Pyomyositis: Difference between revisions

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{{SK}} Tropical pyomyositis; Myositis tropicans; Bungpagga; Lambo lambo; Tropical skeletal muscle abscess; Myositis purulenta tropica; Bacterial myositis; Suppurative myositis; Epidemic abscess
{{SK}} Tropical pyomyositis; Myositis tropicans; Bungpagga; Lambo lambo; Tropical skeletal muscle abscess; Myositis purulenta tropica; Bacterial myositis; Suppurative myositis; Epidemic abscess


==Overview==
==Overview==
'''Pyomyositis''', also known as '''tropical pyomyositis''' or '''myositis tropicans''' is an [[acute]] primary deep [[bacterial infection]] of the [[skeletal muscle]]s which results in a [[pus]]-filled single or multiple [[abscess]]es. This condition is more common in tropical areas but can also occur in the temperate zones. Pyomyositis is most often caused by the bacterium ''[[Staphylococcus aureus]]''. In tropical regions, the infection often follows minor trauma, while in temperate zones the infection typically occurs in people with [[immunocompromised|immune deficiencies]]. The [[abscess]] within the muscle is drained [[surgery|surgically]] and [[antibiotics]] are administered to fully clear the infection. The infection can affect any [[skeletal muscle]], but most often infects the large muscle groups such as the [[quadriceps]] or [[gluteal muscles]].<ref name="pmid19340425">{{cite journal| author=Unnikrishnan PN, Perry DC, George H, Bassi R, Bruce CE| title=Tropical primary pyomyositis in children of the UK: an emerging medical challenge. | journal=Int Orthop | year= 2010 | volume= 34 | issue= 1 | pages= 109-13 | pmid=19340425 | doi=10.1007/s00264-009-0765-6 | pmc=2899277 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19340425  }} </ref><ref name="pmid15138315">{{cite journal| author=Chauhan S, Jain S, Varma S, Chauhan SS| title=Tropical pyomyositis (myositis tropicans): current perspective. | journal=Postgrad Med J | year= 2004 | volume= 80 | issue= 943 | pages= 267-70 | pmid=15138315 | doi= | pmc=1743005 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15138315  }} </ref>
'''Pyomyositis''', also known as '''tropical pyomyositis''' or '''myositis tropicans''' is an [[acute]] primary deep [[bacterial infection]] of the [[skeletal muscle]]s that results in a single or multiple [[pus]]-filled [[abscess]]es. This condition is more common in tropical areas but may also occur in the temperate zones. The majority of pyomyositis is caused by the bacterium ''[[Staphylococcus aureus]]''. In tropical regions, the infection often follows minor trauma, while in temperate zones the infection typically occurs in people with [[immunocompromised|immune deficiencies]]. The [[abscess]] within the muscle is drained [[surgery|surgically]] and [[antibiotics]] are administered to fully clear the infection. The infection can affect any [[skeletal muscle]], but most commonly infects the large muscle groups such as the [[quadriceps]] or [[gluteal muscles]].<ref name="pmid19340425">{{cite journal| author=Unnikrishnan PN, Perry DC, George H, Bassi R, Bruce CE| title=Tropical primary pyomyositis in children of the UK: an emerging medical challenge. | journal=Int Orthop | year= 2010 | volume= 34 | issue= 1 | pages= 109-13 | pmid=19340425 | doi=10.1007/s00264-009-0765-6 | pmc=2899277 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19340425  }} </ref><ref name="pmid15138315">{{cite journal| author=Chauhan S, Jain S, Varma S, Chauhan SS| title=Tropical pyomyositis (myositis tropicans): current perspective. | journal=Postgrad Med J | year= 2004 | volume= 80 | issue= 943 | pages= 267-70 | pmid=15138315 | doi= | pmc=1743005 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15138315  }} </ref>


==Historical Perspective==
==Historical Perspective==
*Traquair credited Virchow for the earliest mention of pyomyositis, however it was first described by Scriba in 1885 as a disease endemic to tropics. Hence the term tropical myositis.<ref name=Pyomyositis> , S., et al. "Tropical pyomyositis (myositis tropicans): current perspective." Postgraduate medical journal 80.943 (2004): 267-270.</ref><ref name="pmid20243861">{{cite journal| author=TRAQUAIR RN| title=Pyomyositis. | journal=J Trop Med Hyg | year= 1947 | volume= 50 | issue= 5 | pages= 81-9 | pmid=20243861 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20243861  }} </ref>
*Traquair credited Virchow for the earliest mention of pyomyositis, however it was first described by Scriba in 1885 as a disease endemic to the tropics, hence the term tropical myositis.<ref name=Pyomyositis> , S., et al. "Tropical pyomyositis (myositis tropicans): current perspective." Postgraduate medical journal 80.943 (2004): 267-270.</ref><ref name="pmid20243861">{{cite journal| author=TRAQUAIR RN| title=Pyomyositis. | journal=J Trop Med Hyg | year= 1947 | volume= 50 | issue= 5 | pages= 81-9 | pmid=20243861 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20243861  }} </ref>
*Levin ''et al'' reported the first case from a temperate region in 1971.
*Levin ''et al.'' reported the first case from a temperate region in 1971.


==Classification==
==Classification==
Pyomyositis may be classified according to international classification of diseases-10(ICD-10) into:<ref name=ICD10>Pyomyositis.ICD-10-WHO Version 2016. http://www.dimdi.de/static/de/klassi/icd-10-who/kodesuche/onlinefassungen/htmlamtl2016/index.htm Accessed on August 18,2016</ref>
*Pyomyositis may be classified according to the International Classification of Diseases-10 (ICD-10) into:<ref name=ICD10>Pyomyositis.ICD-10-WHO Version 2016. http://apps.who.int/classifications/apps/icd/icd10online2007/index.htm?gm60.htm+ Accessed on August 18,2016</ref>
* M60.0 Infectious myositis, Tropical pyomyositis (optionally, B95-B97 to indicate the infectious agent; B95.6 for ''[[Staphylococcus aureus]]'')
:* M60.0 Infectious myositis, Tropical pyomyositis (optionally, B95-B97 to indicate the infectious agent; B95.6 for ''[[Staphylococcus aureus]]'')
*Based on prognosis, pyomyositis is classified into three stages:
:*Invasive stage
:*[[Purulent]] or [[suppurative]] stage
:*Late or [[septic]] stage


==Pathophysiology==
==Pathophysiology==
===Pathogenesis===
===Pathogenesis===
*Pyomyositis is an [[acute]], primary deep [[bacterial infection]] of the [[skeletal muscle]].<ref name="pmid15138315">{{cite journal| author=Chauhan S, Jain S, Varma S, Chauhan SS| title=Tropical pyomyositis (myositis tropicans): current perspective. | journal=Postgrad Med J | year= 2004 | volume= 80 | issue= 943 | pages= 267-70 | pmid=15138315 | doi= | pmc=1743005 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15138315  }} </ref>
*Pyomyositis is an [[acute]] primary deep [[bacterial infection]] of the [[skeletal muscle]].<ref name="pmid15138315">{{cite journal| author=Chauhan S, Jain S, Varma S, Chauhan SS| title=Tropical pyomyositis (myositis tropicans): current perspective. | journal=Postgrad Med J | year= 2004 | volume= 80 | issue= 943 | pages= 267-70 | pmid=15138315 | doi= | pmc=1743005 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15138315  }} </ref>
*Pyomyositis may be associated with [[Immunoglobulin M deficiency|IgM antibody deficiency]] or with [[phagocytosis|defective phagocytosis]].
*Pyomyositis may be associated with [[Immunoglobulin M deficiency|IgM antibody deficiency]] or with [[phagocytosis|defective phagocytosis]].
:*It does not include
:**Intermuscular abscess
:**Abscesses extending into muscles from adjoining tissues such as [[bone]] and [[subcutaneous tissue]]s
:**Abscesses secondary to previous [[septicemia]]
*The exact [[pathogenesis]] of pyomyositis is not fully understood.  
*The exact [[pathogenesis]] of pyomyositis is not fully understood.  
*Under normal circumstances, the [[skeletal muscle]] tissue is intrinsically resistant to [[bacterial infections]]. It is thought that there is sequestration of [[iron]] by [[myoglobin]], which is an essential nutritional requirement of proliferating bacteria. This results in slower growth of bacteria, allowing [[cell-mediated immunity|cell-mediated]] and [[humoral immunity|humoral]] defences to enter infected zones and thereby preventing establishment of infection.
*Under normal circumstances, the [[skeletal muscle]] tissue is intrinsically resistant to [[bacterial infections]]. It is thought that there is sequestration of [[iron]] by [[myoglobin]], which is an essential nutritional requirement of proliferating bacteria. This results in slower growth of bacteria, allowing [[cell-mediated immunity|cell-mediated]] and [[humoral immunity|humoral]] defences to enter infected zones and thereby preventing establishment of infection.
*Pyomyositis is the result of hematogenous (i.e. through the blood) invasion of bacteria to damaged skeletal muscle (20%- with subsequent abscess formation).
*Pyomyositis results from hematogenous invasion of bacteria to damaged skeletal muscle (20% with subsequent abscess formation).
*It does not include:
:*Intermuscular abscess
:*Abscesses extending into muscles from adjoining tissues such as [[bone]] and [[subcutaneous tissue]]s
:*Abscesses secondary to previous [[septicemia]]


===Commonly involved muscles===
===Common locations===
Commonly involved muscles are:<ref>Drosos, Georgios. "Pyomyositis. A literature review." Acta Orthop Belg 71.1 (2005): 9-16.</ref><ref name="pmid15138315">{{cite journal| author=Chauhan S, Jain S, Varma S, Chauhan SS| title=Tropical pyomyositis (myositis tropicans): current perspective. | journal=Postgrad Med J | year= 2004 | volume= 80 | issue= 943 | pages= 267-70 | pmid=15138315 | doi= | pmc=1743005 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15138315  }} </ref><ref> Pyomyositis. Orphanet(2016). http://www.orpha.net/consor/cgi-bin/OC_Exp.php?Lng=GB&Expert=764 Accessed on August 16,2016</ref><ref name="pmid3700476">{{cite journal| author=Wolf DE, Hagopian SS, Lewis RG, Voglmayr JK, Fairbanks G| title=Lateral regionalization and diffusion of a maturation-dependent antigen in the ram sperm plasma membrane. | journal=J Cell Biol | year= 1986 | volume= 102 | issue= 5 | pages= 1826-31 | pmid=3700476 | doi= | pmc=2114211 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3700476  }} </ref>
Commonly involved muscles include:<ref>Drosos, Georgios. "Pyomyositis. A literature review." Acta Orthop Belg 71.1 (2005): 9-16.</ref><ref name="pmid15138315">{{cite journal| author=Chauhan S, Jain S, Varma S, Chauhan SS| title=Tropical pyomyositis (myositis tropicans): current perspective. | journal=Postgrad Med J | year= 2004 | volume= 80 | issue= 943 | pages= 267-70 | pmid=15138315 | doi= | pmc=1743005 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15138315  }} </ref><ref> Pyomyositis. Orphanet(2016). http://www.orpha.net/consor/cgi-bin/OC_Exp.php?Lng=GB&Expert=764 Accessed on August 16,2016</ref><ref name="pmid3700476">{{cite journal| author=Wolf DE, Hagopian SS, Lewis RG, Voglmayr JK, Fairbanks G| title=Lateral regionalization and diffusion of a maturation-dependent antigen in the ram sperm plasma membrane. | journal=J Cell Biol | year= 1986 | volume= 102 | issue= 5 | pages= 1826-31 | pmid=3700476 | doi= | pmc=2114211 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3700476  }} </ref>
*[[Quadriceps]]
*[[Quadriceps]]
*[[Glutei]]
*[[Glutei]]
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===Microscopic histopathological analysis===
===Microscopic histopathological analysis===
On microscopic histopathological analysis, the following are the characteristic findings of pyomyositis in sequence:<ref name="pmid15138315">{{cite journal| author=Chauhan S, Jain S, Varma S, Chauhan SS| title=Tropical pyomyositis (myositis tropicans): current perspective. | journal=Postgrad Med J | year= 2004 | volume= 80 | issue= 943 | pages= 267-70 | pmid=15138315 | doi= | pmc=1743005 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15138315  }} </ref>
On microscopic histopathological analysis, the following are characteristic findings of pyomyositis in sequence:<ref name="pmid15138315">{{cite journal| author=Chauhan S, Jain S, Varma S, Chauhan SS| title=Tropical pyomyositis (myositis tropicans): current perspective. | journal=Postgrad Med J | year= 2004 | volume= 80 | issue= 943 | pages= 267-70 | pmid=15138315 | doi= | pmc=1743005 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15138315  }} </ref>
*[[Edema|Edematous]] separation of [[muscle fibers]]
*[[Edema|Edematous]] separation of [[muscle fibers]]
*[[Coagulation necrosis]]
*[[Coagulation necrosis]]
*Patchy [[myocytolysis]] and inflammatory infiltatrate
*Patchy [[myocytolysis]] and inflammatory infiltrate
*Loss of striations and granular degeneration of [[myofibers]]
*Loss of striations and granular degeneration of [[myofibers]]
*Appearance of [[lymphocytes]], [[plasma cells]] and [[eosinophils]] when myofibrils degenerate
*Appearance of [[lymphocytes]], [[plasma cells]] and [[eosinophils]] when myofibrils degenerate
The following is the microscopic histopathological image of pyomyositis:<ref>Histology pyomyositis. Pier digital library http://peir.path.uab.edu/library/picture.php?/30207 Accessed on August 23,2016</ref>
<gallery>
Image:Histology_of_Pyomyositis.jpg
</gallery>


==Causes==
==Causes==
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'''Bacteria'''
'''Bacteria'''


Most common cause of pyomyositis include:
Most common cause of pyomyositis includes:
*''[[Staphylococcus aureus]]''(90% cases in tropical and 75% cases in temperate regions)
*''[[Staphylococcus aureus]]'' (90% cases in tropical and 75% cases in temperate regions)
Less common causes of pyomyositis include:
Less common causes of pyomyositis include:
*[[Streptococci|Group A streptococci]](1%-5% of cases)
*[[Streptococci|Group A streptococci]] (1%-5% of cases)
*[[Streptococci|Group B,C,G streptococci]]
*[[Streptococci|Group B,C,G streptococci]]
*''[[Streptococcus pneumoniae]]''
*''[[Streptococcus pneumoniae]]''
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==Differentiating {{PAGENAME}} from Other Diseases==
==Differentiating {{PAGENAME}} from Other Diseases==
Pyomyositis must be differentiated from other diseases that cause [[muscle pain]], [[fever]] and/or [[leukocytosis]] such as:<ref> Pyomyositis. Orphanet(2016). http://www.orpha.net/consor/cgi-bin/OC_Exp.php?Lng=GB&Expert=764 Accessed on August 16,2016</ref><ref name="pmid15138315">{{cite journal| author=Chauhan S, Jain S, Varma S, Chauhan SS| title=Tropical pyomyositis (myositis tropicans): current perspective. | journal=Postgrad Med J | year= 2004 | volume= 80 | issue= 943 | pages= 267-70 | pmid=15138315 | doi= | pmc=1743005 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15138315  }} </ref>
*Pyomyositis must be differentiated from other diseases that cause [[muscle pain]], [[fever]], and/or [[leukocytosis]] such as:<ref> Pyomyositis. Orphanet(2016). http://www.orpha.net/consor/cgi-bin/OC_Exp.php?Lng=GB&Expert=764 Accessed on August 16,2016</ref><ref name="pmid15138315">{{cite journal| author=Chauhan S, Jain S, Varma S, Chauhan SS| title=Tropical pyomyositis (myositis tropicans): current perspective. | journal=Postgrad Med J | year= 2004 | volume= 80 | issue= 943 | pages= 267-70 | pmid=15138315 | doi= | pmc=1743005 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15138315  }} </ref>
*[[Osteomyelitis]]
:*[[Osteomyelitis]]
*[[Pyrexia of unknown origin]]
:*[[Pyrexia of unknown origin]]
*[[Contusion|Muscle contusion]]
:*[[Contusion|Muscle contusion]]
*[[Cellulitis]]
:*[[Cellulitis]]
*[[Hematoma|Muscle hematoma]]
:*[[Hematoma|Muscle hematoma]]
*[[Thrombophlebitis]]
:*[[Thrombophlebitis]]
*[[Appendicitis]]
:*[[Appendicitis]]
*[[Septic arthritis]]
:*[[Septic arthritis]]
*[[Deep venous thrombosis]]
:*[[Deep venous thrombosis]]
*Muscle rupture or [[muscle strain]]
:*Muscle rupture or [[muscle strain]]
*[[Osteosarcoma]]  
:*[[Osteosarcoma]]  
*[[Rhabdomyosarcoma]]
:*[[Rhabdomyosarcoma]]
*[[Trichinosis]]
:*[[Trichinosis]]
*[[Leptospirosis]]
:*[[Leptospirosis]]
*[[Polymyositis]]
:*[[Polymyositis]]
*[[Cysticercosis|Cysticercosis cellulosae]]
:*[[Cysticercosis|Cysticercosis cellulosae]]
*[[Trypanosomiasis]] or [[toxoplasmosis]]
:*[[Trypanosomiasis]] or [[toxoplasmosis]]
*[[Myositis|Spontaneous gangrenous myositis]]
:*[[Myositis|Spontaneous gangrenous myositis]]
*It does not include:
:*Intermuscular abscess
:*Abscesses extending into muscles from adjoining tissues such as [[bone]] and [[subcutaneous tissue]]s
:*Abscesses secondary to previous [[septicemia]]


==Epidemiology and Demographics==
==Epidemiology and Demographics==
===Tropical countries===
===Tropical countries===
*Majority(1,000-4,000 per 100,000 of all hospital asmissions) of pyomyositis cases are reported in some tropical countries such as Asia,tropical Africa, Oceana and the Caribbean islands.
*Majority (1,000-4,000 per 100,000 of all hospital asmissions) of pyomyositis cases are reported in some tropical countries such as Asia, tropical Africa, Oceania (islands of tropical pacific ocean), and the Caribbean islands.
* Between 1980-1989, the incidence of pyomyositis is approximately 2,000 per 100,000 of surgical admissions in Ecuador. <ref name="pmid1566321">{{cite journal| author=Kerrigan KR, Nelson SJ| title=Tropical pyomyositis in eastern Ecuador. | journal=Trans R Soc Trop Med Hyg | year= 1992 | volume= 86 | issue= 1 | pages= 90-1 | pmid=1566321 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1566321  }} </ref>
* Between 1980-1989, the incidence of pyomyositis was approximately 2,000 per 100,000 of surgical admissions in Ecuador. <ref name="pmid1566321">{{cite journal| author=Kerrigan KR, Nelson SJ| title=Tropical pyomyositis in eastern Ecuador. | journal=Trans R Soc Trop Med Hyg | year= 1992 | volume= 86 | issue= 1 | pages= 90-1 | pmid=1566321 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1566321  }} </ref>


===Temperate countries===
===Temperate countries===
*In temperate countries like United states, pyomyositis was a rare condition(accounting for 1 in 3000 pediatric admissions), but has become more common since the appearance of the USA300 strain of [[MRSA]], especially in [[Immunocompromised|immunocompromised patients]].<ref name="pmid1420680">{{cite journal| author=Christin L, Sarosi GA| title=Pyomyositis in North America: case reports and review. | journal=Clin Infect Dis | year= 1992 | volume= 15 | issue= 4 | pages= 668-77 | pmid=1420680 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1420680  }} </ref><ref name="pmid4023003">{{cite journal| author=Przyjalkowski ZW| title=Intestinal microecology and immune response of germfree and conventional mice in mixed trichinellosis. | journal=Prog Clin Biol Res | year= 1985 | volume= 181 | issue=  | pages= 415-9 | pmid=4023003 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4023003  }} </ref>
*In temperate countries, such as the United States, pyomyositis was a rare condition (accounting for 1 in 3000 pediatric admissions), but has become more common since the appearance of the USA300 strain of [[MRSA]], especially in [[Immunocompromised|immunocompromised patients]].<ref name="pmid1420680">{{cite journal| author=Christin L, Sarosi GA| title=Pyomyositis in North America: case reports and review. | journal=Clin Infect Dis | year= 1992 | volume= 15 | issue= 4 | pages= 668-77 | pmid=1420680 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1420680  }} </ref><ref name="pmid4023003">{{cite journal| author=Przyjalkowski ZW| title=Intestinal microecology and immune response of germfree and conventional mice in mixed trichinellosis. | journal=Prog Clin Biol Res | year= 1985 | volume= 181 | issue=  | pages= 415-9 | pmid=4023003 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4023003  }} </ref>


===Age===
===Age===
*In tropical countries, pyomyositis effects children and young adults but may occur in any age group.<ref name=Pyomyositis>Wikipedia(2016). https://en.wikipedia.org/wiki/Pyomyositis Accessed on August 15,2016</ref><ref name= ICD>Wikipedia(2016).https://de.wikipedia.org/wiki/Pyomyositis Accessed on August 15,2016</ref>
*In tropical countries, pyomyositis most commonly affects children and young adults but may occur in any age group.<ref name=Pyomyositis>Wikipedia(2016). https://en.wikipedia.org/wiki/Pyomyositis Accessed on August 15,2016</ref><ref name= ICD>Wikipedia(2016).https://de.wikipedia.org/wiki/Pyomyositis Accessed on August 15,2016</ref>
*In temperate countries, pyomyositis effects mainly adults and elderly.
*In temperate countries, the majority of pyomyositis cases occur in adults and elderly patients.


===Gender===
===Gender===
*In tropical countries males are more commonly effected than females.<ref name=Pyomyositis>Wikipedia(2016). https://en.wikipedia.org/wiki/Pyomyositis Accessed on August 15,2016</ref><ref name= ICD>Wikipedia(2016).https://de.wikipedia.org/wiki/Pyomyositis Accessed on August 15,2016</ref>
*In tropical countries, males are more commonly affected than females.<ref name=Pyomyositis>Wikipedia(2016). https://en.wikipedia.org/wiki/Pyomyositis Accessed on August 15,2016</ref><ref name= ICD>Wikipedia(2016).https://de.wikipedia.org/wiki/Pyomyositis Accessed on August 15,2016</ref>
*In temperate countries both males and females are equally effected.
*In temperate countries, both males and females are equally affected.


==Risk Factors==
==Risk Factors==
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==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==
===Natural History===
===Natural History===
If left untreated, pyomyositis is a potentially life threatening condition(mortality rate of 0.5-2%) which may progress to develop [[bacteremia]], [[septicemia]], [[Abscess|metastatic abscess]], [[acute renal failure]], [[septic shock]] and death.
If left untreated, pyomyositis is a potentially life threatening condition (mortality rate of 0.5-2%) which may progress to develop [[bacteremia]], [[septicemia]], [[Abscess|metastatic abscess]], [[acute renal failure]], [[septic shock]], and death.


===Complications===
===Complications===
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*[[Endocarditis|Valve infection]]
*[[Endocarditis|Valve infection]]
Other complications
Other complications
*Metastatic abscesses(microabscesses in [[liver]], [[spleen]], [[kidney]], [[lung]] and other organs)
*Metastatic abscesses (microabscesses in [[liver]], [[spleen]], [[kidney]], [[lung]], and other organs)
*[[Anterior uveitis]]
*[[Anterior uveitis]]
*[[Wasting|Local wasting]] and deformity
*[[Wasting|Local wasting]] and deformity
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===Prognosis===
===Prognosis===
*Depending of the clinical stage of pyomyositis at the time of diagnosis, the prognosis may vary. However, the prognosis is generally good when diagnosed and treated properly.<ref name="pmid15138315">{{cite journal| author=Chauhan S, Jain S, Varma S, Chauhan SS| title=Tropical pyomyositis (myositis tropicans): current perspective. | journal=Postgrad Med J | year= 2004 | volume= 80 | issue= 943 | pages= 267-70 | pmid=15138315 | doi= | pmc=1743005 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15138315  }} </ref>
*Based on prognosis, pyomyositis is classified into three stages:
*There is very little residual deformity of the muscles if any.
:*Invasive stage
:*[[Purulent]] or [[suppurative]] stage
:*Late or [[septic]] stage
*Depending on the clinical stage of pyomyositis at the time of diagnosis, the prognosis may vary. However, the prognosis is generally good when diagnosed and treated properly.<ref name="pmid15138315">{{cite journal| author=Chauhan S, Jain S, Varma S, Chauhan SS| title=Tropical pyomyositis (myositis tropicans): current perspective. | journal=Postgrad Med J | year= 2004 | volume= 80 | issue= 943 | pages= 267-70 | pmid=15138315 | doi= | pmc=1743005 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15138315  }} </ref>


==Diagnosis==
==Diagnosis==
Early diagnosis of pyomyositis is critical for saving the tissue and also the life of patient but often missed due to following:<ref name="pmid15138315">{{cite journal| author=Chauhan S, Jain S, Varma S, Chauhan SS| title=Tropical pyomyositis (myositis tropicans): current perspective. | journal=Postgrad Med J | year= 2004 | volume= 80 | issue= 943 | pages= 267-70 | pmid=15138315 | doi= | pmc=1743005 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15138315  }} </ref>
Early diagnosis of pyomyositis is critical for good prognosis but is often missed due to following:<ref name="pmid15138315">{{cite journal| author=Chauhan S, Jain S, Varma S, Chauhan SS| title=Tropical pyomyositis (myositis tropicans): current perspective. | journal=Postgrad Med J | year= 2004 | volume= 80 | issue= 943 | pages= 267-70 | pmid=15138315 | doi= | pmc=1743005 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15138315  }} </ref>
*Unfamiliarity with the disease
*Unfamiliarity with the disease
*Atypical presentations
*Atypical presentations
Line 205: Line 211:
====Atypical symptoms====
====Atypical symptoms====
The atypical symptoms of pyomyositis include:<ref name="pmid15138315">{{cite journal| author=Chauhan S, Jain S, Varma S, Chauhan SS| title=Tropical pyomyositis (myositis tropicans): current perspective. | journal=Postgrad Med J | year= 2004 | volume= 80 | issue= 943 | pages= 267-70 | pmid=15138315 | doi= | pmc=1743005 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15138315  }} </ref><ref name="pmid27477417">{{cite journal| author=Itaya S, Kobayashi Z, Tomimitsu H, Shintani S| title=Pneumococcal Pyomyositis of the Neck Muscles. | journal=Intern Med | year= 2016 | volume= 55 | issue= 15 | pages= 2069-71 | pmid=27477417 | doi=10.2169/internalmedicine.55.6552 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27477417  }} </ref>
The atypical symptoms of pyomyositis include:<ref name="pmid15138315">{{cite journal| author=Chauhan S, Jain S, Varma S, Chauhan SS| title=Tropical pyomyositis (myositis tropicans): current perspective. | journal=Postgrad Med J | year= 2004 | volume= 80 | issue= 943 | pages= 267-70 | pmid=15138315 | doi= | pmc=1743005 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15138315  }} </ref><ref name="pmid27477417">{{cite journal| author=Itaya S, Kobayashi Z, Tomimitsu H, Shintani S| title=Pneumococcal Pyomyositis of the Neck Muscles. | journal=Intern Med | year= 2016 | volume= 55 | issue= 15 | pages= 2069-71 | pmid=27477417 | doi=10.2169/internalmedicine.55.6552 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27477417  }} </ref>
*Toxic shock syndrome
*[[Toxic shock syndrome]]
*Pyrexia of unknown origin(when invasive stage is prolonged)
*[[Pyrexia of unknown origin]] (when invasive stage is prolonged)
*Acute abdomen
*[[Acute abdomen]]
*Spinal cord compression
*[[Spinal cord compression]]
*Compartment syndrome
*[[Compartment syndrome]]
*Cervicobrachial neuralgia(when localizes to neck muscles)
*Cervicobrachial neuralgia (when localized to neck muscles)


===Physical Examination===
===Physical Examination===
Line 226: Line 232:


====Images====
====Images====
<gallery>
Image:Gross_appearance_pyomyositis.jpg|Swelling of the left quadriceps, intramuscular abscess, and pyomyositis<ref name=pyomyositis>Critical ultrasound journal. https://criticalultrasoundjournal.springeropen.com/articles/10.1186/2036-7902-5-3 Accessed on August 23,2016</ref>
</gallery>


===Laboratory Findings===
===Laboratory Findings===
Laboratory findings consistent with pyomyositis include:<ref name="pmid15138315">{{cite journal| author=Chauhan S, Jain S, Varma S, Chauhan SS| title=Tropical pyomyositis (myositis tropicans): current perspective. | journal=Postgrad Med J | year= 2004 | volume= 80 | issue= 943 | pages= 267-70 | pmid=15138315 | doi= | pmc=1743005 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15138315  }} </ref>
Laboratory findings consistent with pyomyositis include:<ref name="pmid15138315">{{cite journal| author=Chauhan S, Jain S, Varma S, Chauhan SS| title=Tropical pyomyositis (myositis tropicans): current perspective. | journal=Postgrad Med J | year= 2004 | volume= 80 | issue= 943 | pages= 267-70 | pmid=15138315 | doi= | pmc=1743005 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15138315  }} </ref>
*Needle aspiration (Gold standard for diagnosis)
*Needle aspiration (gold standard for diagnosis)
:*Negative for pus in invasive stage
:*Negative for pus in invasive stage
:*Positive for [[pus]] in suppurative and septic stage
:*Positive for [[pus]] in suppurative and septic stage
:*Aspirated pus is sent for culture(aerobic and anaerobic culture)
:*Aspirated pus is sent for culture (aerobic and anaerobic culture)
*[[Biopsy]](Gold standard for diagnosis)
*[[Biopsy]] (gold standard for diagnosis)
:*Biopsy of the abscess wall and/muscle taken at the time of abscess drainage should be cultured
:*Biopsy of the abscess wall and muscle taken at the time of abscess drainage should be cultured
*Blood culture and sensitivity helps to identify the following:
*Blood culture and sensitivity helps to identify the following:
:*Septicemic process in blood
:*Septicemic process in blood
:*Antibiotics of choice
:*Antibiotics of choice
*Heamatological tests:
*Hematological tests:
:*[[Complete blood count]]
:*[[Complete blood count]]
::*[[Leukocytosis]]
::*[[Leukocytosis]]
Line 248: Line 251:
::*[[Anemia]]
::*[[Anemia]]
:*Raised [[erythrocyte sedimentation rate]]
:*Raised [[erythrocyte sedimentation rate]]
:*[[Creatine phosphokinase]] and [[aldolase]](Usually markers of muscle damage are normal)
:*[[Creatine phosphokinase]] and [[aldolase]] (markers of muscle damage are usually normal)
:*Raised [[C-reactive protein]]
:*Raised [[C-reactive protein]]
*Other laboratory tests to identify risk factors
*Other laboratory tests to identify risk factors


===Imaging Findings===
===Imaging Findings===
The following non invasive imaging studies can be used in the diagnosis of pyomyositis
The following non invasive imaging studies can be used in the diagnosis of pyomyositis:
====Ultrasonography====
====Ultrasonography====
*Ultrasonography is the initial imaging study of choice.
*Ultrasonography is the initial imaging study of choice.
Line 261: Line 264:
:*Hypoechoic areas  
:*Hypoechoic areas  
:*Hyperechoic areas
:*Hyperechoic areas
<gallery>
Image:Normal_quadriceps_muscle_(left)_and_quadriceps_intramuscular_loculated_abscess_or_pyomyositis_(right).jpg|Ultrasonography
</gallery>
Description of image:<ref name=pyomyositis>Critical ultrasound journal. https://criticalultrasoundjournal.springeropen.com/articles/10.1186/2036-7902-5-3 Accessed on August 23,2016</ref>
*Normal quadriceps muscle (left)
*Quadriceps intramuscular loculated abscess or pyomyositis (right)


====CT scan====
====CT scan====
Line 272: Line 269:
:*The affected muscle shows areas of low attenuation with loss of muscle planes  
:*The affected muscle shows areas of low attenuation with loss of muscle planes  
:*Surrounding rim of contrast enhancement
:*Surrounding rim of contrast enhancement
*It is also useful in differentiating [[tumour]]s, [[hematoma]] and [[thrombophlebitis]] from abscess
*It is also useful in differentiating [[tumour]]s, [[hematoma]] and [[thrombophlebitis]] from abscess.
<gallery>
Image:CT_pyomyositis.jpg|CT pyomyositis
</gallery>
Description of image:<ref name=pyomyositis>wiley online library. http://onlinelibrary.wiley.com/doi/10.1111/jdi.12393/pdf(2015) Accessed on August 22,2016</ref>
*Computed tomography with contrast enhancement in the right thigh on admission(a,b)
*Frontal slice(a)
*Mid-femoral cross sectional slice(b)
*Disseminated abscesses throughout the patient's body including the kidney and muscle(c)


====MRI====
====MRI====
Line 287: Line 276:
:*Heterogenous areas of low intensity appear on T1-weighted images
:*Heterogenous areas of low intensity appear on T1-weighted images
:*In the early stage, the only finding may be [[edema]] (area of high signal intensity on fluid-sensitive sequences)
:*In the early stage, the only finding may be [[edema]] (area of high signal intensity on fluid-sensitive sequences)
<gallery>
Image:T1_weighted_MRI.jpg|MRI
</gallery>
Description of image:<ref name="pmid24350072">{{cite journal| author=Chattopadhyay B, Mukhopadhyay M, Chatterjee A, Biswas PK, Chatterjee N, Debnath NB| title=Tropical pyomyositis. | journal=N Am J Med Sci | year= 2013 | volume= 5 | issue= 10 | pages= 600-3 | pmid=24350072 | doi=10.4103/1947-2714.120796 | pmc=3842701 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24350072  }} </ref>
*T1 weighted magnetic resonance imaging image showing hypointense lesions involving the left iliopsoas muscle (arrow)


====Plain radiography====
====Plain radiography====
Line 308: Line 292:
==Treatment==
==Treatment==
===Resuscitation===
===Resuscitation===
The following conditions require immediate resuscitation
The following conditions require immediate resuscitation:
*[[Anemia]]: Blood transfusion
*[[Anemia]]: Blood transfusion
*[[Malnutrition]]: Nutritional support and rehabilitation
*[[Malnutrition]]: Nutritional support and rehabilitation
Line 314: Line 298:


===Surgery===
===Surgery===
Surgery is the mainstay of treatment for pyomyositis
Surgery is the mainstay treatment for pyomyositis.
*Abscess drainage
*Abscess drainage includes:
:*[[Incision and drainage]] or
:*[[Incision and drainage]]
:*[[Percutaneous drainage]](ultrasound or CT guided)
:*[[Percutaneous drainage]] (ultrasound or CT guided)


===Medical Therapy===
===Medical Therapy===
====Analgesia====
====Analgesia====
Appropriate [[analgesia]] is given when patient presents with pain.
Appropriate [[analgesics]] are given when the patient presents with pain.


====Antimicrobial therapy====
====Antimicrobial therapy====
*Antimicrobial therapy is recommended for patients with pyomyocitis<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
*Antimicrobial therapy is recommended for patients with pyomyocitis:<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
:* Preferred regimen (1): [[Nafcillin]]   
:* Preferred regimen (1): [[Nafcillin]]   
:* Preferred regimen (2): [[Oxacillin]] 2 g IV q4h  
:* Preferred regimen (2): [[Oxacillin]] 2 g IV q4h  
Line 340: Line 324:
==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{WH}}
{{WS}}


[[Category:Rheumatology]]
[[Category:Rheumatology]]
[[Category:Infectious disease]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Primary care]]
[[Category:Dermatology]]
[[Category:Dermatology]]
 
[[Category:Disease]]
{{WH}}
[[Category:Up-To-Date]]
{{WS}}
[[Category:Orthopedics]]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yamuna Kondapally, M.B.B.S[2]

Synonyms and keywords: Tropical pyomyositis; Myositis tropicans; Bungpagga; Lambo lambo; Tropical skeletal muscle abscess; Myositis purulenta tropica; Bacterial myositis; Suppurative myositis; Epidemic abscess

Overview

Pyomyositis, also known as tropical pyomyositis or myositis tropicans is an acute primary deep bacterial infection of the skeletal muscles that results in a single or multiple pus-filled abscesses. This condition is more common in tropical areas but may also occur in the temperate zones. The majority of pyomyositis is caused by the bacterium Staphylococcus aureus. In tropical regions, the infection often follows minor trauma, while in temperate zones the infection typically occurs in people with immune deficiencies. The abscess within the muscle is drained surgically and antibiotics are administered to fully clear the infection. The infection can affect any skeletal muscle, but most commonly infects the large muscle groups such as the quadriceps or gluteal muscles.[1][2]

Historical Perspective

  • Traquair credited Virchow for the earliest mention of pyomyositis, however it was first described by Scriba in 1885 as a disease endemic to the tropics, hence the term tropical myositis.[3][4]
  • Levin et al. reported the first case from a temperate region in 1971.

Classification

  • Pyomyositis may be classified according to the International Classification of Diseases-10 (ICD-10) into:[5]
  • M60.0 Infectious myositis, Tropical pyomyositis (optionally, B95-B97 to indicate the infectious agent; B95.6 for Staphylococcus aureus)
  • Based on prognosis, pyomyositis is classified into three stages:

Pathophysiology

Pathogenesis

Common locations

Commonly involved muscles include:[6][2][7][8]

Microscopic histopathological analysis

On microscopic histopathological analysis, the following are characteristic findings of pyomyositis in sequence:[2]

Causes

Pyomyositis is an acute bacterial infection of skeletal muscle.[3][9]

Bacteria

Most common cause of pyomyositis includes:

Less common causes of pyomyositis include:

Rare causes of pyomyositis include:

Differentiating Pyomyositis from Other Diseases

  • It does not include:

Epidemiology and Demographics

Tropical countries

  • Majority (1,000-4,000 per 100,000 of all hospital asmissions) of pyomyositis cases are reported in some tropical countries such as Asia, tropical Africa, Oceania (islands of tropical pacific ocean), and the Caribbean islands.
  • Between 1980-1989, the incidence of pyomyositis was approximately 2,000 per 100,000 of surgical admissions in Ecuador. [11]

Temperate countries

  • In temperate countries, such as the United States, pyomyositis was a rare condition (accounting for 1 in 3000 pediatric admissions), but has become more common since the appearance of the USA300 strain of MRSA, especially in immunocompromised patients.[12][13]

Age

  • In tropical countries, pyomyositis most commonly affects children and young adults but may occur in any age group.[3][14]
  • In temperate countries, the majority of pyomyositis cases occur in adults and elderly patients.

Gender

  • In tropical countries, males are more commonly affected than females.[3][14]
  • In temperate countries, both males and females are equally affected.

Risk Factors

The common risk factors in the development of pyomyositis include:[2][15][16][17][18]

Screening

According to the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for pyomyositis.

Natural History, Complications, and Prognosis

Natural History

If left untreated, pyomyositis is a potentially life threatening condition (mortality rate of 0.5-2%) which may progress to develop bacteremia, septicemia, metastatic abscess, acute renal failure, septic shock, and death.

Complications

Common complications of pyomyositis include:[19][2]

Cardiac complications

Other complications

Prognosis

  • Based on prognosis, pyomyositis is classified into three stages:
  • Depending on the clinical stage of pyomyositis at the time of diagnosis, the prognosis may vary. However, the prognosis is generally good when diagnosed and treated properly.[2]

Diagnosis

Early diagnosis of pyomyositis is critical for good prognosis but is often missed due to following:[2]

  • Unfamiliarity with the disease
  • Atypical presentations
  • A wide range of differential diagnosis
  • Lack of early specific signs

History

A detailed and thorough history from the patient is necessary. Specific areas of focus when obtaining a history from the patient include:[20]

Symptoms

The symptoms of pyomyositis are divided into three stages[3][20]

Stage Clinical features
Invasive stage ● Lasts 1-2 weeks
● With or without fever
● Firm swelling
● Localised pain
● Loss of apetite (anorexia)
Purulent or
Suppurative stage		 ● Next 2 weeks
● High spiky fever
● Firm mass with pus
Late or
Septic stage		 ● Fluctuant mass
● Dissemination of infection
● Septicemia
● Acute renal failure
● Metastatic abscesses
● Septic shock
● Death

Atypical symptoms

The atypical symptoms of pyomyositis include:[2][21]

Physical Examination

Common physical examination findings of pyomyositis include:[3][20]

Stage General appearance Vitals Local examination
Invasive stage Ill apprearing Low raise in temperature With or without tenderness
Indurated or woody hard
Edema
Localised raised of temperature
Purulent
or
Suppurative stage		 Severely ill High rise in temperature Marked tenderness of affected muscle
Fluctuant mass
Edema
Erythema
Localised raised of temperature
Late
or
Septic stage		 Acutely ill
Altered mental status		 High rise in temperature
Tachycardia
Tachypnea
 Fluctuant swelling in muscle
Edema
Erythema

Images

Laboratory Findings

Laboratory findings consistent with pyomyositis include:[2]

  • Needle aspiration (gold standard for diagnosis)
  • Negative for pus in invasive stage
  • Positive for pus in suppurative and septic stage
  • Aspirated pus is sent for culture (aerobic and anaerobic culture)
  • Biopsy (gold standard for diagnosis)
  • Biopsy of the abscess wall and muscle taken at the time of abscess drainage should be cultured
  • Blood culture and sensitivity helps to identify the following:
  • Septicemic process in blood
  • Antibiotics of choice
  • Hematological tests:
  • Other laboratory tests to identify risk factors

Imaging Findings

The following non invasive imaging studies can be used in the diagnosis of pyomyositis:

Ultrasonography

  • Ultrasonography is the initial imaging study of choice.
  • On ultrasonography, pyomyositis is characterized by the following features:[22][23]
  • Muscle swelling
  • Heterogenous hypoechoic areas
  • Hypoechoic areas
  • Hyperechoic areas

CT scan

  • On CT scan, pyomyositis is characterized by the following features:
  • The affected muscle shows areas of low attenuation with loss of muscle planes
  • Surrounding rim of contrast enhancement

MRI

  • On MRI, pyomyositis is characterized by the following features:[24][25]
  • The affected muscle may appear swollen, with loss of architectural definition
  • Heterogenous areas of low intensity appear on T1-weighted images
  • In the early stage, the only finding may be edema (area of high signal intensity on fluid-sensitive sequences)

Plain radiography

Other Diagnostic Studies

X ray Chest

  • All patients should have initial radiography of chest and also repeated after an interval to detect complications of pyomyositis(like lung and cardiac complications).

Echocardiography

  • Echocardiogram is used to diagnose cardiac complications of pyomyositis.

ECG

  • ECG is used to diagnose cardiac complications of pyomyositis.

Treatment

Resuscitation

The following conditions require immediate resuscitation:

Surgery

Surgery is the mainstay treatment for pyomyositis.

  • Abscess drainage includes:

Medical Therapy

Analgesia

Appropriate analgesics are given when the patient presents with pain.

Antimicrobial therapy

  • Antimicrobial therapy is recommended for patients with pyomyocitis:[26]
  • Preferred regimen (3): Cefazolin 2 g IV q8h (if MSSA)
  • Alternate regimen: Vancomycin 1 g IV q12h (if MRSA)

Prevention

Primary prevention

There are no primary preventive measures available for pyomyositis.

Secondary prevention

There are no secondary preventive measures available for pyomyositis.

References

  1. ↑ Unnikrishnan PN, Perry DC, George H, Bassi R, Bruce CE (2010). "Tropical primary pyomyositis in children of the UK: an emerging medical challenge". Int Orthop. 34 (1): 109–13. doi:10.1007/s00264-009-0765-6. PMC 2899277. PMID 19340425.
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 Chauhan S, Jain S, Varma S, Chauhan SS (2004). "Tropical pyomyositis (myositis tropicans): current perspective". Postgrad Med J. 80 (943): 267–70. PMC 1743005. PMID 15138315.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 , S., et al. "Tropical pyomyositis (myositis tropicans): current perspective." Postgraduate medical journal 80.943 (2004): 267-270.
  4. ↑ TRAQUAIR RN (1947). "Pyomyositis". J Trop Med Hyg. 50 (5): 81–9. PMID 20243861.
  5. ↑ Pyomyositis.ICD-10-WHO Version 2016. http://apps.who.int/classifications/apps/icd/icd10online2007/index.htm?gm60.htm+ Accessed on August 18,2016
  6. ↑ Drosos, Georgios. "Pyomyositis. A literature review." Acta Orthop Belg 71.1 (2005): 9-16.
  7. ↑ Pyomyositis. Orphanet(2016). http://www.orpha.net/consor/cgi-bin/OC_Exp.php?Lng=GB&Expert=764 Accessed on August 16,2016
  8. ↑ Wolf DE, Hagopian SS, Lewis RG, Voglmayr JK, Fairbanks G (1986). "Lateral regionalization and diffusion of a maturation-dependent antigen in the ram sperm plasma membrane". J Cell Biol. 102 (5): 1826–31. PMC 2114211. PMID 3700476.
  9. ↑ D'Antonio F, Arias AP, Jaureguizar Mde L, Castagnotti I, Gómez L, Sapia EY; et al. (2014). "[Bilateral thigh pyomyositis caused by community-acquired methicillin-resistant Staphylococcus aureus]". Arch Argent Pediatr. 112 (6): e273–6. doi:10.1590/S0325-00752014000600020. PMID 25362928.
  10. ↑ Pyomyositis. Orphanet(2016). http://www.orpha.net/consor/cgi-bin/OC_Exp.php?Lng=GB&Expert=764 Accessed on August 16,2016
  11. ↑ Kerrigan KR, Nelson SJ (1992). "Tropical pyomyositis in eastern Ecuador". Trans R Soc Trop Med Hyg. 86 (1): 90–1. PMID 1566321.
  12. ↑ Christin L, Sarosi GA (1992). "Pyomyositis in North America: case reports and review". Clin Infect Dis. 15 (4): 668–77. PMID 1420680.
  13. ↑ Przyjalkowski ZW (1985). "Intestinal microecology and immune response of germfree and conventional mice in mixed trichinellosis". Prog Clin Biol Res. 181: 415–9. PMID 4023003.
  14. ↑ 14.0 14.1 Wikipedia(2016).https://de.wikipedia.org/wiki/Pyomyositis Accessed on August 15,2016
  15. ↑ Tanabe A, Kaneto H, Kamei S, Hirata Y, Hisano Y, Sanada J; et al. (2016). "Case of disseminated pyomyositis in poorly controlled type 2 diabetes mellitus with diabetic ketoacidosis". J Diabetes Investig. 7 (4): 637–640. doi:10.1111/jdi.12393. PMC 4931217. PMID 27181931.
  16. ↑ Navinan MR, Yudhisdran J, Kandeepan T, Kulatunga A (2015). "Tropical pyomyositis as a presenting feature of subclinical leukemia: a case report". J Med Case Rep. 9: 39. doi:10.1186/s13256-015-0513-z. PMC 4340827. PMID 25889902.
  17. ↑ Lin FC, Jeng KC, Tsai SC (2014). "Oesophageal pyomyositis in an intravenous drug user". Interact Cardiovasc Thorac Surg. 19 (5): 867–8. doi:10.1093/icvts/ivu269. PMID 25125141.
  18. ↑ Adams S, Petz C (2015). "Tropical Pyomyositis in a Temperate Climate". J S C Med Assoc. 111 (4): 137–8. PMID 27141707.
  19. ↑ Akhtar K, Sultan M, Akbar H, Ahmed W, Sadiq N, Saleem K; et al. (2012). "Pancarditis: a rare complication of tropical pyomyositis". J Coll Physicians Surg Pak. 22 (5): 320–2. doi:05.2012/JCPSP.320322 Check |doi= value (help). PMID 22538039.
  20. ↑ 20.0 20.1 20.2 Stevens, Dennis L., et al. "Practice guidelines for the diagnosis and management of skin and soft-tissue infections." Clinical Infectious Diseases 41.10 (2005): 1373-1406.
  21. ↑ Itaya S, Kobayashi Z, Tomimitsu H, Shintani S (2016). "Pneumococcal Pyomyositis of the Neck Muscles". Intern Med. 55 (15): 2069–71. doi:10.2169/internalmedicine.55.6552. PMID 27477417.
  22. ↑ Méndez N, Gancedo E, Sawicki M, Costa N, Di Rocco R (2016). "[Primary pyomyositis. Review of 32 cases diagnosed by ultrasound]". Medicina (B Aires). 76 (1): 10–8. PMID 26826987.
  23. ↑ Traub WH, Raymond EA (1971). "Epidemiological surveillance of Serratia marcescens infections by bacteriocin typing". Appl Microbiol. 22 (6): 1058–63. PMC 376485. PMID 4944804.
  24. ↑ Tharmarajah H, Marks M (2015). "Early use of MRI for suspected pyomyositis". J Paediatr Child Health. 51 (6): 651–2. doi:10.1111/jpc.12916. PMID 26036298.
  25. ↑ Fry EM (1987). "FDA update on aseptic processing guidelines". J Parenter Sci Technol. 41 (2): 56–60. PMID 3598820.
  26. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

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