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Necrotising myositis is a rare but devastating consequence of invasive group A streptococcal infection. Early presentation could be non-specific, and clinicians might have a low index of clinical suspicion due to the rarity of cases. Prompt recognition and early aggressive surgical management are the cornerstones of treatment to reduce morbidity and mortality. We report the case of a child aged 5 years with necrotising myositis and highlight the successes and potential pitfalls in the treatment of this life-threatening condition.

Currently, there are no non-invasive tools to accurately diagnose wound and surgical site infections before they become systemic or cause significant anatomical damage. Fluorescence and photoacoustic imaging are cost-effective imaging modalities that can be used to noninvasively diagnose bacterial infections when paired with a molecularly targeted infection imaging agent. Here, we develop a fluorescent derivative of maltotriose (Cy7-1-maltotriose), which is shown to be taken up in a variety of gram-positive and gram-negative bacterial strains in vitro. In vivo fluorescence and photoacoustic imaging studies highlight the ability of this probe to detect infection, assess infection burden, and visualize the effectiveness of antibiotic treatment in E. coli -induced myositis and a clinically relevant S. aureus wound infection murine model. In addition, we show that maltotriose is an ideal scaffold for infection imaging agents encompassing better pharmacokinetic properties and in vivo stability than other maltodextrins (e.g. maltohexose). Sensitive diagnostic tools for bacterial infections of wounds and surgical sites are necessary to enable early detection and determine optimal means of treatment. Here, the authors develop a fluorescent and optoacoustic probe based on a maltotriose scaffold, which is selectively taken up by gram-positive and gram-negative bacteria.

Background Purulent Infectious Myositis is a common bacterial infection in peripheral limb muscles, but its involvement in deep core muscles is rare. Staphylococcus aureus is one of the most common organisms causing purulent infectious myositis. With an increase in antibiotic resistance in India, many cases are now being reported caused by Methicillin-resistant Staphylococcus aureus (MRSA). Case presentation A male farmer in his early 50 s presented with lower back pain, diffuse abdominal pain, significant weight loss, fatigue for one month, and high-grade fever for one week. Clinical examination revealed severe sepsis with tachycardia, hypotension, tachypnoea, and mild diffuse abdominal tenderness. Laboratory investigations demonstrated leucocytosis, elevated inflammatory markers, acute kidney injury, and deranged liver function tests. Imaging studies revealed multiple deep-core muscle abscesses. Ultrasound-guided aspiration yielded pus, and cultures confirmed Methicillin-resistant Staphylococcus aureus . The patient was diagnosed with purulent infectious myositis complicated by severe sepsis, septic shock, acute kidney injury, and sepsis-associated cholestasis. Treatment comprised drainage of abscesses, prolonged antimicrobial therapy and supportive care. The patient had complete resolution of the abscesses on follow-up. Conclusion This case emphasises the importance of maintaining a high clinical suspicion for purulent infectious myositis—early diagnosis, combined with aggressive medical and surgical management —to achieve early sepsis management and a good prognosis.

Necrotizing fasciitis and myositis are devastating infections characterized by high mortality. Group A streptococcus (GAS) is a common cause of these infections, but the molecular pathogenesis is poorly understood. We report a genome-wide analysis using serotype M1 and M28 strains that identified GAS genes contributing to necrotizing myositis in nonhuman primates (NHP), a clinically relevant model. Using transposon-directed insertion-site sequencing (TraDIS), we identified 126 and 116 GAS genes required for infection by serotype M1 and M28 organisms, respectively. For both M1 and M28 strains, more than 25% of the GAS genes required for necrotizing myositis encode known or putative transporters. Thirteen GAS transporters contributed to both M1 and M28 strain fitness in NHP myositis, including putative importers for amino acids, carbohydrates, and vitamins and exporters for toxins, quorum-sensing peptides, and uncharacterized molecules. Targeted deletion of genes encoding 5 transporters confirmed that each isogenic mutant strain was significantly (P < 0.05) impaired in causing necrotizing myositis in NHPs. Quantitative reverse-transcriptase PCR (qRT-PCR) analysis showed that these 5 genes are expressed in infected NHP and human skeletal muscle. Certain substrate-binding lipoproteins of these transporters, such as Spy0271 and Spy1728, were previously documented to be surface exposed, suggesting that our findings have translational research implications.

Invasive and biomaterial-associated infections in humans are often difficult to diagnose and treat. Here, guided by recent advances in clinically relevant optical imaging technologies, we explore the use of fluorescently labelled vancomycin (vanco-800CW) to specifically target and detect infections caused by Gram-positive bacteria. The application potential of vanco-800CW for real-time in vivo imaging of bacterial infections is assessed in a mouse myositis model and a human post-mortem implant model. We show that vanco-800CW can specifically detect Gram-positive bacterial infections in our mouse myositis model, discriminate bacterial infections from sterile inflammation in vivo and detect biomaterial-associated infections in the lower leg of a human cadaver. We conclude that vanco-800CW has a high potential for enhanced non-invasive diagnosis of infections with Gram-positive bacteria and is a promising candidate for early-phase clinical trials. Invasive and biomaterial-associated infections in humans are often difficult to diagnose and treat. Here, the authors demonstrate that real-time in vivo detection and imaging of these bacterial infections can be successfully performed with fluorescently labelled vancomycin.

Aggregatibacter actinomycetemcomitans (Aa), a Gram-negative coccobacillus commonly associated with endocarditis, poses a rare diagnostic challenge in pediatric cases. The presentation of two pediatric cases—myositis and chest mass—highlights novel aspects, including unusual symptom presentations in children which can be mistaken for malignancy. The limited sensitivity of standard blood tests complicates diagnosis, leading to delayed diagnosis and treatment. Representative samples must be taken, especially if blood cultures are negative. Despite advances in detection methods, diagnosing Aa infection remains difficult due to its rarity in children and variable clinical presentation. In conclusion, a comprehensive understanding of Aa infection in children is essential for early and effective diagnostic and therapeutic management.

Background Post-streptococcal myalgia and myositis are very rare complications of streptococcal infections with group A β-haemolytic streptococci . Data on this condition are scarce and even less is known about findings in clinical imaging. Until today, there are no descriptions of ultrasonographic changes in this condition. Case presentation We present a case of a 31-year-old female patient with immobilizing myalgia of the left outer thigh following a streptococcal upper respiratory tract infection, accompanied with erythemata nodosa on both shins. Laboratory results indicated post-streptococcal myositis since Creatine kinase, Lactate dehydrogenase and Antistreptolysin antibodies were significantly elevated. An ultrasound of the affected vastus medialis of the left quadriceps femoris muscle was performed, which showed a focal increase in muscle echogenicity with loss of architecture and hypervascularisation in Power Doppler Mode. The diagnosis of focal myositis was confirmed with magnetic resonance imaging. The patient’s symptoms as well as the ultrasonographic changes fully resolved under therapy with Ibuprofen and intravenous Ampicillin/Sulbactam. Conclusions This is the first description of ultrasound findings in this rare condition. We conclude that muscular ultrasound is helpful to identify myositis in post-streptococcal myalgia and myositis.

Streptococcus dysgalactiae subspecies equisimilis (SDSE) has emerged as an increasingly important bacterial pathogen causing serious invasive infections in humans worldwide. Despite its clinical importance, the mechanisms through which SDSE causes infections remain poorly understood, and no licensed vaccine currently exists. SDSE can cause necrotizing myositis, an infection with high morbidity and mortality. We used a primate infection model and bacterial transcriptome analysis to gain new understanding of the molecular events contributing to SDSE pathogenesis in necrotizing myositis. Our results provide extensive new information about the transcriptome of SDSE in vivo and reveal numerous potential targets for future therapeutic and vaccine research.

Necrotizing myositis caused by Streptococcus pyogenes has high morbidity and mortality rates and relatively few successful therapeutic options. In addition, there is no licensed human S. pyogenes vaccine. To gain enhanced understanding of the molecular basis of this infection, we employed a multidimensional analysis strategy that included dual RNA-seq and other data derived from experimental infection of nonhuman primates. The data were used to target five streptococcal genes for pathogenesis research, resulting in the unambiguous demonstration that these genes contribute to pathogen-host molecular interactions in necrotizing infections. We exploited fitness data derived from a recently conducted genome-wide transposon mutagenesis study to discover significant correlation between the magnitude of bacterial virulence gene expression in vivo and pathogen fitness. Collectively, our findings have significant implications for translational research, potentially including vaccine efforts. A fundamental goal of contemporary biomedical research is to understand the molecular basis of disease pathogenesis and exploit this information to develop targeted and more-effective therapies. Necrotizing myositis caused by the bacterial pathogen Streptococcus pyogenes is a devastating human infection with a high mortality rate and few successful therapeutic options. We used dual transcriptome sequencing (RNA-seq) to analyze the transcriptomes of S. pyogenes and host skeletal muscle recovered contemporaneously from infected nonhuman primates. The in vivo bacterial transcriptome was strikingly remodeled compared to organisms grown in vitro , with significant upregulation of genes contributing to virulence and altered regulation of metabolic genes. The transcriptome of muscle tissue from infected nonhuman primates (NHPs) differed significantly from that of mock-infected animals, due in part to substantial changes in genes contributing to inflammation and host defense processes. We discovered significant positive correlations between group A streptococcus (GAS) virulence factor transcripts and genes involved in the host immune response and inflammation. We also discovered significant correlations between the magnitude of bacterial virulence gene expression in vivo and pathogen fitness, as assessed by previously conducted genome-wide transposon-directed insertion site sequencing (TraDIS). By integrating the bacterial RNA-seq data with the fitness data generated by TraDIS, we discovered five new pathogen genes, namely, S. pyogenes 0281 ( Spy0281 [ dahA ]), ihk-irr , slr , isp , and ciaH , that contribute to necrotizing myositis and confirmed these findings using isogenic deletion-mutant strains. Taken together, our study results provide rich new information about the molecular events occurring in severe invasive infection of primate skeletal muscle that has extensive translational research implications. IMPORTANCE Necrotizing myositis caused by Streptococcus pyogenes has high morbidity and mortality rates and relatively few successful therapeutic options. In addition, there is no licensed human S. pyogenes vaccine. To gain enhanced understanding of the molecular basis of this infection, we employed a multidimensional analysis strategy that included dual RNA-seq and other data derived from experimental infection of nonhuman primates. The data were used to target five streptococcal genes for pathogenesis research, resulting in the unambiguous demonstration that these genes contribute to pathogen-host molecular interactions in necrotizing infections. We exploited fitness data derived from a recently conducted genome-wide transposon mutagenesis study to discover significant correlation between the magnitude of bacterial virulence gene expression in vivo and pathogen fitness. Collectively, our findings have significant implications for translational research, potentially including vaccine efforts.

Idiopathic inflammatory myopathies (IIMs) are systemic autoimmune disorders with unknown etiology. Despite the established link between gut microbes and immunity, the roles of gut bacteriome, mycobiome, and virome in IIM are unexplored. We performed shotgun metagenomic sequencing on fecal samples from 34 IIM patients and 37 healthy controls to profile gut microbiota. Taxonomic, functional, network, and machine-learning analyses revealed microbial dysbiosis and its potential for discriminating IIM. All three microbial kingdoms were significantly altered in IIM. Several inflammation-associated bacterial taxa (e.g., Rothia mucilaginosa , Streptococcus parasanguinis , Trueperella pyogenes ) and opportunistic fungi (e.g., Aspergillus spp.) were enriched in IIM, while SCFA-producing bacteria and fungi were depleted. Virome analysis revealed substantial shifts, with higher abundance of Siphoviridae in IIM. Altered viral functional gene profiles suggesting enhanced phage-mediated genome integration, recombination, and bacterial stress adaptation. Multi-kingdom network analysis showed extensive rewiring in IIM, characterized by increased network connectivity and a shift toward fungi-centered ecological hubs, contrasting with bacteria/virus-dominated networks in controls. In machine-learning models, the virome demonstrated the strongest discriminatory power, and viral signatures dominated the combined multi-kingdom classifier (AUC = 0.997). This first comprehensive multi-kingdom gut microbiota analysis in IIM provides a foundation for developing diagnostic and therapeutic strategies.