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Infectious myositis

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Infectious myositis, an infection of the skeletal muscle(s), is uncommon. This clinical entity may be caused by viral, bacterial, fungal, and parasitic pathogens. Viral etiologies typically cause diffuse myalgias and/or myositis, whereas bacteria and fungi usually lead to a local myositis which may be associated with sites compromised by trauma or surgery and are more common among immunocompromised patients. Localized collections within the muscles are referred to as pyomyositis. Other pyogenic causes of myositis include gas gangrene, group A streptococcal myonecrosis, and other types of non-clostridial myonecrosis. Early recognition and treatment of these conditions are necessary as they may rapidly become life-threatening.

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Infectious myositis

The infectious causes of myositis, summarized in Table 2, include viral, bacterial, fungal, and parasitic pathogens.*1, *3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, *15, 16, 17 Some infections cause focal myositis, while others lead to diffuse involvement of the musculature (Table 3). Bacteria and fungi usually present as a focal myositis, whereas viral and parasitic pathogens are more likely to present as a diffuse myositis. Further, bacterial myositis may occur in association with areas of the

Pyomyositis

Pyomyositis is an intramuscular infection which involves one or more of the skeletal muscle groups, and which is not a result of infection of adjacent skin, soft tissue, or bone (Table 3). It was originally described in the tropics, and originally named pyomyositis tropicans.22 In these areas, the pyomyositis accounts for 1–4% of hospitalizations and is often associated with trauma, nutritional deficiencies, and/or concomitant parasitic infections (e.g. migration of Toxocara or the guinea worm,

Psoas abscess

Although this infection is similar to pyomyositis given the development of an abscess or phlegmon within the psoas muscle, it differs in that most occur due to the spread of infection from a nearby site such as from a gastrointestinal source (malignancy, Crohn's disease, appendicitis, diverticulitis) or an adjacent vertebral osteomyelitis usually due to S. aureus or M. tuberculosis.38 Other inciting events may be a complication of pregnancy or abortion in women, a retroperitoneal hematoma, or,

Gas gangrene

Gas gangrene is a rapidly progressive infection of the skeletal muscle(s) with necrosis and the potential for systemic toxicity. This infection may occur in association with a dirty wound after trauma or surgery and is usually due to Clostridium perfringens. Clinical scenarios include unclean traumatic wounds contaminated with soil (e.g. war wounds), wounds associated with gastrointestinal surgeries (e.g. bowel and biliary), septic abortions, injection sites, or trauma to an area with an

Other forms of bacterial myonecrosis

Synergistic non-clostridial myonecrosis may occur among patients with vascular insufficiency (e.g. diabetes mellitus, cardiorenal disease, obesity) or among neutropenic patients. This infection involves the skin, subcutaneous tissues, fascia, and muscle; it is usually polymicrobial, with both aerobic and anaerobic pathogens.

Similar infections can involve patients with vascular grafts with a variety of organisms, including Bacillus.56 Patients with wounds and exposure to fresh water may develop

Myalgias associated with eosinophilia

Infectious myositis accompanied by eosinophilia is typically due to a parasitic infection. These disorders characteristically manifest as diffuse myalgias, although specific muscles may be most involved.

Disclaimer

The views expressed in this article are those of the author and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.

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