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Oxford Textbook of Medicine (5 ed.)

Edited by David A. Warrell, Timothy M. Cox, John D. Firth

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Latest update

The November 2012 update sees updates to over 70 chapters, focusing on Neurology and Gastroenterology. This update also incorporates a selection of 29 Case Histories taken from related titles in the Oxford Case Histories series, linked to from related chapters. Each case includes several questions followed by detailed answers and discussion to enhance diagnostic and clinical understanding.

Neurology updates include substantial updates to key chapters and new material on a wide range of topics including spinal cord injury, autonomic nervous system disorders, and inherited neurodegenerative diseases. 

Gastroenterology updates include extensive revisions of key chapters on liver failure and acute pancreatitis and new material on a wide range of matters, ranging from the common to the rare: including surgical treatments for colonic diverticular disease, antibody tests for immune disorders, and a revised treatment algorithm for small bowel bacterial overgrowth.

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Publisher:
Oxford University Press
Print Publication Date:
May 2010
Print ISBN-13:
9780199204854
Published to Oxford Medicine:
May 2012
DOI:
10.1093/med/9780199204854.001.1

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Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding.

Contents

Primary (tropical) pyomyositis

Chapter:
Primary (tropical) pyomyositis
Author(s):

D A Warrell

DOI:
10.1093/med/9780199204854.003.0242406_update_001

Update:

New information on pathogenesis and imaging.

Updated on 28 November 2012. The previous version of this content can be found here.

Pyomyositis is a primary intramuscular abscess, not tracking from adjacent structures but usually presumed to be haematogenous in origin. Formerly a disease almost exclusively of tropical developing countries, it is now seen increasingly in patients in Western countries who have underlying diseases and immunosuppression, notably HIV infection.

Aetiology—transient bacteraemia may seed an abscess in a focal area of previously damaged muscle if there is immunocompromise. The predisposing vulnerability of apparently healthy younger people in the tropics is unexplained, but malnutrition and preceding arboviral or helminthic infections are postulated. Staphylococcus aureus accounts for 90% of tropical and 70% of nontropical cases.

Clinical features, investigation and treatment—pyomyositis may evolve through subacute, suppurative, and septicaemic phases over weeks or months. Early clinical evidence is local swelling and tenderness in a muscle, often with minimal systemic signs. Diagnosis is confirmed by imaging, ideally gadolinium-enhanced MRI. Treatment requires (1) drainage by open surgery or image-guided needle aspiration—whenever there is suppuration; (2) antibiotics—initial regimen must cover S. aureus, but should then be guided by culture findings.

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