PDF(Pubmed)
Abstract：
Pyomyositis or tropical pyomyositis is an uncommon infection of skeletal muscle that may be primary or secondary. Primary type has bacterial aetiology, and Staphylococcus aureus is associated in most cases. The diagnosis requires high index of suspicion and careful assessment of radiological investigations. Diagnosis often requires magnetic resonance imaging (MRI) for better delineation of the disease process, associated site involvement and exclusion of related conditions. Evacuation of pus coupled with appropriate antibiotic therapy is the mainstay and curative in most cases. Caution, however, is required due to increased morbidity, protracted course of recovery and mortality in few cases. The association with comorbidities including immunocompromised status compounds the problem. We describe our experience with this condition in a series of five cases (four male and one female) with diverse involvement of scapular muscle. All cases had primary pyomyositis except one case secondary to shoulder joint tuberculosis. Right side was involved in three and left in two cases. Infraspinatus was commonly involved, and one case had extensive involvement around scapula. All cases were managed by one or multiple aspiration, except one managed with open surgical drainage. The outcome was good in all cases with no recurrence or complication noted in their respective follow-up. Primary care centres may play important role in the early diagnosis of this condition with clinical evaluation and judicious use of imaging. Cases with severe involvement or those requiring advanced procedures may be referred to higher centres as per the requirement. Most of the times, timely diagnosis, antibiotic therapy and drainage of the pus is required and may also be performed in the primary care level through a standard protocol.
摘要：
化脓性肌炎或热带化脓性肌炎是一种罕见的骨骼肌感染，可能是原发性或继发性的。原发性有细菌病因，和金黄色葡萄球菌在大多数情况下是相关的。诊断需要高度怀疑并仔细评估放射学检查。诊断通常需要磁共振成像（MRI）以更好地描绘疾病过程，相关网站的参与和排除相关条件。在大多数情况下，脓液的清除加上适当的抗生素治疗是主要的治疗方法。Caution,然而,由于发病率增加而需要，在少数情况下，恢复和死亡的过程旷日持久。与包括免疫受损状态在内的合并症的关联加剧了问题。我们在一系列5例（4例男性和1例女性）中描述了我们在这种情况下的经历，这些病例涉及肩cap肌。除1例继发于肩关节结核外，所有病例均为原发性化脓性肌炎。右侧参与了三个案例，左侧参与了两个案例。通常累及的是冈内肌，其中一例广泛累及肩胛骨周围。所有病例均通过一次或多次抽吸处理，除了一个用开放式手术引流管理。所有病例的结果均良好，在各自的随访中均未发现复发或并发症。通过临床评估和明智的影像学检查，初级保健中心在这种情况的早期诊断中可能发挥重要作用。严重参与的案件或需要高级程序的案件可根据要求转交给上级中心。大多数时候,及时诊断,抗生素治疗和脓液引流是必需的,也可以通过标准方案在初级保健水平进行.
