Tropical pyomyositis

Abstract

Background:Tropical pyomyositis is characterized by suppuration within skeletal muscles, manifesting as single or multiple abscesses. Though primarily a disease of tropics, it is increasingly being reported from temperate regions in immunosuppressed patients. However, India has only few sporadic case reports.Aims:The aim of this study is to evaluate the causative organisms, clinical presentations, diagnostic modalities, treatment protocols and outcome data in tropical pyomyositis patients.Subjects and Methods:The study was carried out in Nilratan Sircar Medical College and Hospital, Kolkata over 3 years (July 2010 to June 2013). A total of 12 patients were diagnosed with tropical pyomyositis (confirmed with aspiration and culture of pus from muscle). All the investigation and treatment data were recorded systematically.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%). Culture of the aspirate showed Staphylococcus aureus in nine patients (75%), Klebsiella pneumonia in one patient (8.33%) and no growth in two patients (16.67%) even after tubercular and fungal culture.Conclusions:Tropical pyomyositis can affect immune-competent individuals. S. aureus is the most commonly cultured organism. Immediate initiation of appropriate antibiotics and surgical debridement are required to avoid complications. The prognosis remains excellent if promptly treated.

Tropical Pyomyositis: Revisited

“…Blood culture is positive in 5-30 % of cases, which remained negative in our case. Up t o 7 5 % o f c u l t u r e p o s i t i v i t y i s r e p o r t e d f o r Staphylococcus, while Gram-negative bacilli are also increasingly isolated [12]. Comparing the common factors among case reports (total of six) published in the MJAFI and IJS since 1950, fever was present in all patients.…”

“…Malnutrition was not evident in either our case or earlier published reports from the MJAFI. Apart from the commonest implicated Staphylococcus, other organisms isolated are group A streptococcus (1-5 %), Hemophilus and Gramnegative bacilli [12].…”

Leg pain followingStaphylococcus aureusbacteraemia

“…Definite diagnosis requires aspirating purulent material and obtaining a positive culture. Successful treatment hinges on early diagnosis combined with drainage and appropriate antibiotic therapy 3. Empiric antimicrobial therapy should include antibiotics with reliable activity against methicillin resistant S aureus such as vancomycin and daptomycin.…”

Absceso del iliopsoas: Claves para el diagnóstico imagenológico

“…En los abscesos primarios el modelo explicativo está dado por la presencia de bacteriemia desde focos ocultos hacia un músculo iliopsoas con un daño celular previo, que suele corresponde a una lesión de tipo traumático no reportada por el paciente. A pesar de que el mecanismo no está del todo claro, patologías como la piomiositis tropical 5,12 o entidades como las bacteriemias complicadas (de descripción más reciente) (Figura 4) pudieran explicar la generación de un compromiso muscular séptico hemató-geno desde una fuente a distancia 13,14 . El principal agente etiológico en occidente es el Staphylococcus aureus 4,6,15 , aunque infecciones por las especies Pseudomonas, Haemophilus y Proteus también han sido documentadas 16 .…”