Pyomyositis: Difference between revisions
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==Clinical Features== | ==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> | 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 | **Localized muscle inflammation without abscess | ||
===Second stage=== | |||
*Worsening pain, muscle swelling, fever, [[abscess]] formation | |||
===Third stage=== | |||
*Infection dissemination | |||
*[[Septic shock]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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*[[Rhabdomyolysis]] | *[[Rhabdomyolysis]] | ||
== | ==Evaluation== | ||
*CBC | *CBC | ||
*Chem 10 | *Chem 10 | ||
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*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 | **[[Vancomycin]] 15-20mg/kg IV q24 hr, [[ceftriaxone]] 1g IV q24 hr, [[clindamycin]] 600mg IV q8 hr | ||
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==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