Edit concept Question Editor Create issue ticket

Pyomyositis

PM

Pyomyositis is characterized by a purulent bacterial infection of skeletal muscles and occurs most frequently in tropical regions. However, pyomyositis has also been reported in temperate climates in association with other diseases such as diabetes mellitus. Pyomyositis is usually caused by a Staphylococcus aureus infection and can be secondary to a mechanical trauma. Early manifestations are often too mild and diffuse for a concise diagnosis, which can only be ascertained by means of imaging techniques, muscle biopsy, and bacterial cultures.

Provided a timely and correct diagnosis, pyomyositis can be efficiently managed with appropriate antibiotics and surgical debridement. Untreated pyomyositis can be fatal because of septic complications.


Presentation

Pyomyositis, also referred to as myositis tropicans, typically manifests as an inflammatory suppuration in skeletal muscles because of bacterial infection of the muscle tissue [1]. Pyomyositis occurs more often in the tropical climate. Patients from temperate regions are scarce and typically develop pyomyositis because of an ongoing immunosuppressive therapy, a proven diabetes mellitus background, or due to HIV infection [2]. In most cases, Staphylococcus aureus is the causative infectious agent. Streptococci from groups A, B, C, and G as well as pneumococci, Gram-negative bacilli, and Haemophilus bacteria have been reported in rare cases [3]. Bacterial infection can occur after a mechanical trauma such as a fall or a traffic accident [3] [4].

Pyomyositis symptoms develop slowly. Patients often suffer from diffuse and unspecific early manifestations like fever, myalgia, swelling, and tenderness. Later on, redness of the skin area and increased warmth of the skin above the affected muscle may occur. Reports have indicated that quadriceps, biceps, iliopsoas, gastrocnemius, pectoralis major, serratus anterior, abdominal, gluteal, and spinal muscles are more prone to be affected by pyomyositis [5] [6]. Pyomyositis can affect both genders and all age groups, however, an increased incidence has been reported in males (overall male to female ratio - 1.5: 1), particularly in young males [5]. The death can occur if the infection is untreated [4].

Angiomatosis
  • Pyomyositis associated with bacillary angiomatosis in patient with HIV infection. Infection. 2002; 30:50-3. [ Links ] 9. Marques GC, Valiatti M, Pereira ER, Barbieri V, Mauro Filho GL.[scielo.br]
Myopathy
  • KEYWORDS: electromyography; inflammatory; myopathy; neuropathy; pyomyositis[ncbi.nlm.nih.gov]
  • .- ) muscular dystrophies and myopathies ( G71 - G72 ) myopathy in amyloidosis ( E85.- ) myopathy in polyarteritis nodosa ( M30.0 ) myopathy in rheumatoid arthritis ( M05.32 ) myopathy in scleroderma ( M34.- ) myopathy in Sjögren's syndrome ( M35.03 )[icd10data.com]
Muscle Tenderness
  • Her physical examination showed muscle tenderness and woody induration. Laboratory tests revealed anemia, increased acute phase reactants and normal muscle enzymes.[ncbi.nlm.nih.gov]
  • Our patient highlights the importance of obtaining a travel history and an early MRI in the evaluation of unexplained myalgias and severe muscle tenderness.[shmabstracts.com]
  • .   Occurs 10 to 21 days after the initial onset of symptoms and is characterized by fever, exquisite muscle tenderness, and edema.  A frank abscess may be clinically apparent, and aspiration of the affected muscle typically yields pus.  Marked leukocytosis[de.slideshare.net]
Myalgia
  • 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.[ncbi.nlm.nih.gov]
  • Our patient highlights the importance of obtaining a travel history and an early MRI in the evaluation of unexplained myalgias and severe muscle tenderness.[shmabstracts.com]
  • Patients often suffer from diffuse and unspecific early manifestations like fever, myalgia, swelling, and tenderness. Later on, redness of the skin area and increased warmth of the skin above the affected muscle may occur.[symptoma.com]
  • Results: The presenting feature was high fever and myalgia in all 12 patients. Quadriceps femoris was the most commonly involved muscle (50%); followed by iliopsoas (25%).[najms.org]
Muscle Swelling
  • Imaging Electromyography Short duration, low amplitude polyphasic potentials Ultrasonography First imaging investigation usually Characteristic features are Muscle swelling; Hypoechoic areas in the muscle belly Heterogenous hypoechoic areas Hyperechoic[boneandspine.com]
  • .  Computed tomography (CT) is helpful for detecting muscle swelling and well-delineated areas of fluid attenuation that display rim enhancement with contrast, as well as for radiographic-guided drainage of purulent material. 5/31/2015 23 Radiography[de.slideshare.net]
Neck Pain
  • Abstract High fever, severe neck pain and neck stiffness can result from meningitis. We report a case of pneumococcal pyomyositis of the neck muscles. A 72-year-old man developed high fever and severe neck pain.[ncbi.nlm.nih.gov]
  • CASE PRESENTATION: A previously well 48-year-old Caucasian male presented with sore throat, left sided neck pain and swelling. He was a lifelong non-smoker with no recent travel or animal exposure.[ncbi.nlm.nih.gov]
Meningism
  • His chief complaint mimicked bacterial meningitis. Although his condition was initially suspected to be bacterial meningitis, his cerebrospinal fluid did not show pleocytosis.[ncbi.nlm.nih.gov]
  • The possibility of respiratory/meningeal co-infection, might also be considered even if the clinical picture is restricted to the muscular system.[ncbi.nlm.nih.gov]
  • Two-thirds of the patients had an antecedent respiratory illness or meningitis.[ncbi.nlm.nih.gov]
  • We herein report a case of a 38-year-old diabetic patient with a history of recent bone marrow biopsy presented multifocal primary pyomyositis complicated by meningitis.[ncbi.nlm.nih.gov]
  • We herein report a case of a 38-year-old diabetic patient with a history of recent bone marrow biopsy presented multifocal primary pyomyositis complicated by meningitis. Actions (login required) View Item[eprints.bice.rm.cnr.it]
Neck Stiffness
  • Abstract High fever, severe neck pain and neck stiffness can result from meningitis. We report a case of pneumococcal pyomyositis of the neck muscles. A 72-year-old man developed high fever and severe neck pain.[ncbi.nlm.nih.gov]
Hyperesthesia
  • Fever, tachycardia, tachypnea, hypotension, pallor, and hyperesthesia were significantly higher (p CONCLUSION: PY is a specific and potentially fatal infection, which is common in our country and must be differentiated from IM.[ncbi.nlm.nih.gov]

Workup

The first suspicion of pyomyositis can be formulated on the basis of the patient's history. If the patient has recently traveled to tropical countries, has been involved in a traffic accident, or is being treated with immunosuppressive agents, further investigations are indicated to validate the suspicion. Blood laboratory tests are typically too unspecific but may be used for cross-checking purposes. Elevated white blood cell counts, particularly peripheral blood eosinophils, together with normal serum creatine kinase (CK) are often found in pyomyositis patients [7] [8]. Blood cultures can reveal a bacterial infection [9].

The gold standard for a final diagnosis is provided by computed tomography (CT) or magnetic resonance imaging (MRI), which can pinpoint the exact locations of the suppurative inflammation in the affected muscles [10]. A muscle biopsy may also be ordered to prove edema in early pyomyositis or necrotic degenerations with abundant inflammatory cells in advanced pyomyositis [5] [10]. Pus aspiration and analysis will help identify the causative bacteria and guide further management and treatment. In the minority of cases, the analyzed pus can be sterile [11].

Treatment

  • Treatment with tetracycline or trimethoprim-sulfamethoxisole may be sufficient in some cases.[orpha.net]
  • Treatment options include antibiotic treatment with surgical or radiologic interventions.[ncbi.nlm.nih.gov]
  • This study was undertaken to review our approach to diagnosis and treatment in a series of 11 patients (mean age 8.2 years) with primary pyomyositis, who had neither an underlying disease nor a compromised immune system.[ncbi.nlm.nih.gov]
  • Abstract This study was undertaken to review our approach to diagnosis and treatment in a series of 11 patients (mean age 8.2 years) with primary pyomyositis, who had neither an underlying disease nor a compromised immune system.[doi.org]
  • Early diagnosis and antibiotic treatment are important as major complications such as abscess formation and sepsis can be avoided.[ncbi.nlm.nih.gov]

Prognosis

  • Tropical pyomyositis is a potentially life threatening disease, but if recognized and treated early, the prognosis is good.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: Our review of the literature revealed that group A streptococcus pyomyositis typically occurs in temperate climates, among young adults without any underlying disease, and is associated with a poorer prognosis, compared to general pyomyositis[ncbi.nlm.nih.gov]
  • Prognosis The prognosis is good when diagnosed and treated properly and there is very little residual deformity of the muscles, if any. When PM is left untreated, the mortality rate is 0.5 - 2%.[orpha.net]
  • The response to treatment and prognosis are good.[ncbi.nlm.nih.gov]
  • Prognosis In general, children do better when the infection is recognized early. There is a greater chance for full recovery when the infection is quickly recognized and treated.[childrens.com]

Etiology

  • The etiologic role of suggested factors remains unclear. Early recognition and aggressive management with antibiotics, incision, and drainage usually lead to rapid resolution.[ncbi.nlm.nih.gov]
  • The exact etiology of the condition remains poorly understood, although a mechanism of transient bacteremia in association with increased muscle susceptibility has been proposed.[ncbi.nlm.nih.gov]
  • The main etiologic agent is Staphylococcus aureus. There are rare cases attributed to Streptococcus pneumoniae.[ncbi.nlm.nih.gov]
  • Etiology The exact etiology is unknown but muscle trauma or vigorous exercise may facilitate hematogenous access of bacteria to the skeletal muscles (usually resistant to these types of infections).[orpha.net]
  • Abstract Tuberculous pyomyositis is a rare manifestation of extrapulmonary tuberculosis, most common in immunosuppressed patients, with clinical manifestations similar to pyomyositis of other etiologies, although with a lower age of presentation; notable[ncbi.nlm.nih.gov]

Epidemiology

  • Summary Epidemiology Prevalence is unknown. PM is commonly found in the tropics and is endemic to Eastern Uganda where 400-900 cases are reported annually. Cases in temperate regions such as the U.S. are now increasing in frequency.[orpha.net]
  • ISSN: 0950-2688 EISSN: 1469-4409 URL: /core/journals/epidemiology-and-infection Unfortunately you do not have access to this content, please use the Get access link below for information on how to access this content.[cambridge.org]
  • This article emphasizes the changing epidemiology of causative organisms of tropical pyomyositis . CrossRef PubMed Google Scholar 22.• Mitchell PD, Hunt DM, Lyall H, Nolam M, et al.[link.springer.com]
  • […] than females.  Most patients with tropical pyomyositis are otherwise healthy without underlying comorbidities, while most patients in temperate regions are immunocompromised or have other serious underlying conditions. 5/31/2015 4 EPIDEMIOLOGY 5. [de.slideshare.net]
  • .  Tropical pyomyositis primarily occurs in two age groups: children (ages 2 to 5) and adults (ages 20 to 45), while the majority of temperate pyomyositis cases occurs in adults. 5/31/2015 3 EPIDEMIOLOGY 4.   Males appear to be more commonly affected[slideshare.net]
Sex distribution
Age distribution

Pathophysiology

  • Systematic review of the literature revealed a few interesting cases of reactivated staphylococcal infection after decades of latency, although the exact pathophysiological mechanisms still need to be elucidated.[ncbi.nlm.nih.gov]
  • Systematic review of the literature revealed a few interesting cases of reactivated staphylococcal infections, 8–14 although the distinct pathophysiological mechanisms still need to be elucidated.[bjid.org.br]

Prevention

  • Author information 1 Department of Medicine, University of Washington, Seattle, Washington, USA. [email protected] Abstract A 66-year-old man with a recent radiographic diagnosis of a parietal brain tumour presented with severe left thigh pain that prevented[ncbi.nlm.nih.gov]
  • Removing the CVC and the combined antibiotics without preventing the neutrophil engraftment could avoid surgical drainage in pyomyositis due to S. maltophilia when detected in an early stage. 2016 John Wiley & Sons A/S.[ncbi.nlm.nih.gov]
  • Early diagnosis is essential to prevent systemic illness and complications associated with this condition. Magnetic resonance imaging with gadolinium is helpful to diagnose and guide treatment. Copyright 2011, SLACK Incorporated.[ncbi.nlm.nih.gov]
  • MAINTENANCE AND RELAPSE PREVENTION Although the cessation attempt is relatively straightforward when patients are motivated to quit, data suggest that maintenance strategies and relapse prevention techniques must be considered from the start.[consultant360.com]
  • . – Apply compresses soaked in 70% alcohol 2 times daily (max. 3 times daily to prevent burns to the skin). Suppurative stage Treatment of pyomyositis is by incision following the rules for incision of abscesses.[medicalguidelines.msf.org]

References

Article

  1. Crum NF. Bacterial pyomyositis in the United States. Am J Med. 2004;117(6):420-428.
  2. Ruiz ME, Seife Y, Wladyka CG. Pyomyositis Caused by Methicillin-Resistant Staphylococcus aureus. N Engl J Med. 2005;352:1488-1489.
  3. Chattopadhyay B, Mukhopadhyay M, Chatterjee A, Biswas PK, Chatterjee N, Debnath NB. Tropical Pyomyositis. N Am J Med Sci. 2013;5(10): 600–603.
  4. Schalinski S, Tsokos M. Pyomyositis. Rechtsmedizin. 2006;16(3):151-155.
  5. Chauhan S, Jain S, Varma S, Chauhan SS. Tropical pyomyositis (myositis tropicans): current perspective. Postgrad Med J. 2004;80(943): 267–270.
  6. Ashken MH, Cotton RE. Tropical skeletal muscle abscesses (pyomyositis tropicans). Br J Surg. 1963;50:846–852.
  7. Crum-Cianflone NF. Bacterial, fungal, parasitic, and viral myositis. Clin Microbiol Rev. 2008;21(3): 473-494.
  8. Crum-Cianflone NF. Infection and musculoskeletal conditions. Infectious myositis. Best Pract Res Clin Rheumatol. 2006;20(6):1083-1097.
  9. Ghambir IS, Singh DS, Gupta SS. Tropical pyomyositis in India. J Trop Med Hyg. 1992;95(1):42-46.
  10. Kamel R, Zeidan S, Aramouny E, Sabouneh M, Sacy R, Hamod DA. Pyomyositis; A Diagnosis Not To Miss. J Pediatr Neonatal Care. 2016;4(6):00163.
  11. Shepherd JJ. Tropical myositis: Is it an entity and what is its cause? Lancet. 1983;2:1240–1242.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2017-08-24 06:56