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