Infectious Myositis Treatment & Management

Updated: Aug 22, 2017
  • Author: Mohammed J Zafar, MD, FAAN, FACP, FASN; Chief Editor: Niranjan N Singh, MD, DM  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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