Tropical Pyomyositis
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This is a condition whereby there is pyogenic infection of large muscle/muscles with extensive necrosis of the involved muscle. This condition occurs more commonly in the tropics, affecting immunocompromised individuals than normal individuals. The cause is uncertain since abscess multiple pockets explored early are sterile but later culture of the pus usually yields Staphylococcus aureus.
Clinical presentation
Fever and painful induration/fluctuation of one or more of the large muscles, mostly in the lower extremities.
Investigations
- Complete blood count (CBC)
- Erythrocyte sedimentation rate (ESR)
- C – Reactive Protein test (CRP)
- Ultrasound
- Plain X-ray
- Muscle biopsy for culture and sensitivity
Pharmacological Treatment
Higher level facilities treatment should be guided by C/S results
Children
B: cloxacillin (IV) 1–2g 6hourly for 7-14days
OR
A: erythromycin (PO) 500mg 6-8hourly for 7-14days
OR
S: vancomycin IV 1g 12hourly for 7days
OR
S: clindamycin (IV) 600mg 8hourly for 7days
Adults
A: erythromycin (PO) 500mg 6-8hourly for 7-14days
OR
B: amoxicillin + clavulanate (FDC) (PO) 625mg 12hourly for 7-14days
OR
S: clindamycin (IV) 600mg 8hourly for 7days
OR
S: vancomycin (IV) 1g 12hourly for 7days
Surgical management
- Incision and drainage and irrigation with copious amount of 0.9% sodium chloride