Piomiositis por Streptococcus pyogenes en un paciente con malformación venolinfática. A propósito de un caso en pediatría / Pyomyositis due to Streptococcus pyogenes in a patient with venolymphatic malformation. Report of one pediatric case

Las infecciones por Streptococcus pyogenes son frecuentes en la población pediátrica en forma de faringoamigdalitis o cuadros cutáneos. Con menor frecuencia, se presenta con formas invasivas, tales como piomiositis o fascitis necrotizante. La mortalidad en niños reportada en estas últimas es de un 7,69 %. Se presenta a una paciente de 11 años con malformación venolinfática subescapular que consultó por síndrome febril asociado a dolor y aumento agudo del tamaño de la lesión. Durante la internación, se arribó al diagnóstico de piomiositis por Streptococcus pyogenes

Streptococcus pyogenes infections are common in the pediatric population in the form of tonsillopharyngitis or cutaneous disease. Less frequently, it presents with invasive forms such as pyomyositis or necrotizing fasciitis. Mortality in children is of 7 %. We present an 11-year-old patient with a subscapular venolymphatic malformation who consulted for febrile syndrome associated with pain and an acute increase in the size of the lesion. During the hospitalization, diagnosis of pyomyositis due to Streptococcus pyogenes was reached.

Piomiositis en niños: experiencia en un hospital pediátrico de referencia en Argentina / Pediatric pyomyositis: experience in a Pediatric Reference Center in Argentina

Resumen Introducción: La piomiositis es la infección del músculo esquelético, entidad poco frecuente en pediatría. Objetivo: Describir las características de 21 niños con piomiositis. Métodos: Estudio prospectivo-analítico de niños ingresados con diagnóstico de piomiositis entre mayo de 2016 y abril de 2017 en el Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina. Resultados: Tasa de hospitalización de 21,5/10.000 admisiones (IC 95% 4,65- 71,43). La mediana de edad fue de 5,4 años (rango 1,25-11,6). El 90,4% presentaba algún factor predisponente. La localización más frecuente fue en miembros inferiores. La proteína C reactiva (PCR) estuvo elevada en todos los pacientes, con una media de 124 mg/L (DS 96), siendo significativamente más elevada en los pacientes que tuvieron hemocultivos positivos 206 (DS 101) vs 98 (DS 81), (p = 0,02). Se obtuvo rescate microbiológico en 17 pacientes (80,9%): Staphylococcus aureus resistente a meticilina (SARM) (n: 15) y Streptococcus pyogenes (n: 2). Se presentó con bacteriemia 23,8% de los pacientes. El 81% requirió drenaje quirúrgico. Conclusión: Staphylococcus aureus RM adquirido en la comunidad (SARMAC) es el patógeno predominante. En la selección del tratamiento empírico adecuado debería tenerse en cuenta: el patrón de resistencia local y el valor de PCR.

Background: Pyomyositis is the infection of skeletal muscle, a rare pathology in children. Aim To describe the characteristics of pyomyositis in pediatric patients. Methods: Prospective analytical study of hospitalized children diagnosed with pyomyositis from May 2016 to April 2017 at the Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina. Results: Twenty-one patients with pyomyositis were identified. Annual rate: 21.5/10,000 admissions (95% CI 4.65-71.43). The median age was 5.4 years (range 1.25-11.6). The lower limbs were the most affected site. C-reactive protein (CRP) was elevated in all patients, with a mean of 124 mg/L (SD 96), being significantly higher in patients with bacteremia: 206 (DS 101) vs 98 (DS 81), p = 0.02. Bacterial cultures were positive in 17/21 (80.9%): 15 methicillin-resistant Staphylococcus aureus (MRSA), and 2 Streptococcus pyogenes. Blood cultures were positive in 5 (23.8%). Conclusion: MRSA-community acquired is the predominant pathogen in our setting. In the selection of the appropriate empirical treatment, the local resistance pattern and the CRP value should be taken into account.

Piomiositis tropical por escherichia coli en paciente con diabetes mellitus: caso atípico, aspectos clínicos y radiológicos / Tropical piomiositis by escherichia coli in patient with diabetes mellitus: atipic case, clinical and radiological aspects

Antecedentes: Piomiositis es la infección purulenta del músculo esquelético que ocurre por diseminación hematógena, con formación de abscesos, el agente etiológico principal es E. aureus (90%) seguido por Estreptococo beta hemolítico grupo A y bacilos entéricos gram negativos (Ej. E. coli). Es frecuente en pacientes inmunocomprometidos por malignidades hematológicas, relacionadas o no con quimioterapia previa y SIDA. Caso clínico: Masculino de 52 años hospitalizado en el Instituto Hondureño de Seguridad Social, Tegucigalpa, Honduras, síntoma principal dolor opresivo en pelvis de 3 semanas de evolución, con irradiación a cara anterior de muslo derecho, con cambios inlamatorios a este nivel, una semana después dolor y cambios inlamatorios en pierna izquierda. Discusión: En comparación con las personas sanas, los pacientes con condiciones médicas subyacentes tienen mayores tasas de infección por bacterias gram negativas, enfermedad multifocal y mayor mortalidad. El estado de inmunosupresión es un factor predisponente importante en la patogénesis...(AU)

Piomiosite no lúpus eritematoso sistêmico juvenil / Pyomyositis in childhood-systemic lupus erythematosus

Resumo A piomiosite é uma infecção piogênica da musculatura esquelética, decorrente da disseminação hematogênica e geralmente acompanhada de formação de abscesso localizado. Esta infecção da musculatura é raramente descrita em adultos com lúpus eritematoso sistêmico (LES) e, até onde se sabe, ainda não o foi em pacientes com LES juvenil (LESJ). De nossos 289 pacientes com LESJ, uma apresentou piomiosite. Diagnosticada com LESJ aos 10 anos de idade e após seis anos de tratamento com prednisona, azatioprina e hidroxicloroquina, a paciente foi hospitalizada em razão de um histórico de 30 dias de dor insidiosa na coxa esquerda, sem relato algum de trauma aparente ou febre. O exame físico mostrou músculos sensíveis e com endurecimento lenhoso. Os exames laboratoriais revelaram anemia, aumento de reagentes de fase aguda e enzimas musculares normais. A tomografia computadorizada da coxa esquerda mostrou coleção no terço médio do vasto intermédio, sugerindo estágio purulento de piomiosite. Iniciou-se tratamento com antibiótico de largo espectro, que levou à resolução clínica completa. Em suma, descreveu-se o primeiro caso de piomiosite em pacientes com LESJ encontrado neste serviço. Este relato reforça que a presença de dor muscular localizada em pacientes imunocomprometidos, ainda que sem aumento de enzimas musculares, deve sugerir o diagnóstico de piomiosite. Recomenda-se tratamento imediato com antibióticos.

Abstract Pyomyositis is a pyogenic infection of skeletal muscle that arises from hematogenous spread and usually presents with localized abscess. This muscle infection has been rarely reported in adult-onset systemic lupus erythematous and, to the best of our knowledge, has not been diagnosed in pediatric lupus population. Among our childhood-onset systemic lupus erythematous population, including 289 patients, one presented pyomyositis. This patient was diagnosed with childhood-onset systemic lupus erythematous at the age of 10 years-old. After six years, while being treated with prednisone, azathioprine and hydroxychloroquine, she was hospitalized due to a 30-day history of insidious pain in the left thigh and no apparent trauma or fever were reported. Her physical examination showed muscle tenderness and woody induration. Laboratory tests revealed anemia, increased acute phase reactants and normal muscle enzymes. Computer tomography of the left thigh showed collection on the middle third of the vastus intermedius, suggesting purulent stage of pyomyositis. Treatment with broad-spectrum antibiotic was initiated, leading to a complete clinical resolution. In conclusion, we described the first case of pyomyositis during childhood in pediatric lupus population. This report reinforces that the presence of localized muscle pain in immunocompromised patients, even without elevation of muscle enzymes, should raise the suspicion of pyomyositis. A prompt antibiotic therapy is strongly recommended.

Piomiositis tropical vs. leptospirosis / Tropical pyomyositis vs. leptospirosis

La piomiositis es una infección bacteriana aguda o subaguda del músculo esquelético, caracterizada por la formación intramuscular de uno o más abscesos. Presentamos un paciente con cuadro clínico sospechoso de Leptospirosis y que en el transcurso de su ingreso se le diagnostica la piomiositis tropical. Se describe la evolución del paciente, los estudios realizados y el tratamiento indicado por los especialistas.

Pyomyositis is an acute bacterial infection or subacute skeletal muscle characterized by intramuscular formation of one or more abscess. A patient with leptospirosis-suspected clinical condition is presented here. During the course of his hospitalization, he is diagnosed with tropical pyomyositis. Patient outcomes, studies and treatment prescribed by specialists are described.

Acromioclavicular Septic Arthritis and Sternoclavicular Septic Arthritis with Contiguous Pyomyositis

Acromioclavicular (AC) and sternoclavicular (SC) septic arthritis with contiguous pyomyositis are rare, especially in immunocompetent individuals. We report a case of septic AC joint with pyomyositis of the deltoid and supraspinatus muscles and a separate case with septic SC joint with pyomysitis of the sternocleidomastoid muscle. Both patients had similar presentations of infections with Staphylococcus aureus and were successfully treated with surgical incision and drainage followed by prolonged antibiotic therapy.

Development of bilateral gluteal pyomyositis during treatment of acute pyelonephritis in a patient with diabetes

No abstract available.

Primary pyomyositis and disseminated septic pulmonary emboli: a reactivated staphylococcal infection?

Staphylococcal pyomyositis is a severe invasive soft tissue infection with high mortality rate that is increasingly being recognized even in temperate climates. In most cases predisposing factors are identified that include either source of skin penetration or/and impaired host immunocompetence. A case of primary, community-acquired pyomyositis of the left iliopsoas muscle in a 59-year-old immunecompetent woman, which was complicated with septic pulmonary emboli within 24 h after hospital admission, is presented. The patient was subjected to abscess drainage under computed tomography guidance. Both pus aspiration and blood cultures revealed methicillin-susceptible Staphylococcus aureus. Given the absolute absence of predisposing factors and a remote history of staphylococcal osteomyelitis in the same anatomical region 53 years ago, reactivation of a staphylococcal soft tissue infection was postulated. Systematic review of the literature revealed a few interesting cases of reactivated staphylococcal infection after decades of latency, although the exact pathophysiological mechanisms still need to be elucidated.

Piomiosite tropical: correlação anatomoclínica: relato de caso / Tropical pyomyositis: an anatomoclinical correlation: case report

JUSTIFICATIVA E OBJETIVOS: A piomiosite tropical é uma infecção bacteriana, supurativa, típica de países tropicais que acomete um ou mais grupos musculares ricamente vascularizados, ocorrendo principalmente em indivíduos com comprometimento imunológico. Os objetivos deste estudo foram correlacionar os achados anatomopatológicos de um paciente submetido à necropsia com alterações encontradas na síndrome metabólica e insuficiência cardíaca por cardiomiopatia hipertrófica, e discutir os aspectos histopatológicos significativos.RELATO DO CASO: Paciente do sexo masculino, 50 anos, hipertenso,diabético, cardiopata, desenvolveu mialgia em região cervical direita associada à febre, hemoptise e dispneia. A necropsia evidenciou miosite purulenta associada a cocos Gram-positivos,corroborando o diagnóstico de piomiosite tropical. CONCLUSÃO: Assim, é importante atentar para quadros de dor e rigidez muscular, acompanhados de febre em pacientes com comorbidades que levem à imunossupressão. O diagnóstico precoce da piomiosite tropical é fundamental para a instituição do tratamento adequado e o controle das complicações.

BACKGROUND AND OBJECTIVES: Tropical pyomiositis is a suppurative bacterial infection, which is typical of tropical countries and affects one or more richly vascularized muscle groups, occurring mainly in immunocompromised individuals. In this article, we make an anatomoclinical correlation of a necropsied patient with alterations seen in metabolic syndrome and heart failure due to hypertrophic cardiomyopathy, showing the importance of these two entities in the predisposition of the muscle infectious process. A histopathological aspect is discussed, which has relation with tropical pyomyositis.CASE REPORT: Male, 50 year-old, hypertensive, diabetic and cardiac patient who developed myalgia in the right cervical region associated with fever, dyspnea and hemoptysis. The autopsy showed purulent myositis, and Gram stain showed Gram-positive cocci, suggesting the diagnosis of tropical pyomyositis.CONCLUSION: It is important to pay attention to pictures of muscular pain and stiffness, accompanied by fever in patients with comorbidities that lead to immunosuppression. Early diagnosis of tropical pyomyositis is essential for appropriate treatment and control of complications.

Piomiositis en niños: Reporte de 2 casos / Pyomyositis in children: Report of two cases

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.

Abscesos profundos por Staphylococcus aureus meticilino resistente adquirido en la comunidad. Reporte de cuatro casos clínicos / Deep abscess methicillin resistant staphylococcus aureus community-acquired. Report of four cases

El Staphylococcus aureus meticilino resistente adquirido en la comunidad (SAMR-AC) emergió en Uruguay en el año 2001 y desde ese momento se ha establecido como agente de múltiples enfermedades infecciosas de la infancia. Algunas formas clínicas de presentación más frecuentes, como las infecciones superficiales, no ofrecen habitualmente dificultades diagnósticas. Otras menos frecuentes, como los abscesos de localización profunda, son formas menos conocidas donde el diagnóstico no es sencillo y existe riesgo de tratamiento tardío lo cual contribuye a una mayor carga de morbimortalidad por este agente. En este trabajo se comunican cuatro casos clínicos de abscesos profundos por SAMR-AC, en pacientes hospitalizados en los años 2009- 2011 en el Hospital Pediátrico del Centro Hospitalario Pereira Rossell. Se presentan tres casos de abscesos musculares, dos de ellos retroperitoneales, y un caso de abscesos hepáticos, forma de presentación infrecuente pero típica de este agente. Se destacan en esta serie las dificultades para el diagnóstico temprano por lo inespecífico de la presentación clínica, el apoyo fundamental de la imagenología en la confirmación diagnóstica, la necesidad de tratamiento antimicrobiano prolongado y del drenaje adecuado del material colectado importante en la identificación microbiológica del agente implicado...

Piomiositis en un paciente inmunocompetente / Pyomyositis in an immunocompetent patient

We report a case of pyomyositis in a 59 year-old immunocompetent male patient caused by methicillin-susceptible Staphylococcus aureus. A CT scan of the chest demonstrated a lesion of the pectoral muscles. The patient was treated with surgical drainage and cephalexin. Pyomyositis is a rare and potentially serious infection that requires early recognition and prompt treatment.

Se presenta un caso de piomiositis en un varón de 59 años, inmunocompetente, producida por Staphylococcus aureus sensible a meticilina, afectando los músculos pectorales del hemitórax derecho. Fue tratado con drenaje quirúrgico y cefalexina. La piomiositis es una infección infrecuente y potencialmente seria que requiere de un reconocimiento temprano y tratamiento oportuno.

Presentación atípica de piomiositis tropical difusa de psoas por Staphylococcus aureus meticilino resistente / Atypical presentation of diffuse tropical pyomiositis of the psoas due to methicillin resistant Staphylococcus aureus

La piomiositis tropical difusa primaria es una enfermedad de presentación infrecuente en nuestro medio, con pocos casos asociados a Staphylococcus aureus meticilino resistente, adquirido en la comunidad (MRSA-AC). Se presenta el caso de un paciente de 70 años, con tratamiento irregular para diabetes mellitus tipo 2, que fue hospitalizado por presentar un cuadro de diez días de evolución, con dolor lumbar irradiado a miembro inferior izquierdo, fiebre y flexión forzada de la cadera derecha por dolor a la movilización. El diagnóstico de piomiositis difusa de ambos psoas se realizó con resonancia magnética. Del cultivo de una colección paravertebral posterior se aisló Staphylococcus aureus resistente a oxacilina, penicilina y dicloxacilina.

Diffuse tropical primary pyomyositis is an infrequent entity in our country, with few cases associated to communityacquired Methicillin- resistant Staphylococcus aureus. There are no reported cases of Community-Acquired Methicillin- Resistant Staphylococcus aureus (CA- MRSA) in Peru. We present the case of a 70 year old male with a previous diagnosis of type 2 diabetes mellitus, receiving irregular treatment, who was admitted to the hospital with a history of 10 days of low back pain radiating to the left leg, fever and forced flexion of the right hip due to pain during movement. The diagnosis of diffuse pyomyositis of both psoas muscles was performed with MRI and culture of a posterior paravertebral collection, from which Staphylococcus aureus resistant to oxacillin, penicillin and dicloxacillin was isolated.

Pyomyositis of extraocular muscle: Case series and review of the literature.

Pyomyositis is a primary acute bacterial infection usually caused by Staphylococcus aureus. Any skeletal muscle can be involved, but the thigh and trunk muscles are commonly affected. Only three cases of extraocular muscle (EOM) pyomyositis have been reported. We herein present four cases of isolated EOM pyomyositis. Three of our cases presented with acute onset of proptosis, pain, swelling and redness. One patient presented with mass in the inferior orbit for 4 months. One patient had central retinal artery occlusion on presentation. None of them had marked systemic symptoms. Computed tomography scan of all patients showed a typical hypodense rim enhancing lesion of the muscle involved. Three patients were started on intravenous antibiotics immediately on diagnosis and the pus was drained externally. Two patients underwent exploratory orbitotomy. In conclusion, it should be considered in any patient presenting with acute onset of orbital inflammation. Management consists of incision and drainage coupled with antibiotic therapy.

Drenagem aberta versus drenagem percutânea no tratamento da piomiosite tropical: estudo prospectivo e randomizado / Open drainage versus percutaneous drainage in the treatment of tropical pyomyositis: prospective and randomized study

OBJETIVO: Comparar, através de estudo prospectivo e randomizado, os resultados do tratamento da piomiosite tropical (PT) através da drenagem percutânea dos abscessos aos da drenagem cirúrgica aberta dos mesmos. MÉTODOS: Foram incluídos neste estudo 25 pacientes com PT, grau II de Chiedozi. Os pacientes foram randomizados em dois grupos: grupo A (n = 13), tratados com antibioticoterapia e drenagem aberta dos abscessos e grupo B (n = 12), tratados com antibioticoterapia e drenagem percutânea dos mesmos. RESULTADOS: A idade média no grupo A foi de 35,3 ± 19,2 anos e, no grupo B, de 30,1 ± 9 anos (p = 0,41). No grupo A, oito pacientes (61,5 por cento) eram do sexo feminino e cinco do masculino (38,5 por cento); no grupo B, três eram do sexo feminino (25 por cento) e nove do masculino (75 por cento) (p = 0,11). O Staphylococcus aureus foi o microorganismo mais frequentemente encontrado (72 por cento). O tempo médio de internação no grupo A foi de 12,7 ± 2,1 dias e, no grupo B, de 10,6 ± 1,6 dias (p = 0,01). O tempo médio de antibiótico no grupo A foi de 12,2 ± 2,3 dias e, no grupo B, de 10,1 ± 1,5 dias (p = 0,02). CONCLUSÃO: A drenagem percutânea dos abscessos associada à antibioticoterapia constituiu-se em método eficaz para o tratamento da piomiosite tropical grau II, diminuindo o tempo de antibioticoterapia e de internação hospitalar dos pacientes.

OBJECTIVE: To compare, by means of a prospective and randomized study, the treatment outcomes of Tropical Pyomyositis (TP) through open drainage of abscesses versus percutaneous surgical drainage. METHODS: 25 patients with TP (Chiedozi stage II) were randomized into two groups: Group A (n=13), treated with antibiotics and open drainage of the abscesses, and Group B (n=12), treated with antibiotics and percutaneous drainage. RESULTS: The mean age was 35.3 years (±19.2) in Group A and 30.1 years in Group B (±9) (p=0.41).There were eight female (61.5 percent) and five male (38.5 percent) patients in Group A; in Group B three were female (25 percent) and nine (75 percent) male (p=0.11). Staphylococcus aureus was the most frequent agent found (72 percent). The mean hospitalization period in Group A was 12.7 days (±2.3), and in Group B, 10.6 days (±1.6) (p=0.01). The mean antibiotics treatment period in Group A was 12.2 days (±2.3), and 10.1 days (±1.5) in Group B (p=0.02). CONCLUSION: The percutaneous drainage of the abscesses is an efficient treatment method for the Tropical Pyomyositis, with a shorter period of hospitalization and antibiotics usage.

Piomiosite tropical ao diagnóstico de LLA: relato de caso / Tropical pyomyositis at diagnosis of ALL: case report

Os autores apresentam o caso de um jovem de 14 anos com história de dor em membros e febre. A investigação radiológica mostrou presença de abscessos compatíveis com o diagnóstico de piomiosite...

The authors report the case of 14 ys.o boy complaining of limbs pain and fever. The disclosure of abscesses at radiology work-up fulfilled the diagnosis S.aureus was isolated from right forearm effusion. Otherside the usual blood count featured in an infectious condition like that, leucopenia...

Pyomyositis: a diagnostic problem.

A case of a 45-year-old lady presenting with symptoms suggestive of pancreatitis is described. Initially the findings on Imaging were ambiguous while the enzyme studies were against the diagnosis of pancreatitis. Recurrence of symptoms and with Increased intensity prompted repeated imaging and further investigations. Finally, by a combination of CT scan, MR imaging and muscle biopsy the rare diagnosis of pyomyositis was established. The fact that this case was difficult to diagnose because of its rarity and its mimicking pencreatitis is discussed.

Piomiositis: presentación de 17 casos en niños y adultos / Pyomyositis: Report of seventeen cases

Background: Pyomyositis is a bacterial infection of skeletal muscle. Although more commonly seen in the tropics, it is increasingly recognized in temperate regions. The age distribution for patients with so called "tropical" or "temperate" pyomyositis differs. Most cases of tropical pyomyositis are seen in otherwise healthy patients and mainly in children, while the majority of cases of temperate pyomyositis occur in inmunocompromised adults. Aim: To report a series of patients with pyomyositis. Material and Methods: Retrospective review of clinical records of patients admitted to our hospital with pyomyositis during the period 1996-2001. Results: Seventeen patients were identified, aged from 5 to 86 years old, nine (53%) males. Staphylococcus aureus (13 cases, 76%) was the most common infecting organism. Eleven patients (65%) had a history of previous trauma. All patients were immunocompetent. Six patients underwent surgical drainage. Six patients (35%) presented complications and of those, one died. Conclusions: All patients of this series were immunocompetent. Pyomyositis is a serious and life threatening disease but curable. An early treatment is the key to a better prognosis.