Pyomyositis: Difference between revisions
(pyomyositis update) |
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*Temperate climates in immune compromised patients | *Temperate climates in immune compromised patients | ||
*Mainly disease of children, age 2-5 most common | *Mainly disease of children, age 2-5 most common | ||
===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> | |||
*Most commonly [[Staph aureus]], followed by [[Strep]] pyogenes, [[pneumococcus]], neisseria, [[haemophilus]], yersinia, [[pseudomonas]], [[klebsiella]], and [[E. coli]] | |||
===Risk Factors=== | |||
*[[DM]] | |||
*[[HIV]] | |||
*IVDU | |||
*Renal failure | |||
*Immunosuppression | |||
==Clinical Features== | ==Clinical Features== | ||
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*Second stage: Worsening pain, muscle swelling, fever, abscess formation | *Second stage: Worsening pain, muscle swelling, fever, abscess formation | ||
*Third stage: Infection dissemination, septic shock | *Third stage: Infection dissemination, septic shock | ||
== | ==Differential Diagnosis== | ||
{{SSTI DDX}} | |||
*[[Rhabdomyolysis]] | |||
==Diagnosis== | |||
*CBC | *CBC | ||
*Chem 10 | *Chem 10 | ||
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*CK | *CK | ||
*Lactate | *Lactate | ||
*CT extremity with contrast | *CT extremity with contrast | ||
*Ultrasound | *Ultrasound | ||
*MRI, study of choice | *MRI, study of choice | ||
*Surgical exploration is gold standard | *Surgical exploration is gold standard | ||
==Treatment== | ==Treatment== | ||
Revision as of 00:46, 15 June 2015
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
Diagnosis
- CBC
- Chem 10
- PT/PTT
- CK
- Lactate
- CT extremity with contrast
- Ultrasound
- MRI, study of choice
- Surgical exploration is gold standard
Treatment
- 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