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Pyomyositis: clinical features and predisposing conditions
S R Patel1, T P Olenginski, J L Perruquet
1Department of Rheumatology, Geisinger Medical Center, Danville, PA 17822-1341, USA.
Objective:
To describe the manifestations of nontropical pyomyositis and associated comorbid conditions that may predispose to pyomyositis.
Methods:
A retrospective review of 13 patients with pyomyositis seen at our center including one illustrative case report. Reports of tropical and nontropical pyomyositis were found by review of Index Medicus, Medline, and references from published cases and clinical review papers.
Results:
All 13 patients had variable presentations including fever, muscle pain, tenderness, and swelling. Eleven patients had comorbid conditions that may have led to their infection, including one with human immunodeficiency virus and 3 with history of trauma. Staphylococcus aureus was found to be a causative organism in 7 patients, 2 patients had multiple organisms isolated, and 2 had no organisms isolated. Eleven patients had successful treatment with intravenous antibiotics and either computerized tomographic scan guided percutaneous or open operative drainage.
Conclusion:
Onset of pyomyositis is usually insidious, with progression to purulent collections. Comorbid conditions likely predispose patients to pyomyositis and may contribute to delay in diagnosis and treatment. Increased awareness of this disease, especially in an immunosuppressed patient, should lead to earlier diagnosis and treatment with improved outcomes.
Insights
Nontropical pyomyositis presents insidiously with fever and muscle pain. Comorbid conditions, like HIV and trauma, increase risk and delay diagnosis, necessitating earlier recognition, especially in immunocompromised patients.
Area of Science:
- Infectious Diseases
- Musculoskeletal Disorders
- Medical Microbiology
Background:
- Nontropical pyomyositis is a bacterial infection of skeletal muscle, often presenting insidiously.
- Pre-existing conditions and immunosuppression are frequently associated with pyomyositis.
- Understanding the clinical spectrum and predisposing factors is crucial for timely diagnosis.
Observation:
- A retrospective review identified 13 patients with nontropical pyomyositis.
- Common manifestations included fever, myalgia, tenderness, and swelling.
- Comorbidities such as HIV and trauma were noted in 11 patients.
Findings:
- Staphylococcus aureus was the most common pathogen identified.
- Variable presentations and delayed diagnosis were observed.
- Successful treatment involved intravenous antibiotics and surgical or percutaneous drainage.
Implications:
- Pyomyositis onset is often insidious, progressing to abscess formation.
- Comorbidities can predispose individuals to pyomyositis and complicate management.
- Increased clinical awareness, particularly in immunocompromised individuals, is vital for early diagnosis and improved outcomes.
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