Introduction: In temperate places pyomyositis is very uncommon in children and adolescents. West European and North American Literature about is relatively poor (104 articles from 1998 to nowadays and most of these papers are case-rep orts). S. Aureus is the etiologic agent in 90% of cases. Muscle of the thighs and hips are the most frequent localisation and severe complications are observed in 10% of cases. Material and Methods: We reviewed all patients affected by primary pyomyositis and admitted in our Department from 1995 to nowadays. Age, sex, history and clinical findings, general and local risk factors were reported. X-rays, Ultrasonography, MRI, Scintigraphy, Haematological investigation and culture were considered in order to state the imaging and laboratory findings of the disease. Result: Pyomyositis was diagnosed in three males, aged 11, 13 and 16. There was no evidence of medical or familiar risk factors. Soleus, Otturatorius and Psoas muscles were respectively involved. In all cases fever, local signs of inflammation and pain, neutrophylic leukocytosis, increased ESR and CRP levels were present. Blood culture was positive in one case. Standard X-Rays were normal in all cases. Ultrasound scan, RMI and Scintigraphy were positive but non-specific in all cases. 2 cases underwent to surgical drainage and a 3 weeks antibiotic therapy; 1 case resolved performing only medical treatment (5 weeks of antibiotic). All patients showed complete clinical, haematological, and RMI recovered without reliquates. Conclusions: Pyomyositis is uncommon in temperate climate and it may be easy misdiagnosed at the onset. In our patients the mean time from onset of symptoms to diagnosis was 10 days. History and clinical examination might be evocative, but there are no pathognomonic haematological or radiological findings so that diagnosis is often the result of extensive and wide considerations. Pyomyositis should be suspected in any unclear septic condition of the musculoskeletal apparatus. High index of suspicion, prompt diagnosis, and early treatment can prevent complications and allow the recovery of this potentially life-threatening disease

Pyomyositis is rarely seen in temperate climates. Typically, it presents with the formation of an abscess requiring surgical drainage and it has been reported as a differential diagnosis for septic arthritis of the hip. We describe the occurrence of pyomyositis of the iliacus muscle in a ten-year-old girl which was diagnosed by MRI and blood culture. Formation of an abscess did not occur despite marked focal inflammation and swelling of the muscle. Conservative treatment with antibiotics alone led to complete clinical and radiological resolution of the infection. We could find no previous description of pyomyositis in a child in the British orthopaedic literature. Orthopaedic surgeons, particularly those with a paediatric interest, should be aware of this condition and its presentation, diagnosis and treatment

Pyomyositis is a primary pyogenic infection in skeletal muscle, often progressing to abscess formation. It is rare in temperate climates and generally deep-seated within the pelvis with non-specific clinical features, making diagnosis difficult. Magnetic Resonance Imaging (MRI) is highly sensitive for muscle inflammation and fluid collection and with its increasing availability is now the investigation of choice. Treatment of pyomyositis abscess has traditionally been with incision and drainage or guided aspiration followed by a prolonged course of antibiotics, although there are sporadic reports of cases treated successfully with antibiotics alone. From our 20 year database of over 16000 paediatric orthopaedic admissions we identified only 3 cases with MRI-confirmed pyomyositis abscess. These were all in boys (aged 2-12) and affected the gluteal, piriformis and adductor muscles. Despite the organisms not being identified, each patient was treated successfully with a short (4-7 day) course of intravenous antibiotics followed by 2-6 weeks of oral therapy. There were no recurrences or complications and all made a full recovery. We propose that uncomplicated pyomyositis abscess in children may usually be managed conservatively without the need for open or percutaneous drainage

Pyomyositis in a temperate climate is a rare condition in children according the number of reports. Most authors postulate trauma with simultaneous bacteriemia is the most likely mechanism. We reviewed 8 cases, 4 boys and 4 girls. Their mean age was 9,2 y. ( 5 to 16 y.). Pain, tenderness, limp and fever were the most common signs. Duration of symptoms before initial evaluation was 8,1 d. (5 to 15 d.). 6 patients had fever (> 38,5°C), all had leukocytosis and a shift to the left in the WBC, and a elevated ESR 69,3 mm/h(32 to110), as well as an increased C-protein reactive (mean=10). All cases had radiographs, US in 6, CT scan in 6 and MRI in 5. These studies demonstrated involvement of psoas muscle in 4, obturator internus and externus in 3, and gluteal and quadratus femoris in 1. We found simultaneous involvement of ischiopubic ramus in 3, one iliac osteomyelitis, one piogenic sacro-ileitis, one supurative lymphadenitis and one resection for Crohn’s disease. Incision and drainage of muscular abcess (5 cases)plus IV antibiotics(8 cases) provided uneventfully resolution. 4 cultures were positive to Staf Aureus, 1 to E. Coli and 3 negatives. In this series we found 87% of pelvic pyomyositis with simultaneous septic factors. We consider them more causative factors than predisponing, and pyomyositis as a secondary entity. Previous reports propose pyomyo-sitis as a primary condition after a speculative bacter-aemia with a muscle strain, as the likeliest cause. MRI could be helpful to determine bone involvement or other regional problems in pelvic pyomyositis

Aims

The aim of this study was to determine the consensus best practice approach for the investigation and management of children (aged 0 to 15 years) in the UK with musculoskeletal infection (including septic arthritis, osteomyelitis, pyomyositis, tenosynovitis, fasciitis, and discitis). This consensus can then be used to ensure consistent, safe care for children in UK hospitals and those elsewhere with similar healthcare systems.

Tropical pyomyosistis is an uncommon condition in the United Kingdom. Early diagnosis and appropriate treatment are crucial for a good outcome. We had seen 13 cases in our previously published series from 1998 to 2009. This is an update showing a significantly increased incidence from 2010 to 2016.

A retrospective review of all cases of pelvic pyomyositis in our centre from January 2010 to April 2016 was undertaken from case notes and radiology reports. All children with clinical and radiographic evidence of pyomyositis were included. Since our previous publication we had changed our practice to get an MRI scan in all children who presented with a limp, fever and raised inflammatory markers, and had no effusion in the hip ultrasound scan.

We identified 24 children with a mean age of 7 years (range, 1 week to 14 years). MSSA (Methicillin-Sensitive Staphylococcus aureus) was the most common cultured organism (n=8). Median hospital stay was 9 days (3 to 12). Obturator internus was the most common muscle affected. All patients had appropriate antibiotics with 2 patients requiring surgical drainage of abscesses. The majority of children (n=22) showed a complete recovery with antibiotics only.

Incidence of pyomyositis has increased dramatically in our population and early diagnosis can result in a good outcome. We recommend MRI scan in all patients who present with a clinical picture of septic arthritis of the hip but with no effusion.

Primary pyomyositis is increasing in incidence in the western world. Although a commonly encountered condition in the tropics it was not described in the USA until 1971 and the UK until 1998. The reason for the increasing incidence is not understood.

Typically pyomyositis affects the muscles around the hip and may present in a variety of ways to orthopaedic or general surgeons – occasionally leading to unnecessary operative intervention. We sought to identify the experience gained, of this condition, within a UK paediatric tertiary referral unit.

A retrospective review of cases of pyomyositis, from our institution, since 1998 was undertaken to identify demographics, presentation, diagnosis and management. Thirteen cases of pyomyositis were identified. Obturator internus was most commonly affected (n = 7). Trauma was implicated in three cases and group A staphylococcus was cultured in nine cases. Male:Female ratio ~ 3: 2. Initial working diagnosis at presentation was septic joint in eight cases, appendicitis in three cases and soft tissue abscess in two cases. Ten cases settled with antibiotics alone. One diagnostic retroperitoneal exploration was performed which may have been avoided with greater preoperative awareness of this condition. On reflection, all cases were identified by CT or MRI.

To our knowledge, this is the first UK series of pyomyositis, reflecting its increasing incidence in the western world. Its presentation is similar to other common paediatric surgical emergencies, yet its management is very different – often not requiring surgery. A greater awareness of this emerging condition is therefore essential to both general and orthopaedic surgeons in order to prevent misdiagnosis and unnecessary surgical intervention.

Pyomyositis of the obturator muscles is a rare condition, characterised by pain in the hip and features of systemic infection. It may follow minor trauma to the hip, sometimes in the presence of an apparently innocuous infective source. All previously reported cases have been diagnosed conclusively on the initial CT or MR scan. We present a case of obturator pyomyositis in a 21-year-old football player in which the first MR scan was misleading. A radiolabelled, white blood cell scan was also negative and the resultant delay in diagnosis proved dangerous. The crucial importance of careful and repeated clinical examination is emphasised