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1.
Neurol Sci ; 44(12): 4519-4524, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37651041

RESUMO

BACKGROUND: The formation of abscesses with necrosis within large, striated muscles leads to pyomyositis, a condition relatively rarely encountered outside the tropics. Intravenous drug users and other immunocompromised individuals are predisposed toward this infection, which may occur due to local or haematogenous spread of infection to skeletal muscles previously damaged by trauma, exercise, or rhabdomyolysis. METHODS: We report a young male intravenous drug user with rhabdomyolysis due to use of a synthetic opioid, in whom disseminated pyomyositis was detected following evaluation for sciatic and radial neuropathies and Horner's syndrome and review available reports of peripheral nerve dysfunction in the setting of this uncommon infection. We searched online databases to identify all published reports on adult patients with pyomyositis complicated by peripheral nerve dysfunction. CONCLUSIONS: Peripheral nerve dysfunction may rarely occur via local spread of infection or compression from abscesses.


Assuntos
Usuários de Drogas , Síndrome de Horner , Doenças do Sistema Nervoso Periférico , Piomiosite , Rabdomiólise , Abuso de Substâncias por Via Intravenosa , Adulto , Humanos , Masculino , Síndrome de Horner/etiologia , Piomiosite/complicações , Piomiosite/diagnóstico por imagem , Abuso de Substâncias por Via Intravenosa/complicações , Abscesso/complicações , Abscesso/diagnóstico por imagem , Doenças do Sistema Nervoso Periférico/complicações
2.
Med Leg J ; 91(3): 159-163, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37288539

RESUMO

A 6-year-old girl was brought to the emergency department with a history of an accidental fall a few days earlier. She presented with a fever, cough and constipation. Sars-CoV-2 infection being suspected, she was transferred to a paediatric facility for Covid-positive patients. During the diagnostic process, the clinical picture suddenly deteriorated with the development of bradycardia, tachypnea and altered sensorium. Despite cardiopulmonary resuscitation attempts, the child died about 16 hours after admission to the emergency department. A judicial forensic autopsy was performed that concluded that her death was due to multiple acute pulmonary, cardiac and renal infarctions secondary to septic thromboembolism in the course of post-traumatic bacterial necrotizing pyomyositis of the right ileo-psoas muscle.


Assuntos
COVID-19 , Piomiosite , Feminino , Humanos , Criança , Piomiosite/complicações , SARS-CoV-2 , Autopsia
4.
Diagnosis (Berl) ; 9(3): 359-363, 2022 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-35619048

RESUMO

OBJECTIVES: Identifying the causative bacterial pathogen for children with acute hematogenous musculoskeletal infections (MSKIs) allows for improved care. The purpose of our study was to determine if clinical markers could predict which patients will have a causative pathogen found on source culture alone, thus being highest yield to undergo operative diagnostic procedures. METHODS: A single-center, retrospective cohort study was performed. Medical records for patients between 6 months and 18 years of age admitted between July 2014 and September 2018 with a discharge diagnosis of acute osteomyelitis, septic arthritis, or pyomyositis were reviewed. Patients were stratified based on results of blood and source cultures. Predictors of interest were screened on a univariable basis with significant predictors retained in a multivariate analysis. RESULTS: There were 170 patients included. No predictors were significantly associated with increased odds of having a causative pathogen found on source culture alone. Degree of C-reactive protein elevation and history of fever were associated with decreased odds of being source culture positive, OR (95% CI); 0.92 (0.87, 0.98) and 0.39 (0.19, 0.81), respectively. CONCLUSIONS: Predictive modeling failed to identify children with MSKIs whose causative pathogen was found by source culture alone. It is difficult to predict which MSKI patients will be highest yield for operative diagnostic procedures.


Assuntos
Artrite Infecciosa , Infecções , Osteomielite , Piomiosite , Artrite Infecciosa/complicações , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/microbiologia , Criança , Humanos , Osteomielite/complicações , Osteomielite/diagnóstico , Osteomielite/microbiologia , Piomiosite/complicações , Piomiosite/diagnóstico , Piomiosite/microbiologia , Estudos Retrospectivos
5.
Medicine (Baltimore) ; 101(2): e28431, 2022 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-35029183

RESUMO

RATIONALE: Pyomyositis is characterized by an insidious and multifactorial inflammatory process, which is often caused by hematogenous pathogen. Predisposing risk factors include immunodeficiency, diabetes, malignancy, or trauma. The spectrum of clinical presentation depends on disease severity, typically presented by fever and hip pain. We hereby present a case with extensive pyomyositis secondary to chronic paronychia infection. PATIENT CONCERNS: A 14-year-old immunocompetent male presented with fever and hip pain. The patient was initially surveyed for common infectious etiologies prior to the presentation of acute limping, which led to image confirmation of extensive pyomyositis. DIAGNOSIS: The patient presented with acute pain in the right hip accompanied by headache, myalgia of the right leg, and intermittent fever for a week. Physical examination disclosed limping gait, limited range of motion marked by restricted right hip flexion and right knee extension, and chronic paronychia with a nail correction brace of the left hallux. Diagnosis of pyomyositis was confirmed by magnetic resonance image. Methicillin-resistant strains of Staphylococcus aureus was isolated from the patient's blood and urine cultures within 2 days of collection. The same strain was also isolated from the pus culture collected via sonography-guided aspiration. INTERVENTIONS: Antibiotics treatment with oxacillin, teicoplanin, daptomycin, and fosfomycin were administered. Sonography-guided aspiration and computed tomography-guided pigtail drainage were arranged, along with nail extraction of his left hallux paronychia prior to discharge. Oral antibiotics fusidic acid was prescribed. Total antibiotics course of treatment was 4 weeks. OUTCOMES: The patient gradually defervesced and was afebrile after drainage. Followed limb doppler sonography showed regression of the abscess at his right lower limb. Gait and range of motion gradually recovered without sequelae. LESSONS: Ambulation and quality of life are greatly affected by the inflammatory process of pyomyositis. Detailed evaluation of predisposing factors should be done, even in immunocompetent individuals. Timely diagnosis is vital to successful treatment.


Assuntos
Staphylococcus aureus Resistente à Meticilina , Paroniquia , Piomiosite , Infecções Estafilocócicas , Adolescente , Antibacterianos/uso terapêutico , Artralgia/tratamento farmacológico , Febre/tratamento farmacológico , Humanos , Masculino , Paroniquia/diagnóstico , Paroniquia/microbiologia , Piomiosite/complicações , Piomiosite/diagnóstico , Piomiosite/tratamento farmacológico , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico
6.
Acta Clin Belg ; 77(2): 421-424, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33629932

RESUMO

CASE REPORT: A 12-year-old boy, of Congolese roots and without medical history, first presented to our Emergency Department 3 days after blunt trauma of the left ankle. The boy represented on two more occasions in the next 3 days due to ongoing pain. On the last occasion he presented with severe hypoglycaemia. He was diagnosed with severe septic shock, secondary to subperiosteal abscess formation / osteomyelitis of the ankle. The patient was transferred to the paediatric intensive care unit where appropriate medical care was provided, including broad-spectrum antibiotic therapy, high dose vasopressor / inotropic support, surgical debridement of abscesses and below-knee amputation. PANTON VALENTINE LEUKOCIDIN TOXIN AND PYOMYOSITIS TROPICALIS: The causative organism was a methicillin-susceptible S. aureus, which upon further identification was a carrier of the PVL (Panton Valentine leukocidin) toxin. This pathogen is responsible for severe musculoskeletal infections. In children these infections are often associated with more severe clinical course requiring a higher need for surgical intervention and longer hospital stay.Tropical pyomyositis is a disease caused by Staphylococcus aureus, often seen in tropical countries, and classically presented with muscle abscesses. Young males between the ages of 10-40 years old are the most susceptible, and often present with a history of blunt trauma. Treatment generally requires a combination of an anti-staphylococcal agent, and an anti-toxic agent blocking bacterial protein-synthesis of PVL. Source control by surgical debridement also plays a major role in the treatment of PVL-infection. Despite agressive treatment, mortality still varies from 0.5% to 2%.


Assuntos
Embolia , Staphylococcus aureus Resistente à Meticilina , Piomiosite , Choque Séptico , Infecções Estafilocócicas , Adolescente , Adulto , Criança , Embolia/complicações , Humanos , Leucocidinas/uso terapêutico , Masculino , Meticilina/uso terapêutico , Piomiosite/complicações , Piomiosite/diagnóstico , Piomiosite/terapia , Choque Séptico/etiologia , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus , Adulto Jovem
7.
Trop Med Int Health ; 26(10): 1210-1219, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34407271

RESUMO

OBJECTIVES: Pyomyositis, an acute bacterial infection of skeletal muscle usually resulting in abscess formation, is well recognised in tropical regions where it can account for up to 4% of adult surgical admissions. It is increasingly being reported from high-income temperate countries. Pyomyositis occurs across all ages and in both sexes. Mortality ranges from 1% to 23%. Many risk factors have been suggested. We aimed to identify factors associated with pyomyositis. METHODS: We undertook a systematic review and meta-analysis, using PubMed, EMBASE, Scopus and the Cochran Library and hand-searching published papers. The random-effects model meta-analysis was used to calculate pooled estimated odd ratios with the corresponding 95% confidence interval. RESULTS: All studies in the systematic review (n = 25) and the meta-analysis (n = 12) were hospital-based. Seven only included children. Relatively few studies have been published in the last decade, the majority of which are from high-income temperate settings. Staphylococcus aureus was the main organism isolated. Males under the age of 20 predominated, and mortality of up to 20% was reported. Factors associated with pyomyositis were HIV infection (OR = 4.82; 95% CI: 1.67-13.92) and fulfilling an AIDS surveillance definition (OR = 6.08; 95% CI: 2.79-13.23). CONCLUSIONS: Our meta-analysis indicated significant associations between pyomyositis infection and HIV/AIDS. Major gaps in our understanding of the epidemiology, pathogenesis, clinical presentation, and outcome remain, highlighting the need for further research and more systematic studies. Pyomyositis merits consideration as a neglected tropical disease.


Assuntos
Infecções Bacterianas/microbiologia , Infecções Bacterianas/patologia , Piomiosite/complicações , Piomiosite/patologia , Bactérias/classificação , Bactérias/isolamento & purificação , Infecções Bacterianas/complicações , Infecções por HIV/complicações , Humanos , Piomiosite/microbiologia , Fatores de Risco
8.
J Pediatr Hematol Oncol ; 43(6): e795-e797, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-33290294

RESUMO

BACKGROUND: We report the case of an 11-year-old girl with a recent diagnosis of common B-cell acute lymphoblastic leukemia who presented with Pseudomonas aeruginosa pyomyositis of the left lower limb during severe neutropenia associated with the induction phase of chemotherapy. OBSERVATIONS: Presenting signs included fever, leg pain, and refusal to walk. Popliteal knee ultrasonography was unremarkable, whereas magnetic resonance imaging showed 2 intramuscular fluid collections requiring surgically drainage. CONCLUSION: A review of medical literature showed that pyomyositis is an infrequent complication in children with hematological malignancies, and most cases are due to Staphylococcus aureus, whereas Pseudomonas aeruginosa appears to be rarely involved.


Assuntos
Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Infecções por Pseudomonas/complicações , Pseudomonas aeruginosa/isolamento & purificação , Piomiosite/complicações , Criança , Feminino , Humanos , Leucemia-Linfoma Linfoblástico de Células Precursoras/patologia , Infecções por Pseudomonas/patologia , Piomiosite/patologia
9.
BMJ Case Rep ; 13(9)2020 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-32928826

RESUMO

Pyomyositis is considered a great mimicker and masquerader. This case is of a 63-year-old man with diabetes who initially presented to the outpatient clinic afebrile with right shoulder pain. His work-up was negative, and he was discharged home. He subsequently presented to the emergency room (ER) two times for worsening right shoulder pain. During his first visit to the ER, his work-up was unremarkable, and he was discharged home. On his return to the ER, he was now febrile with inflammation involving his right upper extremity and right chest wall. Imaging studies of his right upper extremity and his right chest wall were consistent with multiple abscesses. Methicillin resistant Staphylococcus aureus was cultured from the abscess, and from blood and urine cultures. The diagnosis of pyomyositis was confirmed. This case illustrates the difficulty of diagnosing pyomyositis and the importance of including it in the differential diagnosis, especially in an immunocompromised patient.


Assuntos
Abscesso/complicações , Músculos Isquiossurais/anormalidades , Músculos Peitorais/anormalidades , Piomiosite/complicações , Abscesso/diagnóstico , Abscesso/fisiopatologia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Piomiosite/fisiopatologia , Dor de Ombro/etiologia
10.
Trop Doct ; 50(4): 375-377, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32623976

RESUMO

Pyomyositis commonly presents with fever, muscle pain and abscess formation involving deep soft-tissue compartments. Staphylococcus aureus is the main causative organism and diagnosis is usually established clinically, supported by imaging, but confirmation may be achieved by histopathological examination. Broad-spectrum antibiotic therapy and surgical debridement are the cornerstone of treatment. Its prognosis is good but, as in all soft-tissue infections, it depends on early intervention, directed antibiotics and, if indicated, prompt surgery. In this paper, we describe a case of pelvic pyomyositis complicated with bacteraemia and bilateral septic pulmonary emboli in a young man in Colombia.


Assuntos
Bacteriemia/etiologia , Embolia Pulmonar/etiologia , Piomiosite/complicações , Infecções Estafilocócicas/complicações , Antibacterianos/uso terapêutico , Bacteriemia/diagnóstico , Bacteriemia/terapia , Colômbia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pelve/diagnóstico por imagem , Pelve/microbiologia , Pelve/patologia , Pelve/cirurgia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Piomiosite/diagnóstico , Piomiosite/terapia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/terapia , Staphylococcus aureus/isolamento & purificação , Adulto Jovem
12.
JBJS Case Connect ; 10(4): e20.00251, 2020 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-33512936

RESUMO

CASE: The authors report a case of piriformis pyomyositis in a teenage female patient with fever and left hip pain. Her pain migrated to the knee with concurrent near resolution of hip pain. Imaging revealed an abscess in the left piriformis with pus tracking along the sciatic nerve sheath. This was complicated by internal iliac vein thrombosis and an embolus to the lung. Open drainage was performed, followed by outpatient intravenous cloxacillin and oral warfarin, with complete resolution of symptoms. CONCLUSION: Piriformis pyomyositis is a rare condition with varying presentations. The threshold for suspicion should be low even in healthy young individuals.


Assuntos
Síndrome do Músculo Piriforme/diagnóstico por imagem , Piomiosite/diagnóstico por imagem , Adolescente , Feminino , Humanos , Imageamento por Ressonância Magnética , Síndrome do Músculo Piriforme/etiologia , Síndrome do Músculo Piriforme/terapia , Piomiosite/complicações , Piomiosite/terapia
15.
Pan Afr Med J ; 32: 4, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31182987

RESUMO

We present a case of a 37-year-old male security officer with fever, severe low back pain radiating to left lower leg and diminished mobility for 1 week. His Lumbar spine X-ray was unremarkable, but his inflammatory markers including CRP, ESR and Neutrophils were high. CT scan with contrast showed rim enhancing fluid collection within the left obturator foramen with inflammatory change in the mesorectal fat. Confirmatory MRI scans depicted inflammatory change in the left piriformis muscle and a localized collection without any abnormality in the spine. Urgent CT guided aspiration was performed and the sample sent for microbiological analysis. Intravenous antibiotics commenced and continued for two weeks with complete resolution.


Assuntos
Dor Lombar/etiologia , Músculo Esquelético/patologia , Piomiosite/diagnóstico , Adulto , Antibacterianos/uso terapêutico , Humanos , Imageamento por Ressonância Magnética , Masculino , Músculo Esquelético/microbiologia , Piomiosite/complicações , Piomiosite/tratamento farmacológico , Tomografia Computadorizada por Raios X
16.
Clin Rheumatol ; 38(7): 1811-1821, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31049761

RESUMO

Piriformis pyomyositis is a rare form of purulent skeletal myositis. As previous studies concerning piriformis pyomyositis had lower level of evidence and no systematic review has been published yet, we performed a systematic search to review and describe causes, symptoms, red flags, and available treatment options for piriformis pyomyositis. Using PubMed and PubMed Central databases, we found 21 articles describing 23 cases of piriformis pyomyositis. Based on the retrieved information, alongside acute sciatica like buttock and/or hip pain, high-grade fever, aggressive deep seated gluteal pain, neurological deficit of sciatic nerve distribution, positive straight leg raising test, and raised inflammatory biomarkers (erythrocyte sedimentation rate, ESR, C-reactive protein, CRP) provide clues for diagnosis of piriformis pyomyositis. Some cases were very ill but no death was documented. Staphylococcus aureus was the most common pathogen, but Group A as well as Group ß Streptococcus, Salmonella typhi, Proteus mirabilis, Brucella melitensis, and Escherichia coli were also involved in the disorder. To treat the piriformis pyomyositis, broad-spectrum antibiotics were found to be useful; however, sometimes, antibiotic switching was warranted based on blood and tissue aspirate reports. Drainage and/or surgical exploration of the affected piriformis muscle were required in cases where antibiotics appeared ineffective. Piriformis pyomyositis is a rara avis and performing of prospective studies will hardly be feasible.


Assuntos
Dor Lombar/etiologia , Síndrome do Músculo Piriforme/diagnóstico , Piomiosite/diagnóstico , Ciática/etiologia , Infecções Estafilocócicas/diagnóstico , Antibacterianos/uso terapêutico , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/tratamento farmacológico , Humanos , Dor Lombar/tratamento farmacológico , Síndrome do Músculo Piriforme/tratamento farmacológico , Síndrome do Músculo Piriforme/etiologia , Piomiosite/complicações , Piomiosite/tratamento farmacológico , Ciática/tratamento farmacológico , Infecções Estafilocócicas/tratamento farmacológico
18.
BMC Infect Dis ; 18(1): 99, 2018 02 27.
Artigo em Inglês | MEDLINE | ID: mdl-29486726

RESUMO

BACKGROUND: Concurrent presence of dengue hemorrhagic fever (DHF), tropical pyomyositis and septicemia due to methicillin-resistant Staphylococcus aureus (MRSA) in a previously healthy person has never been reported. These three conditions even individually are potentially fatal. "Here we describe a case of a patient contracting dengue and developing DHF along with concurrent pyomyositis likely to be due to MRSA, leading to MRSA septicemia with abscesses formed by MRSA". CASE PRESENTATION: A 44-year old previously healthy Sinhalese man presented on day 3 of the illness with fever, headache, arthralgia and myalgia and watery loose stools. His pulse rate was 76/min, blood pressure was 110/80 mmHg, while cardiovascular, respiratory and abdomen examination findings were unremarkable. The test for the dengue NS1 antigen was positive on the same day. We have diagnosed dengue and started managing him symptomatically as per the current national guidelines. The patient developed DHF with bilateral pleural effusion and ascitis. On the day 5 he developed severe myalgia, tenderness and non pitting edema of lower limbs especially in the thighs. His creatine kinase levels were high and an ultrasound scan confirmed myositis of both thighs. We suspected myositis due to dengue but investigated for possible simultaneous sepsis as well. On day 9 his blood culture became positive for MRSA. Considering the sensitivity of the bacteria intravenous vancomycin and ciprofloxacin was administered for 21 days. He developed a small abscess at the site of the first intravenous access and a large one above the ankle on the left. On day 12 the latter was drained and the pus culture yielded MRSA sensitive to the same antibiotics. The rapid test for dengue IgM was negative initially but later a positive MAC-ELISA test entrenched dengue infection. After improvement he was sent home on day 33 of the illness. He has developed two other abscesses in the proximity of the drained one and they were drained on day 57. The patient recovered. CONCLUSIONS: When dengue patients develop symptoms and signs of myositis, prompt investigations for pyomyositis and the treatment can save lives.


Assuntos
Coinfecção/diagnóstico , Staphylococcus aureus Resistente à Meticilina , Piomiosite/diagnóstico , Sepse/diagnóstico , Dengue Grave/diagnóstico , Infecções Estafilocócicas/diagnóstico , Abscesso/diagnóstico , Abscesso/microbiologia , Adulto , Antibacterianos/uso terapêutico , Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Piomiosite/complicações , Piomiosite/microbiologia , Sepse/complicações , Sepse/microbiologia , Dengue Grave/complicações , Dengue Grave/microbiologia , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/microbiologia
19.
Pediatr Emerg Care ; 34(1): e18-e20, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29293205

RESUMO

Septic arthritis of the shoulder is rare in the pediatric population. In younger children and infants, it can be very difficult to diagnose. Septic arthritis of the shoulder is more commonly associated with concurrent osteomyelitis when compared to septic arthritis of the lower extremity. We describe a case of a 9-month-old patient with septic arthritis, osteomyelitis, and pyomyositis of the shoulder, and a discussion of diagnosis and management of pediatric bone and joint infection in the emergency department setting.


Assuntos
Artrite Infecciosa/complicações , Osteomielite/complicações , Infecções Pneumocócicas/complicações , Piomiosite/complicações , Articulação do Ombro/patologia , Antibacterianos/uso terapêutico , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/terapia , Desbridamento/métodos , Serviço Hospitalar de Emergência , Feminino , Humanos , Lactente , Osteomielite/terapia , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/terapia , Piomiosite/terapia , Streptococcus pneumoniae/isolamento & purificação
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