Pyomyositis

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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

Overview

Pyomyositis, also known as tropical pyomyositis or myositis tropicans is a bacterial infection of the skeletal muscles which results in a pus-filled abscess. Pyomyositis is more common in tropical areas but can also occur in the temperate zones. Pyomyositis is most often caused by the bacterium Staphylococcus aureus. The infection can affect any skeletal muscle, but most often infects the large muscle groups such as the quadriceps or gluteal muscles. 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.

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.

Classification

Pyomyositis may be classified according to international classification of diseases-10(ICD-10) into

• M60.0 Infectious myositis, Tropical pyomyositis (optionally, B95-B97 to indicate the infectious agent; B95.6 for Staphylococcus aureus)

Causes

Common causes of pyomyositis include: Bacteria Most common cause

• Staphylococcus aureus(95% of cases)

Less common bacteria

• Group A Streptococci
• Streptococcal pneumoniae
• Escherichia coli
• Pseudomonas mallei
• Pseudomonas pseudomallie

Epidemiology and Demographics

Age

Pyomyositis is mainly a disease of children(2-5 yrs) but infection may occur in any age group.

Tropical countries

Pyomyositis is more common in the tropics, Where it accounts for 4% of all hospital admissions.

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.

Treatment

Medical Therapy

• Pyomyositis

• Preferred regimen (1): Nafcillin
• Preferred regimen (2): Oxacillin 2 g IV q4h

• Preferred regimen (3): Cefazolin 2 g IV q8h (if MSSA)
• Alternate regimen: Vancomycin 1 g IV q12h (if MRSA)