- Larry M Baddour, MD, FIDSA
Larry M Baddour, MD, FIDSA
- Professor of Medicine
- Mayo Clinic College of Medicine
- Anuwat Keerasuntornpong, MD
Anuwat Keerasuntornpong, MD
- Division of Infectious Diseases
- Siriraj Hospital Mahidol University, Bangkok
Pyomyositis is a purulent infection of skeletal muscle that arises from hematogenous spread, usually with abscess formation . The clinical approach to pyomyositis will be reviewed here. Other soft tissue infections such as clostridial myonecrosis and necrotizing fasciitis are discussed separately. (See "Clostridial myonecrosis" and "Necrotizing soft tissue infections".)
Pyomyositis is classically an infection of the tropics, although it has been recognized in temperate climates with increasing frequency [2-8]. Tropical pyomyositis primarily occurs in two age groups: children (ages 2 to 5) and adults (ages 20 to 45), while the majority of temperate pyomyositis cases occurs in adults. Males appear to be more commonly affected than females. Most patients with tropical pyomyositis are otherwise healthy without underlying comorbidities, while most patients in temperate regions are immunocompromised or have other serious underlying conditions.
Predisposing factors — Predisposing factors for pyomyositis include immunodeficiency, trauma, injection drug use, concurrent infection, and malnutrition [2,9-13].
Immunodeficiency — Immunodeficiency has been implicated in the development of pyomyositis in both temperate and tropical climates. Forms of immunodeficiency associated with pyomyositis include HIV infection, diabetes mellitus, malignancy, cirrhosis, renal insufficiency, organ transplantation, and administration of immunosuppressive agents [2,14].
HIV is a particularly important risk factor [2,4,7,12,15-19]. A case-control series in Uganda demonstrated a significant association between pyomyositis and HIV infection . In a review of 98 cases in North America, about half of pyomyositis patients with underlying medical conditions were seropositive for HIV . The mechanism of HIV infection in the predisposition to pyomyositis is unclear; factors may include immune compromise, primary HIV myopathy, antiretroviral therapy, and increased rates of staphylococcal carriage [2,7,18,19].
- Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. Clin Infect Dis 2014; 59:147.
- Crum NF. Bacterial pyomyositis in the United States. Am J Med 2004; 117:420.
- Gibson RK, Rosenthal SJ, Lukert BP. Pyomyositis. Increasing recognition in temperate climates. Am J Med 1984; 77:768.
- Christin L, Sarosi GA. Pyomyositis in North America: case reports and review. Clin Infect Dis 1992; 15:668.
- Bickels J, Ben-Sira L, Kessler A, Wientroub S. Primary pyomyositis. J Bone Joint Surg Am 2002; 84-A:2277.
- Chauhan S, Jain S, Varma S, Chauhan SS. Tropical pyomyositis (myositis tropicans): current perspective. Postgrad Med J 2004; 80:267.
- Horn CV, Master S. Pyomyositis tropicans in Uganda. East Afr Med J 1968; 45:463.
- Moriarty P, Leung C, Walsh M, Nourse C. Increasing pyomyositis presentations among children in Queensland, Australia. Pediatr Infect Dis J 2015; 34:1.
- Small LN, Ross JJ. Tropical and temperate pyomyositis. Infect Dis Clin North Am 2005; 19:981.
- Widrow CA, Kellie SM, Saltzman BR, Mathur-Wagh U. Pyomyositis in patients with the human immunodeficiency virus: an unusual form of disseminated bacterial infection. Am J Med 1991; 91:129.
- Schwartzman WA, Lambertus MW, Kennedy CA, Goetz MB. Staphylococcal pyomyositis in patients infected by the human immunodeficiency virus. Am J Med 1991; 90:595.
- Rodgers WB, Yodlowski ML, Mintzer CM. Pyomyositis in patients who have the human immunodeficiency virus. Case report and review of the literature. J Bone Joint Surg Am 1993; 75:588.
- Gomez-Reino JJ, Aznar JJ, Pablos JL, et al. Nontropical pyomyositis in adults. Semin Arthritis Rheum 1994; 23:396.
- Belsky DS, Teates CD, Hartman ML. Case report: diabetes mellitus as a predisposing factor in the development of pyomyositis. Am J Med Sci 1994; 308:251.
- Ansalonl L, Acaye GL, Re MC. High HIV seroprevalence among patients with pyomyositis in northern Uganda. Trop Med Int Health 1996; 1:210.
- Blumberg HM, Stephens DS. Pyomyositis and human immunodeficiency virus infection. South Med J 1990; 83:1092.
- Jellis JE. Viral infections: musculoskeletal infection in the human immunodeficiency virus (HIV) infected patient. Baillieres Clin Rheumatol 1995; 9:121.
- Holbrook KA, Klein RS, Hartel D, et al. Staphylococcus aureus nasal colonization in HIV-seropositive and HIV-seronegative drug users. J Acquir Immune Defic Syndr Hum Retrovirol 1997; 16:301.
- Miller M, Cespedes C, Vavagiakis P, et al. Staphylococcus aureus colonization in a community sample of HIV-infected and HIV-uninfected drug users. Eur J Clin Microbiol Infect Dis 2003; 22:463.
- Burkhart BG, Hamson KR. Pyomyositis in a 69-year-old tennis player. Am J Orthop (Belle Mead NJ) 2003; 32:562.
- Chusid MJ, Hill WC, Bevan JA, Sty JR. Proteus pyomyositis of the piriformis muscle in a swimmer. Clin Infect Dis 1998; 26:194.
- Jayoussi R, Bialik V, Eyal A, et al. Pyomyositis caused by vigorous exercise in a boy. Acta Paediatr 1995; 84:226.
- King RJ, Laugharne D, Kerslake RW, Holdsworth BJ. Primary obturator pyomyositis: a diagnostic challenge. J Bone Joint Surg Br 2003; 85:895.
- Koutures CG, Savoia M, Pedowitz RA. Staphylococcus aureus thigh pyomyositis in a collegiate swimmer. Clin J Sport Med 2000; 10:297.
- Meehan J, Grose C, Soper RT, Kimura K. Pyomyositis in an adolescent female athlete. J Pediatr Surg 1995; 30:127.
- Viani RM, Bromberg K, Bradley JS. Obturator internus muscle abscess in children: report of seven cases and review. Clin Infect Dis 1999; 28:117.
- Hsueh PR, Hsiue TR, Hsieh WC. Pyomyositis in intravenous drug abusers: report of a unique case and review of the literature. Clin Infect Dis 1996; 22:858.
- Ebright JR, Pieper B. Skin and soft tissue infections in injection drug users. Infect Dis Clin North Am 2002; 16:697.
- Lo TS, Mooers MG, Wright LJ. Pyomyositis complicating acute bacterial endocarditis in an intravenous drug user. N Engl J Med 2000; 342:1614.
- Crossley M. Temperate pyomyositis in an injecting drug misuser. A difficult diagnosis in a difficult patient. Emerg Med J 2003; 20:299.
- Rayes AA, Nobre V, Teixeira DM, et al. Tropical pyomyositis and human toxocariasis: a clinical and experimental study. Am J Med 2000; 109:422.
- Gubbay AJ, Isaacs D. Pyomyositis in children. Pediatr Infect Dis J 2000; 19:1009.
- Chiedozi LC. Pyomyositis. Review of 205 cases in 112 patients. Am J Surg 1979; 137:255.
- Martínez-Aguilar G, Avalos-Mishaan A, Hulten K, et al. Community-acquired, methicillin-resistant and methicillin-susceptible Staphylococcus aureus musculoskeletal infections in children. Pediatr Infect Dis J 2004; 23:701.
- Ruiz ME, Yohannes S, Wladyka CG. Pyomyositis caused by methicillin-resistant Staphylococcus aureus. N Engl J Med 2005; 352:1488.
- Zalavras CG, Rigopoulos N, Poultsides L, Patzakis MJ. Increased oxacillin resistance in thigh pyomyositis in diabetic patients. Clin Orthop Relat Res 2008; 466:1405.
- Fowler A, Mackay A. Community-acquired methicillin-resistant Staphylococcus aureus pyomyositis in an intravenous drug user. J Med Microbiol 2006; 55:123.
- Wang TK, Wong SS, Woo PC. Two cases of pyomyositis caused by Klebsiella pneumoniae and review of the literature. Eur J Clin Microbiol Infect Dis 2001; 20:576.
- Falasca GF, Reginato AJ. The spectrum of myositis and rhabdomyolysis associated with bacterial infection. J Rheumatol 1994; 21:1932.
- Lawn SD, Bicanic TA, Macallan DC. Pyomyositis and cutaneous abscesses due to Mycobacterium avium: an immune reconstitution manifestation in a patient with AIDS. Clin Infect Dis 2004; 38:461.
- Vigil KJ, Johnson JR, Johnston BD, et al. Escherichia coli Pyomyositis: an emerging infectious disease among patients with hematologic malignancies. Clin Infect Dis 2010; 50:374.
- Barakat MT, Gajurel K, Fischer K, et al. A Case of Meningococcal Pyomyositis in an Otherwise Healthy Adult. Open Forum Infect Dis 2016.
- Chu CK, Yang TL, Tan CT. Tuberculous pyomyositis of the temporal muscle in a nonimmunocompromised woman: diagnosis by sonography. J Laryngol Otol 2004; 118:59.
- Wang JY, Lee LN, Hsueh PR, et al. Tuberculous myositis: a rare but existing clinical entity. Rheumatology (Oxford) 2003; 42:836.
- Ahmed J, Homans J. Tuberculosis pyomyosits of the soleus muscle in a fifteen-year-old boy. Pediatr Infect Dis J 2002; 21:1169.
- Johnson DW, Herzig KA. Isolated tuberculous pyomyositis in a renal transplant patient. Nephrol Dial Transplant 2000; 15:743.
- Shih JY, Hsueh PR, Chang YL, et al. Pyomyositis due to Mycobacterium haemophilum in a patient with polymyositis and long-term steroid use. Clin Infect Dis 1998; 26:505.
- Shepherd JJ. Tropical myositis: is it an entity and what is its cause? Lancet 1983; 2:1240.
- Niamane R, Jalal O, El Ghazi M, et al. Multifocal pyomyositis in an immunocompetent patient. Joint Bone Spine 2004; 71:595.
- Peckett WR, Butler-Manuel A, Apthorp LA. Pyomyositis of the iliacus muscle in a child. J Bone Joint Surg Br 2001; 83:103.
- Nourse C, Starr M, Munckhof W. Community-acquired methicillin-resistant Staphylococcus aureus causes severe disseminated infection and deep venous thrombosis in children: literature review and recommendations for management. J Paediatr Child Health 2007; 43:656.
- Lin MY, Rezai K, Schwartz DN. Septic pulmonary emboli and bacteremia associated with deep tissue infections caused by community-acquired methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2008; 46:1553.
- Sharma A, Kumar S, Wanchu A, et al. Clinical characteristics and predictors of mortality in 67 patients with primary pyomyositis: a study from North India. Clin Rheumatol 2010; 29:45.
- Theodorou SJ, Theodorou DJ, Resnick D. MR imaging findings of pyogenic bacterial myositis (pyomyositis) in patients with local muscle trauma: illustrative cases. Emerg Radiol 2007; 14:89.
- Mitsionis GI, Manoudis GN, Lykissas MG, et al. Pyomyositis in children: early diagnosis and treatment. J Pediatr Surg 2009; 44:2173.
- Bertrand SL, Lincoln ED, Prohaska MG. Primary pyomyositis of the pelvis in children: a retrospective review of 8 cases. Orthopedics 2011; 34:e832.
- Struk DW, Munk PL, Lee MJ, et al. Imaging of soft tissue infections. Radiol Clin North Am 2001; 39:277.
- Quillin SP, McAlister WH. Rapidly progressive pyomyositis. Diagnosis by repeat sonography. J Ultrasound Med 1991; 10:181.
- Tichter A, Riley DC. Emergency department diagnosis of a quadriceps intramuscular loculated abscess/pyomyositis using dynamic compression bedside ultrasonography. Crit Ultrasound J 2013; 5:3.
- Hsu WC, Hsu JY, Chen MY, Liang CC. Obturator internus pyomyositis manifested as sciatica in a patient with subacute bacterial endocarditis: A rare case report. Medicine (Baltimore) 2016; 95:e4340.
- Scharschmidt TJ, Weiner SD, Myers JP. Bacterial Pyomyositis. Curr Infect Dis Rep 2004; 6:393.
- Predisposing factors
- - Immunodeficiency
- - Trauma
- - Injection drug use
- - Concurrent infection
- CLINICAL MANIFESTATIONS
- DIFFERENTIAL DIAGNOSIS
- Laboratory data
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- SUMMARY AND RECOMMENDATIONS