Overview
Necrotizing myositis is a severe inflammatory condition characterized by muscle necrosis, often caused by bacterial infections, including zoonotic transmission from animals. 1Diagnosis
Rapid onset of localized muscle pain, erythema, and systemic symptoms like sepsis.
Imaging (MRI, CT) showing muscle necrosis and edema.
Cultures from muscle tissue or aspirates identifying causative organisms (e.g., Streptococcus equi subsp. zooepidemicus).
Laboratory markers indicative of systemic inflammation (elevated CRP, WBC).Management
First-line treatments:
- Broad-spectrum antibiotics (initially empirical, adjusted based on culture and sensitivity): Vancomycin or other glycopeptides if Gram-positive coverage is needed.
- Surgical debridement of necrotic tissue.
Adjunctive treatments:
- Supportive care including vasopressors, mechanical ventilation, and renal replacement therapy as needed.
- Hyperbaric oxygen therapy may be considered for severe cases. 1Special Populations
Elderly: Severe clinical course with high risk of complications and organ failure, as seen in a 73-year-old patient requiring prolonged intensive care support. 1Key Recommendations
Prompt surgical intervention for necrotic tissue debridement in confirmed cases of necrotizing myositis (Evidence: Weak 1)
Initiate broad-spectrum antibiotics early, tailored to culture results, especially targeting suspected zoonotic sources like Streptococcus equi subsp. zooepidemicus (Evidence: Weak 1)
Consider adjunctive therapies such as hyperbaric oxygen therapy in severe, refractory cases (Evidence: Weak 1)References
1 Kittang BR, Pettersen VK, Oppegaard O, Skutlaberg DH, Dale H, Wiker HG et al.. Zoonotic necrotizing myositis caused by Streptococcus equi subsp. zooepidemicus in a farmer. BMC infectious diseases 2017. link