Scientific Letter
Pyomyositis in a non-tropical area. 12 years of cased-based experience
Piomiositis en un entorno no tropical. Casuística de 12 años
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Gómez, Manuel Vargas Pérez, Teresa del Rosal Rabes, Franciso Javier Aracil Santos, Fernando Baquero-Artigao" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Beatriz" "apellidos" => "González Gómez" "email" => array:1 [ 0 => "beatrizglgm@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Manuel" "apellidos" => "Vargas Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Teresa" "apellidos" => "del Rosal Rabes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Franciso Javier" "apellidos" => "Aracil Santos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Fernando" "apellidos" => "Baquero-Artigao" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Pediatría Hospitalaria Enfermedades, Infecciosas y Tropicales Pediátricas, Hospital Infantil La Paz, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Pediatría, Hospital de Poniente, El Ejido, Almería, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Piomiositis en un entorno no tropical. Casuística de 12 años" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Pyomyositis is a bacterial infection of skeletal muscle characterised by the formation of intramuscular abscesses. Although it is an entity that originated in tropical regions, there has been an increase in its incidence in regions with a temperate climate in recent years. It occurs more frequently in adult patients with chronic conditions,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> so its diagnosis in the paediatric population requires a high index of suspicion.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1–5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Our aim was to describe the characteristics of pyomyositis in the paediatric population. To do so, we conduced a retrospective descriptive study of patients aged less than 15 years that received a diagnosis of pyomyositis in our hospital over a period of 12 years (2004–2015). We reviewed medical records for the purpose of analysing clinical, epidemiological, diagnostic and treatment data, which we did using the software Microsoft Excel<span class="elsevierStyleSup">®</span> 2010.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We included a total of 15 patients, 8 girls and 7 boys, with a median age of 4.5 years (interquartile range [IQR], 1.3–7 years). All were of Spanish descent and had acquired the infection in Spain; none of the cases were imported. Furthermore, none of the patients were immunosuppressed or had chronic disease. Thirteen patients (87%) had primary pyomyositis, of whom 7 (54%) reported previous trauma in the involved region. Two patients had pyomyositis secondary to sacroiliitis and contiguous skin infection. The muscles involved most frequently were those in the lower extremities (10 children, 67%), mainly the quadriceps femoris (5 patients) and the iliopsoas (2 patients). The rest of the cases involved the upper extremities and the cervical musculature (2 patients each). There was 1 case with infection in multiple locations, with involvement of both quadriceps, the left calf and the right adductor magnus, soleus, biceps brachii and pronator teres. The most frequent presenting symptoms at diagnosis were pain (93%), fever (80%), swelling (60%), warmth (33%) and local erythema (20%).</p><p id="par0020" class="elsevierStylePara elsevierViewall">Laboratory tests found leukocytosis with more than 15,000<span class="elsevierStyleHsp" style=""></span>cells/mm<span class="elsevierStyleSup">3</span> in 11 children (73%) at the time of diagnosis. Leukopaenia was only detected in the patient with multiple muscle involvement and bacteraemia. The mean level of C-reactive protein (CPR) was 146.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>119.1<span class="elsevierStyleHsp" style=""></span>mg/L, and 10 patients (67%) had levels exceeding 40<span class="elsevierStyleHsp" style=""></span>mg/L. The most frequently used imaging test was ultrasound, which was performed in 12 patients (80%) and diagnostic in 7 (58%). Magnetic resonance imaging (MRI) was performed in 8 patients (53%) and was diagnostic in all. Blood culture was performed in 9 patients (60%) and a culture of a drainage specimen in the 6 patients that underwent drainage. The only identified bacterium was <span class="elsevierStyleItalic">Staphylococcus aureus</span>, isolated in 8 patients (53%), with a meticillin-resistant strain in one case. The yield of blood culture was 33% (3/9) and the yield of culture of a drainage specimen was 83% (5/6).</p><p id="par0025" class="elsevierStylePara elsevierViewall">Antibiotherapy was administered intravenously at initiation until symptoms improved, and the most frequently used combination was cloxacillin with clindamycin. Subsequently, the administration of antibiotics continued by the oral route, most frequently with cefadroxil or amoxicillin-clavulanic acid for a mean total duration of 30.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>18.6 days. Only 40% of patients required surgical drainage of abscesses. The median length of stay was 12 days (IQR, 9–24 days). All patients had favourable outcomes without sequelae.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In Spain, the diagnosis of pyomyositis should be considered in previously healthy children presenting with fever and severe pain in an extremity, especially if there is a previous history of trauma.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2,4,5</span></a> There may be swelling, but local inflammatory signs such as warmth or erythema are less frequent. The microbiological technique that offers the highest diagnostic yield is culture of a drainage spcimen,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> although blood culture has a higher yield compared to other infections and should be performed in all patients. As for imaging studies, ultrasound is diagnostic in more than half of the patients, and should be the first test performed. If the ultrasound examination is normal, and especially in cases of suspected involvement of deep muscles, MRI is the gold standard on account of its greater sensitivity.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2–5</span></a> The most frequent aetiological agent is <span class="elsevierStyleItalic">S. aureus</span>,<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1–5</span></a> which in Spain is usually sensitive to meticillin, so that cloxacillin continues to be the first-line empiric treatment. Clindamycin may be added to improve coverage against anaerobes and to cover the possibility of meticillin-resistant strains. In our series, more than half of the cases had favourable outcomes with antibiotherapy alone, in contrast with the classic therapeutic approach, which favours the combination of medical treatment and surgical drainage.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: González Gómez B, Vargas Pérez M, del Rosal Rabes T, Aracil Santos FJ, Baquero-Artigao F. Piomiositis en un entorno no tropical. Casuística de 12 años. 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| 2023 August | 23 | 16 | 39 |
| 2023 July | 27 | 27 | 54 |
| 2023 June | 36 | 26 | 62 |
| 2023 May | 39 | 24 | 63 |
| 2023 April | 46 | 11 | 57 |
| 2023 March | 38 | 24 | 62 |
| 2023 February | 36 | 16 | 52 |
| 2023 January | 24 | 18 | 42 |
| 2022 December | 32 | 22 | 54 |
| 2022 November | 45 | 30 | 75 |
| 2022 October | 40 | 36 | 76 |
| 2022 September | 27 | 24 | 51 |
| 2022 August | 33 | 42 | 75 |
| 2022 July | 40 | 45 | 85 |
| 2022 June | 31 | 24 | 55 |
| 2022 May | 40 | 45 | 85 |
| 2022 April | 29 | 39 | 68 |
| 2022 March | 41 | 44 | 85 |
| 2022 February | 27 | 26 | 53 |
| 2022 January | 33 | 18 | 51 |
| 2021 December | 24 | 32 | 56 |
| 2021 November | 32 | 38 | 70 |
| 2021 October | 39 | 62 | 101 |
| 2021 September | 21 | 45 | 66 |
| 2021 August | 20 | 39 | 59 |
| 2021 July | 20 | 33 | 53 |
| 2021 June | 28 | 34 | 62 |
| 2021 May | 36 | 34 | 70 |
| 2021 April | 70 | 65 | 135 |
| 2021 March | 53 | 34 | 87 |
| 2021 February | 14 | 27 | 41 |
| 2021 January | 29 | 13 | 42 |
| 2020 December | 19 | 19 | 38 |
| 2020 November | 30 | 17 | 47 |
| 2020 October | 29 | 25 | 54 |
| 2020 September | 25 | 24 | 49 |
| 2020 August | 13 | 9 | 22 |
| 2020 July | 21 | 20 | 41 |
| 2020 June | 15 | 3 | 18 |
| 2020 May | 32 | 20 | 52 |
| 2020 April | 20 | 17 | 37 |
| 2020 March | 31 | 14 | 45 |
| 2020 February | 36 | 15 | 51 |
| 2020 January | 36 | 16 | 52 |
| 2019 December | 33 | 20 | 53 |
| 2019 November | 11 | 10 | 21 |
| 2019 October | 13 | 21 | 34 |
| 2019 September | 25 | 8 | 33 |
| 2019 August | 30 | 25 | 55 |
| 2019 July | 32 | 21 | 53 |
| 2019 June | 16 | 9 | 25 |
| 2019 May | 48 | 56 | 104 |
| 2019 April | 43 | 30 | 73 |
| 2019 March | 24 | 12 | 36 |
| 2019 February | 29 | 16 | 45 |
| 2019 January | 28 | 21 | 49 |
| 2018 December | 35 | 26 | 61 |
| 2018 November | 46 | 21 | 67 |
| 2018 October | 80 | 22 | 102 |
| 2018 September | 39 | 16 | 55 |
| 2018 August | 4 | 0 | 4 |
| 2018 July | 2 | 0 | 2 |
| 2018 June | 4 | 0 | 4 |
| 2018 May | 10 | 0 | 10 |
| 2018 April | 33 | 0 | 33 |
| 2018 March | 31 | 0 | 31 |
| 2018 February | 11 | 0 | 11 |
| 2018 January | 12 | 0 | 12 |
| 2017 November | 0 | 10 | 10 |
Show all
