Pyomyositis is the name given to an acute infection of the skeletal muscles. In most cases, it is caused by the bacterium Staphylococcus aureus.
What is pyomyositis?
In medicine, pyomyositis also goes by the names pyomyositis tropicans, lambo lambo, bungpagga, or myositis purulenta. This refers to an acute infection of the skeletal muscles. Pain and tenderness occur in the affected muscle. In addition, pus-filled abscesses may form within the muscles. Pyomyositis presents preferentially in tropical regions, where it is endemic. Eastern Uganda is particularly affected. Between 400 and 900 cases of the disease occur there every year. Most of the patients are men. About 13 percent of all patients die from pyomyositis. In principle, the infectious disease can occur at any age, but it is most common between the ages of 10 and 40. In non-tropical areas, however, pyomyositis occurs only rarely. There, it primarily affects adults and seniors. In most cases, pyomyositis is a sequelae of serious diseases such as cancer associated with chemotherapy or AIDS. However, patients who have undergone organ transplantation and are required to take immunosuppressants are also at risk. HIV infection is present in approximately 20 percent of all pyomyositis patients. About 25 percent of all affected persons traveled to tropical regions before the onset of the disease. Twenty-five to 40 percent of all patients suffered an injury in the diseased muscle area in advance due to an accident or exposure to violence.
Causes
Pyomyositis is caused by an attack of bacteria on the skeletal muscles. In most cases, the bacterium Staphylococcus aureus is responsible for the disease. The germ is found in 90 to 95 percent of all patients in tropical countries and in 70 to 75 percent of all affected persons in non-tropical countries. The remaining pathogens are Streptococcus pyogenes, Streptococcus pneumoniae, Staphylococcus epidermis, Escherichia coli, Yersinia enterocolitica, Proteus mirabilis and various Salmonella. Injuries are considered a frequent risk factor for pyomyositis infection. In addition to trauma, these include generalized muscle contractions that occur in the course of electrical accidents, as well as severe stress. Also classified as risk factors are chronic diseases such as diabetes mellitus and the use of steroids and drugs such as zidovudine, which damage the muscles. Tropical pyomyositis can also be caused by viruses or worm diseases originating from nematodes. The origin of pyomyositis has not yet been precisely clarified. However, many facts speak for a bacterial genesis. Physicians suspect that the disease is a complication of bacteremia. In this case, bacteria get into the blood. An injury in the musculature creates a site of lowered resistance to bacterial infestation, allowing them to advance further. The release of iron from the myoglobin of damaged muscles is also thought to promote the growth of the germs.
Symptoms, complaints, and signs
Pyomyositis often results in the formation of abscesses, which can basically occur on any muscle in the body. Large muscles seem to be more commonly affected by abscess formation than smaller ones. The first stage of pyomyositis is called the invasive phase. It occurs approximately two weeks after infection. The symptoms that appear are considered nonspecific and subacute. Not infrequently, they even remain undetected. Typical symptoms are loss of appetite and fever. In addition, mild pain and swelling may occur. Some patients also suffer from overheating of the diseased areas and reddened skin. The second phase is called the suppurative phase. It is characterized by chills, high fever and SIRS (systemic inflammatory response syndrome). There is also increased pain and tension in the muscles, skin inflammation and pus formation. The third and most serious phase is the late phase, in which more pus is formed. The development of abscesses and joint inflammation increases.In addition, kidney failure and sepsis, which is associated with septic shock, can occur.
Diagnosis and course of the disease
Diagnosis of pyomyositis is considered difficult. Imaging methods and ultrasonography are used. Sonography can detect pus accumulation in the muscles as well as disturbances of the muscle structure. However, this has limited utility in the initial disease phase. Magnetic resonance imaging (MRI) takes place to determine the extent and location of the infection. Confirmation of the diagnosis can be made by microbiological detection of the pathogens, with puncture of the abscesses. If pyomyositis is recognized in the first or second phase and treated accordingly, it usually takes a positive course. However, if the disease progresses further, it can assume life-threatening proportions.
Complications
As a rule, pyomyositis itself is diagnosed relatively late because the symptoms are not particularly characteristic and are ambiguous. Those affected suffer mainly from fever and a severe loss of appetite. There is also a severe loss of weight and, furthermore, deficiency symptoms. These have a very negative effect on the quality of life and general health of the affected person. The skin of the affected person is reddened by the pyomyositis and there is swelling and pain. Furthermore, patients suffer from chills and joint pain. The muscles themselves are tense and cramps may occur. If pyomyositis is not treated, the patient’s kidneys are also damaged. The kidneys no longer detoxify the body and blood poisoning occurs, from which the affected person may eventually die. The patient is then dependent on a kidney transplant or dialysis due to the pyomyositis. The treatment of pyomyositis is carried out with the help of medication. This usually results in a positive course of the disease and no further complications. The patient’s life expectancy is also not affected if treatment is successful.
When should you go to the doctor?
Pyomyositis should always be treated by a physician. It is a serious and, above all, serious disease that cannot be treated even with self-help remedies. Only medical treatment can prevent further complications. A doctor should be consulted for pyomyositis if the affected person suffers from high fever and a severe loss of appetite. Swelling may occur on the body in various regions, and the skin may also appear red and inflamed. If these symptoms are prolonged and do not disappear on their own, a doctor must be consulted. Likewise, the internal organs can be damaged. The affected person is often very warm and the muscles ache. Pyomyositis can be diagnosed by a general practitioner. However, in emergencies, the hospital may be visited or the emergency physician may be called. If pyomyositis is diagnosed early, it can be treated relatively well.
Treatment and therapy
To treat pyomyositis, the physician usually performs surgical abscess drainage. Only rarely do the affected muscle areas need to be amputated. In addition, the patient receives antibiotics. The choice of antibiotics depends on the type of bacterium, possible resistance and the Gram status. In the first phase of the disease, antibiotic treatment alone is often sufficient. The duration of therapy is usually between three and four weeks, but this depends on the extent of pyomyositis.
Prevention
Promising measures for the prevention of pyomyositis are not known. In some cases, eradication of staphylococci on the nasal mucosa by oral administration of rifampin or topical treatment with mupirocin is considered useful.
Follow-up
Usually, the measures or options for follow-up care in pyomyositis are significantly limited or not available to the affected person at all. In this case, the affected person is primarily dependent on a rapid and, above all, an early diagnosis of this disease so that complications or further spread of the tumor do not occur in the further course. As a rule, self-healing is not possible with this disease. Those affected are usually dependent on taking various medications.The prescribed dosage and regular use should always be observed in order to alleviate the symptoms properly and permanently. Regular checks by a doctor are also very useful and can prevent further damage. Most sufferers also rely on the support of their own family or partner, which can prevent the development of depression or other psychological upsets. Pyomyositis does not reduce the life expectancy of the affected person. However, the further course of pyomyositis is highly dependent on the time of diagnosis and also on the severity of the disease, so that a general prediction is not possible in this regard.
