Pneumococcal pyomyositis secondary to pneumonia

Pneumococcal pyomyositis: report of 2 cases and review of the literature

Streptococcus pneumoniae is an uncommon cause of pyomyositis. It is unclear whether the clinical presentation and outcome of pneumococcal pyomyositis differ depending on the host's underlying immune status. We describe 2 patients with pneumococcal pyomyositis, review all published cases, and compare characteristics between apparently healthy hosts and at-risk hosts. A total of 35 cases of pneumococcal pyomyositis were identified, 11 in apparently healthy hosts and 24 in at-risk hosts. Two-thirds of the patients had an antecedent respiratory illness or meningitis. At-risk hosts tended to have a longer interval between the development of symptomatic muscle infection and the diagnosis of pyomyositis and a significantly higher risk of disseminated disease at presentation, as manifested by involvement of multiple noncontiguous muscles or presence of meningitis. Overall, other than 1 death, all patients recovered with antibiotics and surgical drainage, but as might be expected there was a significantly higher rate of complications among at-risk hosts.

Streptococcus pneumoniae skin and soft tissue infections: characterization of causative strains and clinical illness

Streptococcus pneumoniae is an uncommon cause of skin and soft tissue infections, yet the incidence and clinical significance of its isolation in samples of skin or soft tissues in unselected hospital samples is poorly understood. In the present study, a review was conducted of the records of all patients with skin and soft tissue infections due to S. pneumoniae at a university hospital between January 1994 and December 2005. The isolates were identified by standard methods and were serotyped, and susceptibility testing was performed by the broth microdilution method following the guidelines of the Clinical and Laboratory Standards Institute. During the study period, 3,201 isolates of S. pneumoniae were recovered from several sources. Of these, 69 (2.2%) were from skin and soft tissue samples (69 patients). Complete information could not be obtained for 13 patients. Of the 56 patients remaining, 36 (64.3%) were infected and fulfilled the inclusion criteria. The following types of infections were observed: surgical wound infection (n = 11), burn infection (n = 7), pyomyositis (n = 6), cellulitis (n = 4), perineal or scrotal abscess (n = 3), and other (n = 5). Thirty-one (86%) patients had a favorable outcome, and 5 (13.8%) patients died. Mortality was directly attributable to S. pneumoniae infection in three of the five fatal cases. Of the 39 S. pneumoniae isolates obtained (36 from skin and soft tissues, three from blood cultures), 58.9% were penicillin nonsusceptible, 7.7% were cefotaxime nonsusceptible, and 20.5% were erythromycin resistant. The most frequent serotypes were 3, 19, 11, and 23. Of the overall number of isolates of S. pneumoniae recovered in a general institution, 2.2% involved skin and soft tissues (of which 64% were clinically significant). Mortality due to pneumococcal skin and soft tissue infections was low.

Pneumococcal cellulitis in an immunocompetent adult

Streptococcus pneumoniae is a rare cause of cellulitis that develops mainly in patients with underlying chronic disease or those immunocompromised by drug or alcohol abuse. We report here a case of pneumococcal cellulitis in an immunocompetent patient.

Pyomyositis in Qatar: Report of a Case Presented as Back Pain and Sciatica and Review of the Literature

Pyomyositis is a bacterial infection affecting the large muscle groups and is usually accompanied by abscess formation; the term “tropical myositis” being an alternative as it is more common in the tropical regions, and has become an increasingly recognized entity in temperate climates. Normally skeletal muscle is resistant to metastatic infections but it seems likely that more than one specific factor can remove this barrier. The most common organism being Staphylococcus aureus found in about 90% of the cases, while Streptococcal spp. are next in frequency. Other bacterial species have been incriminated; fungal infection can also cause local destruction and abscess formation, while viral infection (notably Coxsackie viruses) may result in acute rhabdomyolysis. The spread is hematogenous except in those cases in which there is direct extension, as from osteomyelitis, and the muscles commonly affected are the glutei, quadriceps, shoulder and axial. The abscess forms deep inside such muscles.

Necrotizing fasciitis due to Streptococcus pneumoniae after intramuscular injection of nonsteroidal anti-inflammatory drugs: report of 2 cases and review

Two cases of pneumococcal necrotizing fasciitis (NF) occurred after intramuscular injections of nonsteroidal anti-inflammatory drugs; another 5 cases reported in the literature fulfilled the criteria for NF involving Streptococcus pneumoniae. Conditions associated with alterations of immune function could be identified in 6 of the 7 cases; 2 patients died despite surgical and antimicrobial treatment.

Necrotizing fasciitis due to penicillin-resistant Streptococcus pneumoniae: case report and review of the literature

Necrotizing fasciitis (NF) is a life-threatening infection involving rapid necrosis of subcutaneous and fascial tissues. Streptococcus pneumoniae (SPN) soft tissue infection is exceedingly uncommon, reported primarily in patients with immunosuppression or other underlying conditions. We report a case of NF and septic shock in a healthy 32-year-old man, whose only predisposing factor was antecedent blunt trauma. Pathological examination and culture of the extensive tissue debridement were positive only for SPN. The serotype 9V isolate was penicillin (PCN)-resistant (MIC=2.0), and closely-related by pulse field gel electrophoresis and multilocus fingerprinting to clone France 9V-3, an important genetic reservoir for increasing PCN-resistance worldwide. This unique case has implications for our pathogenic under-standing and empiric management of NF.

Streptococcus pneumoniae: a rare skin pathogen?

Streptococcus pneumoniae is a rare cause of skin infections in adults. We present three cases and a review of the literature on this infection. Nine of the 42 (21%) cases occurred in previously healthy individuals without predisposing conditions. The majority of cases (88%) had bacteraemia. More than half the cases (22/42, 52%) required surgical intervention in addition to antimicrobial therapy.

Pneumococcal Pyomyositis: A Patient with Diagnostic Problems and Complications

Pyomyositis is an uncommon condition that may present a difficult problem in diagnosis. We report the development of Streptococcus pneumoniae pyomyositis involving the iliacus, iliopsoas, and gluteus muscles in a patient with elevated serum levels of antinuclear and antiphospholipid antibodies but without clinical evidence of connective tissue disease. Magnetic resonance imaging demonstrated rapid evolution of the infection, with progression from muscle edema to abscess formation over a period of 10 days. The diagnosis was initially missed, and osteomyelitis and sacroiliitis developed. Pyomyositis should be suspected in patients with the acute onset of severe, localized muscle pain and fever. As in this case, failure to promptly diagnose and treat this infection can result in significant morbidity.

Clinical syndromes associated with adult pneumococcal cellulitis

Streptococcus pneumoniae is an uncommonly recognized etiology of cellulitis in adults. A review of the literature uncovered 30 cases of pneumococcal skin infection in adults. Typically, all patients with pneumococcal cellulitis had an underlying chronic illness, or were immunocompromised by drug or alcohol abuse. Pneumococcal cellulitis presents as two distinctive clinical syndromes: one with extremity involvement in individuals with diabetes and substance abuse; and a second involving the head, neck and upper torso in individuals with systemic lupus erythematosis, nephrotic syndrome and hematologic disorders. For each there are statistically significant associations between the location of pneumococcal cellulitis and underlying clinical disorders. In contrast to other common bacterial etiologies, pneumococcal cellulitis is frequently associated with blood stream invasion, tissue necrosis and suppurative complications. Patients often require surgical interventions and prolonged hospitalizations. A high degree of suspicion and early aggressive management is needed for those presenting with cellulitis characterized by bullae and violaceous color.