(Table 1) Muscle involvement can occur with viral infection (e.g., influenza, dengue, or coxsackievirus B infection) or parasitic invasion (e.g., trichinellosis, cysticercosis, or toxoplasmosis). Although myalgia develops in most of these infections, severe muscle pain is the hallmark of pleurodynia (coxsackievirus B), trichinellosis, and bacterial infection. Acute rhabdomyolysis predictably occurs with clostridial and streptococcal myositis but may also be associated with influenza virus, echovirus, coxsackievirus, Epstein-Barr virus, and Legionella infections.

Table1. Skin and Soft Tissue Infections

Pyomyositis is usually due to S. aureus, is common in tropical areas, and generally has no known portal of entry. Cases of pyomyositis caused by MRSA producing the PVL toxin have been described among children in the United States. Muscle infection begins at the exact site of blunt trauma or muscle strain. Infection remains localized, and shock does not develop unless organisms produce toxic shock syndrome toxin 1 or certain enterotoxins and the patient lacks antibodies to the toxin produced by the infecting organisms. In contrast, S. pyogenes may induce primary myositis (referred to as streptococcal necrotizing myositis) in association with severe systemic toxicity. Myonecrosis occurs concomitantly with necrotizing fasciitis in ~50% of cases. Both are part of the streptococcal toxic shock syndrome.

Gas gangrene usually follows severe penetrating injuries that result in interruption of the blood supply and introduction of soil into wounds. Such cases of traumatic gangrene are usually caused by the clostridial species C. perfringens, C. septicum, and C. histolyticum. Rarely, latent or recurrent gangrene can occur years after penetrating trauma; dormant spores that reside at the site of previous injury are most likely responsible. Spontaneous nontraumatic gangrene among patients with neutropenia, gastrointestinal malignancy, diverticulosis, or recent radiation therapy to the abdomen is caused by several clostridial species, of which C. septicum is the most commonly involved. The tolerance of this anaerobe to oxygen probably explains why it can initiate infection spontaneously in normal tissue anywhere in the body.

Gas gangrene of the uterus, especially that due to Clostridium sordellii, historically occurred as a consequence of illegal or self induced abortion and nowadays also follows spontaneous abortion, vaginal delivery, and Caesarean section. C. sordellii has also been implicated in medically induced abortion. Postpartum C. sordellii infections in young, previously healthy women present with little or no fever, lack of a purulent discharge, refractory hypotension, extensive peripheral edema and effusions, hemoconcentration, and a markedly elevated white blood cell count. The infection is often fatal, with death ensuing rapidly. C. sordellii and C. novyi have also been associated with cutaneous injection of black tar heroin; mortality rates are lower among these individuals, probably because their injection-site infections are readily apparent and diagnosis is therefore prompt.

Synergistic nonclostridial anaerobic myonecrosis, also known as necrotizing cutaneous myositis and synergistic necrotizing cellulitis, is a variant of necrotizing fasciitis caused by mixed aerobic and anaerobic bacteria with the exclusion of clostridial organisms.

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مواضيع ذات صلة

Necrotizing Fasciitis

Cellulitis

Laboratory Diagnosis of Francisella

Laboratory Diagnosis of Bordetella pertussis, Bordetella parapertussis, and Related Species

Epidemiology and Pathogenesis of Bordetella pertussis, Bordetella parapertussis, and Related Species

Group B Streptococcal Disease

Streptococcal Toxic Shock Syndrome

Signs and Symptoms of Streptococcal Infections

Corynebacterium diphtheriae

Clostridium tetani

Laboratory Diagnosis of Brucella

Epidemiology and Pathogenesis of Helicobacter