Aetiological Organisms Research Articles

Prevalence of reproductive tract infections including sexually transmitted infections among married women in urban and peri-urban mid to low socioeconomic neighbourhoods of Delhi, North India: an observational study protocol

IntroductionThe Global Health Sector Strategy on sexually transmitted infections (STIs), endorsed by the World Health Assembly in 2016 aims to end STIs as public health threat by 2030. WHO conducts...

Update on fungal keratitis in France: a case-control study.

To report an epidemiological update of documented fungal keratitis (FK) in a French tertiary ophthalmological centre from 2014 to 2018 in comparison with a previous period from 1993 to 2008. Sixty-two consecutive FK documented by microbiological corneal scrapings were compared with the 64 FK of the previous study. Amphotericin B and voriconazole eye drops were administered hourly. Population characteristics, clinical findings, aetiological organisms and treatments were analysed. The most frequently identified fungi were Fusarium (61%), Aspergillus (6.5%) and Candida (5%). Thirty out of 44 cases examined with invivo confocal microscopy (IVCM) presented filaments. Ten required conventional cross-linking, 9 therapeutic penetrating keratoplasty, and 2 enucleation. Risk factors significantly associated with the absence of response to medical treatment were patient age (p = 0.01), presence of a deep stromal infiltrate at presentation (p = 0.04) and high numbers of filaments in IVCM images (p = 0.01). The two populations were comparable in age, but not in sex ratio males/females (18/44 versus 37/26 in the previous study; p = 0.001). The frequency of contact lens-associated infection increased from 35.5% to 71% (p = 0.0001) between the two periods. Since then, filamentous FK increased from 69% (44/64) to 95% (59/62) (p = 0.0001). A history of keratoplasty was less frequently reported during the last period (3.2% (2/62) versus 17% (11/64) of cases (p = 0.01)). A clear decrease in the frequency of therapeutic keratoplasty was noted from 39% (25/64) to 14% (9/62) (p = 0.02). The frequency of filamentous keratomycosis is currently increasing. Elderly patients and the presence of numerous filaments in IVCM are associated with poor clinical outcomes.

Short Communication: Otitis externa in a tertiary care hospital in Zagazig, Egypt: Isolated pathogens and their antibiotic sensitivity patterns

Introduction: Recurrent otitis externa is a worldwide problem. This study aims to identify the different aetiological organisms isolated from otitis externa and their sensitivity to different antibiotics. Methods: A total of 27 patients with clinical presentation of otitis externa for a period of three weeks or more were enrolled for the study. Two swab samples collected from each infected ear were cultured for bacterial and fungi, and growth identified using standard microbiological methods including analytical profile index (API) system. Antibiotic susceptibility of isolated bacteria was performed by the disk diffusion technique. Results: Thirty one organisms were isolated from the 27 patients; 12 (38.7%) fungi and 19 (61.3%) bacteria species. Aspergillus spp was the most frequently isolated organism (35.4%) while Pseudomonas aeruginosa was the most frequently isolated bacteria (19.3%), and was most sensitive to amikacin. Four of 11 patients with Aspergillus infection showed clinical resistance to econazole local treatment but had complete clinical response to itraconazole oral treatment. Conclusion: Otitis externa in Egypt is caused by antibiotic resistant bacteria or fungi, and the most causative organisms are Aspergillus spp and Ps. aeruginosa. Keywords: Otitis externa, antibiotic resistance, Pseudomonas aeruginosa, Egypt

Prognostic factors associated with long-term mortality in 1445 patients with nontuberculous mycobacterial pulmonary disease: a 15-year follow-up study.

Limited data are available regarding the prognostic factors for patients with nontuberculous mycobacterial pulmonary disease (NTM-PD). We investigated the prognostic factors associated with long-term mortality in NTM-PD patients after adjusting for individual confounders, including aetiological organism and radiological form.A total of 1445 patients with treatment-naïve NTM-PD who were newly diagnosed between July 1997 and December 2013 were included. The aetiological organisms were as follows: Mycobacterium avium (n=655), M. intracellulare (n=487), M. abscessus (n=129) and M. massiliense (n=174). The factors associated with mortality in NTM-PD patients were analysed using a multivariable Cox model after adjusting for demographic, radiological and aetiological data.The overall 5-, 10- and 15-year cumulative mortality rates for the NTM-PD patients were 12.4%, 24.0% and 36.4%, respectively. On multivariable analysis, the following factors were significantly associated with mortality in NTM-PD patients: old age, male sex, low body mass index, chronic pulmonary aspergillosis, pulmonary or extrapulmonary malignancy, chronic heart or liver disease and erythrocyte sedimentation rate. The aetiological organism was also significantly associated with mortality: M. intracellulare had an adjusted hazard ratio (aHR) of 1.40, 95% CI 1.03-1.91; M. abscessus had an aHR of 2.19, 95% CI 1.36-3.51; and M. massiliense had an aHR of 0.99, 95% CI 0.61-1.64, compared to M. avium Mortality was also significantly associated with the radiological form of NTM-PD for the cavitary nodular bronchiectatic form (aHR 1.70, 95% CI 1.12-2.59) and the fibrocavitary form (aHR 2.12, 95% CI 1.57-3.08), compared to the non-cavitary nodular bronchiectatic form.Long-term mortality in patients with NTM-PD was significantly associated with the aetiological NTM organism, cavitary disease and certain demographic characteristics.

Prostate abscess: A comprehensive review of the literature

Prostate abscess (PA) is a rare but serious infection of the prostate gland. Traditionally a complication of urethral gonococcal infection, the majority of PAs are now seen in the older or immunosuppressed populations, in men with existing prostatic disease, or those who have undergone recent instrumentation of the lower urinary tract. Aetiological organisms are diverse, often with non-specific presentations posing a diagnostic challenge. Multiple management options have been described, however no consensus exists on what is the best practice. This comprehensive review examines the literature surrounding this condition in detail, with a focus on diagnostic and surgical treatment options. Recommendations for practice are made where appropriate. This article aims to edge towards a national guideline for the management of PA and inspire more research in the field.Level of evidence - 3a

IL-1β induces increased tight junction permeability in bovine mammary epithelial cells via the IL-1β-ERK1/2-MLCK axis upon blood-milk barrier damage.

Bovine mastitis occurs frequently in dairy cows and is often caused by various aetiological organisms, for example, Escherichia coli. Lipopolysaccharide (LPS) is a key virulence factor of E. coli. In this study, we stimulated bovine mammary epithelial cells (BMECs) with LPS to investigate the global transcriptional response and identify specific proinflammatory factors that play important roles in blood-milk barrier damage during mastitis caused by E. coli. By performing RNA-seq, we identified a large number of significantly differentially expressed genes (DEGs) between the LPS-treated BMECs and the control cells. Among the DEGs, interleukin-1β (IL-1β) was selected because its messenger RNA expression was induced by LPS and its enrichment is involved in multiple inflammatory signal pathways, and its roles in blood-milk barrier damage during the process of mastitis were investigated. Exogenous IL-1β treatment damaged the integrity of the blood-milk barrier, as indicated by the increased BMEC tight junction (TJ) permeability and confirmed by in vitro and in vivo experiments. Furthermore, the IL-1β-induced increase in the BMEC TJ permeability was mediated by the IL-1β-ERK1/2-MLCK axis pathway. Our data provide insights into the functions of IL-1β in blood-milk barrier damage caused by mastitis in dairy cows.

Evaluation of daptomycin combinations with cephalosporins or gentamicin against Streptococcus mitis group strains in an in vitro model of simulated endocardial vegetations (SEVs)

Among viridans group streptococcal infective endocarditis (IE), the Streptococcus mitis group is the most common aetiological organism. Treatment of IE caused by the S. mitis group is challenging due to the high frequency of β-lactam resistance, drug allergy and intolerability of mainstay antimicrobial agents such as vancomycin or gentamicin. Daptomycin has been suggested as an alternative therapeutic option in these scenarios based on its excellent susceptibility profile against S. mitis group strains . However, the propensity of many S. mitis group strains to rapidly evolve stable, high-level daptomycin resistance potentially limits this approach. We evaluated the activity of 6 mg/kg/day daptomycin alone or in combination with gentamicin, ceftriaxone or ceftaroline against two daptomycin-susceptible S. mitis group strains over 96 h in a pharmacokinetic/pharmacodynamic model of simulated endocardial vegetations. Daptomycin alone was not bactericidal and high-level daptomycin resistance evolved at 96 h in both organisms. Combinations of daptomycin + ceftriaxone and daptomycin + ceftaroline demonstrated enhanced killing activity compared with each antibiotic alone and prevented emergence of daptomycin resistance at 96 h. Use of gentamicin as an adjunctive agent neither improved the efficacy of daptomycin nor prevented the development of daptomycin resistance. Addition of ceftriaxone or ceftaroline to daptomycin improves the bactericidal activity against S. mitis group strains and prevents daptomycin resistance emergence. Further investigation with combinations of daptomycin and β-lactams in a large number of strains is warranted to fully elucidate the clinical implications of such combinations for treatment of S. mitis group IE.

Characterisation of invasive clinical Haemophilus influenzae isolates in Queensland, Australia using whole-genome sequencing.

Haemophilus influenzae is an important aetiological organism of both adult and child respiratory disease. The number of non-typeable (NTHi) invasive H. influenzae isolates referred to the Queensland (QLD) Public Health Microbiology laboratory has increased notably year-by-year. In this study we used whole-genome sequencing to molecularly characterise 100 referred invasive H. influenzae, including 74 NTHi isolates over a 15-year period, observing the carriage of capsular and putative virulence genes, including the major adhesins, antimicrobial resistance genes and population diversity. Encapsulated isolates were largely clonal, however NTHi isolates displayed high genetic variability by MLST and single nucleotide polymorphism typing with no dominant clone observed. The only mechanism for β-lactam resistance identified in the QLD isolates was β-lactamase production. No single set of virulence determinants was conclusively associated with invasive QLD NTHi isolates.

Clinical and microbiological study of paediatric infectious keratitis in South India: a 3-year study (2011–2013)

PurposeTo study the risk factors, microbiological profile and clinical outcomes of infectious keratitis affecting paediatric patients.Study designRetrospective case series.MethodsReview of case records of paediatric patients (0–16 years) diagnosed with infectious...

Clinical Features and Haematological Indices of Neonatal Septicaemia in Poor Resource Setting

Background: The burden of neonatal septicaemia has remained high worldwide and even more severe in the developing countries like ours. Clinical manifestation is variable and non-specific thereby resulting in delay in diagnosis. Blood culture which is the gold standard for diagnosis of neonatal septicaemia (NNS) has many drawbacks due to long waiting time for culture process, low yield, improper inoculation adding to the problem of late diagnosis. Haematological parameters have been utilized in rapid and early diagnosis of NNS and prompt treatment thus circumventing problems associated with drawbacks in blood culture. Objective: The study was to identify the common clinical features of neonatal septicaemia and haematological indices that were commonly utilized in rapid diagnosis of NNS, and also to determine their sensitivity, specificity, positive predictive and negative predictive value. Materials and Methods: The study was prospective and neonates that had clinical features suggestive of neonatal septicaemia were enrolled consecutively into the study. The patients were appropriately investigated including blood cultures, CSF cultures and urine among others, also blood sample for packed cell volume (PCV), total white cell count (TWBC), absolute neutrophil count (ANC), absolute platelet count (APC). Immature to mature neutrophil ratio (I/MNR), immature to total neutrophil ratio (I/TNR) and micro-ESR (erythrocyte sedimentation rate) was also done and analyzed. Results: The common clinical symptoms were fever 39.5%, poor feeding 33.6%, excessive cry 38.7%, difficulty in breathing 50.0%, yellowish skin 26.9%, while the common physical signs were hyper/hypothermia 41.1%, tachypnoea 41.2%, septic umbilical stump 64.0%, hepatomegally 37.3% and convulsions 42.0%. Blood culture yield was positive in 41.82% and mortality was as high as 28.00%, the incidence of NNS was 5.9/1000 live births. The haematological parameters as marker of NNS PCV, TWBC, ANC, APC, I/MNR, I/TNR and micro-ESR individually were statistically significant (P < 0.05), also their individual sensitivity, specificity, positive and negative predictive values were highly associated with neonatal septicaemia. However, when they were tested in combinations these markers of neonatal septicaemia had low sensitivity, specificity and their predictive values were weak in excluding NNS. Conclusions: The need for early and rapid diagnosis of NNS is pertinent, culturing of the appropriate specimens remains the only way to identify the aetiological organisms, but is associated with delay. Haematological indices are excellent markers of NNS and analysis is rapid and can easily be done in our laboratory settings, and when utilized efficiently, it would circumvent the delay associated with blood culture for long waiting period for the result, thereby reducing morbidity and mortality.

Molecular Diagnosis In Infectious Keratitis

Microbial keratitis is a very important public health problem in our country. The magnitude of the burden of this problem is not often fully understood and hence it is often termed as a “silent epidemic”. The affected population are often the vulnerable members of the society like people working in fields, warehouses and manual unskilled labour intensive activities. Very often, these affected individuals delay their presentation to an ophthalmologist and often indulge in self medications. Even though classic clinical features have been described for various aetiological organisms causing keratitis, it is extremely difficult to accurately predict the same by clinical examination alone. Microbiological support systems are extremely important and mandatory for diagnosing and ultimately treating this problem. While routine microbiological investigations like smears and cultures remain the backbone of the armamentarium, newer molecular tests such as polymerase chain reaction (PCR) tests are useful in certain indications. These tests are useful to detect slow growing organisms, fastidious organisms and may offer a comparative quick diagnosis. This review offers the current applications of the use of these molecular tests with reference to suppurative microbial keratitis.

Ventilator associated pneumonia in major paediatric burns

More than three-quarters of deaths related to major burns are a consequence of infection, which is frequently ventilator associated pneumonia (VAP). A retrospective study was performed, over a five-year period, of ventilated children with major burns.92 patients were included in the study; their mean age was 3.5 years and their mean total body surface area burn was 30%. 62% of the patients sustained flame burns, and 31% scalds. The mean ICU stay was 10.6 days (range 2–61 days) and the mean ventilation time was 8.4 days (range 2–45 days). There were 59 documented episodes of pneumonia in 52 patients with a rate of 30 infections per 1000 ventilator days. Length of ventilation and the presence of inhalational injury correlate with the incidence of VAP. 17.4% of the patients died (n=16); half of these deaths may be attributed directly to pneumonia.Streptococcus pneumonia, Pseudomonas aeruginosa, Acinetobacter baumanii and Staphylococcus aureus were the most prominent aetiological organisms. Broncho-alveolar lavage was found to be more specific and sensitive at identifying the organism than other methods.This study highlights the importance of implementing strictly enforced strategies for the prevention, detection and management of pneumonia in the presence of major burns.

In Silico Identification of Novel Candidate Drug Targets in Haemophilus Influenzae Rd KW20

Background: Globally, respiratory diseases cause an estimated 1.9 million deaths per year. One of the most important aetiological organisms of both adult and childhood respiratory disease is Non-Typeable Haemophilus influenzae (NTHi). NTHi is frequently isolated from the respiratory tract during episodes of sinusitis, Otitis Media and pneumonia and is the most common cause of Chronic Obstructive Pulmonary Disease (COPD) and bronchiectasis exacerbations. Methods: The work has been effectively complemented with the compilation of the Database of Essential Genes (DEG) of H. influenzae Rd KW20. Each protein is subjected to BLASTP in NCBI server http://www.ncbi.nlm.nih.gov/blastp. The candidate drug targets are determined by KAAS (KEGG Automatic Annotation Server), KEGG ORTHOLOGY and KEGG GENES. Results: The given gram negative bacteria H. influenzae Rd KW20 has six distinguished domains i.e., cytoplasmic, cytoplasmic membrane, periplasmic, outer membrane, extracellular and unknown domains. Out of 642 essential genes, the predicted non-human Homologous are 412 in the different domain of given bacteria. With the help of KAAS (KEGG Automatic Annotation Server), KEGG ORTHOLOGY and KEGG GENES, we successfully identified 35 novel drug targets which have common metabolic pathways both in host and pathogen & pathogen specific metabolic pathways. Conclusion: The novel drug targets suggest those genes which are active in both the host and pathogen metabolic pathway and should be a pathogen specific metabolic pathway. The important drug target regions are vacJ, lepB, emrB, MurG & dgkA. vacJ is present in outer membrane while lepB, emrB, MurG&dgkA are present in cytoplasmic membrane. All these genes are fully sequenced and specifically annotated in KEGG PATHWAY.

Clinical analysis of deep cutaneous mycoses: a 12‐year experience at a single institution

Deep cutaneous mycoses can cause significant morbidity and mortality, especially in immunocompromised patients. There have been few studies focusing on deep cutaneous mycoses and there are no data from Asian countries. This study aimed to investigate clinical characteristics, underlying predisposing factors, aetiological organisms and outcomes in patients with deep cutaneous mycoses. A retrospective medical record review of patients with deep cutaneous mycoses treated at a tertiary referral centre in Korea from 1999 to 2010. Forty-one cases of deep cutaneous mycosis were identified (median age: 49). Most patients (32/41) had impaired immunological status, and seven of the remaining nine had a history of physical trauma. Neutropenia and long-term use of antibiotics were detected in 13 and 12 patients respectively. Nodular skin lesions were the most common type (17/41) and the morphology of the lesions varied. Fungal organisms were identified by culture and histopathology of skin specimens. Candida (16/41) was the most common organism, followed by Aspergillus, Alternaria, Fusarium (4/41 each). Systemic antifungal treatment was successful in 28 patients, while nine patients died from the fungal infection. Our study may lead to improved insights into deep cutaneous mycoses as their incidence is increasing and they vary in different clinical settings.

Aetiological agents in chronic suppurative otitis media in Sri Lanka

Chronic suppurative otitis media (CSOM) is assumed to be a complication of acute otitis media (AOM), but the risk factors for CSOM are not clear. 1. To study the aetiological organisms for CSOM. 2. To identify the effect of demographic factors on disease manifestation. This retrospective study included a case series of 234 patients who had been admitted to National Hospital of Sri Lanka (NHSL), with the complaint of ear discharge and from whom the specimens were sent for microscopy and culture at Department Of Microbiology, NHSL. The period of analysis was 1 year extending from 1 January 2009 to 31 December 2009.Consecutive patients who fulfilled the inclusion criteria were recruited to the retrospective analysis. Among 234 patients studied, 129 (55.1%) were male and 150 (64.1%) were under 40 yrs old. The mean age was 39.5 yrs (range 12 to 60 yrs, SD = 22.6). The mean duration of ear discharge was 1.2 yrs. (range 6 weeks to 20 yrs.) Pseudomonas species (29.5%) was the commonest microbial organism to cause ear discharge, followed by staphylococcus (20.5%) and coliform (16.7%) species. Among the fungal agents identified, candida was the most common. 23.1% of the cultures did not reveal any microbiological agent. Eighteen patients (8%) had a prior history of trauma to the affected ear and 51 patients (21.8%) were diagnosed with diabetes mellitus. The commonest microbial agents implicated in CSOM was pseudomonas species followed by staphylococci and coliforms. Demographic variables such as gender or age did not seem to affect the disease manifestation significantly, though CSOM was less common among elderly and women.

Evidence of intravenous immunoglobulin as a critical supportive therapy against Clostridium difficile toxin-mediated lethality in mice

Clostridium difficile produces toxins and is an aetiological organism of pseudomembranous colitis. Immunoglobulin is one of the treatment strategies against fulminant C. difficile infections, but the clinical evidence is still limited. We examined the efficacy of intravenous immunoglobulin (IVIg) in C. difficile toxin (CDT)-mediated lethality and cellular injury in mice. Mice were intraperitoneally injected with 0.2 mL of filter-sterilized C. difficile culture supernatant (CDT preparation). The IVIg preparation was intravenously administered at several timepoints. We also examined alteration of intestinal permeability and an apoptosis marker in the gut. In in vitro experiments, HEp-2 cells were incubated with a CDT preparation in the presence or absence of the IVIg preparation, after which cell viability and lactate dehydrogenase release were examined. All control mice died by day 2 after injection of the CDT preparation. The maximum effects of IVIg (100% survival) were observed when the mice were treated with IVIg at the same time as injection of the CDT preparation. The IVIg effects were closely associated with improvement of intestinal vascular permeability and mucosal damage in the gut. In addition, reduction of an apoptosis marker (histone-associated DNA fragments) was demonstrated in the mice treated with IVIg. Interestingly, a smaller increase in histone-associated DNA fragments was observed in FasL-deficient mice treated with the CDT preparation compared with wild-type. These data demonstrated that IVIg may be protective against CDT-mediated lethality, when administered at the appropriate time. The present data also suggest an increase in intestinal permeability, probably through exaggeration of Fas/FasL-mediated apoptosis, as a key mechanism of C. difficile-mediated diseases.

Community acquired pneumonia in Port Harcourt River State of Nigeria

Community acquired pneumonia (CAP) is a major cause of death world wide. Knowledge of the likely pathogens and their sensitivity/resistance pattern can help in the choice of antibiotic therapy and improve outcome. To identify the seasonal variation; age and sex distribution; bacteriology; antimicrobial sensitivity pattern of isolates; haematological data; radiology and clinicaloutcome of community-acquired pneumonia (CAP) in adult patients admitted to hospital in Port Harcourt, Nigeria. Prospective study. University of Port Harcourt Teaching Hospital, and Braithwaite Memorial Hospital, Port Harcourt, Rivers State. Adults admitted to the hospitals with CAP between 1 May 2002, and 30 April 2003. A diagnostic strategy using regular collection of sputum samples for gram stain, bacteriological culture and chest radiography were done. Blood cultures were done in severe cases. Antibiotic sensitivity testing was done on the positive cultures. During a 12 month period, 54 patients aged 16 to 82 years (mean 38.1 years) were evaluated. A total of 944 medical admissions were seen during the same period. This gives a prevalence rate of 5.7%. Twenty six classes of bacteria were isolated from the sputum of 23 patients (yield, 42.6%). Streptococcus pneumoniae, the most common pathogen, was isolated in nine cases (34.6%), followed by Klebsiella pneumoniae which was present in eight (30.8%). Other isolates included, Escherichia coli, four cases (15.4%), Pseudomonas aeruginosa, three cases (11.5%), and Staphylococcus aureus, two cases (7.7%). The commonest radiological pattern was lobar consolidation (49.9%) with no Distinct pattern associated with any conventional bacterial pathogen. The isolates showed good sensitivity to the newer and more expensive antibiotics (quinolines and cephalosporines) with marked resistance to the older and cheaper ones. However, clinical responses to benzyl penicillin and gentamycin were found to be good. Out of 54 patients evaluated, four (7.4%) died. Streptococcus pneumoniae and Klebsiella were common aetiological organisms of CAP in Port Harcourt. Treatment of CAP with benzyl penicillin remains an appropriate first line choice in this environment while the more expensive quinolines and cephalosporines can be used as backups.

Infección nosocomial en postoperados de cirugía cardíaca

Nosocomial infection (NI) is a possible complication in patients who undergo cardiac surgery, and represents an important cause of morbidity and mortality. This study was undertaken to determine the NI rate, main risk factors, and microbial spectrum in a paediatric intensive care unit (PICU) for this group of patients. A prospective review was performed, including all patients admitted to the PICU after cardiac surgery between December 2003 and November 2004. NI was defined according to Centers for Disease Control criteria. Sixty-nine patients were included. Sixteen patients (23.2 %) acquired at least one episode of NI. The NI rate was 4.9 per 100 patient-days. The most common NI was pneumonia, followed by urinary tract infection. There were no episodes of sepsis. No patients died from infectious causes. The main aetiological organism was Haemophilus influenzae, associated with 41.6 % of pneumonias, and followed by Pseudomonas aeruginosa. No multiresistant organisms were isolated. There was a statistically significant association between the duration of use of external devices (mechanical ventilation, urinary and central venous catheterization) and development of NI. Aggressive monitoring and support devices are the main risk factors for NI. Based on our data, we suggest early removal of these. Presumed NI should be diagnosed according standard criteria before starting antibiotic therapy, and treatment modified depending on culture results.

Human adenoviruses types associated with non-gonococcal urethritis

Role of adenoviruses in non-gonococcal urethritis (NGU) has been reported in only a few studies. The aim of the study was to detect and type adenoviruses in men presenting with NGU. 636 heterosexual and homosexual men presenting with NGU from Melbourne, Australia were recently evaluated for various aetiological organisms including adenovirus. We utilised methods including polymerase chain reaction for detection followed by sequence analysis to type positive samples. Overall, 12 samples from patients with NGU had adenovirus detected. Five types were identified: type 4 (subgenus E), type 35 (subgenus B), and types 9, 37 and 49 (subgenus D). The presence of mixed adenovirus strains was not detected in any sample. Overall, subgenus B, D and E were predominant in this patient population.

Acute iliopsoas and adductor brevis abscesses presenting with proximal leg muscle weakness

Pyomyositis is a bacterial infection of skeletal muscle. We describe the clinical case of a 77-year-old woman affected by gait disturbance, repetitive falls, low back pain and left thigh and groin pain, but without symptoms of systemic infection. Computed tomography and magnetic resonance imaging of the abdomen and pelvis showed abscesses in the left psoas and adductor brevis muscles. Investigations of urogenital tract and gastrointestinal system were normal. Systemic antibiotic treatment alone was not efficient, while surgical drainage improved the clinical picture. The aetiological organism, isolated from the abscess, was Staphylococcus aureus. We suggest that this patient had a primary pyomyositis rather than a secondary form. This is the first report of concomitant abscesses of psoas and adductor brevis muscles with early neurological involvement.