Abstract
Aims
We present the largest series of paediatric pelvic pyomyositis from a temperate country, analyse the factors influencing long term prognosis and suggest a diagnostic protocol.
Materials and method
We included 41 patients diagnosed with primary paediatric pelvic pyomyositis between 1998 and 2016, in this study with a mean age of 7.5 years. Demographic, clinical, radiological and follow-up data were reviewed. Statistical analysis was performed to analyse the influence of early diagnosis and treatment on the final outcome.
Results
There was an increased occurrence of primary pelvic pyomyositis in the last two years. Of cases identified, 85% fulfilled Kocher’s criteria for hip septic arthritis. The mean time to diagnosis was 2.8 ± 0.8 days. The most common muscle affected was obturator internus (65.85%) and multifocal involvement was common (46.34%). Early diagnosis and antibiotic treatment within seven days from the time of onset of symptoms was the only factor that influenced final outcome (p < 0.001).
Discussion and conclusion
Pyomyositis is no longer restricted to tropical countries. The time from onset of symptoms to start of antibiotic treatment influences the final outcome. Clinical examination and inflammatory markers have low specificity in distinguishing between pyomyositis, septic arthritis, osteomyelitis or other infections. MRI is more sensitive and can diagnose pyomyositis in its early stages. Every suspected case of septic arthritis of the hip should undergo an ultrasound. MRI scan may be performed if the ultrasound shows inconclusive evidence of an effusion. Early identification will facilitate early antibiotic treatment which will improve the final outcome.
Clinical relevance
There is an increasing occurrence of this tropical disease in temperate countries. Early diagnosis with an MRI scan and early antibiotic use results in good outcomes.
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References
Unnikrishnan PN, Perry DC, George H, Bassi R, Bruce CE (2010) Tropical primary pyomyositis in children of the UK: an emerging medical challenge. Int Orthop 34(1):109–113
Chattopadhyay B, Mukhopadhyay M, Chatterjee A, Biswas PK, Chatterjee N, Debnath NB (2013) Tropical pyomyositis. N Am J Med Sci 5(10):600–603
Crum NF (2004) Bacterial pyomyositis in the United States. Am J Med 117(6):420–428
Moriarty P, Leung C, Walsh M, Nourse C (2015) Increasing pyomyositis presentations among children in Queensland, Australia. Pediatr Infect Dis J 34(1):1–4
Brown JD, Wheeler B (1984) Pyomyositis. Report of 18 cases in Hawaii. Arch Intern Med 144(9):1749–1751
Adams S, Petz C (2015) Tropical pyomyositis in a temperate climate. J S C Med Assoc 111(4):137–138
Verma S (2016) Pyomyositis in children. Curr Infect Dis Rep 18(4):12
Verma S, Singhi SC, Marwaha RK, Singhi P, Singh S, Singh M (2013) Tropical pyomyositis in children: 10 years experience of a tertiary care hospital in northern India. J Trop Pediatr 59(3):243–245
Horn CV, Master S (1968) Pyomyositis tropicans in Uganda. East Afr Med J 45(7):463–471
Chiedozi LC (1979) Pyomyositis. Review of 205 cases in 112 patients. Am J Surg 137(2):255–259
Kocher MS, Zurakowski D, Kasser JR (1999) Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence- based clinical prediction algorithm. J Bone Joint Surg Am 81(12):1662–1670
Bertrand SL, Lincoln ED, Prohaska MG (2011) Primary pyomyositis of the pelvis in children: a retrospective review of 8 cases. Orthopedics 34(12):e832–e840
Pannaraj PS, Hulten KG, Gonzalez BE, Mason EO Jr, Kaplan SL (2006) Infective pyomyositis and myositis in children in the era of community- acquired, methicillin-resistant Staphylococcus aureus infection. Clin Infect Dis 43(8):953–960
Gubbay AJ, Isaacs D (2000) Pyomyositis in children. Pediatr Infect Dis J 19(10):1009–1012
Mitsionis GI, Manoudis GN, Lykissas MG, Sionti I, Motsis E, Georgoulis AD, Berisa AE (2009) Pyomyositis in children: early diagnosis and treatment. J Pediatr Surg 44(11):2173–2178
Ghazala CG, Fatone E, Bentley R, Rajeev A (2016) Primary bacterial gluteal pyomyositis: a rare disease in temperate climates presenting as suspected septic arthritis of the hip. J Emerg Med 51(3):319–321
Park E, Chilstrom M (2016) Diagnosis of pyomyositis in a pediatric patient with point-of-care ultrasound. West J Emerg Med 17(4):464–465
Plumb J, Mallin M, Bolte RG (2015) The role of ultrasound in the emergency department evaluation of the acutely painful pediatric hip. Pediatr Emerg Care 31(1):54–58
Tharmarajah H, Marks M (2015) Early use of MRI for suspected pyomyositis. J Paediatr Child Health 51(6):651–652
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Kiran, M., Mohamed, S., Newton, A. et al. Pelvic pyomyositis in children: changing trends in occurrence and management. International Orthopaedics (SICOT) 42, 1143–1147 (2018). https://doi.org/10.1007/s00264-017-3746-1
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DOI: https://doi.org/10.1007/s00264-017-3746-1