title: Pyomyositis is not only a tropical pathology: a case series.
abstract: BACKGROUND
  Pyomyositis is an acute bacterial infection of skeletal muscle that results in localized abscess formation. This infection was thought to be endemic to tropical countries, and is also known as "tropical pyomyositis". However, pyomyositis is increasingly recognized in temperate climates and is frequently associated with an immunosuppressive condition, such as human immunodeficiency virus, malignancy, and diabetes mellitus. It is also found in healthy and athletic people after strenuous or vigorous exercise or following localized and possibly unnoticed trauma. It can be primary or secondary to neighboring or remote infection. Primary pyomyositis is a rare condition that can affect children and adolescents. Diagnosis can be delayed because the affected muscle is deeply situated and local signs are not apparent. This delay in diagnosis can result in increased morbidity and a significant mortality rate. The pediatric population, which comprises 35% of the reported pyomyositis cases, is an especially difficult subset of patients to diagnose.
  
  
  METHODS
  In our series, we describe the cases of four previously healthy Caucasian children who were admitted to our Pediatric Department with different clinical presentations. Pyomyositis in our patients was related to factors affecting the muscle itself, including strenuous exercise and direct muscle trauma. Therapy was started with a cephalosporin antibiotic and teicoplanin was subsequently added. The minimum length of therapy was 3 weeks.
  
  
  CONCLUSIONS
  The diagnosis of pyomyositis in our patients, none of whom were immune-compromised, is confirmation that this disease is not an exclusive pathology of tropical countries and demonstrates that there is an increasing prevalence of pyomyositis in temperate climates.
authors.affiliation: Department of Paediatrics, University of Chieti, Chieti, Italy. lauracomegna@gmail.com.
authors.forename: Laura
authors.initials: L
authors.lastname: Comegna
authors.affiliation: Department of Paediatrics, University of Chieti, Chieti, Italy.
authors.forename: Paola Irma
authors.initials: PI
authors.lastname: Guidone
authors.affiliation: Department of Paediatrics, University of Chieti, Chieti, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Prezioso
authors.affiliation: Department of Paediatrics, University of Chieti, Chieti, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Franchini
authors.affiliation: Department of Paediatrics, University of Chieti, Chieti, Italy.
authors.forename: Marianna Immacolata
authors.initials: MI
authors.lastname: Petrosino
authors.affiliation: Department of Paediatrics, University of Chieti, Chieti, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Di Filippo
authors.affiliation: University "G. D'Annunzio", Chieti, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Chiarelli
authors.affiliation: Department of Paediatrics, University of Chieti, Chieti, Italy.|University "G. D'Annunzio", Chieti, Italy.
authors.forename: Angelika
authors.initials: A
authors.lastname: Mohn
authors.affiliation: Department of Paediatrics, University of Chieti, Chieti, Italy.
authors.forename: Nadia
authors.initials: N
authors.lastname: Rossi
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002443:Ceftriaxone / Q000008:administration & dosage; D002511:Cephalosporins / Q000008:administration & dosage; D002648:Child; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D018482:Muscle, Skeletal / Q000382:microbiology / Q000473:pathology*; D052880:Pyomyositis / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D017334:Teicoplanin / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D017334:Teicoplanin; D002443:Ceftriaxone
keywords: Case report; Childhood; Muscle infection; Pyomyositis; Tropical pathology