Navarro V, Meseguer V, Fernández A, Medrano F, Sáez J A, Puras A
Servicio de Medicina Interna, Hospital General de Albacete.
Enferm Infecc Microbiol Clin. 1998 Mar;16(3):118-22.
Abscess of the psoas muscle (PA) is every more frequently observed in recent years. The PA diagnosed in the authors' center over a period of 91 months are presented, analyzing the main clinical features, microbiologic causal agents, risk factors, treatment and the differences between primary and secondary PA. A total of 19 cases of which 14 were secondary PA (73.7%) and 5 primary PA (26.3%) were diagnosed. The main foci of infection of the former were the bone and the genitourinary tract, with intestinal infection being rare. The most frequent clinical data were lumbar pain with possible irradiation to the lower limb, fever, and leucocytosis with neutrophilia. Gram negative and enteric anaerobes were the bacteria most often identified, followed by Staphylococcus aureus and Mycobacterium tuberculosis. In a high percentage of patients (57.8%) a history of immunodeficiency was reported. In regard to treatment, surgical drainage was performed in 5 cases (26.3%), while ten cases (52.6%) were treated by DPCT. Four patients (21%) were exclusively treated with antibiotics. Recurrence was observed in three cases (15.3%) of the DPCT group requiring new drainage. Of all the cases, 18 were cured while one death occurred, being attributed to the underlying tumoral disease of advanced stage. The authors believe DPCT to be a good therapeutic option in both primary and secondary PA, thereby avoiding the risks of major surgery. In the cases with no underlying immunodeficiency the existence of secondary PA should be discarded as occurred in 7 out of 8 cases with no history of immunodeficiency in this series of patients.
近年来，腰大肌脓肿（PA）的发病率越来越高。本文介绍了作者所在中心在91个月内诊断出的PA病例，分析了其主要临床特征、微生物病原体、危险因素、治疗方法以及原发性和继发性PA之间的差异。共诊断出19例病例，其中14例为继发性PA（73.7%），5例为原发性PA（26.3%）。前者的主要感染源是骨骼和泌尿生殖道，肠道感染较为罕见。最常见的临床症状是腰痛，可能向下肢放射，发热，白细胞增多伴中性粒细胞增多。革兰氏阴性菌和肠道厌氧菌是最常鉴定出的细菌，其次是金黄色葡萄球菌和结核分枝杆菌。在高比例患者（57.8%）中报告有免疫缺陷病史。在治疗方面，5例（26.3%）进行了手术引流，10例（52.6%）接受了经皮导管引流术（DPCT）治疗。4例患者（21%）仅接受了抗生素治疗。经皮导管引流术组有3例（15.3%）复发，需要再次引流。所有病例中，18例治愈，1例死亡，死亡原因是晚期基础肿瘤疾病。作者认为经皮导管引流术在原发性和继发性PA中都是一种很好的治疗选择，从而避免了大手术的风险。在没有潜在免疫缺陷的病例中，应排除继发性PA的存在，本系列患者中8例无免疫缺陷病史的病例中有7例出现这种情况。
