Tropical Pyomyositis: Is it an Immunodeficiency Disease?

Abstract

Serum immunoglobulin (IgG, IgM, IgA) and complement (C3, C4) levels were measured by radial immunodiffusion technique in a group of 16 Nigerian patients with tropical pyomyositis (TP). Sixteen healthy Nigerians, age- and sex-matched with the patients, were also included in the study as control subjects (CS). A significantly low level of circulating IgM (P less than 0.01) and elevation of the serum levels of IgG (P less than 0.01) and IgA (P less than 0.01) were observed in TP compared to CS. Mean serum complement (C3, C4) levels were found to be similar in patients and controls. Microbiological culture tests showed that 14 pus specimens (88%) and 3 blood specimens (19%) from the patients were positive for Staphylococcus aureus. It was therefore proposed that IgM antibody deficiency (primary or acquired) against S. aureus may be the cause of tropical pyomyositis in Nigerians.

New epidemiology of Staphylococcus aureus infection in Africa

“…The spectrum of S. aureus ‐related infections differs from that in other parts of the world, with a higher proportion of pyomyositis, of up to 27%, among cases with bone, skin and soft tissue infection , and up to 21.7% among all S. aureus ‐related infections . Multifocal lesions are frequently encountered, and occur mostly in immunocompromised patients, but might also affect immunocompetent individuals . In addition, some studies have suggested a higher proportion of S. aureus in urinary tract infections: 6.3–13.9% of urinary tract infections are caused by S. aureus in Senegal , Ghana , and Nigeria , as compared with 1.06% in Europe and Brazil .…”

Metastatic Infection by Methicillin-Sensitive Staphylococcus aureus and its Potential Association to an Unusual Humoral Immunodeficiency

“…Apparently, there is no difference in SIgMD sex-distribution [2], however it tends to be more frequently symptomatic in men, finding a male-to-female ratio of even 11:2 [3,5,9,11,12]. Given this incomplete penetrance, an autosomal hereditary basis, perchance related to the X-chromosome, has been proposed for SIgMD etiology, in accordance with some familial case-reports and others related to congenital disorders such as Wiskott-Aldrich-Syndrome [2,5,7,12]. Another consistent association about genetic involvement is 22q11.2-deletion syndrome, yet it would not explain this immunodeficiency by itself [2].…”

“…Prevalence is estimated around 0.03-0.37% in general population, 0.07-0.26% in Immunology-&-Allergy Clinics, 0.1-3.8% in hospitalized patients, and up to 6% within primary-immunodeficiency patients [2][3][4][5]10]. Apparently, there is no difference in SIgMD sex-distribution [2], however it tends to be more frequently symptomatic in men, finding a male-to-female ratio of even 11:2 [3,5,9,11,12]. Given this incomplete penetrance, an autosomal hereditary basis, perchance related to the X-chromosome, has been proposed for SIgMD etiology, in accordance with some familial case-reports and others related to congenital disorders such as Wiskott-Aldrich-Syndrome [2,5,7,12].…”

High HIV seroprevalence among patients with pyomyositis in Northern Uganda

“…It has been suggested that some abnormalities of the immune system, e.g. IgM antibody deficiency (Giasuddin et al 1986) or defective phagocytosis (Ikodo et a/. r987), play a causative role in tropical pyomyositis.…”

“…The results presented in this study demonstrate that pyomyositis is a bacterial infection very significantly associated with HIV infection. The increased incidence of pyomyositis in HIV infected individuals appears to occur because these patients have an increased rate of asymptomatic S. aureus infection (Ganesh et al 1989) and a dysfunction in B-lymphocyte (Parkin et al 1 9 8 9 ) , neutrophil and phagocytic activity (Ellis et al 19881, thus allowing a higher rate of staphylococcal infection and bacteraemic episodes (Jacobson et al 1988).…”