Pyomyositis In Children Research Articles

Primary Bacterial Pyomyositis in Children: A Systematic Review.

Tropical pyomyositis has had a recent increase in the United States, Europe, and other nontropical areas. The purpose of this study was to provide an accurate description of the demographics, presenting features, sites of involvement, microbiology, imaging modalities, medical and surgical management, complications, and predictors of clinical course. We searched PubMed, Cochrane, Web of Science Collection, Scopus, and Embase databases yielding 156 studies. Of these, 23 articles were selected for statistical analysis. The average age at presentation was 8.4±1.9 years with males more commonly affected. Fever, painful limp, and localized pain were the most common presenting symptoms. Pelvis, lower extremity, trunk and spine, in descending order, were the most commonly affected locations. Iliopsoas, obturator musculature, and gluteus musculature were the most commonly affected muscle groups. The mean time to diagnosis was 6.6±3.05 days. Staphylococcus aureus was the most common offending organism. The mean length of hospital stay was 12.0±4.6 days. Medical management alone was successful in 40% of cases (143/361) with an average duration of 9.5±4.0 and 22.7±7.2 days of intravenous and oral antibiotics, respectively. Surgical management consisted of open drainage in 91.3% (199/218) or percutaneous drainage in 8.7% (19/218) of cases. Painful limp, fever, and larger values of white cell count and erythrocyte sedimentation rate were associated with an increased need for surgery. Obturator and calf muscle involvement were strongly associated with multifocal involvement. There were 42 complications in 41 patients (11.3%). Methicillin-resistant S. aureus was associated with an increased risk of complications. The most common complications were osteomyelitis, septicemia, and septic arthritis. Primary pyomyositis should be considered in cases suggesting pediatric infection. Magnetic resonance imaging is the most commonly used imaging modality; however, ultrasound is useful given its accessibility and low cost. Medical management alone can be successful, but surgical treatment is often needed. The prognosis is favorable. Early diagnosis, appropriate medical management, and potential surgical drainage are required for effective treatment. Level IV-systematic review.

Multifocal Οsteomyelitis Localization after Pyomyositis in Children: Importance of Timely Response.

Pyomyositis is a rare bacterial infection that used to prevail in tropical areas for the past century. Nowadays though, more and more cases are reported in high-temperature climate areas. Diagnosis is often delayed due to the variance in clinical presentation, the challenging nature of physical examination of a child, and lack of specific laboratory investigating tools. When the diagnosis is delayed, the outcome may be unpredictable. Multifocal localization through hematogenous or direct spread that may affect the skeletal bone tissue is common. Timely diagnosis and response is a race against septic shock.We present a case series of seven children diagnosed with pyomyositis due to Staphylococcus aureus. High or less clinical suspicion has obviously affected the final outcome since two patients who were not treated in time were subjected to a life-threatening hazard. Five patients who were diagnosed and treated within the first three days after initiation of their symptoms had a predictable and good outcome without complications.

Pelvic pyomyositis in children: changing trends in occurrence and management.

We present the largest series of paediatric pelvic pyomyositis from a temperate country, analyse the factors influencing long term prognosis and suggest a diagnostic protocol. We included 41 patients diagnosed with primary paediatric pelvic pyomyositis between 1998 and 2016, in this study with a mean age of 7.5years. Demographic, clinical, radiological and follow-up data were reviewed. Statistical analysis was performed to analyse the influence of early diagnosis and treatment on the final outcome. There was an increased occurrence of primary pelvic pyomyositis in the last two years. Of cases identified, 85% fulfilled Kocher's criteria for hip septic arthritis. The mean time to diagnosis was 2.8 ± 0.8days. The most common muscle affected was obturator internus (65.85%) and multifocal involvement was common (46.34%). Early diagnosis and antibiotic treatment within sevendays from the time of onset of symptoms was the only factor that influenced final outcome (p < 0.001). Pyomyositis is no longer restricted to tropical countries. The time from onset of symptoms to start of antibiotic treatment influences the final outcome. Clinical examination and inflammatory markers have low specificity in distinguishing between pyomyositis, septic arthritis, osteomyelitis or other infections. MRI is more sensitive and can diagnose pyomyositis in its early stages. Every suspected case of septic arthritis of the hip should undergo an ultrasound. MRI scan may be performed if the ultrasound shows inconclusive evidence of an effusion. Early identification will facilitate early antibiotic treatment which will improve the final outcome. There is an increasing occurrence of this tropical disease in temperate countries. Early diagnosis with an MRI scan and early antibiotic use results in good outcomes.

Primary pyomyositis in children.

Pyomyositis (PM) is defined as a primary pyogenic infection of the striated skeletal muscle; although it has many dystrophic musculoskeletal complications, it is always misdiagnosed by many orthopedic surgeons. PM is rare in temperate climates and usually considered to be a tropical disease, until recent times, after globalization, it is possible to occur in the subtropical climate as in our country. In the present series, the results of 15children patients with primary pyomyositis have been reviewed. In five out of them, conservative treatment protocol alone which has been by intravenous and oral antibiotics therapy was effective. The remaining ten patients with confirmed abscess formation needed invasive procedures which have been percutaneous US-guided drainage in two patients and an open surgical drainage in the remaining 8patients. Conservative treatment was successful in five cases with marked improvement within 3days, but in the other ten patients who needed surgical treatment, all were effectively treated except three out of them who were complicated as follows; elbow stiffness in one case, hip joint septic arthritis with epiphysitis in the second case and osteomyelitis of the lower femoral end with knee joint septic arthritis in last one. Both clinical picture and laboratory investigation of PM are not specific and resembled many other differential diagnoses so the proper imaging study is of valuable importance needs to be accurately identified and treated to avoid its delayed complications. In children complaining of joint pain or muscle aches and septic-appearing, pyomyositis should be considered in the differential diagnosis. MRI is the most valuable tool for diagnosis of PM. Early diagnosis, the use of appropriate antibiotic therapy and complete drainage of the purulent material are important factors for successful treatment that leads to complete resolution of PM. IV.

Pyomyositis in Children.

Primary pyomyositis in children is prevalent in the tropics and increasingly being recognised from temperate regions. Staphylococcus aureus remains the principle causative organism worldwide, while proportion of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is on rise. Commonly involved groups are around the pelvis and lower limbs. Clinical presentation depends on the stage of disease, most commonly a child presenting with limping with fever. Early diagnosis and management are crucial. The investigation of choice is MRI scan. Appropriate antibiotic treatment should be instituted at the earliest opportunity along with drainage. Majority of patients show excellent and complete recovery with no long-term complications once treatment is started early. A high level of awareness and suspicion of this condition is warranted from all paediatric clinicians.

FRI0533 Primary Pyomyositis in Children: A Retrospective Review of 25 Cases

BackgroundPrimary pyomyositis is a rare condition in children that should be included in the differential diagnosis of musculoskeletal infections.ObjectivesTo describe the clinical features of pyomyositis as well as its diagnostic...

Tropical Pyomyositis in Children: 10 Years Experience of a Tertiary Care Hospital in Northern India

Tropical pyomyositis (TP) is characterized by suppuration within skeletal muscles, manifesting as single or multiple abscesses. It has been reported frequently from Africa and Latin America. However, there are only a few cases reported in children from India. Between January 2002 and December 2011, 40 children with TP were admitted to our hospital, and their retrospective review formed the study material. TP is not an uncommon disease in children in Northern India, especially during rainy seasons. Most of the patients were admitted with short history of fever, pain and localized swelling. Pus drainage was done in 87.5% cases, with the amount of pus varying from 5 to 2000 ml. The pus grew methicillin-sensitive Staphylococcus aureus (MSSA) in 42.5% cases, whereas initial blood cultures were sterile. All received antibiotics along with surgical drainage, and recovered. It is important for health professionals to have a high index of suspicion and familiarity with this imminently treatable disease entity.

Pyomyositis in children: a report of two cases

Pyomyositis in children: a report of two cases

Imaging on pelvic pyomyositis in children related to pathogenesis

Pelvic pyomyositis in children is a rare infectious condition, although it is increasingly reported in temperate climates. Often considered a primary disease, new diagnostic methods are able to identify additional foci of infection. The purpose of this study is to review our patients and to analyze the imaging studies to determine its pathogenesis. A retrospective study of the clinical charts and imaging records of 11 patients was made, noting the number and location of muscles involved, as well as bone and joint involvement. Besides the classical form of pelvic pyomyositis, i.e., iliopsoas pyomyositis, other muscular groups were frequently affected, often with multiple involvement. Bone involvement is also frequent. Magnetic resonance imaging (MRI) gives the most useful information. MRI is the diagnostic procedure of choice for diagnosing pelvic pyomyositis in children. It may also have an elucidating role in the debated pathogenesis of this condition. In most of the cases, pelvic pyomyositis in children could be secondary.

Pyomyositis in children: early diagnosis and treatment

Purpose This study was conducted to evaluate early diagnosis, clinical course, and treatment outcome in children with pyomyositis. Methods Between 2001 and 2006, 6 children with a mean age of 7.2 years were diagnosed and treated for pyomyositis in our clinic. The most common site of involvement was the hip and thigh region. All patients underwent early magnetic resonance imaging (MRI) examination that played a significant role in the early diagnosis and management of the disease. Results Staphylococcus aureus was the most common pathogen and was identified in 3 cases. Intravenous antibiotics were administered and were followed by oral agents for an additional period. The duration of therapy ranged from 3 to 6 weeks. No surgical intervention was needed. Magnetic resonance imaging was used to evaluate response to the therapy. Conclusions Although pyomyositis is a rare disease, it should be considered in the differential diagnosis of immediate onset of musculoskeletal pain in children. Early diagnosis and antibiotic treatment are important as major complications such as abscess formation and sepsis can be avoided. Having a high sensitivity to reactive inflammatory changes, MRI is a valuable tool in the armamentarium of the clinician in early diagnosis of pyomyositis.

Tropical primary pyomyositis in children of the UK: an emerging medical challenge

Pyomyositis is a commonly encountered condition in the tropics. It was not described in the UK until 1998. The reason for the increasing incidence is not understood. We sought to identify the experience gained of this condition within a UK paediatric tertiary referral unit. Retrospective review of cases of pyomyositis from our institution since 1998 was undertaken to identify demographics, presentation, diagnosis and management. Thirteen cases were identified. The obturator internus was most commonly affected (62%). Staphylococcus aureus was cultured in nine cases (69%). One diagnostic retroperitoneal exploration was performed and all cases were identified by computed tomography or magnetic resonance imaging. To our knowledge, this is the first UK series of pyomyositis, reflecting its increasing Western incidence. Early diagnosis and treatment with antibiotics is all that is needed in the majority of cases. A greater awareness of this emerging condition is necessary to prevent misdiagnosis and unnecessary surgical intervention by all surgeons.

Pyomyositis in children; two cases report

Pyomyositis in children; two cases report

Correspondence: Tropical pyomyositis in children

Correspondence: Tropical pyomyositis in children

The Role of Pelvic Magnetic Resonance in Evaluating Nonhip Sources of Infection in Children With Acute Nontraumatic Hip Pain

We retrospectively identified all children with acute hip pain who underwent pelvic magnetic resonance (MR). Children with septic hip or history of trauma were excluded; the remaining children with signs of infection (fever, >38 degrees C; leukocytosis, >12 x 10(9)/L; or elevated erythrocyte sedimentation rate [ESR], >30 mm/h) comprised the study group. Thirty-three children (9 girls; age, 0.8-15.8 years) were identified. On MR examination, 18 (55%) of 33 children had hip joint effusion, whereas 19 (58%) of 33 children had other abnormalities, including pyomyositis (n=15), osteomyelitis (n=12), and sacroiliitis (n=3). Staphylococcus aureus was cultured from 13 (68%) of these 19 children. Compared with MR, sensitivity for bone and soft tissue abnormalities was 30% for pelvic radiography (n=26) and 71% for bone scintigraphy (n=8). Elevated ESR (>30 mm/h) was the clinical finding that best predicted pelvic osteomyelitis or pyomyositis. Pelvic MR should be performed to rule out pelvic osteomyelitis or pyomyositis in children with acute hip pain, ESR of more than 30 mm/h, and no evidence of septic hip.

R2318 Pyomyositis in children

R2318 Pyomyositis in children

Pyomyositis in children: report of three cases and review of the literature

In temperate places, pyomyositis is uncommon in children and adolescents. We report 3 cases of pyomyositis in boys aged 11, 13 and 16 years. Staphylococcus aureus was the etiologic agent in all cases. Antibiotics therapy alone, or associated to surgical treatment was performed to resolve the infections. We describe the clinical and radiological work-up used to arrive at a diagnosis, and review the literature on this infection, which could be easily misdiagnosed because of its rarity outside of tropical climates.

Primary pyomyositis in children: a retrospective analysis of 11 cases

This study was undertaken to review our approach to diagnosis and treatment in a series of 11 patients (mean age 8.2 years) with primary pyomyositis, who had neither an underlying disease nor a compromised immune system. Nine of the children had positive blood cultures, Staphylococcus aureus (eight) and Streptococcus group A (one). The sites of infection were iliopsoas (four), obturator (two), hip adductors (two), levator scapula (one), thoracolumbar paraspinal (one) and gastrocnemius (one) muscles. Antibiotic treatment was initially intravenous, followed by oral administration. Of five patients with evidence of abscess formation, three underwent percutaneous drainage, whereas two required open surgical drainage. The infection resolved completely without any sequela in 10 children. One patient who developed acute compartment syndrome showed late signs of osteonecrosis of the tibial shaft segment.

3477: Primary pyomyositis in children: Sonographic appearance

Objectives: Primary pyomyositis is rare, subacute, deep bacterial infection of skeletal muscle not associated with contiguous infection of the skin, bone or soft tissues. Most common in first to second decades of life, male predominance. Methods: Fourteen children (mean age 8.2y) diagnosed and successfully treated for primary pyomyositis are presented with emphasis on imaging, especially sonographic evaluation. Sites of infection were iliopsoas, obturator, hip adductors, levator scapula, thoracolumbar paraspinal and gastrocnemius muscles. The imaging modalities involved were plain radiographs, isotope scans, ultrasonography, CT and MRI. The follow up studies were mainly ultrasound. Results: Sonographic findings included thickening and hypoechogenicity along affected muscles, fluid collections between muscle fibers c/w abscess formation and required drainage. Iliopsoas and hip muscles when involved were associated with hip effusion. The infection resolved completely in 11 patients; one patient developed acute compartment syndrome of the calf and later osteonecrosis of the tibial shaft. Conclusions: US was helpful for detection of pyomyositis, for percutaneous drainage, for ruling out bony involvement and for routine monitoring until full recovery.

Pyomyositis of the quadratus femoris and gluteus minimus in two children

There has been an increase in the prevalence of pyomyositis in children living in temperate climates over recent years. Its presentation in the muscles surrounding the pelvis is similar to other diseases of the hip joint including septic arthritis and transient synovitis. This can lead to a delay in diagnosis and treatment. We present two cases of pyomyositis in children, at previously undescribed sites, highlight the importance of careful clinical examination and underline that MRI remains the gold standard for accurate diagnosis. Prompt treatment can prevent abscess formation and thus the need for surgical intervention.

Ultrasound and MRI features of pyomyositis in children.

Pyomyositis (PM) is an infectious disease of the skeletal muscle with a wide range of symptoms such as pain, fever or swelling, and is predominantly found in the tropics. In recent years PM has increasingly been diagnosed in Europe and in the U.S. Our objective is to describe the ultrasound and MRI features of PM in children. A retrospective analysis of 12 children with PM (2 girls and 10 boys; age range 1-13 years) admitted to our hospital between 1998 and 2002 was carried out. All children had a US exam and 8 children underwent MRI. Children with osteomyelitis and accompanying myositis were excluded from this study. In all patients who had MRI ( n=8) the infected muscles were found to have the following features: hyperintensity on the T2-weighted images, diffuse borders and contrast enhancement. In the pelvis ( n=4), only one PM could be detected with US, in the other 3 cases only US of the hip joint was performed based on the clinical symptoms. In the extremities ( n=8) US always revealed an altered echogenicity of the affected muscles as well as fluid collection in 5 cases. Both US and MRI reveal characteristic changes of the PM. Ultrasound should be the first imaging modality in the extremities. In the pelvis MRI is the imaging modality of choice. The MRI is needed to differentiate pyomyositis from osteomyelitis.