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1.
BMJ Case Rep ; 15(7)2022 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-35863859

RESUMO

A patient in her mid-30s presented to hospital at 25 weeks' gestation with acute onset of leg pain.Routine investigations were performed to rule out the common causes of leg and back pain in pregnancy, which were grossly normal. Piriformis pyomyositis was diagnosed on MRI and a collection was drained. Following an initial response to antibiotic therapy, the patient delivered by elective caesarean section, but the pain returned on postnatal day 2 and muscle inflammation was diagnosed again, requiring a repeat course of antibiotics.This case highlights a rare cause of leg pain in a pregnant patient, and the additional complexities of managing cases in the obstetric population.


Assuntos
Miosite , Piomiosite , Antibacterianos/uso terapêutico , Cesárea , Feminino , Humanos , Músculo Esquelético/diagnóstico por imagem , Miosite/complicações , Miosite/diagnóstico , Miosite/tratamento farmacológico , Dor/tratamento farmacológico , Gravidez , Piomiosite/diagnóstico , Piomiosite/tratamento farmacológico
5.
BMJ Case Rep ; 15(3)2022 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-35260400

RESUMO

Pyomyositis may mimic deep vein thrombosis and be misdiagnosed in patients with systemic lupus erythematosus (SLE). We report here on patient with SLE with severe thoracic pyomyositis presented with right upper arm swelling and fever. The patient fully recovered after a serial surgical debridement and antibiotic therapy. Pyomyositis, as well as deep vein thrombosis, should be considered during the differential diagnosis of patients with SLE experiencing fever and unilateral limb oedema. CT and identification of causal pathogens are crucial in the diagnosis of pyomyositis. Early effective antibiotic treatment as well as surgical intervention can together bring about a better outcome.


Assuntos
Lúpus Eritematoso Sistêmico , Piomiosite , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Febre/diagnóstico , Humanos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Piomiosite/tratamento farmacológico
7.
J Emerg Med ; 62(3): e51-e56, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35065870

RESUMO

BACKGROUND: Intramuscular (i.m.) injections are a commonly utilized route for medication delivery. Intramuscular-associated soft tissue infections are rare and can include pyomyositis and i.m. abscess. Intramuscular testosterone injections have not been previously implicated in causing pyomyositis. Point-of-care ultrasound is an important bedside tool that can identify pyomyositis and differentiate this infection from more common entities such as cellulitis. CASE REPORTS: We present two cases of i.m. testosterone-associated pyomyositis. In both cases, the physical examination features were consistent with simple cellulitis. However, point-of-care ultrasound evaluation revealed changes consistent with pyomyositis in each case. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although uncommon, i.m. injections such as testosterone carry a risk of soft tissue infection. As demonstrated in the above cases, ultrasound can be helpful in making the differentiation between simple cellulitis and pyomyositis. The emergency physician should be cognizant of this complication of therapeutic i.m. injections, as well as the diagnostic efficacy of point-of-care ultrasound in evaluating the extent and location of the soft tissue infection.


Assuntos
Piomiosite , Infecções dos Tecidos Moles , Celulite (Flegmão)/complicações , Celulite (Flegmão)/diagnóstico , Celulite (Flegmão)/tratamento farmacológico , Humanos , Sistemas Automatizados de Assistência Junto ao Leito , Piomiosite/diagnóstico , Piomiosite/tratamento farmacológico , Infecções dos Tecidos Moles/diagnóstico , Infecções dos Tecidos Moles/tratamento farmacológico , Infecções dos Tecidos Moles/etiologia , Testosterona
8.
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
9.
J Investig Med High Impact Case Rep ; 10: 23247096211069766, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35073772

RESUMO

Pyomyositis is a bacterial infection occurring mainly in skeletal muscles. It is most commonly caused by Staphylococcus aureus with initial symptoms including muscle pain, swelling, and site tenderness. When available, the most accurate technique to determine the extent and the specific location of disease is the magnetic resonance imaging. Successful management includes early recognition, timely surgical debridement or drainage, and appropriate antibiotic therapy. This case report describes a case of Mycobacterium fortuitum pyomyositis in an elderly male associated with challenges of successful diagnosis.


Assuntos
Mycobacterium fortuitum , Piomiosite , Infecções Estafilocócicas , Idoso , Antibacterianos/uso terapêutico , Humanos , Masculino , Piomiosite/diagnóstico , Piomiosite/tratamento farmacológico , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus
10.
Pediatr Infect Dis J ; 41(2): e62-e63, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-34840310

RESUMO

The authors report a rare case of an unusual primary pyomyositis of the biceps cruralis assigned to Kingella kingae in a 21-month-old girl. The reported case demonstrated that primary pyomyositis may be encountered during invasive infection due to K. kingae even if this manifestation remains rare. This bacterial etiology must, therefore, be evoked when a primary pyomyositis is observed, and this is in particular in children under 4 years of age.


Assuntos
Kingella kingae , Infecções por Neisseriaceae , Piomiosite , Antibacterianos/uso terapêutico , Feminino , Humanos , Lactente , Joelho/diagnóstico por imagem , Joelho/fisiopatologia , Infecções por Neisseriaceae/diagnóstico , Infecções por Neisseriaceae/tratamento farmacológico , Infecções por Neisseriaceae/fisiopatologia , Orofaringe/microbiologia , Piomiosite/diagnóstico , Piomiosite/tratamento farmacológico , Piomiosite/fisiopatologia
11.
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
13.
J Med Invest ; 68(3.4): 372-375, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34759161

RESUMO

Background : Pyomyositis is a subacute bacterial infection of the skeletal muscles. Its most common features are fever, muscle swelling, and focal pain. There have been insufficient data regarding pyomyositis in healthy infants. Case report : A one-month-old boy presented with an impairment of his left arm movement. He was well-nourished and not under any apparent distress. His vital signs were within the normal limits but neurological examination revealed left forearm paralysis. Physical examination showed no abnormal findings in the region from the left shoulder joint to the fingertips. Considering these factors, an intracranial pathology was initially suspected. However, he developed a fever, regular tachycardia, and swelling in the left forearm. Magnetic resonance imaging revealed inflammation in the left forearm muscles. He was diagnosed with bacterial myositis and started on intravenous antibiotics. On the 17th day, he was discharged with oral antibiotic treatment, which was completed over 25 days without any sequelae nor relapse. Conclusion : Here we report the case of Japanese primary pyomyositis following one-day afebrile upper limb monoplegia in an infant. Even when infants exhibit afebrile symptoms, a bacterial infection should be suspected. J. Med. Invest. 68 : 372-375, August, 2021.


Assuntos
Piomiosite , Antibacterianos/uso terapêutico , Antebraço , Hemiplegia/tratamento farmacológico , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Piomiosite/diagnóstico , Piomiosite/tratamento farmacológico
15.
Acta Ortop Mex ; 35(1): 80-84, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-34480445

RESUMO

INTRODUCTION: Pyomyositis is a term that denotes pyogenic infection usually primary skeletal muscle, associated with hematogenous dispersion due to transient bacteremia, or penetrating trauma, usually forming abscesses. Classically described frequently in tropical areas and predominantly affecting the lower limb musculature, however, in recent decades it has increasingly been associated with areas of temperate climates and relatively more frequently in immunosuppressed patients, being the patients under 30 years the most affected. CLINICAL CASE: Male of 15 years without relevant medical history. The patient had no history of trauma, falls, surgical interventions, infections or any other systemic condition. He came because of a clinical picture of 7 days of evolution characterized by pain referred to the groin and left iliac crest area associated with claudication and hyperthermia not quantified, which yielded partially to NSAIDs and paracetamol, but without achieving improvement so it is taken emergency by relatives. CONCLUSIONS: It is necessary to bear in mind this pathology when performing the differential diagnostic approach of a patient presenting with pain and functional limitation of some joint associated with data suggestive of an infectious or inflammatory process.


INTRODUCCIÓN: La piomiositis es un término que denota infección piógena por lo general primaria de músculo esquelético. Clásicamente descrita de manera frecuente en zonas tropicales y en pacientes inmunocomprometidos; sin embargo, en las últimas décadas se observa cada vez más en zonas de climas templados y con relativa mayor frecuencia en pacientes inmunocompetentes, siendo el grupo etario más afectado el de menores de 30 años. CASO CLÍNICO: Masculino de 15 años sin antecedentes médicos de relevancia. Acude por presentar cuadro clínico de siete días de evolución caracterizado por dolor referido en ingle y zona de la cresta ilíaca izquierda asociado a claudicación e hipertermia no cuantificada, que cedían parcialmente a AINES y paracetamol, pero sin lograr mejoría, por lo que es llevado a urgencias por familiares. CONCLUSIONES: Es necesario tener en mente esta patología al momento de realizar el abordaje diagnóstico diferencial de un paciente que se presenta con dolor y limitación funcional de alguna articulación asociada a datos sugestivos de un proceso infeccioso o inflamatorio.


Assuntos
Piomiosite , Humanos , Imageamento por Ressonância Magnética , Masculino , Músculo Esquelético , Dor , Piomiosite/diagnóstico , Coxa da Perna
16.
J Pediatr Orthop ; 41(9): e849-e854, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34411048

RESUMO

BACKGROUND: Tropical pyomyositis has had a recent increase in the United States, Europe, and other nontropical areas. The purpose of this study was to provide an accurate description of the demographics, presenting features, sites of involvement, microbiology, imaging modalities, medical and surgical management, complications, and predictors of clinical course. METHODS: We searched PubMed, Cochrane, Web of Science Collection, Scopus, and Embase databases yielding 156 studies. Of these, 23 articles were selected for statistical analysis. RESULTS: The average age at presentation was 8.4±1.9 years with males more commonly affected. Fever, painful limp, and localized pain were the most common presenting symptoms. Pelvis, lower extremity, trunk and spine, in descending order, were the most commonly affected locations. Iliopsoas, obturator musculature, and gluteus musculature were the most commonly affected muscle groups. The mean time to diagnosis was 6.6±3.05 days. Staphylococcus aureus was the most common offending organism. The mean length of hospital stay was 12.0±4.6 days. Medical management alone was successful in 40% of cases (143/361) with an average duration of 9.5±4.0 and 22.7±7.2 days of intravenous and oral antibiotics, respectively. Surgical management consisted of open drainage in 91.3% (199/218) or percutaneous drainage in 8.7% (19/218) of cases. Painful limp, fever, and larger values of white cell count and erythrocyte sedimentation rate were associated with an increased need for surgery. Obturator and calf muscle involvement were strongly associated with multifocal involvement. There were 42 complications in 41 patients (11.3%). Methicillin-resistant S. aureus was associated with an increased risk of complications. The most common complications were osteomyelitis, septicemia, and septic arthritis. CONCLUSIONS: Primary pyomyositis should be considered in cases suggesting pediatric infection. Magnetic resonance imaging is the most commonly used imaging modality; however, ultrasound is useful given its accessibility and low cost. Medical management alone can be successful, but surgical treatment is often needed. The prognosis is favorable. Early diagnosis, appropriate medical management, and potential surgical drainage are required for effective treatment. LEVEL OF EVIDENCE: Level IV-systematic review.


Assuntos
Artrite Infecciosa , Staphylococcus aureus Resistente à Meticilina , Osteomielite , Piomiosite , Infecções Estafilocócicas , Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Criança , Humanos , Masculino , Osteomielite/tratamento farmacológico , Piomiosite/diagnóstico por imagem , Piomiosite/terapia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/terapia
17.
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
20.
Brain Pathol ; 31(3): e12950, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34043257

RESUMO

Myositis is inflammation especially of the voluntary muscles, characterized by localized or diffuse pain, tenderness on movement or palpation, swelling, and/or weakness. The two main categories of myositis include non-infectious and infectious. Infective myositis may be due to a wide variety of pathogens, including bacteria, fungi, viruses, and parasites. A brief account of the various pathogens causing infective myositis is discussed.


Assuntos
Infecções Bacterianas/patologia , Músculo Esquelético/patologia , Miosite/patologia , Piomiosite/patologia , Infecções Bacterianas/complicações , Humanos , Hanseníase/patologia
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