Piomiositis Informe de 132 pacientes

Abstract

Background. Bacteria1 infection of striated muscle accompanied by abscess formation is an unusual situation. We evaluated the clinical features of pyomyositis in order to make an earlier diagnosis and treatment possible. Method. A sample of one hundred and thirty-two patients suffering from pyomyositis seen over the last 9 years was studied. lnclusion criteria were: 1) compatible clinical manifestations; 2) demonstration of an abscess through puncture or drainage; 3) evidence of local muscle pain, with or without swelling or mass, and the favourable clinical response due exclusively to oxacillin, regardless of puncture or drainage having been made. Results. Mean age of the patients in the study was 21.5 years (range: 15 months to 68 years). The condition was present in 88 males (66.6%). The onset of clinical manifestations prior to consultation was between 2 and 94 days, with an average of 11.6. The most frequent symptom was fever (98.4%) while the most noticeable sign was the presence of a mass or swelling (97.7%). 96.9% of the subjects reported pain. Previous trauma appeared in 25 (18.9%) patients and pyodermitis in another 64 (48.4%). The most affected muscles were those of the lower limbs (47%) i.e. thighs, calves and buttocks. Although the presence of acute abscess was the most common clinical ocurrence (82.5%), it was found that not all lesions evolved into abscesses, anda new presentation was identified in three patients (2.3%) - localized muscle ache without mass or tumescence with fever. The hard mass without abscess (10.7%) and son mass with suppuration (4.5%) were the other clinical occurrences. Staphylococcus aureus coagulase (+) was the most frequent germ isolated at the site of the lesions (96.7%), followed by Staphylococcus epidermidis (2.2%) and Pseudononas aeruginosa (1.1%). Complications were: staphylococcal pneumonia (1.7%) and septic arthritis (0.7%). All patients healed with appropriate medical treatment. Gonclusions. 1) Pyomyositis is a frequent disease in our country. 2) Up to date, this is the greatest number of cases published both in Colombia and in America. 3) Three cases of local pain and fever as a further way of clinical presentation were found. 4) A case of Pseudomonas aeruginosa as a muscle colonizer agent was evidenced. 5) Prior trauma was found in 18% of the cases. 6) The presentation of the disease does not always correspond to the evolutive stage herein described. 7) The disease follows a similar clinical course non-dependent from the causative microorganism.