Pyomyositis: Difference between revisions
(pyomyositis organisms) |
(pyomyositis article with references) |
||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Primary bacterial infection of skeletal | *Primary bacterial infection of skeletal muscle | ||
*Also known as myositis tropicans, more common in tropical settings | *Also known as myositis tropicans, more common in tropical settings | ||
*Temperate climates in immune compromised patients | *Temperate climates in immune compromised patients | ||
*Mainly disease of children, age 2-5 most common | |||
==Clinical Features== | ==Clinical Features== | ||
| Line 11: | Line 12: | ||
*Third stage: Infection dissemination, septic shock | *Third stage: Infection dissemination, septic shock | ||
===Pathophysiology=== | ===Pathophysiology=== | ||
*Transient bacteremia after | *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 [[ | *Most commonly [[Staph aureus]], followed by [[Strep]] pyogenes, [[pneumococcus]], neisseria, [[haemophilus]], yersinia, [[pseudomonas]], [[klebsiella]], and [[E. coli]] | ||
===Risk Factors=== | ===Risk Factors=== | ||
*DM | *DM | ||
| Line 18: | Line 19: | ||
*IVDU | *IVDU | ||
*Renal failure | *Renal failure | ||
* | *Immunosuppression | ||
* | |||
==Work-Up== | |||
*CBC | |||
*Chem 10 | |||
*PT/PTT | |||
*CK | |||
*Lactate | |||
==Diagnosis== | |||
*CT extremity with contrast | |||
*Ultrasound | |||
*MRI, study of choice | |||
*Surgical exploration is gold standard | |||
==Differential Diagnosis== | |||
{{Template:SSTI DDX}} | |||
*[[Rhabdomyolysis]] | |||
==Treatment== | |||
*IV antibiotics alone for first stage | |||
**[[Vancoymcin]] 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 | |||
==References== | |||
<references/> | |||
Revision as of 19:47, 13 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
Clinical Features
- First stage: localized muscle pain, low grade fevers, vague complaints[1]
- Localized muscle inflammation without abscess
- Second stage: Worsening pain, muscle swelling, fever, abscess formation
- Third stage: Infection dissemination, septic shock
Pathophysiology
- Transient bacteremia after blunt trauma to muscle group, or vigorous exercise[2]
- 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
Work-Up
- CBC
- Chem 10
- PT/PTT
- CK
- Lactate
Diagnosis
- CT extremity with contrast
- Ultrasound
- MRI, study of choice
- Surgical exploration is gold standard
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
Treatment
- IV antibiotics alone for first stage
- Vancoymcin 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