Two cases of pyomyositis caused by Klebsiella pneumoniae and review of theliterature

Two patients with diabetes mellitus developed Klebsiella pneumoniae pyomyos itis involving multiple muscles and other metastatic foci associated with b acteraemia. The cases are presented here, and the 22 cases of gram-negative pyomyositis reported previously in the literature are reviewed. As gram-po sitive cocci cause 99% of pyomyositis, it is postulated that the pathogenes is of pyomyositis may be associated with the ability of the bacteria to adh ere to muscles by various cell surface adhesins that are not present in gra m-negative bacilli. It is also postulated that a high serum glucose concent ration may facilitate the growth and formation of the Klebsiella pneumoniae capsule, hence increasing its virulence and causing serious disseminated K lebsiella infections in diabetic patients.