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Journeau L, de la Chapelle M, Guimard T, Ferfar Y, Saadoun D, Mahé I, Castier Y, Montravers P, Lescure X, Van Gysel D, Asseray N, Lascarrou JB, Ngohou C, Vandamme YM, Connault J, de Cepoy PD, Brochard J, Goueffic Y, Pistorius MA, Boutoille D, Espitia O. A strobe multicenter descriptive study of 55 infectious aortitis. Medicine (Baltimore) 2020; 99:e22422. [PMID: 33019420 PMCID: PMC7535642 DOI: 10.1097/md.0000000000022422] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Infectious aortitis (IA) is a rare and severe disease. The treatment classically associates open surgery with prolonged antibiotic therapy. This study aimed to describe clinical characteristics, medical and surgical supports in a large and current series of IA.We conducted a retrospective multicenter study of native aorta IA, between 2000 and 2019. Inclusion criteria were the presence of a microorganism on blood culture, aortic sample or any other validated technique and structural anomaly in imaging.We included 55 patients (85% men), with a median age of 65. Microbiology data substantially differed from previous studies with 12 Gram-negative rods IA, of which only 3 due to Salmonella spp., 24 Gram-positive cocci IA of which 12 Streptococcus spp., and 18 IA due to intracellular growth and/or fastidious microorganisms, of which 8 Coxiella burnetii, 3 Treponema pallidum, and 5 tuberculosis suspicious cases. Fifteen patients (27%) presented with thoracic IA, 31 (56%) with abdominal IA, and 9 (16%) with thoraco-abdominal IA. Eight patients had no surgery, 41 underwent open surgery, only 4 endovascular aneurysm repair, and 2 a combination of these 2 techniques. Nine patients died before 1-month follow-up. There was no difference in the mortality rate between the different types of germ or localization of IA.The variety of germs involved in IA increases. Positron emission tomography-computed tomography scan is a very useful tool for diagnosis. Surgery is still mainly done in open approach and a prospective multicenter study seems necessary to better determine the place of endovascular aneurysm repair versus open surgery.
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Affiliation(s)
- Louis Journeau
- Department of Internal Medicine, Hôpital Louis Mourier (AP-HP), Colombes
- Department of Internal Medicine, CHD René Dubos, Pontoise
| | | | | | - Yasmina Ferfar
- Department of Internal Medicine and Clinical Immunology, INSERM, UMR_S 959, CNRS, FRE3632, Groupe Hospitalier Pitié-Salpêtrière (AP-HP)
| | - David Saadoun
- Department of Internal Medicine and Clinical Immunology, INSERM, UMR_S 959, CNRS, FRE3632, Groupe Hospitalier Pitié-Salpêtrière (AP-HP)
| | - Isabelle Mahé
- Department of Internal Medicine, Hôpital Louis Mourier (AP-HP), Colombes
| | | | | | - Xavier Lescure
- Department of Infectious Diseases, Hôpital Bichat – Claude Bernard (AP-HP), Paris
| | - Damien Van Gysel
- Department of Medical Information, Hôpital Louis Mourier (AP-HP), Colombes
| | | | | | | | | | | | | | - Julia Brochard
- Department of Infectious Diseases, Saint-Nazaire Hospital, Saint-Nazaire
| | - Yann Goueffic
- Department of Vascular Surgery, CHU Nantes, Nantes, France
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Guo Y, Bai Y, Yang C, Wang P, Gu L. Mycotic aneurysm due to Salmonella species: clinical experiences and review of the literature. ACTA ACUST UNITED AC 2018; 51:e6864. [PMID: 29947649 PMCID: PMC6040868 DOI: 10.1590/1414-431x20186864] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 03/26/2018] [Indexed: 11/22/2022]
Abstract
The mortality of patients with mycotic aneurysms is high, especially in East Asia, and infection by Salmonella species is the most common. Our study aimed to improve prognosis of adult mycotic aneurysms with early diagnosis and accurate treatment. Four adult patients with mycotic aneurysm caused by Salmonella were included and analyzed by single-center retrospective analysis. Cases reported in the literature during the past 10 years were also summarized. The average age of the 4 male patients was 61.25 years, while that of the 53 cases reported in the literature was 65.13 years. Hypertension, diabetes, and atherosclerosis were common complications. Most patients presented fever and experienced pain at the corresponding position of the aneurysm. Laboratory examination found an increased number of white blood cells accompanied by an increase in inflammatory markers. Most aneurysms were found in the abdominal aorta, while the rupture of an aneurysm was the most common complication. The mortality rates were 21.43 and 7.14% after open surgery or endovascular aneurysm repair (EVAR) intervention, respectively. The recurrence rates of infection were 0 and 17.85% for both treatments, respectively. The mortality rate of mycotic aneurysm caused by Salmonella infection was high in middle-aged males with hypertension, diabetes, and atherosclerosis. The possibility of a Salmonella-infected aneurysm should be considered in these high-risk groups presenting chills, fever, chest, and back pain. Open surgery was superior to EVAR treatment in the clearance of infected foci and the reduction of postoperative recurrence. The recurrence of postoperative infection can be prevented by intravenous antibiotic therapy for 6 weeks post-surgery.
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Affiliation(s)
- Yiqun Guo
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Yu Bai
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Chunxia Yang
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Peng Wang
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Li Gu
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
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Multilevel Mycotic Aneurysms Due to Salmonella Infection: Case Report and Review of the Literature. Ann Vasc Surg 2017; 44:424.e11-424.e13. [PMID: 28602900 DOI: 10.1016/j.avsg.2017.05.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 05/18/2017] [Indexed: 01/16/2023]
Abstract
Infected or mycotic aneurysms (MAs) of the aorta and adjacent arteries are rare and difficult to treat. We report a unique case of a Salmonella serotype enteritidis-induced rapidly expanding aortic and iliac pseudoaneurysm during preoperative workup. Based on the presented case, we postulate that the agressive nature of Salmonella enteritidis MAs should not be underestimated. If postponed intervention is chosen and the patient is managed conservatively with antibiotic therapy to create a window of definitive diagnosis, one should consider close follow-up imaging to observe progression of the pseudoaneurysm. This may prevent the need of acute intervention.
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