ABSTRACT
Pyomyositis (PM) is an uncommon pyogenic infection of skeletal muscle and, when not properly treated, it can progress to a high-risk clinical situation with high mortality. Because it usually has a subacute presentation, diagnosis is often delayed. We present two cases of PM of the paraspinal muscles in healthy children and discuss the current state of knowledge of this disease.
La piomiositis (PM) es una infección piógena infrecuente del músculo estriado y, cuando no es tratada adecuadamente, puede evolucionar hasta una situación clínica de alto riesgo vital. Debido a su presentación usualmente subaguda, el diagnóstico es a menudo tardío. Presentamos dos casos clínicos de PM de la musculatura paraespinal en escolares sanos y se describe el estado actual del conocimiento de esta enfermedad.
Subject(s)
Child , Female , Humans , Male , Pyomyositis/diagnosis , Staphylococcus aureus , Staphylococcal Infections/diagnosis , Anti-Bacterial Agents/therapeutic use , Cloxacillin/therapeutic use , Lumbosacral Region , Pyomyositis/drug therapy , Staphylococcal Infections/drug therapyABSTRACT
Radionuclide imaging studies are routinely used to evaluate patients suspected of having musculoskeletal infection. Three-phase bone imaging is readily available, relatively inexpensive, and very accurate in the setting of otherwise normal bone. Labeled leukocyte imaging should be used in cases of "complicating osteomyelitis" such as prosthetic joint infection. This test also is useful in clinically unsuspected diabetic pedal osteomyelitis as well as in the neuropathic joint. It is often necessary, however, to perform complementary bone marrow imaging, to maximize the accuracy of labeled leukocyte imaging. In contrast to other regions in the skeleton, labeled leukocyte imaging is not useful for diagnosing spinal osteomyelitis. At the moment, gallium is the preferred radionuclide procedure for this condition and is a useful adjunct to magnetic resonance imaging. FDG-PET likely will play an important role in the evaluation of musculoskeletal infection, especially spinal osteomyelitis, and may replace gallium imaging for this purpose.
Estudos através de imagens com o uso de radionuclídeos são rotineiramente usadas para avaliar pacientes suspeitos de terem infecção músculo-esquelética. A imagem óssea em tridimensional é facilmente avaliável, relativamente de baixo custo, e muito precisa na localização de alterações ósseas. Imagem com leucócito marcado poderia ser usada nos casos de "osteomielite com complicações" tais como infecção prostética articular. Esse teste também é útil na não suspeita clinica de osteomielite associada ao pé diabético tanto quanto nas junções neuropáticas. É sempre necessário, por outro lado, realizar imagem complementar da medula óssea para aumentar a precisão da imagem com leucócito marcado. Em contraste com outras regiões no esqueleto, imagem com leucócito marcado não é útil para diagnosticar osteomielite da coluna vertebral. Até agora, o gálio é o radionuclídeo preferido para essa condição e é um adicional utilizável para imagem por ressonância magnética. FDG-PET igualmente será importante na avaliação de infecção músculo-esquelética, especialmente osteomielite espinhal, e pode substituir o gálio para esse propósito.
Subject(s)
Gallium , Infections , Magnetic Resonance Imaging , Muscle, Skeletal , OsteomyelitisABSTRACT
PURPOSE: We evaluate in vitro and in vivo efficacy of newly developed gentamicin loaded PLGA microspheres for the treatment of musculoskeletal infection. MATERIALS AND METHODS: Controlled gentamicin sulfate releasing microspheres manufactured from biodegradable PLGA were prepared with an Oil/Oil solvent evaporation method for the treatment of musculoskeletal infection. The in vitro release amount of GS was analyzed by high performance liquid chromatography (HPLC) and the released GS activity was determined by microbiological assay using staphylococcus (S) aureus, respectively. The results of inhibition zone test agree well with the HPLC results obtained from the in vitro release test. RESULTS: The microspheres of different size were obtained with varying the experimental conditions, and the shape of microspheres was smooth and spherical. The PLGA microspheres release gentamicin for 67 days in in vitro test. There was significant inhibition around microphere PLGA from 1 day to 7th week in inhibition zone test The inhibition was reduced after 8th week. and there was no inhibition at 9th week PLGA microspheres. CONCLUSION: It can be suggested that GS/PLGA MSs implantable system that provided a prolonged delivery of GS was found to be effective against S. aureus infection for desired period.