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. 2004 May;80(943):267–270. doi: 10.1136/pgmj.2003.009274

Tropical pyomyositis (myositis tropicans): current perspective

S Chauhan 1, S Jain 1, S Varma 1, S Chauhan 1
PMCID: PMC1743005  PMID: 15138315

Abstract

Tropical pyomyositis, a disease often seen in tropical countries, is characterised by suppuration within skeletal muscles, manifesting as single or multiple abscesses. The most common organism implicated is Staphylococcus aureus. In 20%–50% of cases there is a history of trauma to the affected muscles. Commonly involved muscles are quadriceps, glutei, pectoralis major, serratus anterior, biceps, iliopsoas, gastrocnemius, abdominal and spinal muscles. Early diagnosis is often missed because of lack of specific signs, unfamiliarity with the disease, atypical manifestations, and a wide range of differential diagnosis. Diagnostic techniques like ultrasound and computed tomography/magnetic resonance imaging are very useful in diagnosis. The diagnosis is confirmed either by biopsy or aspiration of pus from the affected muscles. The initial antibiotic of choice is cloxacillin. Incision and drainage are important components of management. Treatment for Gram negative or anaerobic organisms should be instituted, whenever indicated. Physicians should become more familiar with this potentially life threatening but curable infective disease entity.

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Selected References

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  1. ASHKEN M. H., COTTON R. E. TROPICAL SKELETAL MUSCLE ABSCESSES (PYOMYOSITIS TROPICANS). Br J Surg. 1963 Sep;50:846–852. doi: 10.1002/bjs.18005022621. [DOI] [PubMed] [Google Scholar]
  2. Adeloye A. Intracranial suppuration complicating tropical pyomyositis. Report of two cases. Trans R Soc Trop Med Hyg. 1982;76(4):463–464. doi: 10.1016/0035-9203(82)90137-7. [DOI] [PubMed] [Google Scholar]
  3. Anand A. C., Narayanan V. A., Kalra A. S., Ray N., Ganguly S. B. Tropical pyomyositis with agammaglobulinaemia. J Assoc Physicians India. 1986 Oct;34(10):745–746. [PubMed] [Google Scholar]
  4. Andy J. J., Ekpo E. B. Cardiovascular complications of tropical pyomyositis. Trop Geogr Med. 1987 Jul;39(3):260–264. [PubMed] [Google Scholar]
  5. Ansaloni L., Acaye G. L. Absence of neutropenia in African patients with AIDS and associated pyomyositis. East Afr Med J. 1994 Nov;71(11):736–738. [PubMed] [Google Scholar]
  6. Ansaloni L. Tropical pyomyositis. World J Surg. 1996 Jun;20(5):613–617. doi: 10.1007/s002689900094. [DOI] [PubMed] [Google Scholar]
  7. Ansalonl L., Acaye G. L., Re M. C. High HIV seroprevalence among patients with pyomyositis in northern Uganda. Trop Med Int Health. 1996 Apr;1(2):210–212. doi: 10.1111/j.1365-3156.1996.tb00028.x. [DOI] [PubMed] [Google Scholar]
  8. Aynaci Osman, Onder Cetin, Kalaycioglu Ahmet. Anterior tibial compartment syndrome due to the pyomyositis in a patient with rheumatoid arthritis. A case report. Joint Bone Spine. 2003 Feb;70(1):77–79. doi: 10.1016/s1297-319x(02)00018-0. [DOI] [PubMed] [Google Scholar]
  9. Biviji Ayaz A., Paiement Guy D., Steinbach Lynne S. Musculoskeletal manifestations of human immunodeficiency virus infection. J Am Acad Orthop Surg. 2002 Sep-Oct;10(5):312–320. doi: 10.5435/00124635-200209000-00003. [DOI] [PubMed] [Google Scholar]
  10. Bonafede P., Butler J., Kimbrough R., Loveless M. Temperate zone pyomyositis. West J Med. 1992 Apr;156(4):419–423. [PMC free article] [PubMed] [Google Scholar]
  11. Brik R., Braun J., Bialik V., Zuckerman N., Berant M. Non-tropical pyomyositis in children--with report of severe neurological complications. Acta Paediatr Scand. 1989 Mar;78(2):331–334. doi: 10.1111/j.1651-2227.1989.tb11085.x. [DOI] [PubMed] [Google Scholar]
  12. Brook I. Pyomyositis in children, caused by anaerobic bacteria. J Pediatr Surg. 1996 Mar;31(3):394–396. doi: 10.1016/s0022-3468(96)90745-9. [DOI] [PubMed] [Google Scholar]
  13. Brown J. D., Wheeler B. Pyomyositis. Report of 18 cases in Hawaii. Arch Intern Med. 1984 Sep;144(9):1749–1751. doi: 10.1001/archinte.144.9.1749. [DOI] [PubMed] [Google Scholar]
  14. Casado E., Olivé A., Holgado S., Perez-Andres R., Romeu J., Lorenzo J. C., Clotet B., Tena X. Musculoskeletal manifestations in patients positive for human immunodeficiency virus: correlation with CD4 count. J Rheumatol. 2001 Apr;28(4):802–804. [PubMed] [Google Scholar]
  15. Chacha P. B. Muscle abscesses in children. Clin Orthop Relat Res. 1970 May-Jun;70:174–180. [PubMed] [Google Scholar]
  16. Chiedozi L. C. Pyomyositis. Review of 205 cases in 112 patients. Am J Surg. 1979 Feb;137(2):255–259. doi: 10.1016/0002-9610(79)90158-2. [DOI] [PubMed] [Google Scholar]
  17. Chiedozi L. C. Pyomyositis. Review of 205 cases in 112 patients. Am J Surg. 1979 Feb;137(2):255–259. doi: 10.1016/0002-9610(79)90158-2. [DOI] [PubMed] [Google Scholar]
  18. Christin L., Sarosi G. A. Pyomyositis in North America: case reports and review. Clin Infect Dis. 1992 Oct;15(4):668–677. doi: 10.1093/clind/15.4.668. [DOI] [PubMed] [Google Scholar]
  19. Crossley M. Temperate pyomyositis in an injecting drug misuser. A difficult diagnosis in a difficult patient. Emerg Med J. 2003 May;20(3):299–300. doi: 10.1136/emj.20.3.299. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Diamandakis V., Grose C. Bad consequences of bicycle accidents. Pyomyositis. Pediatr Infect Dis J. 1994 May;13(5):422–425. [PubMed] [Google Scholar]
  21. Ebright John R., Pieper Barbara. Skin and soft tissue infections in injection drug users. Infect Dis Clin North Am. 2002 Sep;16(3):697–712. doi: 10.1016/s0891-5520(02)00017-x. [DOI] [PubMed] [Google Scholar]
  22. Falasca G. F., Reginato A. J. The spectrum of myositis and rhabdomyolysis associated with bacterial infection. J Rheumatol. 1994 Oct;21(10):1932–1937. [PubMed] [Google Scholar]
  23. Fincher R. M., Jackson M. W., Fischer A. Q. Citrobacter freundii: a newly reported cause of pyomyositis. Am J Med Sci. 1990 May;299(5):331–333. doi: 10.1097/00000441-199005000-00008. [DOI] [PubMed] [Google Scholar]
  24. Flory P., Brocq O., Euller-Ziegler L., Ziegler G. Pyomyositis: cervical localization. J Rheumatol. 1993 Aug;20(8):1411–1413. [PubMed] [Google Scholar]
  25. Foster W. D. The bacteriology of tropical pyomyositis in Uganda. J Hyg (Lond) 1965 Dec;63(4):517–524. doi: 10.1017/s002217240004540x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Gambhir I. S., Singh D. S., Gupta S. S., Gupta P. R., Kumar M. Tropical pyomyositis in India: a clinico-histopathological study. J Trop Med Hyg. 1992 Feb;95(1):42–46. [PubMed] [Google Scholar]
  27. Ganesh R., Castle D., McGibbon D., Phillips I., Bradbeer C. Staphylococcal carriage and HIV infection. Lancet. 1989 Sep 2;2(8662):558–558. doi: 10.1016/s0140-6736(89)90675-2. [DOI] [PubMed] [Google Scholar]
  28. Gibson R. K., Rosenthal S. J., Lukert B. P. Pyomyositis. Increasing recognition in temperate climates. Am J Med. 1984 Oct;77(4):768–772. doi: 10.1016/0002-9343(84)90383-8. [DOI] [PubMed] [Google Scholar]
  29. Gordon B. A., Martinez S., Collins A. J. Pyomyositis: characteristics at CT and MR imaging. Radiology. 1995 Oct;197(1):279–286. doi: 10.1148/radiology.197.1.7568838. [DOI] [PubMed] [Google Scholar]
  30. Gransden W. R., Eykyn S. J., Phillips I. Staphylococcus aureus bacteraemia: 400 episodes in St Thomas's Hospital. Br Med J (Clin Res Ed) 1984 Jan 28;288(6413):300–303. doi: 10.1136/bmj.288.6413.300. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Gupta B., Khanna S. K., Sharma B. K. Pyomyositis. J Assoc Physicians India. 1980 Mar-Apr;28(3-4):91–94. [PubMed] [Google Scholar]
  32. HILL L. Oxygen poisoning in man. Br Med J. 1947 Jun 21;1(4511):900–900. doi: 10.1136/bmj.1.4511.900-b. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Hall R. L., Callaghan J. J., Moloney E., Martinez S., Harrelson J. M. Pyomyositis in a temperate climate. Presentation, diagnosis, and treatment. J Bone Joint Surg Am. 1990 Sep;72(8):1240–1244. [PubMed] [Google Scholar]
  34. Horn C. V., Master S. Pyomyositis tropicans in Uganda. East Afr Med J. 1968 Jul;45(7):463–471. [PubMed] [Google Scholar]
  35. Hossain A., Reis E. D., Soundararajan K., Kerstein M. D., Hollier L. H. Nontropical pyomyositis: analysis of eight patients in an urban center. Am Surg. 2000 Nov;66(11):1064–1066. [PubMed] [Google Scholar]
  36. Hudson I. R. The efficacy of intranasal mupirocin in the prevention of staphylococcal infections: a review of recent experience. J Hosp Infect. 1994 Jun;27(2):81–98. doi: 10.1016/0195-6701(94)90001-9. [DOI] [PubMed] [Google Scholar]
  37. Idoko J. A., Oyeyinka G. O., Giassudin A. S., Naida A. Neutrophil cell function and migration inhibition studies in Nigerian patients with tropical pyomyositis. J Infect. 1987 Jul;15(1):33–37. doi: 10.1016/s0163-4453(87)91376-4. [DOI] [PubMed] [Google Scholar]
  38. Immerman R. P., Greenman R. L. Toxic shock syndrome associated with pyomyositis caused by a strain of Staphylococcus aureus that does not produce toxic-shock-syndrome toxin-1. J Infect Dis. 1987 Sep;156(3):505–507. doi: 10.1093/infdis/156.3.505. [DOI] [PubMed] [Google Scholar]
  39. Jayoussi R., Bialik V., Eyal A., Shehadeh N., Etzioni A. Pyomyositis caused by vigorous exercise in a boy. Acta Paediatr. 1995 Feb;84(2):226–227. doi: 10.1111/j.1651-2227.1995.tb13618.x. [DOI] [PubMed] [Google Scholar]
  40. Kerrigan K. R., Nelson S. J. Tropical pyomyositis in eastern Ecuador. Trans R Soc Trop Med Hyg. 1992 Jan-Feb;86(1):90–91. doi: 10.1016/0035-9203(92)90458-o. [DOI] [PubMed] [Google Scholar]
  41. Ladipo G. O., Fakunle Y. F. Tropical pyomyositis in the Nigerian Savanna. Trop Geogr Med. 1977 Sep;29(3):223–228. [PubMed] [Google Scholar]
  42. Levin M. J., Gardner P., Waldvogel F. A. An unusual infection due to staphylococcus aureus. N Engl J Med. 1971 Jan 28;284(4):196–198. doi: 10.1056/NEJM197101282840407. [DOI] [PubMed] [Google Scholar]
  43. Malhotra P., Singh S., Sud A., Kumari S. Tropical pyomyositis: experience of a tertiary care hospital in north-west India. J Assoc Physicians India. 2000 Nov;48(11):1057–1059. [PubMed] [Google Scholar]
  44. Meena A. K., Rajashekar S., Reddy J. J., Kaul S., Murthy J. M. Pyomyositis - clinical and MRI characteristics report of three cases. Neurol India. 1999 Dec;47(4):324–326. [PubMed] [Google Scholar]
  45. Minami Koichi, Sakiyama Michiyo, Suzuki Hiroyuki, Yoshikawa Norishige. Pyomyositis of the vastus medialis muscle associated with Salmonella enteritidis in a child. Pediatr Radiol. 2003 Mar 1;33(7):492–494. doi: 10.1007/s00247-003-0889-6. [DOI] [PubMed] [Google Scholar]
  46. Mootsikapun Piroon, Mahakkanukrauh Ajanee, Suwannaroj Siraphop, Nanagara Ratanavadee. Tuberculous pyomyositis. J Med Assoc Thai. 2003 May;86(5):477–481. [PubMed] [Google Scholar]
  47. Murphy P. M., Lane H. C., Fauci A. S., Gallin J. I. Impairment of neutrophil bactericidal capacity in patients with AIDS. J Infect Dis. 1988 Sep;158(3):627–630. doi: 10.1093/infdis/158.3.627. [DOI] [PubMed] [Google Scholar]
  48. Nielsen H., Kharazmi A., Faber V. Blood monocyte and neutrophil functions in the acquired immune deficiency syndrome. Scand J Immunol. 1986 Sep;24(3):291–296. doi: 10.1111/j.1365-3083.1986.tb02096.x. [DOI] [PubMed] [Google Scholar]
  49. Pretorius E. S., Hruban R. H., Fishman E. K. Tropical pyomyositis: imaging findings and a review of the literature. Skeletal Radiol. 1996 Aug;25(6):576–579. doi: 10.1007/s002560050139. [DOI] [PubMed] [Google Scholar]
  50. Rodgers W. B., Yodlowski M. L., Mintzer C. M. Pyomyositis in patients who have the human immunodeficiency virus. Case report and review of the literature. J Bone Joint Surg Am. 1993 Apr;75(4):588–592. doi: 10.2106/00004623-199304000-00013. [DOI] [PubMed] [Google Scholar]
  51. SMITH I. M., VICKERS A. B. Natural history of 338 treated and untreated patients with staphylococcal septicaemia (1936-1955). Lancet. 1960 Jun 18;1(7138):1318–1322. [PubMed] [Google Scholar]
  52. Sarubbi F. A., Gafford G. D., Bishop D. R. Gram-negative bacterial pyomyositis: unique case and review. Rev Infect Dis. 1989 Sep-Oct;11(5):789–792. doi: 10.1093/clinids/11.5.789. [DOI] [PubMed] [Google Scholar]
  53. Schiff R. G., Silver L. Tropical pyomyositis. Demonstration of extent and distribution of disease by gallium scintigraphy. Clin Nucl Med. 1990 Aug;15(8):542–544. [PubMed] [Google Scholar]
  54. Schumacher T. M., Genant H. K., Korobkin M., Bovill E. G., Jr Computed tomography. Its use in space-occupying lesions of the musculoskeletal system. J Bone Joint Surg Am. 1978 Jul;60(5):600–607. [PubMed] [Google Scholar]
  55. Shepherd J. J. Tropical myositis: is it an entity and what is its cause? Lancet. 1983 Nov 26;2(8361):1240–1242. doi: 10.1016/s0140-6736(83)91281-3. [DOI] [PubMed] [Google Scholar]
  56. Singh S. B., Singh V. P., Gupta S., Gupta R. M., Sunder S. Tropical myositis. A clinical immunological and histopathological study. J Assoc Physicians India. 1989 Sep;37(9):561–563. [PubMed] [Google Scholar]
  57. Smith P. G., Pike M. C., Taylor E., Taylor J. F. The epidemiology of tropical myositis in the Mengo Districts of Uganda. Trans R Soc Trop Med Hyg. 1978;72(1):46–53. doi: 10.1016/0035-9203(78)90300-0. [DOI] [PubMed] [Google Scholar]
  58. Soler R., Rodríguez E., Aguilera C., Fernández R. Magnetic resonance imaging of pyomyositis in 43 cases. Eur J Radiol. 2000 Jul;35(1):59–64. doi: 10.1016/s0720-048x(99)00108-4. [DOI] [PubMed] [Google Scholar]
  59. Taylor J. F., Templeton A. C., Henderson B. Pyomyositis. A clinico-pathological study based on 19 autopsy cases, Mulago Hospital 1964-1968. East Afr Med J. 1970 Oct;47(10):493–501. [PubMed] [Google Scholar]
  60. Trusen Andreas, Beissert Matthias, Schultz Georg, Chittka Bernd, Darge Kassa. Ultrasound and MRI features of pyomyositis in children. Eur Radiol. 2002 Sep 11;13(5):1050–1055. doi: 10.1007/s00330-002-1585-x. [DOI] [PubMed] [Google Scholar]
  61. Vassilopoulos D., Chalasani P., Jurado R. L., Workowski K., Agudelo C. A. Musculoskeletal infections in patients with human immunodeficiency virus infection. Medicine (Baltimore) 1997 Jul;76(4):284–294. doi: 10.1097/00005792-199707000-00006. [DOI] [PubMed] [Google Scholar]
  62. Wolf R. F., Konings J. G., Prins T. R., Weits J. Fusobacterium pyomyositis of the shoulder after tonsillitis. Report of a case of Lemierre's syndrome. Acta Orthop Scand. 1991 Dec;62(6):595–596. doi: 10.3109/17453679108994504. [DOI] [PubMed] [Google Scholar]
  63. Yuh W. T., Schreiber A. E., Montgomery W. J., Ehara S. Magnetic resonance imaging of pyomyositis. Skeletal Radiol. 1988;17(3):190–193. doi: 10.1007/BF00351006. [DOI] [PubMed] [Google Scholar]

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