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Chapter 30

Tropical Pyomyositis

"Rudis indigestaque moles"
Ovid (Metamorphosis i.7)

"... quare id faciam, fortasse requiris.
Nescio, sed fieri sentio et excrucior"
Catullus (Carmina LXXXV)

Tropical pyomyositis is indeed "an unformed and confused mass;" and "the course thereof, should you ask me, I do not know, but feel it is so, and I am in agony;" is exactly how many patients have described their condition.

We cannot know if the Romans suffered from pyomyositis, but infection of skeletal muscle, sometimes with copious pus formation and yet without obvious cause, has been known for many years. It was described first by Scriba in 1885, then by Zieman in New Guinea in 1904, and in 1912 by Scott in Jamaica and Kulz in the Cameroons. By 1972, about 800 cases had been recorded in Kampala, Uganda where, at that time, it accounted for 3% to 4% of all hospital admissions. In the tropical forests of eastern Ecuador, 2.2% of surgical admissions were for pyomyositis. The cause is obscure but there are several theories. Although the response to antibiotics is disappointing, the results of surgery are usually good yet some patients still die. Modern imaging techniques show the extent of the infection and are important in the recognition and management of the complications.

Synonyms

Tropical myositis. Pyomyositis of unknown origin. Pyomyositis tropicans. Bung pagga.

Definition

Tropical pyomyositis is a suppurative disease of skeletal muscle with single or multiple abscesses, which may lead to fatal complications (Fig. 30.1). It is most common in tropical countries, but does occasionally occur in temperate climates. (Abscesses which complicate trauma or other infections as in HIV-positive or AIDS patients are excluded from this definition).

Fig. 30.1. Gross swelling of the left thigh and knee due to tropical pyomyositis. The patient had tried local remedies before accepting Western medicine.

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Copyright: Palmer and Reeder