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

Abstract

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.

Tropical pyomyositis: an update

“…Furthermore, it accounted for 4% (Gabon) to 27% (Benin) of S. aureus infections in Africa [28,29]. Very few prospective monocentre studies with only limited case numbers that systematically assessed the clinical course and outcome of TP are available [12,16], and to the best of our knowledge, no prospective multicentre studies have been carried out, or are currently ongoing. However, limited data on mortality [7,8] suggest that it ranges between 0 (14‐day mortality, sub‐Saharan Africa [30]), 2.4% (in‐hospital mortality, Brazil [7]) and 10% (in‐hospital mortality, Northern India [8]).…”

“…Although MRI is the imaging gold standard, ultrasound demonstrating muscle enlargement, changes in echogenicity due to inflammation and abscess formation are increasingly recognised as appropriate imaging tools [7,46]. There are no specific laboratory tests, but C‐reactive protein, leucocyte counts and erythrocyte sedimentation rates (which can also be performed in resource‐poor settings) can be helpful [12]. It is recommended that blood culture (aerobic and anaerobic) and pus from intramuscular abscesses are taken for microbiological analysis, including species identification and antimicrobial susceptibility testing [47].…”

“…nafcillin, oxacillin) or cefazolin for methicillin‐susceptible S. aureus , and glycopeptides or linezolid for methicillin‐resistant S. aureus [47,48]. The optimal duration of the definitive antimicrobial therapy is not clear but should be several weeks (2–9 weeks) [12,47,49].…”

“…Early diagnosis of TP is often missed because of its non‐specific presentation. In advanced stages, fever and myalgia/limping are the most common presenting symptoms, sometimes associated with bacteraemia and multi‐organ failure (sepsis) [8‐10], toxic shock syndrome [11] or osteomyelitis (per continuitatem or haematogenous) [12]. Frequently affected areas are large muscle of the lower extremities (especially the quadriceps, iliopsoas or gluteal muscles) [2,8].…”

Obturator pyomyositis and labium majus cellulitis: A case report and literature review

“…If pyomyositis is diagnosed early, antibiotic therapy is usually sufficient, but if the diagnosis is delayed, it causes abscess formation, and further progression leads to sepsis. 4 , 5 Therefore, early diagnosis is important.…”