Brief Report Tropical Pyomyositis in Children: 10 Years Experience of a Tertiary Care Hospital in Northern India by Sanjay Verma, Sunit C. Singhi, R. K. Marwaha, Pratibha Singhi, Surjit Singh, and Meenu Singh Department of Pediatrics, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India Correspondence: Sanjay Verma, House No. 3001/1, Sector-38 D, Chandigarh-160034, India. Tel: þ91 9914208482. E-mail <sanjay06verma@yahoo.com>. Summary Tropical pyomyositis (TP) is characterized by suppuration within skeletal muscles, manifesting as single or multiple abscesses. It has been reported frequently from Africa and Latin America. However, there are only a few cases reported in children from India. Between January 2002 and December 2011, 40 children with TP were admitted to our hospital, and their retrospective review formed the study material. TP is not an uncommon disease in children in Northern India, especially during rainy seasons. Most of the patients were admitted with short history of fever, pain and localized swelling. Pus drainage was done in 87.5% cases, with the amount of pus varying from 5 to 2000 ml. The pus grew methicillin- sensitive Staphylococcus aureus (MSSA) in 42.5% cases, whereas initial blood cultures were sterile. All received antibiotics along with surgical drainage, and recovered. It is important for health professionals to have a high index of suspicion and familiarity with this imminently treatable disease entity. Introduction Tropical pyomyositis (TP) was first described by Scriba in 1885, as an endemic disease in tropics [1]. It is characterized by single or multiple muscle abscesses, arising within skeletal muscles by transient bacteraemia and not by contiguous spread from sur- rounding tissues [2]. The most common organism implicated is Staphylococcus aureus [3]. Cases of TP have been widely reported from Asia, tropical Africa, Oceania and the Caribbean islands [4,5]. Similar cases have also been reported from temperate areas. There are few reports of TP cases from Indian sub- continent as well, but reports from paediatric popu- lation remain scarce [6–11]. We share our experience of managing 40 children with TP who had been admitted in our hospital in the past 10 years. Methods In this retrospective study, records of the children with a diagnosis of TP who were admitted to our hospital, a tertiary care centre in North India, were analysed with respect to clinical presentation, course, treatment and outcome. Data were extracted, and descriptive statistics were used. Results A total of 40 cases with TP were analysed. The age group of children ranged from 1 to 12 years, with mean age of 7.75 years. Majority (87.5%) were aged >5 years, with male to female ratio being 2:1. Although cases were reported throughout the year, the majority (55%) were between July and September, which coincides with the rainy season. All the patients had a short history of localized swelling (100%), pain (100%) and fever (95%). Primarily the disease involved limb muscles, espe- cially of the lower limb. Muscles most commonly involved were that of thigh (58%), leg (35%), psoas (30%), gluteal (20%), arm (15%), chest wall (12%), back (10%), forearm (8%) and abdominal wall (3%). Number of muscles involved in a patient varied from 1 to 5 (mean: 1.97). Majority (68%) presented with Acknowledgements S.V. and S.C.S. conceptualized the idea of review. S.V., S.C.S., R.K.M., P.S., S.S. and M.S. managed the cases. S.V. collected the literature and drafted the manuscript. S.V., S.C.S., R.K.M., P.S., S.S. and M.S. edited and approved the final manuscript. JOURNAL OF TROPICAL PEDIATRICS, VOL. 59, NO. 3, 2013 ß The Author [2013]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com 243 doi:10.1093/tropej/fmt005 Advance Access published on 13 February 2013 Downloaded from https://academic.oup.com/tropej/article-abstract/59/3/243/1668719 by guest on 20 May 2020