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Pyomyositis in children

Abstract number: 1734_214

Manoudis G., Mitsionis G., Kontogeorgakos V., Kordalis N., Sionti I., Xenakis T.

Introduction: Pyomyositis is an acute pyogenic infection of the skeletal muscle. Pyomyositis is common in the tropics but rarely reported in temperate climates.

High fever and painful swelling of the affected limb are the commonest symptoms. Leucocytosis is present with elevated erythrocytes sedimentation rate (ESR) and C-reactive protein (CRP). The most common causative organisms are Staphylococcus aureus and Streptococcus pyogenes. Magnetic Resonance Imaging (MRI) is the image modality of choice.

Purpose: Diagnosis, clinical course and treatment outcome of children with pyomyositis.

Material and Methods: Between 2002 and 2004 5 children, 2 boys and 3 girls were diagnosed and treated for pyomyositis. The mean age of patients was 7.2 years, ranging from 3 to 14 years. The locations of involvement were gluteus muscles in 3 cases, quadriceps in one case thus in one case there was bifocal involvement of gastrocnemius and biceps muscle. The causative organisms, cultured from blood, were St. aureus in 3 cases, Str. pyogenes in one case though in one patient no organism could be identified. 4 children had fever (>38.5°C), elevated ESR and CRP (ESR: 73–110, CRP: 142–410) and raised WBC count (14580–19900). One patient had normal temperature and increased ESR (<55).

A history of prior trauma at lower limb was obtained in all patients. MRI plays a significant role in the early recognition and diagnosis of pyomyositis, identifying muscle inflammation and detecting bone involvement. Intravenous antibiotics were administered and were followed by oral agents for an additional period of time. The duration of therapy ranged from 6 to 8 weeks. No surgical intervention was needed. MRI was used in order to evaluate response to the therapy.

Conclusion: Although pyomyositis is a rare disease, it should be considered in the differential diagnosis of acute onset of musculoskeletal pain in children. Early diagnosis and antibiotic treatment are important as abscess formation, which require surgical drainage, sepsis and other major systemic complications can be avoided.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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