Current Infectious Disease Reports

, Volume 12, Issue 5, pp 374–382

Nonbacterial Myositis



Infectious myositis is defined as an infection of a skeletal muscle. Infectious myositis is most commonly caused by bacteria; however, a variety of viral, parasitic, and fungal agents may also cause myositis. The pathogenesis of nonbacterial infectious myositis is via direct or hematogenous infection of the musculature or immune mechanisms. Symptoms typically include muscular pain, tenderness, swelling, and/or weakness. The diagnosis of the specific microbe is often suggested by the presence of concordant clinical signs and symptoms, a detailed medical and travel history, and laboratory data. For example, immunocompromised hosts have a heightened risk of fungal myositis, whereas the presence of a travel history to an endemic location and/or eosinophilia may suggest a parasitic cause. Definitive diagnosis requires detecting the organism by specific laboratory testing including serologies, histopathology, and/or cultures. Treatment entails antimicrobial agents against the pathogen, with consideration for surgical drainage for focal purulent collections within the musculature.


Infectious myositis Nonbacterial myositis Viral Fungal Parasitic Influenza Coxsackievirus Human immunodeficiency virus Rhabdomyolysis Candida Cryptococcus Histoplasmosis Aspergillus Trichinosis Cysticercosis Toxoplasmosis Microsporidia 


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    • Brook I: Microbiology and management of soft tissue and muscle infections. Int J Surg 2007, 30:1–11. This article provides a review of the microbiology, diagnosis, and management of bacterial myositis.Google Scholar
  2. 2.
    Crum NF: Bacterial pyomyositis in the United States. Am J Med 2004, 117:420–428.CrossRefPubMedGoogle Scholar
  3. 3.
    •• Parasca I, Damian L, Albu A: Infectious muscle disease. Rom J Intern Med 2006, 44:131–141. This paper is a brief review of the causes of myositis including commentary on the most common bacterial, viral, and parasitic causes.PubMedGoogle Scholar
  4. 4.
    Miyake H: Beitrage (Beitraege) zur Kenntnis der sogenannten Myositis Infectiosa. Mitt Grenzgeb Med Chir 1904, 13:155–198.Google Scholar
  5. 5.
    •• Crum-Cianflone NF: Bacterial, fungal, parasitic, and viral myositis. Clin Microbiol Rev 2008, 21:473–494. This article is a comprehensive review of the pathogens associated with infectious myositis, including a robust bibliography of the existing literature.CrossRefPubMedGoogle Scholar
  6. 6.
    Jiménez-Lucho VE, Del Busto R, Fisher EJ: Disseminated cryptococcosis with muscular involvement. J Infect Dis 1985, 151:567.PubMedGoogle Scholar
  7. 7.
    Lundberg A: Myalgia cruris epidemica. Acta Paediatr 1957, 46:18–31.CrossRefPubMedGoogle Scholar
  8. 8.
    • Hu JJ, Kao CL, Lee PI, et al.: Clinical features of influenza A and B in children and association with myositis. J Microbiol Immunol Infect 2004, 37:95–98. This paper describes a retrospective study of nearly 200 cases of influenza A and B infections among children who developed myositis that provides valuable information on incidence rates and the clinical presentation of cases.PubMedGoogle Scholar
  9. 9.
    Buss BF, Shinde VM, Safranek TJ, Uyeki TM: Pediatric influenza-associated myositis—Nebraska, 2001–2007. Influenza Other Respi Viruses 2009, 3:277–285.CrossRefPubMedGoogle Scholar
  10. 10.
    •• Agyeman P, Duppenthaler A, Heininger U, Aebi C: Influenza-associated myositis in children. Infection 2004, 32:199–203. This paper provides a concise review of more than 300 cases of influenza-associated myositis, with information on epidemiology, clinical features, and outcomes.CrossRefPubMedGoogle Scholar
  11. 11.
    Yoshino M, Suzuki S, Adachi K, et al.: High incidence of acute myositis with type A influenza virus infection in the elderly. Intern Med 2000, 39:431–432.CrossRefPubMedGoogle Scholar
  12. 12.
    • Koliou M, Hadjiloizou S, Ourani S, et al.: A case of benign acute childhood myositis associated with influenza A (H1N1) virus infection. Clin Microbiol Infect 2010, 16:193–195. This paper presents the first reported case of myositis from the 2009 novel H1N1 influenza strain.CrossRefPubMedGoogle Scholar
  13. 13.
    Gamboa ET, Eastwood AB, Hays AP, et al.: Isolation of influenza virus from muscle in myoglobinuric polymyositis. Neurology 1979, 29:1323–1335.PubMedGoogle Scholar
  14. 14.
    Kessler HA, Trenholme GM, Harris AA, Levin S: Acute myopathy associated with influenza A/Texas/1/77 infection. Isolation of virus from a muscle biopsy specimen. JAMA 1980, 243:461–462.CrossRefPubMedGoogle Scholar
  15. 15.
    Singh U, Scheld WM: Infectious etiologies of rhabdomyolysis: three case reports and review. Clin Infect Dis 1996, 22:642–649.PubMedGoogle Scholar
  16. 16.
    Bell EJ, Grist NT: ECHO viruses, carditis, and acute pleurodynia. Am Heart J 1971, 82:133–135.CrossRefPubMedGoogle Scholar
  17. 17.
    Bain HW, McLean DM, Walker SJ: Epidemic pleurodynia (Bornholm disease) due to Coxsackie B-5 virus. The inter-relationship of pleurodynia, benign pericarditis and aseptic meningitis. Pediatrics 1961, 27:889–903.PubMedGoogle Scholar
  18. 18.
    Warin JF, Davies JB, Sanders FK, Vizoso AD: Oxford epidemic of Bornholm disease, 1951. Br Med J 1953, 1:1345–1351.CrossRefPubMedGoogle Scholar
  19. 19.
    Josselson J, Pula T, Sadler JH: Acute rhabdomyolysis associated with an echovirus 9 infection. Arch Intern Med 1980, 140:1671–1672.CrossRefPubMedGoogle Scholar
  20. 20.
    Fodili F, van Bommel EF: Severe rhabdomyolysis and acute renal failure following recent Coxsackie B virus infection. Neth J Med 2003, 61:177–179.PubMedGoogle Scholar
  21. 21.
    Verma NA, Zheng XT, Harris MU, et al.: Outbreak of life-threatening coxsackievirus B1 myocarditis in neonates. Clin Infect Dis 2009, 49:759–763.CrossRefPubMedGoogle Scholar
  22. 22.
    Dalakas MC, Pezeshkpour GH, Gravell M, Sever JL: Polymyositis associated with AIDS retrovirus. JAMA 1986, 256:2381–2383.CrossRefPubMedGoogle Scholar
  23. 23.
    Ytterberg SR: Infectious agents associated with myopathies. Curr Opin Rheumatol 1996, 8:507–513.CrossRefPubMedGoogle Scholar
  24. 24.
    Authier FJ, Chariot P, Gherardi RK: Skeletal muscle involvement in human immunodeficiency virus (HIV)-infected patients in the era of highly active antiretroviral therapy (HAART). Muscle Nerve 2005, 32:247–260.CrossRefPubMedGoogle Scholar
  25. 25.
    Chariot P, Ruet E, Authier FJ, et al.: Acute rhabdomyolysis in patients infected by human immunodeficiency virus. Neurology 1994, 44:1692–1696.PubMedGoogle Scholar
  26. 26.
    Leon-Monzon M, Illa I, Dalakas MC: Polymyositis in patients infected with human T-cell leukemia virus type I: the role of the virus in the cause of the disease. Ann Neurol 1994, 36:643–649.CrossRefPubMedGoogle Scholar
  27. 27.
    Mihas AA, Kirby JD, Kent SP: Hepatitis B antigen and polymyositis. JAMA 1978, 239:221–222.CrossRefPubMedGoogle Scholar
  28. 28.
    Di Muzio A, Bonetti B, Capasso M, et al.: Hepatitis C virus infection and myositis: a virus localization study. Neuromuscul Disord 2003, 13:68–71.CrossRefPubMedGoogle Scholar
  29. 29.
    Bowles NE, Ni J, Kearney DL, et al.: Detection of viruses in myocardial tissues by polymerase chain reaction. Evidence of adenovirus as a common cause of myocarditis in children and adults. J Am Coll Cardiol 2003, 42:466–472.CrossRefPubMedGoogle Scholar
  30. 30.
    Sakata H, Taketazu G, Nagaya K, et al.: Outbreak of severe infection due to adenovirus type 7 in a paediatric ward in Japan. J Hosp Infect 1998, 39:207–211.CrossRefPubMedGoogle Scholar
  31. 31.
    Kishore J, Singh J: Detection of parvovirus B19 in a case of erythema infectiosum with myositis. Indian Pediatr 2006, 43:814–817.PubMedGoogle Scholar
  32. 32.
    Smith RD, Konoplev S, DeCourten-Myers G, Brown T: West Nile virus encephalitis with myositis and orchitis. Hum Pathol 2004, 35:254–258.CrossRefPubMedGoogle Scholar
  33. 33.
    Ahmad R, Abdul Latiff AK, Abdul Razak S: Myalgia cruris epidemica: an unusual presentation of dengue fever. Southeast Asian J Trop Med Public Health 2007, 38:1084–1087.PubMedGoogle Scholar
  34. 34.
    Finsterer J, Kongchan K: Severe, persisting, steroid-responsive Dengue myositis. J Clin Virol 2006, 35:426–428.CrossRefPubMedGoogle Scholar
  35. 35.
    Montgomery SP, Chow CC, Smith SW, et al.: Rhabdomyolysis in patients with west nile encephalitis and meningitis. Vector Borne Zoonotic Dis 2005, 5:252–257.CrossRefPubMedGoogle Scholar
  36. 36.
    Tsai SH, Peng YJ, Wang NC: Pyomyositis with hepatic and perinephric abscesses caused by Candida albicans in a diabetic nephropathy patient. Am J Med Sci 2006, 331:292–294.CrossRefPubMedGoogle Scholar
  37. 37.
    Kallen PS, Louie JS, Nies KM, Bayer AS: Infectious myositis and related syndromes. Semin Arthritis Rheum 1982, 11:421–439.CrossRefPubMedGoogle Scholar
  38. 38.
    Jarowski CI, Fialk MA, Murray HW, et al.: Fever, rash, and muscle tenderness. A distinctive clinical presentation of disseminated candidiasis. Arch Intern Med 1978, 138:544–546.CrossRefPubMedGoogle Scholar
  39. 39.
    Schwartz DM, Morgan ER: Multimodality imaging of Candida tropicalis myositis. Pediatr Radiol 2008, 38:473–476.CrossRefPubMedGoogle Scholar
  40. 40.
    Sharma M, Khatib R, Jones BA, Fakih MG: Cryptococcus neoformans myositis without dissemination. Scand J Infect Dis 2002, 34:858–859.CrossRefPubMedGoogle Scholar
  41. 41.
    Barber BA, Crotty JM, Washburn RG, Pegram PS: Cryptococcus neoformans myositis in a patient with AIDS. Clin Infect Dis 1995, 21:1510–1511.PubMedGoogle Scholar
  42. 42.
    Goel D, Prayaga AK, Rao N, Damodaram P: Histoplasmosis as a cause of nodular myositis in an AIDS patient diagnosed on fine needle aspiration cytology. A case report. Acta Cytol 2007, 51:89–91.PubMedGoogle Scholar
  43. 43.
    Voloshin DK, Lacomis D, McMahon D: Disseminated histoplasmosis presenting as myositis and fasciitis in a patient with dermatomyositis. Muscle Nerve 1995, 18:531–535.CrossRefPubMedGoogle Scholar
  44. 44.
    Bourré-Tessier J, Fortin C, Belisle A, et al.: Disseminated Histoplasma capsulatum infection presenting with panniculitis and focal myositis in rheumatoid arthritis treated with etanercept. Scand J Rheumatol 2009, 38:311–316.CrossRefPubMedGoogle Scholar
  45. 45.
    Reboli AC, Reilly RF, Jacobson RJ: Aspergillus myositis in a patient with a myelodysplastic syndrome. Mycopathology 1987, 97:117–119.CrossRefGoogle Scholar
  46. 46.
    Javier RM, Sibilia J, Lugger AS, et al.: Fatal Aspergillus fumigatus myositis in an immunocompetent patient. Eur J Clin Microbiol Infect Dis 2001, 20:810–813.CrossRefPubMedGoogle Scholar
  47. 47.
    Li DM, Xiu DR, Li RY, et al.: Aspergillus flavus myositis in a patient after liver transplantation. Clin Transplant 2008, 22:508–511.PubMedGoogle Scholar
  48. 48.
    Crum-Cianflone NF, Truett AA, Teneza-Mora N, et al.: Unusual presentations of coccidioidomycosis: a case series and review of the literature. Medicine (Baltimore) 2006, 85:263–277.CrossRefGoogle Scholar
  49. 49.
    Pearl GS, Sieger B: Granulomatous Pneumocystis carinii myositis presenting as an intramuscular mass. Clin Infect Dis 1996, 22:577–578.PubMedGoogle Scholar
  50. 50.
    Jain JK, Markowitz A, Khilanani PV, Lauter CB: Localized mucormycosis following intramuscular corticosteroid. Case report and review of the literature. Am J Med Sci 1978, 275:209–216.CrossRefPubMedGoogle Scholar
  51. 51.
    Schneller FR, Gulati SC, Cunningham IB, et al.: Fusarium infections in patients with hematologic malignancies. Leuk Res 1990, 14:961–966.CrossRefPubMedGoogle Scholar
  52. 52.
    Halverson PB, Lahiri S, Wojno WC, Sulaiman AR: Sporotrichal arthritis presenting as granulomatous myositis. Arthritis Rheum 1985, 28:1425–1429.CrossRefPubMedGoogle Scholar
  53. 53.
    Hardjasudarma M, Willis B, Black-Payne C, Edwards R: Pediatric spinal blastomycosis: case report. Neurosurg 1995, 37:534–536.CrossRefGoogle Scholar
  54. 54.
    Pozio E, Gomez Morales MA, Dupouy-Camet J: Clinical aspects, diagnosis and treatment of trichinellosis. Expert Rev Anti Infect Ther 2003, 1:471–482.CrossRefPubMedGoogle Scholar
  55. 55.
    Santos Durán-Ortiz J, García-de la Torre I, Orozco-Barocio G, et al.: Trichinosis with severe myopathic involvement mimicking polymyositis. Report of a family outbreak. J Rheumatol 1992, 19:310–312.PubMedGoogle Scholar
  56. 56.
    Watt G, Saisorn S, Jongsakul K, et al.: Blinded, placebo-controlled trial of antiparasitic drugs for trichinosis myositis. J Infect Dis 2000, 182:371–374.CrossRefPubMedGoogle Scholar
  57. 57.
    Basuroy R, Pennisi R, Robertson T, et al.: Parasitic myositis in tropical Australia. Med J Aust 2008, 188:254–256.PubMedGoogle Scholar
  58. 58.
    Dennett X, Siejka SJ, Andrews JR, et al.: Polymyositis caused by a new genus of nematode. Med J Aust 1998, 168:226–227.PubMedGoogle Scholar
  59. 59.
    Ergen FB, Turkbey B, Kerimoglu U, et al.: Solitary cysticercosis in the intermuscular area of the thigh: a rare and unusual pseudotumor with characteristic imaging findings. J Comput Assist Tomogr 2005, 29:260–263.CrossRefPubMedGoogle Scholar
  60. 60.
    Takayanagui OM, Chimelli L: Disseminated muscular cysticercosis with myositis induced by praziquantel therapy. Am J Trop Med Hyg 1998, 59:1002–1003.PubMedGoogle Scholar
  61. 61.
    Sawhney BB, Chopra JS, Banerji AK, Wahi PL: Pseudohypertrophic myopathy in cysticercosis. Neurology 1976, 26:270–272.PubMedGoogle Scholar
  62. 62.
    Montoya JG, Jordan R, Lingamneni S, et al.: Toxoplasmic myocarditis and polymyositis in patients with acute acquired toxoplasmosis diagnosed during life. Clin Infect Dis 1997, 24:676–683.PubMedGoogle Scholar
  63. 63.
    Plonquet A, Bassez G, Authier FJ, et al.: Toxoplasmic myositis as a presenting manifestation of idiopathic CD4 lymphocytopenia. Muscle Nerve 2003, 27:761–765.CrossRefPubMedGoogle Scholar
  64. 64.
    Gherardi R, Baudrimont M, Lionnet F, et al.: Skeletal muscle toxoplasmosis in patients with acquired immunodeficiency syndrome: a clinical and pathological study. Ann Neurol 1992, 32:535–542.CrossRefPubMedGoogle Scholar
  65. 65.
    Cuturic M, Hayat GR, Vogler CA, Velasques A: Toxoplasmic polymyositis revisited: case report and review of literature. Neuromuscul Disord 1997, 7:390–396.CrossRefPubMedGoogle Scholar
  66. 66.
    Coyle CM, Weiss LM, Rhodes LV III, et al.: Fatal myositis due to the microsporidian Brachiola algerae, a mosquito pathogen. N Engl J Med 2004, 351:42–47.CrossRefPubMedGoogle Scholar
  67. 67.
    Curry A, Beeching NJ, Gilbert JD, et al.: Trachipleistophora hominis infection in the myocardium and skeletal muscle of a patient with AIDS. J Infect 2005, 51:e139–e144.CrossRefPubMedGoogle Scholar
  68. 68.
    Cossermelli W, Friedman H, Pastor EH, et al.: Polymyositis in Chagas’s disease. Ann Rheum Dis 1978, 37:277–280.CrossRefPubMedGoogle Scholar
  69. 69.
    Arness MK, Brown JD, Dubey JP, et al.: An outbreak of acute eosinophilic myositis attributed to human Sarcocystis parasitism. Am J Trop Med Hyg 1999, 61:548–553.PubMedGoogle Scholar
  70. 70.
    Walsh SS, Robson WJ, Hart CA: Acute transient myositis due to Toxocara. Arch Dis Child 1988, 63:1087–1088.CrossRefPubMedGoogle Scholar
  71. 71.
    Mansours E-D, Reese H: A previously unreported myopathy in patients with schistosomiasis. Neurology 1964, 14:355–361.Google Scholar
  72. 72.
    Thursky K, Torresi J: Primary muscle hydatidosis of the thigh: management of a complicated case with combination adjunctive albendazole and praziquantel chemotherapy. Clin Infect Dis 2001, 32:E65–E68.CrossRefPubMedGoogle Scholar
  73. 73.
    O’Leary C, Finch R: Amoebic psoas and liver abscesses. Postgrad Med J 1992, 68:972–973.CrossRefPubMedGoogle Scholar
  74. 74.
    Kim JR, Lee JM: A case of intramuscular sparganosis in the sartorius muscle. J Korean Med Sci 2001, 16:378–380.PubMedGoogle Scholar
  75. 75.
    Davi TM, Pongponratan E, Supanaranond W, et al.: Skeletal muscle involvement in falciparum malaria: biochemical and ultrastructural study. Clin Infect Dis 1999, 29:831–835.CrossRefGoogle Scholar
  76. 76.
    Neumann H, Herz R, Baum C: Granulomatose und eosinophilic myositis due to Onchocerca volvulus. Pathologe 1985, 6:101–107.PubMedGoogle Scholar
  77. 77.
    • Nagaraju K, Lundberg IE: Inflammatory diseases of muscle and other myopathies. In Kelley’s Textbook of Rheumatology, edn 8. Edited by Firestein GS, Budd RC, Harris ED, et al. Philadelphia, PA: Elsevier/Saunders; 2008:1353–1380. This chapter provides a comprehensive review of the noninfectious causes of myositis.Google Scholar
  78. 78.
    Brenner J, Solitar BM, Golden BD: Rheumatic manifestations of current pharmacopeia. Curr Rheumatol Rep 2000, 2:151–155.CrossRefPubMedGoogle Scholar

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© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Infectious Disease Clinical Research ProgramUniformed Services University of the Health SciencesBethesdaUSA
  2. 2.Infectious Disease ClinicNaval Medical Center San DiegoSan DiegoUSA
  3. 3.Clinical Investigation Department (KCA)Naval Medical Center San DiegoSan DiegoUSA

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