PYOMYOSITIS

Background
P yo myositis is an infla mmation of mus cle tissue, usuall y of voluntar y muscles
that results in pus production. Once considered a tropical disease, it is now
s e e n i n t e m p e r a t e climates as well.

The pathogenesis is unclear, but trauma, infections (S. aureus, S. pneumoniae),and malnutrition have
been implicated. Although most cases of pyomyositis occur in healthyindividuals, other
pathogenetic factors include nutritional deficiency and associated parasitic infection in
tropical climates. In the temperate climates, pyomyositis is seen most commonly in patients with diabetes,
HIV infection, and malignancy.

Clinical Presentations

Presentation with painful, tender, localized swelling over muscle

Fever

Epidural abscess
Complications

Life-threatening complications include sepsis and toxic shock syndrome.

Diagnosis

CT scan or MRI demonstrates muscle abscess.

Aspiration of abscess (by surgery or CT/US guided) yields pus, usually yielding
S. aureus
.

Bacteremia may accompany.

Treatment
Medical Care

Promptly administer systemic antibiotics. This could eliminate the need for surgical drainage
in selected cases.

T h e c h o i c e o f a n t i b i o t i c i s d e t e r m i n e d b y i d e n t i f i c a t i o n o f t h e c a u s a t i v e organism.

Antibiotics initially are given intravenously until clinical improvement is noted, followed by
oral antibiotics for a total course of 3 weeks (eg, cefazolinor ceftriaxone IV followed by cephalexin PO).
Surgical Care

During the suppurative phase, abscess aspiration under ultrasonic or CT guidance may berequired.
Surgical drainage is especially necessary for large abscesses.

Complicated cases may require fasciotomies and debridement.

Prognosis

Prompt administration of antibiotics can result in complete resolution.

Specific Objectives:

Define Pyomyositis.

Identify the signs and symptoms manifested by the patient.

Distinguish the precipitating and predisposing factors that trigger this development.

Trace the pathogenesis based on the signs and symptoms manifested by the patient.

Determine appropriate medical and nursing management for the patient.

Use the nursing process as the framework for the care of the patient.
Significance of the Study in Nursing Field:

Shall have critical thinking skills necessary for providing safe and effective nursing care.

Shall have a comprehensive assessment and implement care base on our knowledge and skills of the
condition.

Shall have familiarized with effective interpersonal skills to emphasize health promotion
andillness prevention.

Shall have imparted the learning experience from direct patient care.
PATIENTS PROFILE
Name: Baby DyeinSex: FemaleBirthday: October 2007Age: 2 - 3 y/oReligion: Roman CatholicCivil
Status: Single Nationality: FilipinoDate of Admission: July 27, 2010Time of Admission: 8:40
PMAdmission Diagnosis: Pyomyositis Left Scapular AreaAttending Physician: Dr. De Guzman
A. Family Background
Baby Dyein is the youngest among the four siblings.
B. Educational and Socio - Economic Status
She does not go to school yet. The rest of the siblings are funded for their
educationalexpenses by one of their mothers rich customers as a laundry woman, except
that the eldestchild does not go to school anymore as she decided to stop studying and just help work.
C. Lifestyle and Diet
She eats three times a day and drinks 5-6 glasses of water a day though mostly breastfeedon her mother.
D. Family Health History
No family history of pyomyositis, diabetes, hypertension, tuberculosis, diabetes, nor anyother diseases
reported.
E. Immunization Record
With complete record of immunization.
F. Past Health History
Had cough, colds and fever but is only hospitalized once now due to pyomyositis.
G. Present Health History
One month prior to consultation, patient together with her older brother had a fall as shewas given a
piggy backride. Patient fell on her left scapular area and complained of pain. Her mother
had her massaged by a so-called
manghihilot
. Three weeks prior to consultation, patientstill complained of pain and endured of fever and
localized swelling on the left scapular area. Another
hilot
session was done and patient was given TSB. But as the swelling and fever
still persevered, patient was brought to the nearest clinic. Patient was given Paracetamol
and wasreferred to Philippine Orthopedic Center. Patient was admitted.