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1.
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
2.
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.


Assuntos
Piomiosite , Humanos , Imageamento por Ressonância Magnética , Masculino , Músculo Esquelético , Dor , Piomiosite/diagnóstico , Coxa da Perna
3.
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
5.
BMJ Case Rep ; 14(5)2021 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-33958367

RESUMO

Tropical pyomyositis manifests as single or multiple abscesses inside skeletal muscles and it has a higher prevalence in immunocompromised patients. Scrub typhus, a zoonotic disease is caused by Orientia tsutsugamushi and the clinical manifestations range from simple febrile illness to organ threatening complications. Here, we present a rare case of an immunocompetent young man diagnosed as tropical pyomyositis in association with scrub typhus. Imaging of both thighs revealed multiple intramuscular abscesses. Blood and aspirated pus were culture negative. Patient was treated aggressively with parenteral antibiotics (linezolid, clindamycin and meropenem) and surgical debridement. But, fever did not subside and total leucocyte count remained persistently high. After serological confirmation of scrub typhus, the patient was put on oral doxycycline and he had a dramatic improvement within next few days. To the best of our knowledge, this is probably the first reported case of tropical pyomyositis in association with scrub typhus.


Assuntos
Orientia tsutsugamushi , Piomiosite , Tifo por Ácaros , Animais , Doxiciclina , Humanos , Masculino , Piomiosite/diagnóstico , Piomiosite/tratamento farmacológico , Tifo por Ácaros/complicações , Tifo por Ácaros/diagnóstico , Tifo por Ácaros/tratamento farmacológico , Zoonoses
9.
Int J Infect Dis ; 104: 677-679, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33540127

RESUMO

Necrotizing soft tissue infection, with or without myositis, is classified among the most dangerous infectious emergencies in clinical practice. The authors report a case of an older diabetic woman who presented to the orthopedic service with right elbow pain after a small trauma with skin abrasion and released with an analgesic prescription. After 48h, she presented to the emergency room with a history of developing bullous and necrotic lesions in the upper right limb, hypotension, and numbness, with rapid and fatal evolution despite adequate clinical and surgical therapeutic support. Muscle biopsy showed necrotizing myositis. Blood culture was positive for Panton-Valentine leukocidin producing (PVL-positive) methicillin-resistant S. aureus. Although PVL has a strong epidemiologic association with Community-Acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) infections, it can also be found in CA-MSSA in the context of necrotizing pneumonia and skin and soft tissue infections. Although infrequent, CA-MRSA or CA-MSSA PVL+ infections should always be suspected in high-risk patients because they can rapidly evolve with severe, sometimes fatal complications.


Assuntos
Complicações do Diabetes/mortalidade , Piomiosite/etiologia , Piomiosite/mortalidade , Infecções Estafilocócicas/mortalidade , Complicações do Diabetes/microbiologia , Evolução Fatal , Feminino , Humanos , Staphylococcus aureus Resistente à Meticilina/genética , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Staphylococcus aureus Resistente à Meticilina/fisiologia , Pessoa de Meia-Idade , Piomiosite/microbiologia , Infecções dos Tecidos Moles/microbiologia , Infecções dos Tecidos Moles/mortalidade , Infecções Estafilocócicas/microbiologia
10.
Pediatrics ; 147(2)2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33414235

RESUMO

BACKGROUND: Pediatric musculoskeletal infection (MSKI) is a common cause of hospitalization with associated morbidity. To improve the care of pediatric MSKI, our objectives were to achieve 3 specific aims within 24 months of our quality improvement (QI) interventions: (1) 50% reduction in peripherally inserted central catheter (PICC) use, (2) 25% reduction in sedations per patient, and (3) 50% reduction in empirical vancomycin administration. METHODS: We implemented 4 prospective QI interventions at our tertiary children's hospital: (1) provider education, (2) centralization of admission location, (3) coordination of radiology-orthopedic communication, and (4) implementation of an MSKI infection algorithm and order set. We included patients 6 months to 18 years of age with acute osteomyelitis, septic arthritis, or pyomyositis and excluded patients with complex chronic conditions or ICU admission. We used statistical process control charts to analyze outcomes over 2 general periods: baseline (January 2015-October 17, 2016) and implementation (October 18, 2016-April 2019). RESULTS: In total, 224 patients were included. The mean age was 6.1 years, and there were no substantive demographic or clinical differences between baseline and implementation groups. There was an 81% relative reduction in PICC use (centerline shift 54%-11%; 95% confidence interval 70-92) and 33% relative reduction in sedations per patient (centerline shift 1.8-1.2; 95% confidence interval 21-46). Empirical vancomycin use did not change (centerline 20%). CONCLUSIONS: Our multidisciplinary MSKI QI interventions were associated with a significant decrease in the use of PICCs and sedations per patient but not empirical vancomycin administration.


Assuntos
Artrite Infecciosa/terapia , Hospitais Pediátricos/normas , Osteomielite/terapia , Piomiosite/terapia , Melhoria de Qualidade/organização & administração , Centros de Atenção Terciária/normas , Adolescente , Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/normas , Gestão de Antimicrobianos/tendências , Cateterismo Venoso Central/normas , Cateterismo Venoso Central/tendências , Criança , Pré-Escolar , Sedação Consciente/normas , Sedação Consciente/tendências , Feminino , Hospitais Pediátricos/organização & administração , Humanos , Lactente , Masculino , Estudos Prospectivos , Melhoria de Qualidade/estatística & dados numéricos , Centros de Atenção Terciária/organização & administração , Resultado do Tratamento , Vancomicina/uso terapêutico
11.
J Pediatr Orthop B ; 30(6): 572-578, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-33136794

RESUMO

Pyomyositis is defined as a pyogenic infection of skeletal muscles principally caused by Staphylococcus aureus. It can present either primarily without any associated soft tissue or bone infection or secondary to any surrounding or distant infection focus. Hip pericapsular pyomyositis is one of the most common types of primary pyomyositis. Although many cases are increasingly being described both in tropical and temperate climates, there is no published study regarding the sequelae of untreated pericapsular pyomyositis around the hip joint. The purpose of this study is to describe the sequelae of unaddressed obturator internus abscesses in four adolescent patients and compare their outcome with patients where obturator abscess was also drained using Vanderbilt medial approach. A retrospective study was done with eight patients divided equally into two groups. All the patients were diagnosed as septic arthritis with pyomyositis of obturator internus. Group 1 includes patients treated in between 2012 and 2014 with only hip arthrotomy through anterior approach. Group 2 includes patients treated after 2014 with anterior hip arthrotomy along with drainage of obturator internus abscess. All patients in group 1 had frequent episodes of pain in the first postoperative year with persistent restriction of hip range of motion. Two patients required re-drainage of the hip joint within the first month of indexed surgery. Final follow-up (average 6 years) X-rays revealed grade 2 protrusio acetabuli in three cases and grade 3 in one case as per the Sotelo-Garza and Charnley classification. In contrast to the group 1, group 2 patients had an excellent outcome with an average Iowa Hip Score of 93 at average follow-up of 4.25 years with near normal range of motion, no radiological deterioration and residual pain. The possibility of pericapsular pyomyositis should always be kept in mind, in older children with acute hip pain. A high index of suspicion is required for its early diagnosis. MRI is the gold standard investigation for confirming diagnosis and planning the preferred early surgical treatment. Safe and effective surgical drainage of obturator internus abscess through a minimally invasive Vanderbilt medial approach may prevent long-term sequelae of chronic pain, protrusio acetabuli and secondary osteoarthritis.


Assuntos
Artrite Infecciosa , Piomiosite , Adolescente , Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/terapia , Criança , Humanos , Músculo Esquelético , Piomiosite/diagnóstico , Piomiosite/terapia , Estudos Retrospectivos
12.
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
13.
Infect Dis Clin North Am ; 35(1): 169-181, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33303334

RESUMO

Persons who inject drugs are at high risk for skin and soft tissue infections. Infections range from simple abscesses and uncomplicated cellulitis to life-threatening and limb-threatening infections. These infections are predominantly caused by gram-positive organisms with Staphylococcus aureus, Streptococcus pyogenes, and other streptococcal species being most common. Although antimicrobial therapy has an important role in treatment of these infections, surgical incision, drainage, and debridement of devitalized tissue are primary. Strategies that decrease the frequency of injection drug use, needle sharing, use of contaminated equipment, and other risk behaviors may be effective in preventing these infections in persons who inject drugs.


Assuntos
Dermatopatias Infecciosas/epidemiologia , Infecções dos Tecidos Moles/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Abscesso/epidemiologia , Antibacterianos/uso terapêutico , Celulite (Flegmão)/epidemiologia , Clostridium perfringens/isolamento & purificação , Clostridium sordellii/isolamento & purificação , Desbridamento/métodos , Drenagem/métodos , Usuários de Drogas , Fasciite Necrosante/epidemiologia , Infecções por Bactérias Gram-Positivas/epidemiologia , Humanos , Piomiosite/epidemiologia , Dermatopatias Infecciosas/microbiologia , Dermatopatias Infecciosas/terapia , Infecções dos Tecidos Moles/microbiologia , Infecções dos Tecidos Moles/terapia , Staphylococcus aureus/isolamento & purificação , Streptococcus pyogenes/isolamento & purificação , Abuso de Substâncias por Via Intravenosa/microbiologia
15.
Orbit ; 40(3): 258-262, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32515624

RESUMO

Pyomyositis is a rare condition which occurs most often in large skeletal muscles. Pyomyositis of extraocular muscles is a very rare entity. The authors describe a case of 2 sites of pyomyositis of extraocular muscles. A 20-year-old man presented with right periocular pain, redness, and proptosis for 1 week.Computed tomography showed well-circumscribed masses with enhancing rims in the medial and inferior rectus muscles. The patient underwent orbital drainage surgery and received an intravenous antibiotic. Haemoculture and pus culture could not identify an organism. Systemic steroid was administered after the infection was controlled, in regard to scar prevention.


Assuntos
Piomiosite , Antibacterianos/uso terapêutico , Drenagem , Humanos , Masculino , Músculos Oculomotores/diagnóstico por imagem , Músculos Oculomotores/cirurgia , Piomiosite/diagnóstico , Piomiosite/tratamento farmacológico , Tomografia Computadorizada por Raios X , Adulto Jovem
17.
Hosp Pediatr ; 10(12): 1107-1113, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33154082

RESUMO

BACKGROUND: Acute hematogenous musculoskeletal infections are a common cause of hospitalization in children. A locally developed clinical care guideline (CCG) for acute musculoskeletal infections was implemented at our quaternary care pediatric hospital in July 2012. The purpose of this study was to evaluate the long-term sustainability of previously described improvements after CCG implementation. METHODS: Clinical outcomes for children hospitalized with musculoskeletal infections at Children's Hospital Colorado from June 2009 through September 2018 were retrospectively reviewed. Patients were included if they had an International Classification of Diseases, Ninth Revision or International Classification of Diseases, 10th Revision discharge diagnosis of acute osteomyelitis, septic arthritis, or pyomyositis and were between 6 months and 18 years of age at admission. Patients with underlying medical complexity or nonhematogenous musculoskeletal infections were excluded. Patients were categorized by date of admission as either "pre-CCG" (June 2009 to June 2011) or "sustain-CCG" (July 2014 to September 2018). Primary outcomes were hospital length of stay and intravenous antimicrobial length of therapy. RESULTS: From pre-CCG to sustain-CCG, median length of stay decreased by 1.29 days (5.56 vs 4.27; P < .004) and median length of therapy decreased by 5.04 days (8.33 vs 3.29; P < .0001). Statistical process control charts support that these were sustained improvements many years after CCG implementation. Additional secondary clinical improvements were observed in the sustain-CCG group including faster fever resolution, more consistent blood and source culture acquisition, and decreased central line placement. There was no increase in related readmissions or therapeutic failures in the sustain-CCG group. CONCLUSIONS: Implementation of a CCG to standardize care for musculoskeletal infections can be sustained many years after implementation.


Assuntos
Artrite Infecciosa , Infecções , Osteomielite , Piomiosite , Criança , Humanos , Tempo de Internação , Estudos Retrospectivos
19.
Clin Exp Rheumatol ; 38 Suppl 127(5): 98-100, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33124570

RESUMO

Salmonella infections usually present with gastrointestinal manifestations including enterocolitis especially in immunocompromised patients. Haematogenous dissemination and abscesses are very rare complications of Salmonella species. This case report documents a patient with Behçet's syndrome (BS) who has pyomyositis due to Salmonella species. A 43-year-old male patient with BS presented to the outpatient rheumatology clinic with bilateral acute-onset lower extremity pain. However, over a short time the pain gradually increased and was accompanied by fever. The magnetic resonance scans demonstrated pyomyositis and muscle abscess in the adductor and obturator muscles. The cultures showed Salmonella enteritidis infection. The patient was successfully treated with antibiotic therapy. This case is important since it is one of the first in the literature to report an adult patient with BS and Salmonella pyomyositis.


Assuntos
Síndrome de Behçet , Piomiosite , Abscesso/diagnóstico por imagem , Abscesso/tratamento farmacológico , Abscesso/etiologia , Adulto , Antibacterianos/uso terapêutico , Síndrome de Behçet/complicações , Síndrome de Behçet/diagnóstico , Síndrome de Behçet/tratamento farmacológico , Humanos , Masculino , Piomiosite/diagnóstico por imagem , Piomiosite/tratamento farmacológico , Salmonella enteritidis
20.
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
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