Infectious Myositis Treatment & Management

Updated: Jan 13, 2018
  • Author: Mohammed J Zafar, MD, FAAN, FACP, FASN; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Treatment

Medical Care

All medical care should be provided in conjunction with an infectious disease specialist and the primary care physician.

  • HIV polymyositis: Corticosteroids remain the mainstay of treatment of polymyositis.

  • Trichinosis

    • Thiabendazole is effective if administered within 24 hours of infection. It has minimal effect in established infection.

    • Optimal dosage has not been established.

    • It can be combined with prednisone 40-60 mg/day in patients with severe pain and weakness.

  • Trypanosomiasis

    • Benznidazole is a trypanocidal drug that is quite effective in the acute phase of the illness.

    • It reduces cardiac complications and parasitemia and has been found to be beneficial in the early chronic phase.

    • Successful treatment is evinced by serological tests remaining negative for at least 1 year after conclusion of treatment.

  • Viral myositis

    • Treatment comprises bed rest, intravenous fluids, and symptomatic management with antipyretics and analgesics.

    • Antiviral agents such as amantadine could be considered in adults.

  • Tuberculous and toxoplasmal myositis, cysticercosis: Please refer to the following articles: HIV-1 Associated Myopathies, Neurocysticercosis, and Neuroimaging in Neurocysticercosis.

  • Pyomyositis

    • Promptly administer systemic antibiotics. This could eliminate the need for surgical drainage in selected cases.

    • The choice of antibiotic is determined by identification of the causative organism.

    • Antibiotics initially are given intravenously until clinical improvement is noted, followed by oral antibiotics for a total course of 3 weeks (eg, cefazolin or ceftriaxone IV followed by cephalexin PO).

  • Streptococcal myositis

    • High-dose penicillin G (4 million units) and clindamycin (800-900mg) IV

    • Intravenous fluids

  • Fungal myositis: Use an antifungal agent such as amphotericin B or an echinocandin such as caspofungin.

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Surgical Care

Pyomyositis: During the suppurative phase, abscess aspiration under ultrasonic or CT guidance may be required. Surgical drainage is especially necessary for large abscesses.

Fungal myositis: Focal fungal abscesses may require surgical drainage/debridement.

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Consultations

Consultations with a neurologist and/or infectious disease specialist may prove useful.

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