Pyomyositis: Difference between revisions
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==Treatment== | ==Treatment== | ||
*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 | ||
Revision as of 21:28, 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
- More commonly affects proximal lower extremity muscles
- 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
- 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