopedic surgery. Aspiration of fluid allowed for detailed fluid analysis and bacterial cultures. Additional diagnostic imaging was performed, confirming the initial US diagnosis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: POC US can be helpful in identifying and further delineating intramuscular abscesses and can subsequently lead to expedited and appropriate care in patients who present with extremity pain, but lack significant dermatologic changes.
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Abstract
Fusobacteria are most often associated with the classic presentation of Lemierre's syndrome consisting of a sore throat, internal jugular vein thrombophlebitis, and septic emboli to the lungs. Unusual presentations due to the causative organism, F. necrophorum, may occur. We present such a case involving a 17-year-old male patient with pyomyositis and fasciitis due to necrobacillosis. Fusobacterium spp. should be considered in the differential diagnosis of cases involving sepsis syndrome and pyomyositis.
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Case Reports |
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Abstract
We carried out a case-control study in children with acute hematogenous osteomyelitis (AHO) with and without suppurative complications discharged from our institution over an 11-year period to test the hypothesis that abscess formation was associated with a delayed presentation to care. Of 102 children with AHO, 54 abscesses were documented in 46 patients (25 bone, 29 muscle). A delay in presentation was not associated with abscess formation (6.5 vs. 5.0 days, P=0.26). Overall, 78% of all bone abscesses were visible on initial MRI. Consistent use of MRI at presentation may identify children with suppurative complications of AHO.
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Abstract
Tuberculous pyomyositis is a rare entity reported in literature. The presented case reports the occurrence of such a lesion in forearm muscles, without any bony involvement. The ambiguity in its diagnosis led to inadequate management by the primary care physician. Clinical suspicion, positive tuberculin test, culture of acid-fast bacilli, 'effective drainage', and timely anti-tubercular chemotherapy ultimately resulted in a good clinical recovery. This case has been presented to increase the awareness about the existence of such an entity in clinical practice, thereby influencing its workup and the possible modes of management.
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case-report |
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Barakat MT, Gajurel K, Fischer K, Stevens K, Ozdalga E, Montoya JG. A Case of Meningococcal Pyomyositis in an Otherwise Healthy Adult. Open Forum Infect Dis 2016; 3:ofw087. [PMID: 27703989 PMCID: PMC5047391 DOI: 10.1093/ofid/ofw087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/29/2016] [Indexed: 11/21/2022] Open
Abstract
The clinical spectrum of Neisseria meningitidis can range from nasopharyngeal colonization to life-threatening invasive diseases such as meningitis. However, its etiologic role in invasive pyomyositis (PM) has never been reported before in the English language. In this study, we report the first case of PM in the English language and the second case in the literature caused by N meningitidis.
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Pelletier J, Gottlieb M, Long B, Perkins JC. Necrotizing Soft Tissue Infections (NSTI): Pearls and Pitfalls for the Emergency Clinician. J Emerg Med 2022; 62:480-491. [PMID: 35115188 DOI: 10.1016/j.jemermed.2021.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/18/2021] [Accepted: 12/23/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Skin and soft tissue infections are common emergency department (ED) presentations. These infections cover a wide spectrum of disease, from simple cellulitis to necrotizing fasciitis. Despite the commonality, a subset of skin and soft tissue infections known as necrotizing soft tissue infections (NSTIs) can cause significant morbidity and mortality. OBJECTIVE This review evaluates the current evidence regarding the presentation, evaluation, and management of NSTI from the ED perspective. DISCUSSION NSTIs are commonly missed diagnoses. History and physical examination findings are inconsistent, and the risk factors for this high mortality disease are common amongst ED populations. Laboratory evaluation and the Laboratory Risk in Necrotizing Fasciitis (LRINEC) score is helpful but is insufficient to rule out the disease. Imaging modalities including ultrasound, computed tomography, and magnetic resonance imaging are highly sensitive and specific, but may delay definitive management. The gold standard for diagnosis includes surgical exploration. Surgical intervention and empiric broad-spectrum antibiotic coverage are the foundations of treatment. Adjuvant therapies including hyperbaric oxygen and intravenous immunoglobulin have not yet been proven to be beneficial or to improve outcome. CONCLUSION NSTIs are associated with significant morbidity and mortality. Knowledge of the history, examination, evaluation, and management is vital for emergency clinicians.
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Review |
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Mitchell PD, Viswanath A, Obi N, Littlewood A, Latimer M. A prospective study of screening for musculoskeletal pathology in the child with a limp or pseudoparalysis using erythrocyte sedimentation rate, C-reactive protein and MRI. J Child Orthop 2018; 12:398-405. [PMID: 30154932 PMCID: PMC6090194 DOI: 10.1302/1863-2548.12.180004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To determine if the detection of musculoskeletal pathology in children with a limp or acute limb disuse can be optimized by screening with blood tests for raised inflammatory markers, followed by MRI. METHODS This was a prospective observational study. Entry criteria were children (0 to 16 years of age) presenting to our emergency department with a non-traumatic limp or pseudoparalysis of a limb, and no abnormality on plain radiographs. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) blood tests were performed. Children with ESR > 10 mm/hr or CRP > 10 mg/L underwent a MRI scan. When the location of the pathology causing the limp was clinically unclear, screening images (Cor t1 and Short Tau Inversion Recovery) of both lower limbs from pelvis to ankles ('legogram') was undertaken. Data was gathered prospectively from 100 consecutive children meeting the study criteria. RESULTS In all, 75% of children had a positive finding on their MRI. A total of 64% of cases had an infective cause for their symptoms (osteomyelitis, septic arthritis, pyomyositis, fasciitis, cellulitis or discitis). A further 11% had positive findings on MRI from non-infective causes (juvenile idiopathic arthritis, cancer or undisplaced fracture). The remaining 25% had either a normal scan or effusion due to transient synovitis. ESR was a more sensitive marker than CRP in infection, since ESR was raised in 97%, but CRP in only 70%. CONCLUSION In our opinion MRI imaging of all children with a limp and either raised ESR or CRP is a sensitive method to minimize the chance of missing important pathology in this group, and is an effective use of MRI resources. We advocate the use of both blood tests in conjunction. LEVEL OF EVIDENCE Level II.
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Fountoukis T, Tsatsanidis N, Tilkeridou M, Konstantinou I, Fytas P, Skandalos I. Abdominal rectus muscle pyomyositis: Report of a case and review of the literature. Infect Dis Rep 2018; 10:7522. [PMID: 29721242 PMCID: PMC5907734 DOI: 10.4081/idr.2018.7522] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/22/2018] [Accepted: 01/29/2018] [Indexed: 01/19/2023] Open
Abstract
Pyomyositis is an uncommon primary bacterial infection of skeletal muscles, usually caused by Staphylococcus aureus. Predisposing factors for pyomyositis include immunodeficiency, trauma, injection drug use, concurrent infection and malnutrition. The diagnosis, staging of the disease and differential diagnosis are established by ultrasound, CT and MRI. Treatment involves surgical drainage and antibiotic therapy. We report a case of abdominal rectus muscle pyomyositis, which constitutes, as far as we know, the second reported in bibliography, while Prevotella disiens is firstly reported as causative agent.
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de Bodman C, Ceroni D, Dufour J, Crisinel PA, Bregou-Bourgeois A, Zambelli PY. Obturator externus abscess in a 9-year-old child: A case report and literature review. Medicine (Baltimore) 2017; 96:e6203. [PMID: 28248876 PMCID: PMC5340449 DOI: 10.1097/md.0000000000006203] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Obturator pyomyositis is a rare condition in children. Diagnosis is often delayed because of its rarity, and the vagaries of its presentation cause it to be easily be missed. Physicians should therefore familiarize themselves with this condition and consider it as a possible differential diagnosis in patients presenting with an acutely painful hip. Inflammatory syndrome is also frequent among sufferers and the MRI is a very sensitive diagnostic tool for obturator pyomyositis. Additionally, joint fluid aspirations and blood cultures are also useful in identifying the pathogen. The appropriate antibiotic therapy provides a rapid regression of symptoms during the early stage of pyomyositis. In cases of MRI-confirmed abscess, surgical treatment is indicated. PATIENT CONCERNS Our report focuses on a case of obturator pyomyositis in a 9-year-old boy. The child was febrile for 5 days and could only manage to walk a few steps. His hip range of motion was restricted in all directions. In addition, the patient had presented pain and swelling of his right elbow for a day, with a restriction of motion in the joint. There was a clear inflammatory syndrome. A diagnosis of hip and elbow septic arthritis was suspected, and the child underwent joint aspiration of the both cited joints. The aspiration of the elbow returned pus. Conversely, no effusion was found in the hip aspiration. The administration of empiric intravenous antibiotherapy was started. DIAGNOSES An MRI revealed an osteomyelitis of the ischio-pubic area associated with a subperiosteal abscess. INTERVENTIONS Subsequently, 3 days after elbow arthrotomy, a surgical treatment was performed on the patient's right hip in order to evacuate the subperiosteal abscess and muscular collection because of the persistence of the patient's symptoms and inflammatory syndrome despite susceptible intravenous antibiotics. Postsurgery the patient showed steady improvement. LESSONS Such cases demonstrate how diagnosis can be difficult because pelvic pyomyositis is often mistaken for more common pathologies such as septic arthritis, osteomyelitis, or appendicitis. This may delay the diagnosis or refer misdiagnosis. We discuss this rare infection in light of the literature with particular reference to its incidence, clinical features, bacteriological etiology, biological, and radiological presentation, and above all, its treatment.
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Case Reports |
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Medappil N, Adiga P. A 31-year-old female with fever and back pain. J Emerg Trauma Shock 2011; 4:385-8. [PMID: 21887031 PMCID: PMC3162710 DOI: 10.4103/0974-2700.83869] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 04/03/2011] [Indexed: 12/04/2022] Open
Abstract
Primary pyomyositis is a suppurative infection of striated muscle, the diagnosis of which is overlooked or delayed due to its rarity and vague clinical presentation. Though rare in the United States and temperate zones, pyomyositis is more frequently reported from tropical countries. The exact pathogenesis of pyomyositis is uncertain in most cases. The disease progresses through three stages with characteristic features and require a high index of suspicion to institute stage-wise treatment. Newer imaging methods, particularly magnetic resonance imaging, have facilitated the accurate diagnosis of the infection and of the extent of involvement. Early recognition with appropriate antibiotics in the pre-suppurative stage and prompt surgical intervention in the late stages form the corner stone of treatment. Delay in diagnosis can result in increased morbidity and mortality, especially in diabetics and immunocompromised state. Here, we report a case of primary paraspinal pyomyositis in a middle-aged female and emphasize the importance of early diagnosis and treatment.
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Case Reports |
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Radcliffe C, Gisriel S, Niu YS, Peaper D, Delgado S, Grant M. Pyomyositis and Infectious Myositis: A Comprehensive, Single-Center Retrospective Study. Open Forum Infect Dis 2021; 8:ofab098. [PMID: 33884279 PMCID: PMC8047863 DOI: 10.1093/ofid/ofab098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/26/2021] [Indexed: 12/15/2022] Open
Abstract
Background Pyomyositis is a bacterial infection of skeletal muscle that classically leads to abscess formation. A related, but distinct, entity is infectious myositis. The epidemiology of these infections has changed in recent years. Methods To better characterize both pyomyositis and infectious myositis, we conducted a retrospective study at our tertiary care institution. We identified 43 cases of pyomyositis and 18 cases of infectious myositis treated between January 2012 and May 2020. Results The mean age of patients was 48 years, and 66% were male. Diabetes mellitus affected one third of patients, and 16% had other immunocompromising comorbidities. Staphylococcal species accounted for 46% of all infections, and common symptoms included muscle pain (95%) and subjective fever (49%). Altered mental status was a presenting symptom in 16% of cases. Approximately half of all patients received >1 class of antibiotic, and the median length of antimicrobial therapy was 18 days. Open and percutaneous drainage procedures figured prominently in the management of these infections, with 28% of patients requiring multiple procedures. Pathology specimens were available for 12 of 61 cases. Overall, the treatment success rate was 84%. Conclusions Gram-positive bacteria accounted for most infections at our institution, and management commonly involved open or percutaneous drainage procedures. Future studies that prospectively evaluate treatment strategies for pyomyositis and infectious myositis are warranted.
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Nelson M, Reens D, Cohen A. Pyomyositis Diagnosed by Point-of-Care Ultrasound in the Emergency Department. J Emerg Med 2018; 55:817-820. [PMID: 30274728 DOI: 10.1016/j.jemermed.2018.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/24/2018] [Accepted: 08/03/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Currently, the role of ultrasound in diagnosing superficial abscesses is well validated, however, its role for deep space infections and intramuscular pathology is limited. Distinguishing between simple cellulitis and abscess is critical for emergency physicians (EP), as the treatment is very different. Management of cellulitis relies on antibiotic therapy, whereas abscess treatment requires incision and drainage. It is important that EPs can accurately distinguish between the two entities. CASE REPORT We report a case of a 41-year-old man with a history of high blood pressure and poorly controlled diabetes who presented with right lateral thigh redness, warmth, and tenderness. A point-of-care ultrasound (POCUS) of the patient's right lateral thigh with a high-frequency linear (8 MHz) ultrasound probe showed a 2.93 × 3.38 × 6.0-cm complex fluid collection deep to the fascial plane, approximately 3.0 cm from the skin surface, that contained mixed echogenicities with posterior acoustic enhancement consistent with an intramuscular abscess of the vastus lateralis. The patient was diagnosed with pyomyositis of his vastus lateralis. He was started on vancomycin and admitted to the surgical service for antibiotic treatment and surgical drainage. WHY SHOULD EMERGENCY PHYSICIANS BE AWARE OF THIS?: This case demonstrates that the use of POCUS by EPs can facilitate the rapid recognition and treatment of a disease that is challenging to diagnose on physical examination and can be potentially life-threatening if missed. EPs can consider performing a POCUS when evaluating skin infections to ensure rapid diagnosis and appropriate medical care for a potentially severe condition.
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Homsi N, Kapila R. Aggregatibacter actinomycetemcomitans Causing Empyema Necessitans and Pyomyositis in an Immunocompetent Patient. Cureus 2020; 12:e9454. [PMID: 32874788 PMCID: PMC7455391 DOI: 10.7759/cureus.9454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Empyema necessitans is a relatively rare clinical entity in which the empyema extends through the parietal pleura into the adjacent soft tissue and musculature of the chest wall. It usually occurs due to inadequate treatment of a primary lung infection. Aggregatibacter (formerly Actinobacillus) actinomycetemcomitans is a facultative anaerobic gram-negative coccobacillus that is part of the normal oral flora. Infections due to this organism usually result from aspiration in conjunction with dental disease or trauma to the oral mucosa resulting in pneumonia or empyema. It often coinfects with Actinomyces and is known to cause empyema necessitans. Cases of monomicrobial empyema necessitans due to Aggregatibacter actinomycetemcomitans in adults have rarely been reported with four such publications found on review of the literature. We present a patient with severe periodontitis who developed empyema necessitans due to Aggregatibacter actinomycetemcomitans likely from aspiration complicated by pyomyositis of the right triceps brachii and a left posterior thigh abscess.
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Case Reports |
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McElnay PJ, McCann PA, Williams MO, Wakeley CJ, Amirfeyz R. Recurrent Fusobacterium pyogenic myositis of the rotator cuff A case report of recurrent Fusobacterium pyogenic myositis of the rotator cuff. INTERNATIONAL JOURNAL OF SHOULDER SURGERY 2014; 8:31-3. [PMID: 24926162 PMCID: PMC4049038 DOI: 10.4103/0973-6042.131854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Pyogenic myositis is uncommon. It normally affects the large muscle groups in the lower limb or trunk and the most common causative organism is Staphylococcus aureus. We present a case of an immunocompetent man who, unusually, had a recurring form of the disease in subscapularis and teres minor. The causative organism was also highly unusual (Fusobacterium).
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Case Reports |
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Ghazala CG, Fatone E, Bentley R, Rajeev A. Primary Bacterial Gluteal Pyomyositis: A Rare Disease in Temperate Climates Presenting as Suspected Septic Arthritis of the Hip. J Emerg Med 2016; 51:319-21. [PMID: 27369856 DOI: 10.1016/j.jemermed.2016.05.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 04/26/2016] [Accepted: 05/06/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND In nations with temperate climates, primary polymyositis is a rare, life-threatening bacterial infection that can mimic various clinical diseases depending on the area involved, leading to delayed diagnosis and management. CASE REPORT We describe a young postpartum woman who presented to the emergency department with hip pain that was initially suspected to be caused by septic arthritis. However, hip arthrocentesis was negative, and a magnetic resonance imaging scan revealed extensive pyomyositis of the gluteal muscles. She underwent surgical debridement and was given parenteral antibiotics with good clinical recovery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We emphasize that cases of pyomyositis in temperate countries are often diagnosed late and therefore delay life- and potentially limb-saving treatment. For patients who present with hip and thigh pain and clinical features of sepsis, pyomyositis should be considered in the differential diagnosis and an early magnetic resonance imaging scan should be performed to confirm the diagnosis and reduce the high morbidity and mortality associated with this emerging disease.
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Methicillin Resistant Staphylococcus Aureus Shoulder Pyomyositis with Multifocal Lung Infiltrations. Pediatr Rep 2020; 12:127-129. [PMID: 33212753 PMCID: PMC7717662 DOI: 10.3390/pediatric12030027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/22/2020] [Indexed: 11/17/2022] Open
Abstract
Pyomyositis is a rare condition in temperate climates. We present a case of Methicillin Resistant Staphylococcus aureus pyomyositis of the shoulder complicated by multifocal lung infiltrations, treated successfully with antibiotic therapy. After excluding shoulder septic arthritis, a low threshold of suspicion for the diagnosis of shoulder pyomyositis should be applied to patients with persistent fever, pain, and decreased range of shoulder motion. A prompt diagnosis and a rapid rise in antibiotic therapy are important to avoid local and systemic complications.
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Case Reports |
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Abstract
Even at a time when HIV/AIDS and immunosuppressive therapy have increased the number of individuals living with significant immunocompromise, diabetes mellitus (DM) remains a major comorbid disorder for several rare but potentially lethal infections, including rhino-orbital-cerebral mucormycosis and malignant external otitis. DM is also a commonly associated condition in patients with nontropical pyomyositis, pyogenic spinal infections, Listeria meningitis, and blastomycosis. As West Nile virus spread to and across North America over a decade ago, DM appeared in many series as a risk factor for death or neuroinvasive disease. More recently, in several large international population-based studies, DM was identified as a risk factor for herpes zoster. The relationships among infection, DM, and the nervous system are multidirectional. Viral infections have been implicated in the pathogenesis of type 1 and type 2 DM, while parasitic infections have been hypothesized to protect against autoimmune disorders, including type 1 DM. DM-related neurologic disease can predispose to systemic infection - polyneuropathy is the predominant risk factor for diabetic foot infection. Because prognosis for many neurologic infections depends on timely institution of antimicrobial and sometimes surgical therapy, neurologists caring for diabetic patients should be familiar with the clinical features of the neuroinfectious syndromes associated with DM.
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Review |
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An Unusual Presentation of Pectoralis Major Pyomyositis Presenting as Septic Arthritis of the Shoulder: A Case Report and Review of the Literature. Diseases 2018; 6:diseases6040100. [PMID: 30423796 PMCID: PMC6313600 DOI: 10.3390/diseases6040100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 11/06/2018] [Accepted: 11/07/2018] [Indexed: 11/25/2022] Open
Abstract
Pyomyositis is a relatively rare condition and often requires a low index of suspicion. We present a case of an otherwise fit and well woman who had pyomyositis of the pectoralis major muscle and presented as an acute septic arthritis of the shoulder. We present the conundrums that arose in arriving at this diagnosis, and how we successfully managed this condition through our multidisciplinary approach. We urge all clinicians to bear in mind this potential diagnosis, even in those patients not deemed to be immunocompromised.
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Case Reports |
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Nair HG, Aggarwal A, Naveen R, Marak RS, Agarwal R, Gupta L. Histoplasma Pyomyositis in a Patient with Disseminated Histoplasmosis and Anti-Synthetase Syndrome: Case-Based Review of Literature. Mediterr J Rheumatol 2020; 31:350-354. [PMID: 33163869 PMCID: PMC7641030 DOI: 10.31138/mjr.31.3.350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/01/2020] [Accepted: 09/22/2020] [Indexed: 11/04/2022] Open
Abstract
Background Histoplasmosis is an endemic mycosis caused by Histoplasma Capsulatum, a thermally dimorphic fungus with mycelial and yeast forms. Muscle involvement is infrequent in Histoplasmosis. Case A 49-year-old lady presented with generalized myalgia and arthritis of two-year duration, which had responded partly to glucocorticoids. The lady reported to us two years into the illness with ulcerative eyelid lesions, worsening myalgia, and painful skin nodules. Eventually, it turned out that anti-synthetase syndrome was the primary diagnosis with Histoplasma infection in the muscles, subcutaneous tissue, and eye. We herewith present the course of her illness and a review of Histoplasmosis of the muscle in literature. Conclusion The differential diagnosis of painful muscle weakness is broad. Histoplasma capsulatum infection should be considered in immunosuppressed myositis patient presenting with orbital ulcers, skin nodules and worsening muscle weakness.
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Case Reports |
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Hsu WC, Hsu JY, Chen MYC, Liang CC. Obturator internus pyomyositis manifested as sciatica in a patient with subacute bacterial endocarditis: A rare case report. Medicine (Baltimore) 2016; 95:e4340. [PMID: 27472717 PMCID: PMC5265854 DOI: 10.1097/md.0000000000004340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Pyomyositis is a pyogenic infection of the skeletal muscles causing myalgia and fever in patients. Hematogenous seeding engendered by persistent bacteremia and septic embolism is usually the underlying cause of the disease. Trauma, intravenous drug use, and immunodeficiency are the main predisposing factors.Obturator internus pyomyositis with sciatica has not previously been reported. We report a rare case of a patient with subacute bacterial endocarditis presenting with left buttock pain and sciatica.Computed tomography confirmed the diagnosis of obturator internus pyomyositis. The patient was discharged uneventfully after successful antibiotic treatment.The mortality rate of patients who have pyomyositis comorbid with another condition or disease is extremely high. Early diagnosis and aggressive management are imperative.
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Case Reports |
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Moriyama Y, Nishioka H. Multifocal pyomyositis after intra-articular injections. J Gen Fam Med 2017; 18:291-292. [PMID: 29264046 PMCID: PMC5689424 DOI: 10.1002/jgf2.49] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 08/17/2016] [Indexed: 11/24/2022] Open
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Journal Article |
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