Introduction

Pyomyositis is a rare condition that affects the skeletal muscle commonly the quadriceps, it is essentially an bacterial infection that develops in two forms. Primary pyomyositis occurs through bacteria within the bloodstream to the muscles from an infection in the body. On the other hand, secondary pyomyositis develops through a trauma and spread of infection in bones or tissues. Common symptoms include a common fever, abscess formation, swelling and pain in the area. Prevention of pyomyositis can be achieved through maintaining hygiene such as washing hands, treating the infection with antibiotics at an early stage to prevent it from spreading and supporting the immune system.

Understanding pyomyositis

A bacterial infection in the skeletal muscle summarises pyomyositis in which staphylococcus aureus is the most common bacterial species that causes this infection.¹ Gram positive bacteria is likely to be the underlying cause of pyomyositis, specifically staphylococcus species are prevalent. The epidemiology of the disorder is based in tropical countries hence why it is also known as tropical pyomyositis. Although rare, the condition is likely to affect individuals with a low immune system or who have diabetes mellitus.² The common symptoms presented by pyomyositis patients are muscle pain accompanied with fever. A study conducted on the clinical presentation of pyomyositis shows that approximately 69% of patients portrayed tenderness in the affected area whilst 11% of patients experienced night sweats.³ A physical examination by a healthcare professional is not enough to confirm clinical diagnosis of pyomyositis, diagnostic testing and medical history of the patient is conducted. Environmental factors affect the chances of pyomyositis, studies show that travel histories of patients are directly linked to the ability of parasitic pathogens affecting immunocompromised hosts specifically in tropical climates.⁴ Immunocompromised hosts are essentially individuals with a very low immune system that have chronic conditions. Travel history is one of the risk factors nevertheless, immunity and pre-existing health conditions can affect the likelihood of developing pyomyositis.

Hygiene practices to prevent pyomyositis 

Personal hygiene such as regular hand washing is very important in preventing the spread of bacteria and infections. General hygiene practices like bathing everyday, frequently cleaning clothing and towels are important. Also personal hygiene products such as razors, toothbrushes and towels should not be shared with anyone to prevent any bacteria transmission. If you have an open wound or skin injury you must avoid touching or scratching it at all times because scratching can create micro tears on the surface of the skin which is a way for bacteria to enter into the body. In the need of changing bandages you must clean your hands with soap and water prior to this and after. The affected area must be kept dry and covered to prevent the spread of infection.                                                                            

Practicing hygiene in households and shared public spaces also prevents the spread of pyomyositis. The bacterial strain s. aureus has the ability to stay on environmental surfaces for many weeks making it easy for contamination.⁵ Risk of contamination via skin contact through shared items within households like hand towels, door handles and remote controls. Therefore, it is important to maintain regular hand washing and sanitise shared spaces using household cleaning products like bleach. Nevertheless, household pets can colonize s. aureus and there is a likelihood of human to pet transmission so regular disinfection of the pets crate or bedding is crucial to decrease chances of transmission.⁶ 

Early detection and treatment of infections

Recognising early signs of infections like redness, swelling and fever could be helpful in diagnosing pyomyositis. Early diagnosis allows suitable antibiotic treatment which prevents complications like abscess formation and sepsis.⁷ A physical examination of the areas affected can not always be enough for confirmation of pyomyositis. In the presence of symptoms, magnetic resonance imaging (MRI) is a useful imaging technique to see abscess formation in detail. Other diagnostic tools used are specific blood tests if there is a sign of inflammation, a full blood count (FBC), leukocyte count and erythrocyte sedimentation rate (ESR) can show inflammation in the body.⁸  

Treatment options include antibiotics which is very successful in preventing spread of infection, common antibiotic therapy that specifically treats s. aureus includes vancomycin which is administered via IV or other types of antibiotics like ceftriaxone and cefazolin. The type of antibiotic prescribed will be dependent on the patient and type of bacterial strain that is associated with pyomyositis. Nevertheless, in cases where there is abscess formation this must be surgically drained via a small incision to remove pus and this will control infection. In severe cases such as severe muscle damage surgery might be needed to remove the infectious tissue and a long course of antibiotics will be accompanied. If there are symptoms of pain, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen could be used as pain management. Monitoring treatment is very important for the management of the disorder to avoid potential complications and adjust dosage of antibiotics. 

Supporting the immune system

Immunocompromised people are more susceptible to catching pyomyositis therefore it is crucial to support the immune system with various factors such as:

• Healthy diet
• Nutritional support 
• Regular exercise
• Adequate sleep
• Stress management 

Maintaining a healthy and balanced diet as well as taking additional vitamins and minerals will strengthen the immune system. Specifically vitamin D plays a big role in bone health and fighting infection in the body, it has been proven in many studies that low levels of vitamin D is associated with increased infection in the human body. The effects of vitamin D on the innate immune system involves expressing antimicrobial response through chemical signalling.⁹ Nevertheless, vitamin C is known for healing bone infection through its antioxidant properties therefore patients with pyomyositis are advised to take vitamin C supplements. In a scientific study, the mechanism of action involves vitamin c acting like an antioxidant to react with free radicals which proves bone healing in the studies.¹⁰ Another scientific study portrays that high levels of dietary vitamin C is linked with lower risk of developing a hip fracture which supports the fact that vitamin C plays an important role in decreasing the risk of bone related health issues. 

Additionally, regular exercise is known to boost the immune system as keeping physically active is good for general health. Exercising daily also improves muscle strength and can reduce inflammation in the body therefore patients with pyomyositis should try their best to keep active. There is also evidence to show that keeping a physically active lifestyle decreases risks of conditions such as cancer and cardiovascular disease.¹¹ Therefore regular exercise not only prevents the chances of pyomyositis but also prevents a wide variety of health conditions. Stress management is also important to prevent the weakening of the immune system, exercising can slow down the effects of stress hormones and lower levels of stress hormones prevents the weakening of the immune system. As well as exercising, meditating and walking instead of taking the public transport could be steps to add to your daily routine. A healthy sleeping pattern is also very important in supporting the immune system, a minimum of 8 hours of sleep a day is adequate.                                                                                    

Summary 

To summarise, detecting pyomyositis at an early stage, keeping a good hygiene and supporting the immune system in many ways will be useful in preventing pyomyositis. Detecting symptoms at an early stage will give a timely diagnosis, any unusual or sudden changes related to pyomyositis symptoms should be checked out by a healthcare professional as soon as possible. An early diagnosis will essentially mean effective treatment, taking antibiotics at an early stage of the infection will effectively control the infection and prevent the spread of the infection. Uncontrolled infection can lead to sepsis which is a life threatening condition that develops when an infection spreads vastly throughout the body and causes organ failure. Furthermore identifying risk factors associated with pyomyositis such as trauma to muscles is also a part of early intervention. Monitoring pyomyositis is also vital for preventing complications. Maintaining overall health and eating a balanced diet will also help increase the chances of a stronger immune system making you less susceptible for infections.