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Emergency Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Alastair Brookes, Yiu-Che Chan, Rebecca Fish, Fung Joon Foo, Aisling Hogan, Thomas Konig, Aoife Lowery, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Colin Walsh, John Wang, Ting Hway Wong
What is necrotising fasciitis?It is polymicrobial infection of skin and fascia with necrosis of subcutaneous tissue, sparing the underlying muscle. It can occasionally invade underlying muscles causing a necrotising pyomyositis.It can progress rapidly to severe sepsis, multiorgan failure and death.Rates of 0.4 – 1/100,000 people per year have been reported. As this is a relatively uncommon condition, much of the evidence to guide practice is from case series, and there is a paucity of level 1 evidence pertaining to this condition.14Higher rates of necrotising fasciitis are seen in men, middle aged and elderly patients, however all ages can be affected.14 Risk factors include diabetes, immunosuppression, steroids, old age, malnourishment, renal failure, arterial occlusive disease, intravenous drug abuse, body mass index >30 kg/m2, recent surgery or traumatic wounds.15,16
Pyomyositis
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Pyomyositis is an acute bacterial infection of skeletal muscle. Clinical presentation can be similar to common conditions such as soft tissue cellulitis which can lead to a delay in treatment and potential clinical deterioration from sepsis. It is then worthwhile to consider the following.
Surgical aspects of HIV infection
Published in Prem Puri, Newborn Surgery, 2017
Alastair J. W. Millar, Brian Eley, Sharon Cox
Approximately 90% of HIV-infected children will develop mucocutaneous disease, which may be infectious or noninfectious.11 Children with symptomatic HIV infection have an increased incidence of soft tissue infections (Figure 28.1). The cutaneous manifestations of HIV are indicators of underlying immune status. Bacterial skin infections are often recurrent, in atypical sites or due to atypical organisms (Figure 28.2).12 The most common organisms causing skin infections are Staphylococcus aureus and Streptococcus species. These usually present as cellulitis, ecthyma, erysipelas, furunculosis (occasionally of disseminated nature), persistent and recurrent folliculitis, and impetigo. Pyomyositis is also increasingly reported, possibly associated with an increased risk of Staphylococcus aureus colonization. Gram-negative organisms may also cause severe, deep-seated skin infection in HIV-infected children. In particular, Pseudomonas species may produce cutaneous manifestations, including ecthyma gangrenosum and a papular rash, often in the perineal area.13 Lethal mucormycosis infection can produce similar features (Figure 28.3a,b,c).14
Streptococcal pyomyositis in asplenia and underlying connective tissue disease
Published in Baylor University Medical Center Proceedings, 2023
John Nguyen, Pardeep Singh, Tapas Gajjar
Pyomyositis is rare in resource-rich countries including the United States, accounting for 0.02% of hospital admissions and mostly occurring in the Southeast/West with a bimodal age distribution of 5 to 9 years and then around 40 years.1–4 Patients can present with muscle pain, fever, and altered mental status.5 Precipitating infection and preceding blunt trauma have been observed, usually affecting the longitudinal lower extremity muscles.1,2,4,6Staphylococcus aureus is the most common cause of pyomyositis followed by group A streptococci, but S. pneumoniae remains the most common cause of life-threatening bacterial infection in asplenic patients.7 Modern pneumococcal vaccinations have decreased the incidence and mortality of S. pneumoniae infection in asplenic patients, but nonadherence to these vaccinations greatly increases the risk of severe sepsis.7 Additional immunocompromising states such as steroid use further increase the risk of severe infection.8
Pyomyositis presenting as myonecrosis secondary to methicillin-resistant Staphylococcus aureus bacteremia in chronic lymphocytic leukemia
Published in Baylor University Medical Center Proceedings, 2022
Shannon Coombs, Albert Bui, Haares S. Mirzan, Kimberly Robelin, Hillary W. Garner, Murli Krishna, Jennifer B. Cowart
Pyomyositis is a microbial infection of the striated muscle and can be a complication of hematologic malignancy.1,2,5–8 Pyomyositis has an estimated mortality rate between 0.89% and 23%9; therefore, a timely diagnostic workup and treatment are important for preventing death. For suspected pyomyositis, current Infectious Diseases Society of America practice guidelines recommend 1) MRI to establish the diagnosis, 2) blood or abscess cultures with collection drainage, 3) empiric intravenous vancomycin plus enteric gram-negative bacilli coverage for the immunocompromised, and 4) 2 to 3 weeks of intravenous antibiotics.10 The MRI in our patient demonstrated edema and enhancement within the muscle tissue consistent with active inflammation in viable muscle tissue as well as large areas of intramuscular nonenhancement consistent with areas of nonviable muscle tissue or myonecrosis. Previous reports of CLL and non-CLL–associated cases describe MRI findings of intramuscular fluid collections with peripheral contrast enhancement and a “feather-like infiltration,” respectively.11,12
Osteomyelitis and pyomyositis due to Staphylococcus aureus in an osteomalacic adult with multiple fractures
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Masumi Ogawa, Takatoshi Kitazawa, Yusuke Yoshino, Koji Morita, Toshio Ishikawa, Yasuo Ota
Adult hematogenous osteomyelitis accounts for approximately 20% of osteomyelitis cases; it most commonly involves the vertebral bones and less frequently involves the long bones of the skeleton [1,2]. Pyomyositis is a purulent skeletal muscle infection that arises from hematogenous dissemination and is usually accompanied by abscess formation [3]. Staphylococcus aureus is the most frequent pathogen of hematogenous osteomyelitis and muscular abscesses [1,4]. Herein, we report a case of multiple fractures accompanied by multifocal pyomyositis and osteomyelitis due to S. aureus. He had hypophosphatemia on admission and was finally diagnosed as osteomalacia.