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Hanger M, Baker DM. Infective Native Extracranial Carotid Artery Aneurysms: A Systematic Review. Ann Vasc Surg 2023; 91:275-286. [PMID: 36549478 DOI: 10.1016/j.avsg.2022.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 11/16/2022] [Accepted: 11/26/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Infective native extracranial carotid artery aneurysms are rare, and their management is variable due to a lack of evidence assessing outcomes. METHODS We performed a systematic literature review following PRISMA guidelines to identify all reported cases of infective native extracranial carotid artery aneurysms between January 1970 and March 2021. RESULTS This study identified 193 infective native aneurysms of the extracranial carotid artery from 154 sources. Patients were predominantly male (71.4%), and age ranged from 6 months to 89 years old. The most common presenting features were a neck mass and fever, but also included hemorrhage, respiratory distress, and neurological symptoms. Most aneurysms were located in the internal carotid artery (47.4%). Staphylococcus (23.3%) was the most commonly identified causative pathogen, followed by Mycobacterium tuberculosis (20.9%). Most appeared to become infected by direct local spread. Treatment strategies involved open surgical methods in 101 cases and an endovascular approach in 41 cases. In 4 cases, a hybrid method involving concurrent endovascular and open surgical management was undertaken. In 5 cases, there was antibiotic treatment alone. In the open surgery-treated group, the complication rate was 20.8% compared to 13.2% in the endovascular group. Mortality rate was 5.6%. CONCLUSIONS Our review identified 193 cases of infective native extracranial carotid artery aneurysms. Direct local spread of a staphylococcus infection was the commonest cause. Endovascular management was associated with fewer early complications than open surgical management.
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Affiliation(s)
- Melissa Hanger
- UCL Division of Medicine, Royal Free Campus, University College London, London, UK
| | - Daryll M Baker
- UCL Division of Medicine, Royal Free Campus, University College London, London, UK.
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Hirai N, Kasahara K, Fujikura H, Yoshihara S, Ogawa T, Ogawa Y, Hishiya N, Suzuki Y, Nakano R, Yano H, Yoshikawa M, Mikasa K. Molecular diagnosis and characterization of a culture-negative mycotic aneurysm due to ST54 Haemophilus influenzae type b with PBP 3 alterations. J Infect Chemother 2018; 24:570-572. [PMID: 29373266 DOI: 10.1016/j.jiac.2017.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/27/2017] [Accepted: 12/15/2017] [Indexed: 01/03/2023]
Abstract
Mycotic aneurysm is a rare but life-threatening disease that warrants an integrated therapeutic approach involving surgical intervention and prolonged antibiotic use. However, the causative organisms are often unidentified because antibiotics started empirically render blood and tissue cultures negative. Molecular diagnosis has been reported to be useful in such culture-negative cases. We report a case of a culture-negative mycotic aortic aneurysm due to Haemophilus influenzae, diagnosed by direct 16S rRNA polymerase chain reaction (PCR) and sequencing of the resected aneurysm tissue. PCR for serotype revealed type b, and PCR and sequencing of the ftsI gene revealed alterations in penicillin-binding protein 3, suggesting resistance to ampicillin. Multilocus sequence typing demonstrated that the isolate belonged to sequence type 54.
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Affiliation(s)
- Nobuyasu Hirai
- Department of Pathogen, Infection and Immunity, Nara Medical University, Shijo-cho, Kashihara, Nara, Japan; Center for Infectious Diseases, Nara Medical University, Shijo-cho, Kashihara, Nara, Japan
| | - Kei Kasahara
- Center for Infectious Diseases, Nara Medical University, Shijo-cho, Kashihara, Nara, Japan.
| | - Hiroyuki Fujikura
- Center for Infectious Diseases, Nara Medical University, Shijo-cho, Kashihara, Nara, Japan
| | - Shingo Yoshihara
- Center for Infectious Diseases, Nara Medical University, Shijo-cho, Kashihara, Nara, Japan
| | - Taku Ogawa
- Center for Infectious Diseases, Nara Medical University, Shijo-cho, Kashihara, Nara, Japan
| | - Yoshihiko Ogawa
- Center for Infectious Diseases, Nara Medical University, Shijo-cho, Kashihara, Nara, Japan
| | - Naokuni Hishiya
- Department of Microbiology and Infectious Diseases, Nara Medical University, Shijo-cho, Kashihara, Nara, Japan
| | - Yuki Suzuki
- Department of Microbiology and Infectious Diseases, Nara Medical University, Shijo-cho, Kashihara, Nara, Japan
| | - Ryuichi Nakano
- Department of Microbiology and Infectious Diseases, Nara Medical University, Shijo-cho, Kashihara, Nara, Japan
| | - Hisakazu Yano
- Department of Microbiology and Infectious Diseases, Nara Medical University, Shijo-cho, Kashihara, Nara, Japan
| | - Masahide Yoshikawa
- Department of Pathogen, Infection and Immunity, Nara Medical University, Shijo-cho, Kashihara, Nara, Japan
| | - Keiichi Mikasa
- Center for Infectious Diseases, Nara Medical University, Shijo-cho, Kashihara, Nara, Japan
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Wheeler HK, Quiroga E, Kohler TR, Tang GL. Mycotic aortic aneurysm caused by haemophilus influenzae group F. Ann Vasc Surg 2013; 27:353.e13-6. [PMID: 23498319 DOI: 10.1016/j.avsg.2012.05.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 05/02/2012] [Accepted: 05/07/2012] [Indexed: 01/16/2023]
Abstract
BACKGROUND Haemophilus influenzae is a rare cause of mycotic aortic aneurysm. We present a case of H. influenzae mycotic aortic aneurysm, which was complicated by prior endovascular stent-graft placement at another facility. METHODS A 58 year-old man was treated by endograft placement for a presumed penetrating aortic ulcer after having symptoms of abdominal pain and malaise for one month. He presented to our institution 11 days after endograft placement with septic physiology. Repeat computed tomography angiogram demonstrated an inflammatory mass around the distal aorta and right common iliac artery, which had an associated contained rupture. RESULTS The patient was treated using intravenous antibiotics, axillo-bifemoral bypass followed by endograft explantation and aortic and iliac ligation. Intraoperative cultures grew Haemophilus influenzae, serotype f. CONCLUSIONS Aortic endografts have been successfully used for treatment of selected mycotic aneurysms, generally after adequate treatment of the primary infection with intravenous antibiotics. This case demonstrates the unfavorable natural history of endograft placement in an unsuspected mycotic aneurysm. A high index of suspicion for possible aortic infection should be maintained for patients with systemic symptoms and unusual aortic pathology prior to choosing endovascular repair.
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Affiliation(s)
- Heather K Wheeler
- Division of Vascular Surgery, University of Washington, Seattle, WA, USA
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Ranganath S, Stratton N, Narasimhan A, Midturi JK. Descending thoracic aortitis due to Haemophilus influenzae: a case report and literature review. Infection 2013; 41:855-8. [PMID: 23389816 DOI: 10.1007/s15010-013-0413-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 01/18/2013] [Indexed: 11/28/2022]
Abstract
Aortitis due to Haemophilus influenzae especially involving the descending thoracic aorta is rarely encountered. We present a case and literature review concerning Haemophilus influenzae aortitis. This article serves to enhance the awareness of this extremely rare disease.
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Affiliation(s)
- S Ranganath
- Division of Infectious Diseases, Scott and White Memorial Hospital, The Texas A&M University Health Science Center College of Medicine, Temple, TX 76508, USA.
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