Department of Plastic Surgery, Fiona Stanley Hospital.
Department of Plastic Surgery, Fiona Stanley Hospital.
J Plast Reconstr Aesthet Surg. 2022 Jan;75(1):145-151. doi: 10.1016/j.bjps.2021.08.046. Epub 2021 Sep 20.
Necrotising myositis (NM) is a life-threatening emergency. Prompt treatment is associated with more favourable outcomes, but early diagnosis is challenging. The initial absence of cutaneous signs and symptoms coupled with delayed recognition commonly result in higher rates of morbidity and mortality.
Analyse data regarding demographics, epidemiology, aetiology, clinical manifestations, diagnosis and treatment of previously reported cases. This publication is intended for plastic surgeons in training to help them look out for this disease.
SEARCH METHODS/CRITERIA: Publications reporting necrotising myositis between 1974 to January 2020 were identified from Embase, Medline All, Web of Science Core Collection, Google Scholar and Cochrane Central Register of Controlled Trial.
Identified studies were exported to an end note library. In animal studies, studies relating to statin-induced myotoxicity and auto-immune myositis were excluded. The quality of included case reports was assessed using JBI Critical Appraisal Checklist for Case Reports.
The most common initial presentation was a few days of antecedent prodromal flu-like symptoms associated with muscle pain. The mean age was 43.3 years and 82% had no significant medical history. The most frequent misdiagnoses were muscle strain (11%), deep vein thrombosis (10%) and viral illness (9%). Seventy-four per cent of presentations were due to Group A Streptococcus infections and only 3.5% of cases were polymicrobial. The most common clinical course following the initial presentation was rapid deterioration into profound sepsis and progression into multi-organ failure. The overall mortality rate was 36.5%.
NM is a life-threatening muscle infection. It is a diagnostic conundrum as initial presentation is often only myalgia without features of preceding trauma. We propose that a high index of suspicion and increased awareness will reduce morbidity.
PROSPERO (registration number CRD42018087060). Nil funding/conflict of interest.
坏死性肌炎（NM）是一种危及生命的急症。及时治疗与更好的结果相关，但早期诊断具有挑战性。初始无皮肤表现和症状，加上延迟识别，通常会导致更高的发病率和死亡率。
分析既往报道病例的人口统计学、流行病学、病因学、临床表现、诊断和治疗数据。本出版物旨在为接受培训的整形外科医生提供帮助，使他们能够发现这种疾病。
检索方法/标准：从 Embase、Medline All、Web of Science 核心合集、Google Scholar 和 Cochrane 对照试验中心注册库中检索 1974 年至 2020 年 1 月期间发表的坏死性肌炎报告。
将鉴定出的研究导出到 EndNote 库中。在动物研究中，排除了与他汀类药物诱导的肌毒性和自身免疫性肌炎相关的研究。使用 JBI 病例报告关键评估清单评估纳入病例报告的质量。
最常见的初始表现是几天前驱性流感样症状，伴有肌肉疼痛。平均年龄为 43.3 岁，82%无明显既往病史。最常见的误诊是肌肉拉伤（11%）、深静脉血栓形成（10%）和病毒感染（9%）。74%的病例是由 A 组链球菌感染引起的，只有 3.5%的病例是多微生物感染。初始表现后最常见的临床病程是迅速恶化成严重败血症，并进展为多器官功能衰竭。总死亡率为 36.5%。
NM 是一种危及生命的肌肉感染。由于初始表现通常仅为肌痛，没有先前创伤的特征，因此这是一个诊断难题。我们提出，提高怀疑指数和增加认识将降低发病率。
PROSPERO（注册号 CRD42018087060）。无资金/利益冲突。
