Blood culture sensitivity: Staphylococcus aureus grown in culture.
Microcytic hypochromic anemia. With leucocytosis with neutrophilia.
Serum CPK 33u/l
Normal LV function.
No regional valve motion abnormality.
Pus culture sensitivity: Staphylococcus aureus grown in culture .
3.Multiple abscess in the muscles.
Probable diagnosis: Tropical pyomyositis due to Staphylococcus aureus . .
Incision and drainage of the abscess done followed that
Patient was given one course of inj.cloxacillin 500 mg I.V. 3 times.
After pus culture and blood culture sensitivity results
Inj. Vancomycin 1G 12 th hourly started and was given for 2 weeks .
Patient was better .He was able to walk and was given fresh blood transfusion to improve his general condition.
Patient was discharged at request as he want to continue his treatment nearby Govt. hospital to his home .
DIFERENTIAL DIAGNOSIS FOR MULTIPLE ABSCESS
2.Anaerobic bacterial infections.
3.Staphylococcus aureus infections.
4.Cat scratch disease.
5.Metastatic staph .aureus abscess syndrome.
9.Glanders disease .
14.Congenital (job syndrome).
Staphylococcus aureus infection is part of normal human flora .25 to 50% healthy persons may be persistently colonized .
The rate of colonization increased among Insulin dependent diabetics,HIV infected patients,Patients undergoing hemodialysis, and individual with skin damage.
This organism is known for its capacity to induce abscess formation at sites of both local and metastatic infections .
This organism may be introduced into tissue as a result of minor abrasions, administration of medication such as insulin or establishment of I.V. access with catheters .
This organism causes skin and soft tissue infections.
It causes pyomyositis presents as fever, pain overlying the involved muscles,and swelling.
Staph .aureus is responsible for 95% cases in tropical areas.
Leukocytosis and hypoalbuminemia is common.
The pyomyositis occurs in three stages.
1.First stage :
Fever, anorexia, erythema, pain, tenderness.
Toxic shock syndrome .
CBC show leukocytosis.
Sometimes elevated CPK enzyme.
Show muscular heterogeneity and purulent collection.
Heterogenous attenuation and fluid collection with ring enhancement.
M.R.I. is the definite modality to assess pyomyositis and to determine localization and extent.
TREATMENT OF STPHYLOCOCCUS INFECTIONS
For penicillin sensitive staph. Penicillin is the drug of choice.
Penicillin G (4mU 4 th hourly).
Penicillin resistant cases are treated with Oxacillin, Nafcillin.
Dose-2G 4 th hourly.
First generation cephalosporins can be given.Cefazolin 2g 8 th hourly.
The carbapenem has excellent activity against methicillin sensitive strains.
Merpenem dose-0.5 to2g(10 to 40 mg/kg) I.V. 8 th hourly.
Faropenem dose-200 to 300 mg oral 3 times.
Imepenem dose-0.5 g I.V. 6 th hourly.(max.4gm/day).
Vancomycin is the drug of choice for methicillin resistant strains .
For vancomycin resistant strains chloramphenical,linezolid,minocyclin,quinupristin/dalfopristin,Trimethoprime-sulfamethoxazole can be given.
Flouroquinolones also given for methicillin sensitive strains.(cipro 4oomg 12 th hourly,levoflox 5oomg OD).
Among the newer antistaph .agents quinupristin and dalfopristin has bactericidal activities. Can be used for serious staph infections .
7.5mg/kg every 8 to 12 hours.
Linezolid bacteriostatic can be used for skin and soft tissue infections.But its use is restricted to prevent emergence of resistence.
Linezolid dose-600mg BD oral.
Tigecyclin a broad spectrum minocyclin analogue has bacteriostatic activity for soft tissue infections and for abdominal infections.
So the choice of empirical treatment depends on susceptibility data for the local geographic area .
However Vancomycin 1gm 12 th hourly(in combination with an aminoglycoside or rifampicin for serious infection ) is the drug of choice for both community as well as hospital acquired Staph. Infections .