Pyomyositis: Difference between revisions
(pyomyositis clinical features) |
Ostermayer (talk | contribs) (Text replacement - "abscess " to "abscess ") |
||
| (10 intermediate revisions by 4 users not shown) | |||
| Line 5: | Line 5: | ||
*Mainly disease of children, age 2-5 most common | *Mainly disease of children, age 2-5 most common | ||
===Pathophysiology=== | ===Pathophysiology=== | ||
*Transient bacteremia after blunt trauma to muscle group, or vigorous exercise<ref>Chauhan, S. (2004) ‘Tropical pyomyositis (myositis tropicans): current perspective’, Postgraduate Medical Journal, 80(943), pp. 267–270.</ref> | *Transient bacteremia after blunt trauma to muscle group, or vigorous exercise<ref>Chauhan, S. (2004) ‘Tropical pyomyositis (myositis tropicans): current perspective’, Postgraduate Medical Journal, 80(943), pp. 267–270.</ref> | ||
*Most commonly [[Staph aureus]], followed by [[Strep]] pyogenes, [[pneumococcus]], neisseria, [[haemophilus]], yersinia, [[pseudomonas]], [[klebsiella]], and [[E. coli]] | *Most commonly [[Staph aureus]], followed by [[Strep]] pyogenes, [[pneumococcus]], neisseria, [[haemophilus]], yersinia, [[pseudomonas]], [[klebsiella]], and [[E. coli]] | ||
===Risk Factors=== | ===Risk Factors=== | ||
*DM | *[[DM]] | ||
*HIV | *[[HIV]] | ||
*IVDU | *IVDU | ||
*Renal failure | *Renal failure | ||
*Immunosuppression | *Immunosuppression | ||
== | ==Clinical Features== | ||
''More commonly affects proximal lower extremity muscles'' | |||
===First stage=== | |||
*Localized muscle pain, low grade fevers, vague complaints<ref> | |||
Scharschmidt, T. J., Weiner, S. D. and Myers, J. P. (2004) ‘Bacterial pyomyositis’, Current Infectious Disease Reports, 6(5), pp. 393–396.</ref> | |||
**Localized muscle inflammation without abscess | |||
===Second stage=== | |||
*Worsening pain, muscle swelling, fever, [[abscess]] formation | |||
===Third stage=== | |||
*Infection dissemination | |||
*[[Septic shock]] | |||
==Differential Diagnosis== | |||
{{SSTI DDX}} | |||
*[[Rhabdomyolysis]] | |||
==Evaluation== | |||
*CBC | *CBC | ||
*Chem 10 | *Chem 10 | ||
| Line 28: | Line 40: | ||
*CK | *CK | ||
*Lactate | *Lactate | ||
*CT extremity with contrast | *CT extremity with contrast | ||
*Ultrasound | *Ultrasound | ||
| Line 35: | Line 45: | ||
*Surgical exploration is gold standard | *Surgical exploration is gold standard | ||
== | ==Management== | ||
*IV antibiotics alone for first stage | *IV antibiotics alone for first stage | ||
**[[ | **[[Vancomycin]] 15-20mg/kg IV q24 hr, [[ceftriaxone]] 1g IV q24 hr, [[clindamycin]] 600mg IV q8 hr | ||
*Surgical debridement plus antibiotics for abscess | *Surgical debridement plus antibiotics for abscess | ||
*IV fluids, pressors, airway management, rapid debridement for septic shock | *IV fluids, pressors, airway management, rapid debridement for septic shock | ||
| Line 47: | Line 53: | ||
==Disposition== | ==Disposition== | ||
*Admit | *Admit | ||
==See Also== | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Surgery]] | |||
[[Category:Orthopedics]] | |||
[[Category:ID]] | |||
Latest revision as of 13:09, 10 March 2017
Background
- Primary bacterial infection of skeletal muscle
- Also known as myositis tropicans, more common in tropical settings
- Temperate climates in immune compromised patients
- Mainly disease of children, age 2-5 most common
Pathophysiology
- Transient bacteremia after blunt trauma to muscle group, or vigorous exercise[1]
- Most commonly Staph aureus, followed by Strep pyogenes, pneumococcus, neisseria, haemophilus, yersinia, pseudomonas, klebsiella, and E. coli
Risk Factors
Clinical Features
More commonly affects proximal lower extremity muscles
First stage
- Localized muscle pain, low grade fevers, vague complaints[2]
- Localized muscle inflammation without abscess
Second stage
- Worsening pain, muscle swelling, fever, abscess formation
Third stage
- Infection dissemination
- Septic shock
Differential Diagnosis
Skin and Soft Tissue Infection
- Cellulitis
- Erysipelas
- Lymphangitis
- Folliculitis
- Hidradenitis suppurativa
- Skin abscess
- Necrotizing soft tissue infections
- Mycobacterium marinum
Look-A-Likes
- Sporotrichosis
- Osteomyelitis
- Deep venous thrombosis
- Pyomyositis
- Purple glove syndrome
- Tuberculosis (tuberculous inflammation of the skin)
- Rhabdomyolysis
Evaluation
- CBC
- Chem 10
- PT/PTT
- CK
- Lactate
- CT extremity with contrast
- Ultrasound
- MRI, study of choice
- Surgical exploration is gold standard
Management
- IV antibiotics alone for first stage
- Vancomycin 15-20mg/kg IV q24 hr, ceftriaxone 1g IV q24 hr, clindamycin 600mg IV q8 hr
- Surgical debridement plus antibiotics for abscess
- IV fluids, pressors, airway management, rapid debridement for septic shock
Disposition
- Admit