Presentation
Aim: To present the features and management of Pyogenic myositis in children. Method: Two boys of four and six years old presented to our hospital within 6 months. [online.boneandjoint.org.uk]
A rationalisation of the 1350 boxes used throughout the book gives a simpler and clearer presentation of the various categories. [books.google.com]
Therapy is based on the clinical presentation and the underlying pathogen. [scinapse.io]
Aeromonas hydrophila is present in wound drainage and surgical excised tissue and is frequently present in blood cultures obtained on presentation. [infectiousdiseaseadvisor.com]
Muscle edema, characterized by high T2 signal is typically present. Abscesses appear, as elsewhere, as fluid collection (high T2, low T1) with peripheral contrast enhancement. There may also be diffuse muscle enlargement. [radiopaedia.org]
Entire Body System
- Fever
Tick-borne Rickettsia rickettsii Rocky Mountain spotted fever Rickettsia conorii Boutonneuse fever Rickettsia japonica Japanese spotted fever Rickettsia sibirica North Asian tick typhus Rickettsia australis Queensland tick typhus Rickettsia honei Flinders [en.wikipedia.org]
Symptoms include muscle pain, FEVER, and leucocytosis. [ebi.ac.uk]
Clinical symptoms: • Muscle pain and swelling, lameness • Bacterial myositis has fever, tachycardia, toxemia • May be asymptomatic or there is fever, anorexia, decreased milk production, diarrhea, abortion and weakness. • If affect the cardiac muscle [veterpedia.net]
Influenza Virus In children, this condition occurs after an episode of fever, malaise, and rhinorrhea followed by severe pain, especially in the calves that coincide with subsidence of fever. [boneandspine.com]
Symptoms of pyomyositis Invasive stage: subacute development of pain, fever, and minimal tenderness at site of infection Suppurative stage: follows 10 to 21 days later, with increased local pain, fever, and tenderness Sepsis stage: spread of infection [infectiousdiseaseadvisor.com]
- Fatigue
Primary symptoms may include muscle pain and soreness, fatigue, trouble swallowing, and difficulty breathing. In the United States, there are an estimated 1,600 to 3,200 new cases per year and 50,000 to 75,000 people living with myositis. [healthline.com]
Kradin has a number of clinical interests including Chronic Fatigue Syndrome, Interstitial Lung Disease, Multiple Chemical Sensitivity and Pulmonary Immunology. He also holds an Associate Professor position of Pathology at Harvard Medical School. [books.google.com]
Other symptoms of myositis may include Fatigue after walking or standing Tripping or falling Trouble swallowing or breathing Doctors may use a physical exam, lab tests, imaging tests and a muscle biopsy to diagnose myositis. [medlineplus.gov]
Side effects may include nausea and vomiting, fatigue, hair loss, low blood counts and an increased risk of infection. Fatigue may increase with each treatment. [hss.edu]
Later symptoms can include: Fever Chills Fatigue (tiredness) Vomiting These confusing symptoms may delay a person from seeking medical attention. If you have these symptoms after a wound, see a doctor right away. [cdc.gov]
- Falling
Other symptoms of myositis may include Fatigue after walking or standing Tripping or falling Trouble swallowing or breathing Doctors may use a physical exam, lab tests, imaging tests and a muscle biopsy to diagnose myositis. [medlineplus.gov]
The weakness from myositis can lead to falls and make it difficult to get up from a chair or after a fall. [webmd.com]
Symptoms of IBM include: difficulty walking tripping and loss of balance frequent falls trouble rising from a seated position weakened hand grip and diminished hand and finger dexterity difficulty swallowing muscle weakness muscle pain diminished deep [healthline.com]
Patients may fall, find it difficult to reach their arms up, have difficulty swallowing, or other symptoms. In addition to these symptoms, it’s common for patients to experience other complications. [myositis.org]
- Severe Pain
Group B virus infection causes severe pain in the muscles between the ribs or in the diaphragm [pleurodynia, also called Bornholm disease or epidemic myalgia. [boneandspine.com]
Discussion : Acute muscle pain and difficulties in walking could be suggestive of both benign and severe degenerative diseases. [pai-india.org]
Edema, pain, and frequently gas in the tissues occur. The infection spreads rapidly and may progress to myonecrosis. In clostridial myonecrosis (gas gangrene), initial severe pain is common, sometimes even before other findings. [merckmanuals.com]
No paresis was apparent in either lower extremity; however, he could not sit because of severe pain. [healio.com]
When a child has benign acute myositis he or she may suddenly complain about having severe pain in the leg and difficulty walking. In most cases the child has recently had a fever and upper respiratory symptoms. [belmarrahealth.com]
- Fishing
Slowly wean off junk food and trade it in for organic produce, nuts, seeds, grass-fed beef, organic poultry, wild-caught fish, eggs, and healthy fats like butter, avocado, coconut oil, and olive oil. [askdrmaxwell.com]
Aeromonas hydrophila myonecrosis Individuals who sustain penetrating injuries in freshwater settings (e.g., after boating or swimming accidents) or associated with fish or other water-based wildlife may develop a fulminant myonecrosis syndrome, often [infectiousdiseaseadvisor.com]
Respiratoric
- Pneumonia
By contrast, Williams et al. observed a higher proportion of Gram positive bacteria (41%), Streptococcus pneumoniae especially [ 11 ]. [bmcinfectdis.biomedcentral.com]
Tests included: C reactive protein (345 mg/dl), normal doppler scan of lower limbs, CD4 count (10 cells/mm3, CD4% of 1), HIV viral load (>1 million copies/ml), CK 453 U/l (30–175 U/l) and blood culture was positive for Streptococcus pneumoniae. [adc.bmj.com]
Rhinoscleroma, Pneumonia Klebsiella granulomatis Granuloma inguinale Klebsiella oxytoca Escherichia coli: Enterotoxigenic Enteroinvasive Enterohemorrhagic O157:H7 O104:H4 Hemolytic-uremic syndrome Enterobacter aerogenes/Enterobacter cloacae Slow/weak [en.wikipedia.org]
Patients with lung disease are at greater risk for developing an opportunistic infection called pneumocystis jiroveci pneumonia because of immunosuppression. [myositis.org]
- Hoarseness
Symptoms of PM include: muscle weakness muscle pain difficulty swallowing falling trouble rising from a seated position fatigue chronic dry cough thickening of the skin on the hands difficulty breathing fever weight loss hoarse voice Toxic myositis Toxic [healthline.com]
(All) Hoarse voice or whispering tone ( dysphonia ). (DM/JDM) Difficulty swallowing ( dysphagia ). (All) Tiredness. (DM/JDM) Gastrointestinal features. (JDM) Irritability. (JDM) [healthhype.com]
Dysphonia Problems with the voice, often resulting in weaker or hoarse sounds. Efficacy The effectiveness of a particular medication in treating the disease or condition for which it is being tested or prescribed. [myositis.org]
- Rhinitis
A 15-year-old boy suffered a brief bout of fever, rhinitis, sore throat, and myalgia 3 weeks prior to admission. Two weeks after the initial episode, he developed pain and tenderness in his proximal muscles, more prominent after physical activity. [atmph.org]
Cardiovascular
- Thrombosis
In four cases there was associated cellulitis, and in one case each,adjacent joint effusion and deep vein thrombosis were seen. After gadolinium infusion, peripheral rim enhancementwas noted in nine cases and heterogeneous enhancement in one. [synapse.koreamed.org]
Differential diagnosis of pyomyositis may include a diverse numberof clinical conditions involving bone (osteomyelitis), joints(septic arthritis), vessels (thrombosis), or muscle (hematoma orstrain). [oneclass.com]
The involved area becomes anesthetic because of thrombosis of the small vessels that supply the superficial nerves. This can antedate the appearance of skin necrosis, and signifies the presence of NF and not simple cellulitis. [anaerobicinfections.blogspot.com]
Infected vascular grafts Devitalized tissue due to arterial insufficiency/graft thrombosis is the focus of this infection. It occurs in patients with failed vascular grafts, especially in diabetic patients. [infectiousdiseaseadvisor.com]
- Heart Failure
Cardiac disturbances, including atrioventricular conduction defects, tachyarrhythmias, dilated cardiomyopathy, a low ejection fraction, and congestive heart failure, which may rarely occur, either from the disease itself or from hypertension associated [what-when-how.com]
failure Critical illness myopathy At least as prevalent as critical illness neuropathy Affects approximately 60% of patients with prolonged ICU stay Symmetrical proximal > distal muscle weakness Critical illness neuropathy Failure to wean off ventilation [clevelandclinicmeded.com]
Skin
- Erythema
Visual findings of the right upper arm. a On day 2 of administration, erythema developed and swelling increased. b After 2 weeks of surgical drainage, erythema disappeared and swelling diminished. Fig. 3. [karger.com]
Streptococcal gangrene starts as painful erythema and edema, followed in 24-72 hours by dusky skin, and yellowish to red-black fluid filled bullae. The area is demarcated and covered by necrotic eschar, surrounded by erythema. [anaerobicinfections.blogspot.com]
Rupture of an intramuscular abscess with overlying skin erythema mimics cellulitis. [infectiousdiseaseadvisor.com]
Left thigh was diffusely tender, swollen, tense, warm, and indurated without overlying erythema. Investigations showed a total leukocyte count of 19,600/cumm, with 82% neutrophils. ESR was 75 mm in the first hour and CK was 112U/L. [neurologyindia.com]
Musculoskeletal
- Arthritis
[…] diagnosis of skeletal muscle edema on MRI cellulitis necrotizing fasciitis osteomyelitis septic arthritis Promoted articles (advertising) [radiopaedia.org]
Arthritis Res Ther. October 12, 2019. doi: 10.1186/s13075-019-1997-5. Related Articles [rheumatologynetwork.com]
The initial presentation suggested septic arthritis of the hip with pain, pyrexia and limited hip movements. Serum inflammatory markers were significantly raised. Hip rotation, however, was not severely reduced when examined carefully. [online.boneandjoint.org.uk]
Myositis of the sternocleidomastoid muscle as a result of arthritis of the sternoclavicular joint. Laryngorhinootologie. 2007;86:124-7. Soleh MN, Irfan M. Sternocleidomastoid pyomyositis mimicking parotid abscess. [revistas.unal.edu.co]
Plotz, one of the authors and chief of the arthritis and rheumatism branch at the National Institute of Arthritis and Musculoskeletal and Skin Diseases. “It is a speculation. It’s a very good idea, but it isn’t really proven in the world yet.” [nytimes.com]
- Myalgia
Muscle Pain, Muscle Ache, Muscle Inflammation What is Myalgia and myositis? Myalgia means muscle pain or aching. Myositis means muscle inflammation. [nmihi.com]
Types of myalgia There are four myalgia types, and no matter which type a person suffers from it can impact quality of life. The type of myalgia depends on what area of the body is being affected and what muscles are involved. [belmarrahealth.com]
[…] crurisepidemica in the 1950s, [5] influenza infections can cause sudden onset of calf pain and severe myalgias. [atmph.org]
ACUTE COXSACKIEVIRUS MYOSITIS Group A virus infection - Myalgias, weakness Group B virus infection - Causes epidemic pleurodynia (Bornholm disease or epidemic myalgia), which is considered a form of myositis This is an acute, febrile disorder with abrupt [pai-india.org]
Group B virus infection causes severe pain in the muscles between the ribs or in the diaphragm [pleurodynia, also called Bornholm disease or epidemic myalgia. [boneandspine.com]
- Osteoporosis
It may be a precursor to osteoporosis. Osteoporosis A disease characterized by decreased bone density, resulting in thinning of bone tissue and decreased mechanical strength. [myositis.org]
There are drugs you can take alongside steroids to reduce the risk of developing osteoporosis. This includes bisphosphonates, which can slow bone loss. [versusarthritis.org]
[…] areas of skin in dermatomyositis higher doses of steroid tablets if there's severe muscle weakness High doses of steroids can cause side effects such as weight gain, high blood pressure, diabetes, cataracts (cloudy patches in the lens of the eye) and osteoporosis [nhs.uk]
The long-term side effects may include: cataracts, steroid-induced diabetes, and bone problems, such as osteoporosis or avascular necrosis. Patients on steroids should have annual or bi-annual eye exams for cataracts. [hss.edu]
- Arthralgia
Arthralgias, synovitis, or deforming arthropathy with subluxation in the interphalangeal joints can occur in some patients with DM and PM who have Jo-1 antibodies (see below). [what-when-how.com]
[…] erythematous rash over the shoulder and exposed areas of the back) Interstitial lung diseases Malignancy GI vasculitis Polymyositis Female > male predominance Peak incidence: 20–50 yr Symmetrical proximal muscle weakness Pelvic girdle > shoulder girdle muscles Arthralgias [clevelandclinicmeded.com]
MALATTIE ENDOCRINE CON DOLORE MUSCOLO-SCHELETRICO • • • • • THYROID DISEASE PARATHYROID DISEASE ADRENAL DISEASE DIABETES MELLITUS ACROMEGALY TERAPIA CORTISONICI High Impact Rheumatology Diffuse Arthralgias and Myalgias Case 1: History • A 48-year-old [studocu.com]
Neurologic
- Irritability
Pyomyositis of the piriformis muscle produces swelling of the muscle, resulting in compression and irritation of the sciatic nerve; thus, it may be a cause of piriformis muscle syndrome. [healio.com]
Short term effects may include: weight gain, bloating, rash, acne, gastrointestinal (GI) problems, insomnia, hair loss, irritability, mood swings, headaches, and flushing of the skin. [hss.edu]
Symptoms of JM include: visible, reddish-purple rash over the eyelids or joints, sometimes in the shape of the heliotrope flower fatigue moodiness or irritability stomachaches motor function difficulties, such as trouble climbing stairs, standing from [healthline.com]
In the inflammatory myopathies (e.g., PM and DM), EMG findings often mimic those seen in neuropathic conditions including fibrillations, positive sharp wave potentials, and increased insertional irritability. [clinicaladvisor.com]
- Dizziness
~Uncle Harold “I get dizzy when I stand up, but only passed out twice. Should I go to the ED?” ~Cousin Jim “I ran out of my nausea medicine and feel terrible. Can you write me a small refill?” [imrespdx.com]
Workup
After all the initial workups and serology were negative, imaging was considered. [mdpi.com]
The inherited disorders are rare and should be considered only if the inpatient workup does not reveal an obvious cause or if the pattern of illness is highly suggestive of an inherited disorder. [clinicaladvisor.com]
Reports indicated that immunocompromised patients should be treated by broad-spectrum antibiotics, for targeting a wide-range of gram-negative and anaerobic pathogens [29] However, Immune workup was not studied in our patient, due to the lack of evidence [medcraveonline.com]
According to Monto et al ., the positive predictive value of typical viral symptoms (as demonstrated in all of our cases) during an influenza epidemic is about 80%. [27] Muscle biopsy is not routinely recommended in the workup of viral myositis as a negative [ruralneuropractice.com]
Treatment
In polymicrobial infections, the treatment becomes even more difficult as different microorganisms have such diverse structures that need specific treatment. [microbewiki.kenyon.edu]
The bacterial myositides include: acute suppurative (tropical) myositis: may result from a Staphylococcal infection of a crush injury commoner in tropical climates treatment is by surgical drainage and high dose antibiotics Clostridial myositis: Clostridium [gpnotebook.com]
Some of the familiar, of many, infections which have been connected with causing Myositis are: Staphylococcus aureus (MRSA) Spirochete (Lyme disease) Treatment Treatment of Infectious, Viral, Bacterial, and Fungal Myositis is often dependent upon the [understandingmyositis.org]
Results: Both children settled with antibiotic treatment alone. The bacterial strain in the second case was of a type requiring combination antibiotic therapy for effective treatment. [online.boneandjoint.org.uk]
Prognosis
If a person with dermatomyositis develops cancer, the prognosis may be worse. Medications taken to treat these muscle diseases may cause complications that affect prognosis. [drugs.com]
Treatment and prognosis Depending on the infective agent systemic antibiotics are administered. If an abscess has formed, then it should usually be drained either surgically or percutaneously. [radiopaedia.org]
Concurrent neutropenia, regardless of cause, predisposes to C. septicum bacteremia, which results in a poor prognosis; the prognosis is worse if intravascular hemolysis occurs. [merckmanuals.com]
In most cases, the prognosis following satisfactory drainage is excellent, with little long-term morbidity. [infectiousdiseaseadvisor.com]
Etiology
Bacterial etiologies did not differ significantly between cases of myositis or pyomyositis. [mdedge.com]
The spectrum of acute myopathy includes various etiologies with different pathophysiology. [annalsofian.org]
The diagnosis of myositis is suggested by the clinical picture and radiologic imaging, and the etiologic agent is confirmed by microbiologic or serologic testing. Therapy is based on the clinical presentation and the underlying pathogen. [scinapse.io]
Conclusions Acute symmetrical proximal muscle weakness has varied etiologies. [mdpi.com]
Etiology: • Direct or indirect trauma • Intramuscular injections of infected or necrotizing materials • Part of syndrome in specific diseases including blackleg, foot-and-mouth disease,ephemeral fever • The exact cause of EM is unknown • May be Sarcocystis [veterpedia.net]
Epidemiology
It also addresses the importance of preventing and controlling infectious disease outbreaks with coverage of epidemiology, biosecurity, antimicrobial therapy, and recognizing foreign equine diseases. [books.google.com]
Myositis in Cattle Definition and Epidemiology: An inflammatory condition grossly characterized by focal, green, muscular lesions in clinically healthy cattle. The most affected tissues are striated skeletal muscle, esophagus and heart. [veterpedia.net]
Endomysium - histological slide Epidemiology The condition affects people with African or Caribbean ancestry at almost double the rate that it affects Caucasians. [kenhub.com]
Theodorou DJ, Theodorou SJ, Kakitsubata Y, Sartoris D, Resnick D (2001) Imaging characteristics and epidemiologic features of atypical mycobacterial infections involving the musculoskeletal system. [link.springer.com]
Antibiotics are given for a minimum of three weeks to clear the infection.[1] Epidemiology[edit] Pyomyositis is most often caused by the bacterium Staphylococcus aureus.[2] The infection can affect any skeletal muscle, but most often infects the large [en.wikipedia.org]
Pathophysiology
Pathophysiology On muscle biopsy, the muscle cells show small rimmed vacuoles, and no evidence of inflammation. This separates it from the inflammatory myopathies such as polymyositis and dermatomyositis. [kenhub.com]
Back to Top Pathophysiology Disruption of the structural integrity and metabolic processes of muscle cells can result from genetic abnormalities, toxins, inflammation, infection, and hormonal and electrolyte imbalances. [clevelandclinicmeded.com]
The spectrum of acute myopathy includes various etiologies with different pathophysiology. [annalsofian.org]
Prevention
Ideal for both practitioners and students, this comprehensive resource covers the diagnosis, treatment, and prevention of infectious disease in horses. [books.google.com]
• Prevention and Control is by: o Vaccination of animals with multivalent clostridial vaccine in areas known to have outbreaks of clostridial diseases. o Preventing the occurrence of sarcocystosis in cattle may also help. [veterpedia.net]
[…] infection Prevention is by far the best treatment for infections. [myositis.org]
Courtesy of Centers for Disease Control and Prevention. American trypanosomiasis: The causative organism is a protozoan, Trypanosoma cruzi. [emedicine.medscape.com]