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; 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 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. 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 often infects the large muscle groups such as the quadriceps or gluteal muscles.

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

Pyomyositis is an acute bacterial infection of skeletal muscle. Common causes of pyomyositis include:

Bacteria

Most common cause

• Staphylococcus aureus(90% cases in tropical and 75% cases in temperate regions)

Less common bacteria

• Group A streptococci(1%-5% of cases)
• Group B,C,G streptococci
• Streptococcus pneumoniae
• Escherichia coli
• Pseudomonas mallei
• Pseudomonas pseudomallei
• Pneumococcus
• Neisseria
• Haemophilus
• Aeromonas
• Serratia
• Yersinia
• Klebsiella

Rare bacteria

• Salmonella
• Citrobacter
• Fusobacterium
• Anaerobes
• Mycobacterium

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.

Risk Factors

The common risk factors in the development of pyomyositis include:

• Blunt trauma
• Vigorous exercise
• Intravenous drug abuse
• Intramuscular injections
• Nutritional deficiencies
• Immunosupression

• HIV
• Immunosupressive drugs
• Organ transplantation
• Liver cirrhosis
• Renal insufficiency

• Diabetis mellitus
• Viral infections
• Parasitic infections

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)