Enterobacter cloacae pyomyositis complicating chronic granulomatous disease and review of gram-negative bacilli pyomyositis

Focal pyomyositis caused by Enterobacter in an immunocompetent patient: A case report

Pyomyositis is a pyogenic infection of skeletal striated muscle, usually found in tropical areas, often in immunocompromised patients. We report a new observation of a nontropical Enterobacter pyomyositis occurring in an immunocompetent female in Tunisia. A 53-year-old patient presented with acute fever and intense myalgia in the right thigh. On clinical examination she had an altered general condition, a fever at 40°C and an important swelling of the lateral side of the right thigh. In biology, she had an inflammatory syndrome. Blood culture had identified Enterobacter. Muscle magnetic resonance imaging showed diffuse inflammatory involvement of the vastus lateralis muscle of the right quadriceps associated with edematous infiltration of subcutaneous fatty tissues. Diagnosis of pyomyositis was retained. Antibiotic therapy initially probabilistic and then adapted to the antibiogram was initiated with a favorable outcome. Although rare outside the tropics, the potential severity of pyomyositis encourages its better knowledge.

Gram negative pyomyositis: Two case reports and a review of the literature

Pyomyositis due to Gram negative bacteria is rare. Here we describe two cases in immunocompromised hosts. Both were bacteremic with a Gram-negative bacterium and had impaired immunity related to prolonged and ongoing chemotherapy for hematologic malignancies. Both eventually cleared the infection with a combination of local drainage and systemic antibiotics. This unusual diagnosis should be considered in an immunocompromised patient with muscle pain and fever.

Purulent infectious myositis (formerly tropical pyomyositis)

Purulent infectious myositis (PIM), formerly known as tropical pyomyositis, is a pyogenic infection of skeletal muscles. Staphylococcus aureus, a normal human skin inhabitant, is the main pathogen involved, but multiple other microorganisms have been implicated. Although usually a progressive febrile disease with pain in the affected muscle(s), severe, life-threatening forms have been described, especially in immunosuppressed patients and children. PIM may elude early diagnosis given the lack of overlying skin changes. Hence, high index of suspicion followed by imaging modalities (ultrasonography when superficial and computed tomography or magnetic resonance imaging with contrast when deep) help confirm the diagnosis. Treatment requires combination of percutaneous or open surgical drainage along with antimicrobial therapy guided by culture results. The rising incidence of cases due to methicillin-resistant Staphylococcus aureus (MRSA) strains, makes the inclusion of vancomycin be recommended. This paper reviews PIM highlighting its global distribution, causative agents, predisposing factors, management, and potential complications.

[Infectious myositis]

Infectious myositis is a rare condition that can be caused by bacteria, viruses, parasites or fungi. Muscle pain or weakness are symptoms shared by all type of myositis. Diagnosis is made on clinical presentation: fever and poor general state is found in bacterial myositis, diffuse muscle pain with flu-like symptoms in viral causes, eosinophilia and a tropical travel history can be related to parasitic etiology, and immunocompromising condition suggests fungal infection. Rhabdomyolysis, leukocytosis and elevated C-reactive protein are common. Imaging (computed tomography or magnetic resonance imaging) can be useful to detect which muscle is affected. The causative organism can be identified on blood cultures, skeletal muscle biopsy, serology or any other pathogen specific test. Treatment depends on the causative organism. Open surgical or imaging-guided drainage is usually necessary in bacterial myositis.

Disseminated Pyomyositis Due to Burkholderia cepacia: A Case Report

Pyomyositis is a tropical infection affecting skeletal muscles manifesting as high-grade fever with pain in the affected limbs usually caused by Gram-positive microorganisms. Gram-negative organisms causing pyomyositis is uncommon but has been reported. Burkholderia cepacia is a Gram-negative nonfermenter causing opportunistic infections in immunocompromised patients, has been reported to cause pyomyositis only once before. We report a case of B. cepacia pyomyositis in a patient with no history of immunocompromised status, manifesting as disseminated infection with hemophagocytic syndrome presenting to our intensive care unit.

High mortality rate associated with KPC-producing Enterobacter cloacae in a Brazilian hospital

We describe a clonal dissemination of KPC-producing Enterobacter cloacae in a Brazilian hospital. Patients diagnosed with theses isolates showed high mortality rate (41.8%) and were associated with previous use of antibiotics and urinary catheterization. Therefore, infection control measures and use of stricter antibiotic policies are required to control the spread of these organisms.

A Case of Meningococcal Pyomyositis in an Otherwise Healthy Adult

The clinical spectrum of Neisseria meningitidis can range from nasopharyngeal colonization to life-threatening invasive diseases such as meningitis. However, its etiologic role in invasive pyomyositis (PM) has never been reported before in the English language. In this study, we report the first case of PM in the English language and the second case in the literature caused by N meningitidis.

Lower extremities and iliopsoas pyomyositis with concurrent septic arthritis and spinal epidural abscess in a diabetic patient

Pyomyositis is a rarely encountered infection among diabetics, which usually affects lower extremities. Herein, we present a case of lower extremities and iliopsoas pyomyositis with concurrent septic arthritis and spinal epidural abscess in a patient with poorly controlled diabetes mellitus.