Journal Article

<i>Escherichia coli</i> Pyomyositis: An Emerging Infectious Disease among Patients with Hematologic Malignancies

Karen J. Vigil, James R. Johnson, Brian D. Johnston, Dimitrios P. Kontoyiannis, Victor E. Mulanovich, Issam I. Raad, Herbert L. DuPont and Javier A. Adachi

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 50, issue 3, pages 374-380
Published in print February 2010 | ISSN: 1058-4838
Published online February 2010 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/649866
Escherichia coli Pyomyositis: An Emerging Infectious Disease among Patients with Hematologic Malignancies

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Background. Pyomyositis is typically caused by gram-positive bacteria, especially Staphylococcus aureus. Few cases of Escherichia coli pyomyositis have been reported, including only 1 involving a patient with a hematologic malignancy.

Methods. The clinical microbiology database at The M. D. Anderson Cancer Center (Houston, TX) was reviewed for the period January 2003 through December 2007 to identify cases of E. coli pyomyositis. Clinical characteristics, laboratory and radiologic findings, treatment, and outcomes were recorded. Available isolates underwent phylogenetic group determination, virulence genotyping, multilocus sequence typing, repetitive-element polymerase chain reaction, and pulsed-field gel electrophoresis.

Results. Six cases of E. coli pyomyositis were identified. All patients were receiving chemotherapy for a hematologic malignancy; 5 were severely neutropenic. Three patients became hypotensive, 2 required intensive care, and 2 (33%) died, despite receiving carbapenem therapy. All E. coli isolates were fluoroquinolone resistant; 55% produced an extended-spectrum β-lactamase (ESBL). Five of 6 available isolates belonged to phylogenetic group B2, had similar virulence factor profiles, exhibited > 95% similar repetitive-element polymerase chain reaction profiles, and represented sequence type ST131; however, all had unique pulsed-field gel electrophoresis profiles.

Conclusions. E. coli pyomyositis has emerged as a serious problem among our patients with hematologic malignancy. It usually is caused by members of E. coli ST131, a recently identified cause of fluoroquinolone-resistant, ESBL-positive E. coli infection worldwide. Awareness of this emerging syndrome and the usual causative agent is important to ensure appropriate management when febrile, neutropenic patients with hematologic malignancy exhibit signs of localized muscle infection.

Journal Article.  3295 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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