Infected aneurysms of bilateral deep femoral arteries due to Campylobacter fetus subspecies fetus

Rupture of Non-aneurysmal Mycotic Thoracic Aortic Arteritis Caused by Campylobacter fetus

Campylobacter fetus (C. fetus) demonstrates a preference for vascular tissue and is an infrequent etiology of mycotic aortic arteritis (MAA), mostly occurring in the abdominal aorta. MAA characteristically has a rapid progression to aneurysm formation and subsequently, to aortic rupture. We present a 73-year-old woman with non-aneurysmal mycotic thoracic aortic arteritis (MTAA) complicated with a rupture caused by C. fetus. She presented after four days of pain in the lower abdomen. Contrast-enhanced computed tomography revealed non-aneurysmal descending thoracic aorta arteritis and an abdominal aorta aneurysm, and the blood cultures were positive for C. fetus. Antibiotic therapy relieved the abdominal pain. However, eight days after the antibiotic therapy, she died because of a rupture of the non-aneurysmal MTAA. The non-aneurysmal MTAA caused by C. fetus ruptured while the infection was being treated with appropriate antibiotics, and there was no sign of arterial dilatation. An early open or endovascular repair after a short pre-operative antibiotic therapy may be required for non-aneurysmal MAA caused by C. fetus. More cases of non-aneurysmal MAA caused by C. fetus are needed to determine the clinical course and to decide the treatment strategy.

Campylobacter fetus Bacteremia Related to Vascular Prosthesis and Pseudoaneurysm Infection: A Case Report and Review

BACKGROUND

Campylobacter fetus rarely causes gastrointestinal diseases but shows an affinity for the endovascular epithelium.

METHODS

We describe a case of C. fetus bacteremia related to vascular prosthesis and pseudoaneurysm infection, with a review of the literature.

RESULTS

A 67-year-old male was admitted with a history of fever, weakness and painful swelling of the groin. After unsuccessful treatment with ciprofloxacin, the patient was transferred to our hospital, where he had been previously treated for aortoiliac occlusive disease including a prosthetic aortobifemoral and popliteal bypass with polyester graft placement. An angiography showed a pseudoaneurysm in the groin and, therefore, repair of the pseudoaneurysm, removal of the prosthesis and biologic graft placement were performed. Blood cultures and tissue samples of the vascular prosthesis and pseudoaneurysm yielded C. fetus resistant to ciprofloxacin. The patient was treated with meropenem for four weeks, followed by amoxicillin-clavulanate for another two weeks after discharge. Eight previously published cases of C. fetus bacteremia due to infected cardiovascular prosthetic devices (prosthetic heart valves, implantable cardioverter-defibrillators and a permanent pacemaker) were summarized in the review.

CONCLUSIONS

To our knowledge, this is the first report of a C. fetus bacteremia related to post-surgical infection of a vascular prosthesis causing a pseudoaneurysm.

Obturator bypass in the treatment of prosthetic graft infection: Classic but still effective

Aortic graft infection is associated with high mortality and morbidity rates. In this article we report a 60-year-old man who developed bilateral groin wound infection and progressively worsening lower extremity ischemia one year after he underwent aortobifemoral bypass. The infected graft was resected and bilateral obturator bypass was performed. The obturator bypass, an extra-anatomical bypass closest to anatomical position with high patency rates, continues to be favored in revascularization of the lower extremity when the inguinal region should be avoided. Likewise, the obturator bypass is an effective surgical approach against recurrent infections.

Infective Internal Iliac Artery Aneurysm Caused by Campylobacter fetus

A 67-year-old man with a persistent high fever was diagnosed to have an infective aneurysm in his left internal iliac artery. A blood culture detected a gram-negative spiral rod that was first identified as Campylobacter fetus subsp. venerealis based on a matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS) analysis. However, the strain was finally confirmed to be Campylobacter fetus subsp. fetus based on a genetic analysis. The infection was successfully treated with emergency resection of the aneurysm, followed by 4 weeks of antibiotic therapy. Involvement of the peripheral artery is uncommon in cases of C. fetus-infective aneurysm. To figure out the epidemiology and pathogenicity of C. fetus infection, the accurate identification of the responsible organisms is essential.

Diagnosis and management of mycotic aneurysms

We reviewed all papers most recently reported in the literature related to infected arterial aneurysms (IAAs) affecting the aorta and vascular beds other than the aorta. In this article, we report on vascular beds other than the aorta. As is the case for aortic IAAs, infected non-aortic aneurysms are rarely encountered. The majority of recent studies are limited to case reports and small series of unusual infected aneurysms. A comprehensive review of this entity was performed based on the available literature from January through December 2008 in all languages. Available reports were analyzed with respect to demographic features, type of presentation, methods of diagnosis and therapy, follow-up, and outcome (morbidity and mortality).