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Elshweikh SA, Abdellatif Ibrahim A, Saleh Almutairi W, AlHarbi F, Alrasheedi AA, Negm Eldine Said Mubark A, Ibrahim Basha E, Elkolaly RM. Mycotic Aortic Aneurysm Secondary to Salmonella enterica Infection: A Case Report and Treatment Approach. Cureus 2024; 16:e56399. [PMID: 38638711 PMCID: PMC11024485 DOI: 10.7759/cureus.56399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
Mycotic (infected) aortic aneurysm is a severe clinical condition with high morbidity and mortality. Salmonella spp. is a Gram-negative, rod-shaped bacteria that is typically limited to the gastrointestinal tract and resolves spontaneously but can progress to invasive infections such as bacteremia. Serious complications may arise, particularly in debilitated, elderly, and neonatal patients. We describe the case of a 74-year-old female with a history of diabetes and hypertension who presented with shortness of breath, fever, chills, abdominal pain, vomiting, and diarrhea. The patient's blood culture tested positive for Salmonella enterica, and she was given ceftriaxone based on the results, but he remained symptomatic. A computed tomography scan of the chest with contrast revealed a mycotic aneurysm of the thoracic aorta. The patient was urgently transferred to a higher level of care and underwent emergency thoracic endovascular aortic repair with stenting and intravenous antibiotics. The presence of an infected aneurysm and associated abscess formation in such high-risk patients makes the endovascular approach more suitable than other options such as open surgery, aneurysmal excision and ligation without arterial reconstruction, excision with immediate reconstruction, and excision with interval reconstruction.
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Affiliation(s)
| | | | | | | | | | | | | | - Reham M Elkolaly
- Chest Diseases, Faculty of Medicine, Tanta University, Tanta, EGY
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2
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Ansari FA, Gafoor S, Aftab M, Nlandu Z. An Unusual Case of Non-typhoidal Salmonella Bacteremia Causing Life-Threatening Aortitis. Cureus 2024; 16:e54645. [PMID: 38523940 PMCID: PMC10959711 DOI: 10.7759/cureus.54645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 03/26/2024] Open
Abstract
Non-typhoidal Salmonella typically presents with gastroenteritis. However, an invasive Salmonella infection, which may be typically seen in immunocompromised patients, has a propensity for aortic involvement, especially in patients with risk factors for atherosclerosis. Here we present a 60-year-old female with multiple comorbid conditions and currently on immunosuppressants for rheumatoid arthritis, who presented with nausea, vomiting, and fever of three weeks duration and was found to have Salmonella bacteremia. Blood cultures were positive for Salmonella enterica. Computed tomography (CT) abdomen with contrast was concerning for mycotic aortitis. The patient underwent endovascular repair of an aortic ulcer and was treated with a six-week course of ceftriaxone. Mycotic aneurysm is a rare but potentially fatal complication of invasive Salmonella infection. It occurs typically in older men with atherosclerotic risk factors. It mostly presents as fever, back pain, and/or abdominal pain. Our patient was a middle-aged female who presented with non-specific symptoms. CT angiogram is the diagnostic modality of choice and treatment may require surgical vascular repair and long-term antibiotics. A high level of suspicion is needed to diagnose Salmonella-related mycotic aneurysm/aortitis. Early diagnosis and treatment may improve the mortality.
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Affiliation(s)
- Fawwad A Ansari
- Internal Medicine, Piedmont Athens Regional Medical Center, Athens, USA
| | - Stefan Gafoor
- Internal Medicine, Piedmont Athens Regional Medical Center, Athens, USA
| | | | - Zola Nlandu
- Internal Medicine, Piedmont Athens Regional Medical Center, Athens, USA
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3
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Kalchev Y, Urdzhanova H, Stanev S, Cheshmedzhieva B, Pavlova M, Lengerova G, Murdjeva M. Yersinia enterocolitica Bacteremia Associated with a Ruptured Abdominal Aortic Aneurysm: A Case Report with Literature Review. Microorganisms 2023; 11:2911. [PMID: 38138055 PMCID: PMC10745443 DOI: 10.3390/microorganisms11122911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
Yersinia enterocolitica is a foodborne pathogen, mainly associated with disorders involving the gastrointestinal tract, including diarrhea, ileitis, and mesenteric lymphadenitis. Extraintestinal presentation is uncommon in healthy individuals, but bacteremia is reported in immunocompromised hosts. We present a 74-year-old male with Y. enterocolitica serogroup O:3 bacteremia who complicated to rupture of an abdominal aortic aneurysm. With the current case report, we aimed to emphasize the association of Y. enterocolitica bacteremia with abdominal aortic aneurysm rupture. Better surveillance is needed, not only to reduce morbidity and mortality but also to update current epidemiological data on the incidence of such associations.
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Affiliation(s)
- Yordan Kalchev
- Department of Medical Microbiology and Immunology “Prof. Dr. Elissay Yanev”, Faculty of Pharmacy, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
- Laboratory of Microbiology, University Hospital St. George, 4000 Plovdiv, Bulgaria
- Research Institute, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
| | - Hristina Urdzhanova
- Department of Pathology, Zealand University Hospital, 4000 Roskilde, Denmark
| | - Stefan Stanev
- Clinic of Vascular Surgery, University Hospital St. George, 4000 Plovdiv, Bulgaria
| | | | - Maria Pavlova
- National Reference Laboratory of Enteric Infections, Pathogenic Cocci and Diphtheria, Department of Microbiology, National Center of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria;
| | - Gergana Lengerova
- Department of Medical Microbiology and Immunology “Prof. Dr. Elissay Yanev”, Faculty of Pharmacy, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
- Laboratory of Microbiology, University Hospital St. George, 4000 Plovdiv, Bulgaria
- Research Institute, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
| | - Marianna Murdjeva
- Department of Medical Microbiology and Immunology “Prof. Dr. Elissay Yanev”, Faculty of Pharmacy, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
- Laboratory of Microbiology, University Hospital St. George, 4000 Plovdiv, Bulgaria
- Research Institute, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
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4
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Sangiorgio M, Choo SZ, Gavaghan D, McDougall K. Case of non-typhoidal Salmonella spp mycotic popliteal artery aneurysm with concurrent deep vein thrombosis. BMJ Case Rep 2023; 16:e255052. [PMID: 37580098 PMCID: PMC10432638 DOI: 10.1136/bcr-2023-255052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
Mycotic aneurysms are a well-recognised complication of non-typhoidal Salmonella bacteraemia; the risk is increased in patients with atherosclerotic disease. The infrarenal abdominal aorta is the most common site of infection; lower extremity aneurysms are uncommon.1Here we present the case of a patient with cardiovascular disease and recurrent non-typhoidal Salmonella bacteraemia, who developed a left-sided popliteal artery mycotic aneurysm with secondary popliteal vein thrombosis. The aneurysm was diagnosed upon rupture, and managed with surgical excision and bypass graft. He went on to have a complete recovery.This case illustrates the importance of clinician awareness of popliteal artery endovascular infection as a rare but significant complication of non-typhoidal Salmonella bacteraemia, which should be considered in cases with cardiovascular risk factors, recurrent or persistent bacteraemia, and lower limb deep vein thrombosis.
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Affiliation(s)
- Michael Sangiorgio
- Department of General Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Shi Zhou Choo
- Department of General Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Daniel Gavaghan
- Department of General Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia
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5
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Yoshida S, Manerikar A, Zhu M, Mehta C. Successful surgical treatment of Stanford type A aortic dissection due to Salmonella aortitis. J Cardiothorac Surg 2023; 18:233. [PMID: 37452382 PMCID: PMC10349517 DOI: 10.1186/s13019-023-02318-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Salmonella spp. cause infectious aortitis through the hematogenous spread of an intestinal Salmonella infection. Salmonella aortitis can result in extensive tissue damage in the aorta leading to complications including dissection, abscess formation, pseudoaneurysms, and rupture, which require early diagnosis and treatment with both surgery and antibiotic therapy. CASE PRESENTATION We report a case of Salmonella aortitis complicated by Stanford type A aortic dissection. A 62-year-old man with a history of heroin use presented with chest pain, epigastric pain and vomiting. The computed tomography scan showed Stanford type A aortic dissection without malperfusion. At the time of surgery, an aortic dissection with purulent fluid and contained rupture was noted in the ascending aorta. Fluid culture was consistent with Salmonella. A composite valve-graft conduit aortic root replacement with ascending aorta and hemiarch replacement was performed. The patient recovered well and was discharged on long-term antibiotics. CONCLUSIONS This rare case of a Stanford type A aortic dissection with contained rupture due to Salmonella aortitis was successfully treated with emergent surgery and antibiotic therapy.
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Affiliation(s)
- Shohei Yoshida
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, 676 North St. Clair, Suite 7-300, Chicago, IL, 60611, USA
| | - Adwaiy Manerikar
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, 676 North St. Clair, Suite 7-300, Chicago, IL, 60611, USA
| | - Mengou Zhu
- Division of Internal Medicine, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, IL, USA
| | - Christopher Mehta
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, 676 North St. Clair, Suite 7-300, Chicago, IL, 60611, USA.
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Han Y, Zhang Y, Gong G, Ou C, Li F. Mycotic Pseudoaneurysm of Thoracic Aortic Caused by Salmonella Paratyphi A: A Case Report. Infect Drug Resist 2023; 16:4171-4176. [PMID: 37396071 PMCID: PMC10314776 DOI: 10.2147/idr.s416783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 06/23/2023] [Indexed: 07/04/2023] Open
Abstract
Background Mycotic pseudoaneurysm, also known as infectious pseudoaneurysm, is a severe disease with a high mortality rate. Although Salmonella infection is a common etiological factor for mycotic pseudoaneurysm, Salmonella paratyphi A infection causing mycotic pseudoaneurysm is extremely rare. Endovascular therapy has been described as a feasible treatment for mycotic pseudoaneurysm. Case Presentation A 63-year-old female patient had a thoracic aortic pseudoaneurysm caused by Salmonella paratyphi A infection. The patient associated with diabetes had a fever, abdominal pain, and low back pain, who was successfully treated using endovascular stents treatment and antibiotics. Conclusion Salmonella paratyphi A is a bloodstream infection bacterium with the ability to cause mycotic pseudoaneurysm. To treat mycotic pseudoaneurysms of the thoracic aorta, endovascular stent-graft treatment combined with antibiotics is an alternative treatment for patients who cannot tolerate open surgery.
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Affiliation(s)
- Ying Han
- Department of Pain Management, The Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
| | - Yue Zhang
- Department of Pain Management, The Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
| | - Gege Gong
- Department of Physical Diagnosis, The Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
| | - Cehua Ou
- Department of Pain Management, The Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
| | - Fubo Li
- Department of Pain Management, The Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
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Digwa K, Wittenberg-Voges L, Hansmann F, Fehr M. Surgical removal of an atypical histiocytic cell proliferation in a bearded dragon (Pogona vitticeps). TIERARZTLICHE PRAXIS. AUSGABE K, KLEINTIERE/HEIMTIERE 2023; 51:201-208. [PMID: 37567182 DOI: 10.1055/a-2109-9778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
A 4-year-old female bearded dragon (Pogona vitticeps) was referred to the Clinic for Small Mammals, Reptiles and Birds of the University of Veterinary Medicine, Hannover, Germany for diagnostics and treatment of a growing mass in the right cervical region. The owner reported that the mass had grown over the past 4 weeks with only little alteration in the lizard´s behavior when the animal started rubbing its neck against the cage equipment. Physical examination as well as ultrasonographic and computed tomographic diagnostics revealed a highly vascularized mass, which allowed for the hypothesis of an aneurysm or a neoplasia. Complete surgical resection of the mass could be performed uneventfully. The bearded dragon recovered well from anesthesia and the surgical procedure. The microbiological sample of the excised mass revealed Group F-67 Salmonella. Histopathological examination of the excised mass revealed a histiocytic cell proliferation with centrally located blood filled cavities, hemorrhages and granulation tissue resembling features of a pseudoaneurysm. This report describes the diagnosis of an atypical growing mass in a bearded dragon and its successful removal.
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Affiliation(s)
- Kathrin Digwa
- Group Practice Decker and Holtz, Hohenhameln, Germany
| | - Liza Wittenberg-Voges
- Equine Clinic (Surgery, Orthopaedics), Faculty of Veterinary Medicine, Justus-Liebig-University, Giessen, Germany
| | - Florian Hansmann
- University of Veterinary Medicine Hannover, Foundation, Department of Pathology, Hannover, Germany
- Institute of Veterinary Pathology, Leipzig University, Leipzig, Germany
| | - Michael Fehr
- Clinic for Small Mammals, Reptiles and Birds, University of Veterinary Medicine, Hannover, Germany
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Hennawy HME, Al-Qahtani S, Faifi ASA, Ghalyoob TM, Khalil HF, Bazeed MF, Atta EA, Safar O, Awad A, Nazer WE, Abdelaziz AA, Mahedy A, Mirza N, Fageeh AA, Elgamal GA, Zaitoun MF, Haddad AE. Successful Endovascular Repair of Infectious External Iliac Artery Anastomotic Pseudoaneurysm With Graft Preservation Post-Kidney Transplantation: Case Report and Review of Literature. Transplant Proc 2022; 54:2709-2715. [PMID: 36786541 DOI: 10.1016/j.transproceed.2022.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/02/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Allograft artery-infected pseudoaneurysm (PA) represents a rare but life-threatening complication of kidney transplantation (KT). A review of the literature, showed that nearly all these cases ended resulted in graft loss. We presented a case of post-KT-infected external iliac artery anastomotic PA successfully managed by endovascular stenting with graft preservation. Additionally, we reviewed the pertinent literature. METHOD In this article, we described a hypertensive, 47-year-old man who presented 1 month post-cadaveric KT with acute kidney injury and gram-negative bacteremia secondary to a large infectious anastomotic PA of the external iliac artery. RESULTS Because of favorable anatomy, successful arterial angio-stent fixation of the main renal artery PA, sparing the lower polar artery, was performed after 1 week of antibiotic and fungal coverage. CONCLUSION Patient was discharged after 2 weeks with functioning graft. Graft function was stable after 3 months.
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Affiliation(s)
- Hany M El Hennawy
- Surgery Department, Section of Transplantation, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia.
| | - Saad Al-Qahtani
- Radiology Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Abdullah S Al Faifi
- Surgery Department, Section of Transplantation, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Tayseer M Ghalyoob
- Radiology Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Haytham Fouad Khalil
- Radiology Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia; Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Kasr Al-Ainy St., Egypt
| | - Mohammed F Bazeed
- Radiology Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Eisa Al Atta
- Surgery Department, Section of Transplantation, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Omar Safar
- Urology Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Ahmed Awad
- Vascular Surgery Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Weam El Nazer
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Abdelaziz A Abdelaziz
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Ahmed Mahedy
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Naveed Mirza
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Ali Al Fageeh
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Galal A Elgamal
- Anesthesia Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, KSA; Anesthesia Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohammad F Zaitoun
- Pharmacy Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Ahmed El Haddad
- Radiology Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia; Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Muacevic A, Adler JR. Mycotic Thoracic Aortic Aneurysm: Epidemiology, Pathophysiology, Diagnosis, and Management. Cureus 2022; 14:e31010. [PMID: 36349070 PMCID: PMC9632233 DOI: 10.7759/cureus.31010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2022] [Indexed: 11/30/2022] Open
Abstract
Mycotic thoracic aortic aneurysm (MTAA) is an aneurysm of the aorta caused by infection of the vessel tissue through microbial inoculation of the diseased aortic endothelium. It is most commonly caused by bacteria. Rarely, it can be caused by fungi. However, viral aortic aneurysm has never been reported. Depending on the area and time period investigated, the infections organism discovered may vary significantly. Little is known about the natural history of MTAA due to its rarity. It is not known if they follow the same pattern as other TAAs. However, it is unclear whether MTAA follows a similar clinical course. The combination of clinical presentation, laboratory results, and radiographic results are used to make the diagnosis of MTAA. Treatment of MTAA is complex since patients frequently present at a late stage, frequently with fulminant sepsis, as well as concomitant complications such as aneurysm rupture. While medical treatment, including antibiotics, is recommended, surgery is still the mainstay of management. Surgery to treat MTAA is complicated and carries a high risk of morbidity and mortality and includes both open repairs and endovascular ones. In this review, we explore the etiology, pathogenesis, clinical presentations, diagnostic modalities as well as treatment management available for MTAA.
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Chinsakchai K, Wiangphoem N, Wongwanit C, Hongku K, Moll FL, Tongsai S, Puangpunngam N, Hahtapornsawan S, Sermsathanasawadi N, Ruangsetakit C. Early and Late Outcomes of Endovascular Aneurysm Repair for Infected Abdominal Aortic and/or Iliac Aneurysms. Ann Vasc Surg 2022; 87:411-421. [PMID: 35667489 DOI: 10.1016/j.avsg.2022.05.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Infected abdominal aortic and/or iliac aneurysm (AAIA) is a rare condition with a high mortality rate when treated with open surgery. In the past decade, the condition has increasingly been treated with endovascular aneurysm repair (EVAR). However, early and late outcomes, including the continued need for antibiotic treatments and predictors of persistent infection, are poorly understood. METHODS We evaluated the outcomes of patients who underwent EVAR for infected AAIA from January 2010 to October 2017. We collected data including patient age, gender, clinical presentation, aneurysm location, culture results, intraoperative details, postoperative complications, 30-day mortality, in-hospital mortality, persistent infection, reintervention, and survival. RESULTS Among 792 patients diagnosed with AAIA, 64 were diagnosed with primary infected aneurysm, underwent EVAR, and were included in this study (81.3% male; median age, 72 years; range, 18-94 years). The most commonly isolated organisms were Salmonella species (34%), followed by Streptococcus (21%), and Staphylococcus species (21%). Aneurysms were intact in 48 patients (75%) and were ruptured in 16 (25%). The perioperative mortality was 4.7% (3 patients) of whom one was diagnosed with ruptured infected AAIA. Six (9.4%) patients died during hospitalization, 5 of severe sepsis with multiorgan failure and one of myocardial infarction. Among the 58 surviving patients, 34 (58.6%) had persistent infection, of whom 13 (22.4%) required early and late reintervention, including 2 with endograft infection, 8 with primary and secondary aortoenteric fistula, 2 with recurrent new aortic infection, and one with graft limb occlusion. The remaining 24 patients were able to discontinue antibiotics and had no recurrence or need for reintervention. Overall survival rates at 1, 3, and 5 years in the antibiotic-discontinuation group were 91.7%, 87.5%, and 68.0%, respectively, and 82.4%, 52.6%, and 32.9%, respectively, in the persistent-infection group (P = 0.009). In multivariable analysis, primary aortoenteric fistula (Adjusted OR [aOR], 20.469; 95% confidence interval (CI), 1.265-331.320; P = 0.034) and preoperative serum albumin level <3 g/dL (aOR, 7.399; 95% CI, 1.176-46.558; P = 0.033) were preoperative parameter that predicted persistent infection. A C-reactive protein level more than 5 mg/L (aOR, 34.378; 95% CI, 4.888-241.788; P < 0.001) was observed in patients with persistent infection. CONCLUSIONS EVAR is a feasible treatment with acceptable perioperative mortality for infected AAIA. Patients able to discontinue antibiotics have better survival and lower reintervention rates than those with persistent infection. A preoperative albumin level below 3 g/dL and primary aortoenteric fistula predicted persistent infection in this population.
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Affiliation(s)
- Khamin Chinsakchai
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Nattawadee Wiangphoem
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chumpol Wongwanit
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kiattisak Hongku
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Frans L Moll
- Vascular Surgery Department, University Medical Center, Utrecht, the Netherlands
| | - Sasima Tongsai
- Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nattawut Puangpunngam
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suteekhanit Hahtapornsawan
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nuttawut Sermsathanasawadi
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chanean Ruangsetakit
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Yamamoto H, Fukushima Y, Ikeda Y, Suda T, Goto M, Isogai J, Hashimoto T, Takahashi T, Ogino H. Decisive diagnostic clue for infectious abdominal aortic aneurysm caused by Arthrobacter russicus in a diabetic elderly woman with renal dysfunction: A case report and literature review. Front Cardiovasc Med 2022; 9:1007213. [PMID: 36386385 PMCID: PMC9650533 DOI: 10.3389/fcvm.2022.1007213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 09/26/2022] [Indexed: 12/05/2022] Open
Abstract
Infectious aortic aneurysm (IAA) can be a rare but potentially fatal sequela of infectious inflammatory disease of the aortic wall with a high incidence of rupture. The definitive diagnosis is based on vascular imaging of the aneurysm using contrast-enhanced computed tomography (CE-CT) and identification of the causative microorganism from positive blood cultures (BCs). However, IAA remains extremely difficult to diagnose and treat in patients with prior antimicrobial treatment or with renal dysfunction. Here we describe a case of an 85-year-old woman with IAA caused by Arthrobacter russicus presenting with abdominal pain and fever that was initially diagnosed as a presumptive urinary tract infection and treated with empiric antimicrobial therapy. However, persistent abdominal pain with increased serological inflammation necessitated further evaluation. Unenhanced multimodality imaging considering the renal dysfunction revealed infectious aortitis of the infrarenal abdominal aorta, together with the initial culture results, leading to the tentative diagnosis of Klebsiella pneumoniae aortitis. Thereafter, serial monitoring with unenhanced magnetic resonance angiography (MRA) using thin-slab maximum intensity projection (TS-MIP) revealed acute aortic expansion strongly suggestive of a pseudoaneurysm that was successfully treated with early surgical repair under adequate infection control. Despite negative Gram staining and tissue culture results for the excised aortic wall, a definitive diagnosis of IAA secondary to A. russicus rather than K. pneumoniae was finally made by confirming the histologic findings consistent with IAA and the identification of A. russicus 16S rRNA on the resected aortic wall. The patient also developed a vascular graft infection during the postoperative course that required long-term systemic antimicrobial therapy. This case highlights the value of unenhanced MRA in the early detection of IAA in patients with renal dysfunction and the importance of a molecular diagnosis for identifying the causative microorganism in cases of culture- or tissue-negative IAA.
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Affiliation(s)
- Hiroyuki Yamamoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
- *Correspondence: Hiroyuki Yamamoto,
| | - Yasuto Fukushima
- Laboratory of Infectious Diseases, Graduate School of Infection Control Sciences and Omura Satoshi Memorial Institute, Kitasato University, Tokyo, Japan
| | - Yoshihiko Ikeda
- Department of Pathology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tomoyuki Suda
- Department of Surgery, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
- Department of General Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Mieko Goto
- Laboratory of Infectious Diseases, Graduate School of Infection Control Sciences and Omura Satoshi Memorial Institute, Kitasato University, Tokyo, Japan
| | - Jun Isogai
- Department of Radiology, Asahi General Hospital, Asahi, Japan
| | - Toru Hashimoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Takashi Takahashi
- Laboratory of Infectious Diseases, Graduate School of Infection Control Sciences and Omura Satoshi Memorial Institute, Kitasato University, Tokyo, Japan
| | - Hidemitsu Ogino
- Department of Surgery, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
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12
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Sivaramalingam S, Ethiraj D, Srinivas S, Kalyanasundaram S, Sundaramoorthy S, M. MB. Salmonella Bacteremia Causing Mycotic Pseudoaneurysm of Right Common Iliac Artery Complicated by Septic Caval Thrombosis. Indian J Radiol Imaging 2022; 32:426-429. [PMID: 36177286 PMCID: PMC9514902 DOI: 10.1055/s-0042-1754314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
AbstractMycotic pseudoaneurysm (MPA) is a blind, saccular outpouching of the arterial lumen of infective origin. MPA is a rare life-threatening condition and if not treated early, has a 67% mortality rate due to sepsis and hemorrhage. Major predisposing factors are diabetes mellitus, chronic renal failure, malignancy, steroids, and intravenous drug use. Imaging modalities include Doppler ultrasound, contrast-enhanced computed tomography, and digital subtraction angiography. We report a unique case of Salmonella bacteremia-related MPA of the right common iliac artery complicated by septic inferior vena cava (IVC) thrombosis in a patient with uncontrolled diabetes. Such transcompartmental involvement of IVC has hitherto not been described in the literature and hence makes for interesting documentation. This case ponders upon the aggressiveness of the invasive nontyphoidal Salmonella infection pathogen and the need for early imaging of suspicious patients to reduce morbidity and mortality.
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Affiliation(s)
- Sinduja Sivaramalingam
- Department of Radiology, Dr. Rela Institute and Medical Centre, Chennai, Tamil Nadu, India
| | - Dillibabu Ethiraj
- Department of Radio-diagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sripriya Srinivas
- Department of Radiology, Dr. Rela Institute and Medical Centre, Chennai, Tamil Nadu, India
| | | | - Subha Sundaramoorthy
- Department of Microbiology, Dr. Rela Institute & Medical Centre, Chennai, Tamil Nadu, India
| | - Madhu Bashini M.
- Department of Internal Medicine, Chettinad Hospital, Chennai, Tamil Nadu, India
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13
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Xing X, Sun Z, Chen L, Zhang N, Xiong W, Li Y. CT Imaging Manifestations of Tuberculous Aortic Aneurysm. Rev Cardiovasc Med 2022; 23:271. [PMID: 39076630 PMCID: PMC11266966 DOI: 10.31083/j.rcm2308271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/24/2022] [Accepted: 06/07/2022] [Indexed: 07/31/2024] Open
Abstract
Background Tuberculous aortic aneurysm (TBAA) is a rare complication of TB and is associated with high mortality. Early diagnosis is critical; however, it is challenging due to nonspecific symptoms. This study summarized the computed tomography (CT) features of TBAA with the aim of assisting with timely clinical diagnosis. Methods Seventeen patients with TBAA between 2015 and 2020 were included in this study. The clinical manifestations, past medical history, laboratory and imaging examinations, treatments, and other data were collected and analyzed. CT angiography was performed in all patients. Results All tuberculous aneurysms were pseudoaneurysms, which were located in the thoracic aorta (8/17, 47%), abdominal aorta (7/17, 41%), junction of the thoracic and abdominal aorta (1/17, 6%) or abdominal aorta and iliac artery (1/17, 6%) region. The shapes of all aneurysms were saccular, and nine of them were lobulated. The aneurysm diameter ranged from 3 to 12 cm. Of the 17 patients, 12 (71%) had calcification; 14 (82%) had intraluminal thrombus; 12 (71%) showed enlarged lymph nodes, which were closely related to the aneurysm; and 9 (53%) had tuberculous spondylitis including TB of the thoracic lumbar and lumbosacral spine. Psoas abscess was detected in 4 (23%) patients and iliopsoas abscess was detected in 1 (6%) patient. Conclusions TBAA typically shows mycotic shapes on CT scans. Another feature is that the surrounding tissues and adjacent organs of tubercular aneurysms are usually infected with TB, and most of them are accompanied by other sites of TB.
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Affiliation(s)
- Xiaona Xing
- Department of Neurology, The Third Affiliated Hospital of Shenzhen University, Shenzhen Luohu People’s Hospital, 518000 Shenzhen, Guangdong, China
| | - Zhonghua Sun
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth, WA 6102, Australia
| | - Li Chen
- Department of Neurology, The Third Affiliated Hospital of Shenzhen University, Shenzhen Luohu People’s Hospital, 518000 Shenzhen, Guangdong, China
| | - Nan Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China
| | - Wei Xiong
- Department of Respiration, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, 300380 Tianjin, China
| | - Yu Li
- Department of Radiology, The Seventh Affiliated Hospital of Sun Yat-sen University, 518107 Shenzhen, Guangdong, China
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14
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Dong N, Wang F, Li Y, Ma H, Xing N, Ding H. Right costophrenic angle abscess due to Salmonella Dublin infection in combination with type 2 diabetes mellitus. J Int Med Res 2021; 49:3000605211066443. [PMID: 34932405 PMCID: PMC8721715 DOI: 10.1177/03000605211066443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The main manifestations of type 2 diabetes mellitus are excessive drinking, polyphagia, polyuria and wasting or weight loss in a short period of time, but it is rare to have persistent fever of unknown origin as the main manifestation. This case report describes a 68-year-old male patient with type 2 diabetes mellitus presenting with unexplained fever with persistent exacerbation and a cystic lesion in the right costophrenic horn on abdominal computed tomography (CT). A cytoculture examination of the puncture fluid suggested that the infection was due to Salmonella Dublin. The patient was treated with drainage of the abscess in the right costophrenic angle area, which then healed successfully. These findings suggest that Salmonella Dublin infection should be considered when a patient with type 2 diabetes mellitus presents with an unexplained persistent fever. At the same time, CT-guided abscess puncture can be performed to improve the patient's symptoms, aid diagnosis and improve the quality of life.
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Affiliation(s)
- Nanxi Dong
- Department of Endocrinology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Fujun Wang
- Department of Endocrinology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Yuekao Li
- Department of Computed Tomography Scanning, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Hongfang Ma
- Department of Endocrinology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Na Xing
- Department of Endocrinology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Haixia Ding
- Department of Endocrinology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
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15
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M’ikanatha NM, Yin X, Boktor SW, Dettinger LA, Tewari D. Integrated Surveillance for Antimicrobial Resistance in Salmonella From Clinical and Retail Meat Sources Reveals Genetically Related Isolates Harboring Quinolone- and Ceftriaxone-Resistant Determinants. Open Forum Infect Dis 2021; 8:ofab213. [PMID: 34409121 PMCID: PMC8364758 DOI: 10.1093/ofid/ofab213] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/22/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Antimicrobial resistance in foodborne pathogens, including nontyphoidal Salmonella (NTS), is a public health concern. Pennsylvania conducts integrated surveillance for antimicrobial resistance in NTS from human and animal sources. METHODS During 2015-2017, clinical laboratories submitted 4478 NTS isolates from humans and 96 isolates were found in 2520 retail meat samples. One hundred nine clinical isolates that shared pulsed-field gel electrophoresis patterns with meat isolates and all strains from meat samples were tested for susceptibility to antimicrobial agents. Six clinical and 96 NTS isolates from meat sources (total 102) were analyzed by whole-genome sequencing (WGS). RESULTS Twenty-eight (25.7%) of the 109 clinical NTS and 21 (21.9%) of strains from meat sources had resistance to ≥3 antimicrobial drug classes (multidrug resistance). Sixteen of the 102 (15.7%) isolates analyzed by WGS had resistance mechanisms that confer resistance to expanded-spectrum cephalosporins, such as ceftriaxone. We identified bla CTX-M-65 in 2 S. Infantis isolates from clinical and 3 S. Infantis isolates from meat sources. These 5 bla CTX-M-65-positive S. Infantis strains carried ≥5 additional resistance genes plus a D87Y mutation in gyrA that encodes fluoroquinolone resistance. WGS showed that isolates from patients and meat samples were within ≤10 and ≤5 alleles for S. Infantis and S. Reading, respectively. CONCLUSIONS A significant proportion of NTS isolates from human and animal sources were multidrug resistant and 16% had genetic mechanisms that confer resistant to ceftriaxone. These results emphasize need for integrated surveillance in healthcare and agricultural settings.
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Affiliation(s)
- Nkuchia M M’ikanatha
- Division of Infectious Disease Epidemiology, Pennsylvania Department of Health, Harrisburg, Pennsylvania, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Xin Yin
- Division of Infectious Disease Epidemiology, Pennsylvania Department of Health, Harrisburg, Pennsylvania, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Sameh W Boktor
- Division of Infectious Disease Epidemiology, Pennsylvania Department of Health, Harrisburg, Pennsylvania, USA
| | - Lisa A Dettinger
- Bureau of Laboratories, Pennsylvania Department of Health, Exton, Pennsylvania, USA
| | - Deepanker Tewari
- Pennsylvania Veterinary Laboratory, Harrisburg, Pennsylvania, USA
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16
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Hsieh CE, Hsu YL, Lin KH, Lin PY, Hung YJ, Lai YC, Weng LC, Chen YL. Association between surgical volumes and hospital mortality in patients: a living donor liver transplantation single center experience. BMC Gastroenterol 2021; 21:228. [PMID: 34016057 PMCID: PMC8136228 DOI: 10.1186/s12876-021-01732-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 03/22/2021] [Indexed: 02/06/2023] Open
Abstract
Background Many factors cause hospital mortality (HM) after liver transplantation (LT). Methods We performed a retrospective research in a single center from October 2005 to June 2019. The study included 463 living donor LT patients. They were divided into a no-HM group (n = 433, 93.52%) and an HM group (n = 30, 6.48%). We used logistic regression analysis to determine how clinical features and surgical volume affected HM. We regrouped patients based on periods of surgical volume and analyzed the clinical features. Results Multivariate analysis revealed that donor age (OR = 1.050, 95% CI 1.011–1.091, p = 0.012), blood loss (OR = 1.000, 95% CI 1.000–1.000, p = 0.004), and annual surgical volumes being < 30 LTs (OR = 2.540, 95% CI 1.011–6.381, p = 0.047) were significant risk factors. A comparison of years based on surgical volume found that when the annual surgical volumes were at least 30 the recipient age (p = 0.023), donor age (p = 0.026), and ABO-incompatible operations (p < 0.001) were significantly higher and blood loss (p < 0.001), operative time (p < 0.001), intensive care unit days (p < 0.001), length of stay (p = 0.011), rate of re-operation (p < 0.001), and HM (p = 0.030) were significantly lower compared to when the annual surgical volumes were less than 30. Conclusions Donor age, blood loss and an annual surgical volume < 30 LTs were significant pre- and peri-operative risk factors. Hospital mortality and annual surgical volume were associated with statistically significant differences; surgical volume may impact quality of care and transplant outcomes.
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Affiliation(s)
- Chia-En Hsieh
- Department of Nursing, Changhua Christian Hospital, Changhua, Taiwan.,Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan, Taiwan
| | - Ya-Lan Hsu
- Department of Nursing, Changhua Christian Hospital, Changhua, Taiwan
| | - Kuo-Hua Lin
- Department of General Surgery, Changhua Christian Hospital, No. 135 Nan-Hsiao Street, Changhua, 500, Taiwan
| | - Ping-Yi Lin
- Department of Nursing, Associate Professor, HungKung University, Taichung, Taiwan
| | - Yu-Ju Hung
- Department of General Surgery, Changhua Christian Hospital, No. 135 Nan-Hsiao Street, Changhua, 500, Taiwan
| | - Yi-Chun Lai
- Department of Nursing, Changhua Christian Hospital, Changhua, Taiwan
| | - Li-Chueh Weng
- Department of Nursing, Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan, 33302, Taiwan.
| | - Yao-Li Chen
- Department of General Surgery, Changhua Christian Hospital, No. 135 Nan-Hsiao Street, Changhua, 500, Taiwan.
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17
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Janvier AL, Ehsan A, Shah SH. An atypical presentation of Salmonella enterica ser Dublin in an immunocompromised patient. Oxf Med Case Reports 2021; 2021:omaa123. [PMID: 33542826 PMCID: PMC7846077 DOI: 10.1093/omcr/omaa123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/04/2020] [Accepted: 10/25/2020] [Indexed: 11/23/2022] Open
Abstract
Mycotic aneurysms of the carotid artery are a rare entity that can be fatal if not diagnosed promptly. We present a 60-year-old man with a tender left-sided neck mass due to a ruptured aneurysm of the left internal carotid artery. Cultures taken intraoperatively grew Salmonella enterica ser Dublin.
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Affiliation(s)
- Adrien L Janvier
- Department of Medicine, Medstar Franklin Square Medical Center, Baltimore, MD, USA
| | - Amrat Ehsan
- Department of Medicine, Medstar Franklin Square Medical Center, Baltimore, MD, USA
| | - Sajid H Shah
- Department of Surgery, Medstar Franklin Square Medical Center, Baltimore, MD, USA
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18
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Liou YT, Tsai CY. Abdominal mycotic aortic aneurysm presenting as chronic constipation. Am J Emerg Med 2020; 42:260.e1-260.e2. [PMID: 33388185 DOI: 10.1016/j.ajem.2020.12.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 12/16/2020] [Accepted: 12/19/2020] [Indexed: 11/26/2022] Open
Abstract
A mycotic aneurysm is a life-threatening disease that usually presents with nonspecific symptoms. A prompt diagnosis is essential because of the risk of aneurysm rupture and high mortality rate. We describe a case of an abdominal mycotic aortic aneurysm presenting as chronic constipation for 3 weeks, without fever or abdominal pain. Point-of-care ultrasound has the ability to detect silent abdominal aortic aneurysms and serves as a follow-up tool for patients under medical treatment.
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Affiliation(s)
- Yaw-Tzeng Liou
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
| | - Chun-Yi Tsai
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan.
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19
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Sharma PK, Garisa SS, Kumaran SV, Varma S. Mycotic (Infected) Pseudoaneurysm, a Diagnostic Challenge - Case Series. J Clin Imaging Sci 2020; 10:86. [PMID: 33408961 PMCID: PMC7771397 DOI: 10.25259/jcis_134_2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 11/11/2020] [Indexed: 01/27/2023] Open
Abstract
Mycotic pseudoaneurysm (or infected pseudoaneurysm) is an infectious arteritis, leading to the destruction of the arterial wall with the formation of a blind, saccular outpouching contiguous with the arterial lumen. Delayed management or non-management of mycotic pseudoaneurysms is associated with high morbidity and mortality due to complications such as arterial rupture, hemorrhage, and fulminant sepsis. Earlier diagnosis of mycotic pseudoaneurysm is essential for time management. Multidetector computed tomography (MDCT) is a widely used imaging modality for detecting the mycotic pseudoaneurysm, its characterization, and vascular mapping. MDCT findings of mycotic pseudoaneurysm are blind, saccular outpouching of an artery with irregular arterial wall, perivascular soft-tissue mass, or edema. Uncommon results of MDCT include arterial lumen thrombosis, arterial wall calcification, and perivascular gas. Management of mycotic pseudoaneurysm includes endovascular stenting with graft repair, endovascular embolization, open surgery, medical therapy (intravenous antibiotics), or a combination of these. We report three cases of mycotic pseudoaneurysm affecting aortic isthmus, a segmental branch of the pulmonary artery, and the internal mammary artery. All cases posed a diagnostic challenge, which only on subsequent imaging revealed to be a mycotic pseudoaneurysm.
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Affiliation(s)
- Praveen K Sharma
- Department of Radiodiagnosis, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Sai Sindhura Garisa
- Department of Radiodiagnosis, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India
| | - S Vinod Kumaran
- Department of Radiodiagnosis, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Sparsh Varma
- Department of Radiodiagnosis, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India
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20
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Occurrence and Impact of Gastrointestinal Bleeding and Major Adverse Cardiovascular Events during Sepsis: A 15-Year Observational Study. Emerg Med Int 2020; 2020:9685604. [PMID: 33062335 PMCID: PMC7537703 DOI: 10.1155/2020/9685604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/10/2020] [Indexed: 11/18/2022] Open
Abstract
Objective Sepsis patients are at risk of gastrointestinal bleeding (GIB) and major adverse cardiovascular events (MACEs), but few data are available on the occurrence of GIB and MACEs and their impact on sepsis outcomes. Methods The medical claims records of 220,082 patients admitted for sepsis between 1999 and 2013 were retrieved from the nationwide database. The adjusted odds ratios (aORs) of composite outcomes including the hospital mortality, intensive care unit (ICU) admission, and mechanical ventilation (MV) in patients with a MACE or GIB were estimated by multivariate logistic regression and joint effect analyses. Results The enrollees were 70.15 ± 15.17 years of age with a hospital mortality rate of 38.91%. GIB developed in 3.80% of the patients; MACEs included ischemic stroke in 1.54%, intracranial hemorrhage (ICH) in 0.92%, and acute myocardial infarction (AMI) in 1.59%. Both ICH and AMI significantly increased the risk of (1) ICU admission (aOR = 8.02, 95% confidence interval (CI): 6.84–9.42 for ICH and aOR = 4.78, 95% CI: 4.21–5.42 for AMI, respectively), (2) receiving MV (aOR = 3.92, 95% CI: 3.52–4.40 and aOR = 1.99, 95% CI: 1.84–2.16, respectively), and (3) the hospital mortality (aOR = 1.08, 95% CI: 0.98–1.19 and aOR = 1.11, 95% CI: 1.03–1.19, respectively). However, sepsis with GIB or ischemic stroke increased only the risk of ICU admission and MV but not the hospital mortality (aOR = 0.98, 95% CI: 0.93–1.03 for GIB and aOR = 0.84, 95% CI: 0.78–0.91 for ischemic stroke, respectively). Conclusions GIB and MACEs significantly increased the risk of ICU admission and receiving MV but not the hospital mortality, which was independently associated with both AMI and ICH. Early prevention can at least reduce the complexity of clinical course and even the hospital mortality.
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21
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Sabaka P, Kachlíková M, Bendžala M, Stankovič I. Mycotic aneurysm as a hidden cause of treatment failure of pyelonephritis caused by Salmonella enterica, serovar Enteritidis. IDCases 2020; 21:e00827. [PMID: 32489877 PMCID: PMC7262434 DOI: 10.1016/j.idcr.2020.e00827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/12/2020] [Accepted: 05/12/2020] [Indexed: 11/18/2022] Open
Abstract
Invasive non-typhoidal Salmonella (NTS) infections are rare in developed countries but their incidence is increasing. One of the most severe complications of extraintestinal NTS infection is mycotic aneurysm. Its natural course is usually fatal and its treatment demands complex interdisciplinary management. We present a case of severe NTS sepsis complicated by mycotic aneurysm of the abdominal aorta and left internal iliac artery and obstructive pyelonephritis. Obstruction of the left ureter was caused by pressure from the left internal iliac artery aneurysm and surrounding edema. The patient presented with clinical symptoms of sepsis and pyelonephritis. Despite abdominal ultrasound and native computed tomography, the mycotic aneurysm eluded initial examination. It remained undiagnosed until the patient presented with recurrent symptoms after stopping 17 days of antimicrobial treatment and was finally revealed by magnetic resonance imaging and contrast computed tomography. The patient was successfully treated by ligation of the left internal iliac artery, partial extirpation of the aneurysm and prolonged parenteral antimicrobial treatment. This case raises concerns that mycotic aneurysm might be present in cases of obstructive pyelonephritis caused by NTS and its early recognition is vital for appropriate management.
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Affiliation(s)
- Peter Sabaka
- Department of Infectology, Geographical Medicine, Faculty, of Medicine, Comenius University in Bratislava, Slovak Republic
- Corresponding author.
| | - Mária Kachlíková
- Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, Limbova 5, 831 01, Slovak Republic
| | - Matej Bendžala
- Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, Limbova 5, 831 01, Slovak Republic
| | - Igor Stankovič
- Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, Limbova 5, 831 01, Slovak Republic
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22
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Nagrodzki J, Sharrocks KE, Wong VK, Carmichael AJ. A mycotic aneurysm related to Salmonella Rissen infection: a case report. BMC Infect Dis 2020; 20:97. [PMID: 32005105 PMCID: PMC6995202 DOI: 10.1186/s12879-020-4819-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 01/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background Salmonella species commonly causes infection in humans and on occasion leads to serious complications, such as mycotic aneurysms. Here, we present the first case reported of a patient with a mycotic aneurysm likely secondary to Salmonella Rissen infection. Case presentation The patient presented with 4 weeks of lower back pain, chills and a single episode of diarrhoea 2 months prior during a 14-day trip to Hong Kong and Taiwan. Magnetic resonance imaging revealed an aneurysmal left internal iliac artery with adjacent left iliacus rim-enhancing collection. A stool culture was positive for Salmonella Rissen ST 469 EBG 66 on whole genome sequencing. The patient underwent an emergency bifurcated graft of his internal iliac aneurysm and was successfully treated with appropriate antibiotics. Conclusions This case highlights the importance of considering the diagnosis of a mycotic aneurysm in an unusual presentation of back pain with features of infection.
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Affiliation(s)
- Jakub Nagrodzki
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP, UK. .,Trinty College, University of Cambridge, Cambridge, CB2 1TQ, UK.
| | | | - Vanessa K Wong
- Infectious Diseases Department, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK.,Microbiology Department, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Andrew J Carmichael
- Infectious Diseases Department, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
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23
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Rawla P, El Helou ML, Vellipuram AR. Fluoroquinolones and the Risk of Aortic Aneurysm or Aortic Dissection: A Systematic Review and Meta-Analysis. Cardiovasc Hematol Agents Med Chem 2019; 17:3-10. [PMID: 30947680 PMCID: PMC6865049 DOI: 10.2174/1871525717666190402121958] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 03/20/2019] [Accepted: 03/25/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES We performed a systematic review and meta-analysis to explore the risk of an aortic aneurysm or aortic dissection following fluoroquinolone administration. METHODS PubMed, Cochrane library, ClinicalTrials.gov, Embase and Google Scholar were systematically reviewed for controlled studies including adult patients exposed to fluoroquinolones with a primary outcome of aortic aneurysm or aortic dissection. RESULTS The meta-analysis was conducted by pooling the effect estimates of four controlled observational studies (one case-control, one case-crossover and two cohort studies). Fluoroquinolone administration more than doubled the risk to develop aortic aneurysm or aortic dissection within 60 days following fluoroquinolone exposure (adjusted Relative Risk [RR] (95% confidence interval [CI]) = 2.14 (1.93 - 2.36); I2 = 15.8%). The quality of the finding was rated as moderate. The risk increase for aortic aneurysm alone was found to be significant (adjusted RR (95% CI) = 2.23 (2.01 - 2.45); I2 = 0%) while the risk increase for aortic dissection alone was not found to be significant (adjusted RR = 1.88 (0.11 - 3.65); I2 = 74%). In subgroup analysis, the risk increase for aortic aneurysm or aortic dissection appeared to be higher in females compared to males (RR = 1.87 (1.24 - 2.51); I2 = 0% versus RR = 1.58 (1.25 - 1.92); I2 = 0%, respectively) and higher in older patients compared to younger patients (RR = 1.72 (1.37 - 2.07); I2 = 0% versus RR = 1.47 (0.91 - 2.04); I2 = 0%, respectively). Subgroup analysis of two studies which measured the duration-response analysis found that as the duration of fluoroquinolone therapy increased from 3 to 14 days to greater than 14 days, there was an increased risk of aortic aneurysm or dissection. CONCLUSION The findings of this meta-analysis confirm the positive association between fluoroquinolones and the development of aortic aneurysm or dissection. The data tend to show that this association may be majorly driven by aortic aneurysm. Additionally, some risk factors appear to prevail including prolonged fluoroquinolone treatment and older age.
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Affiliation(s)
- Prashanth Rawla
- Department of Internal Medicine, SOVAH Health, Martinsville, Virginia 24112, United States
| | | | - Anantha R Vellipuram
- Texas Tech University Health Sciences Center, Department of Neurology, El Paso, Texas 79905, United States
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24
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Qi X, Li P, Xu X, Yuan Y, Bu S, Lin D. Epidemiological and Molecular Investigations on Salmonella Responsible for Gastrointestinal Infections in the Southwest of Shanghai From 1998 to 2017. Front Microbiol 2019; 10:2025. [PMID: 31620098 PMCID: PMC6759537 DOI: 10.3389/fmicb.2019.02025] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 08/19/2019] [Indexed: 12/02/2022] Open
Abstract
Purpose To investigate the characteristics of gastrointestinal infections in Southwest Shanghai. Methods Clinical and epidemiological characteristics of patients with Salmonella infections between 1998 and 2017 admitted to the Jinshan Hospital in the Southwest of Shanghai were retrospectively analyzed. A total of 565 isolated Salmonella strains were classified by serotyping and pulsed field gel electrophoresis (PFGE). Results From 1998 to 2006, diarrhea was mainly caused by Vibrio parahaemolyticus followed by Shigella and Salmonella. From 2007 to 2010, Vibrio parahaemolyticus infection was the major cause of diarrhea followed by Salmonella and Shigella. From 2011 to 2017, Salmonella infections became the main cause of diarrhea after Vibrio parahaemolyticus. Salmonella infections increased from 2006 on and peaked between May and October, accounting for 82.48% of yearly infections. Patients with Salmonella infections (90.5%) had a history of eating unclean food, abdominal pain (58.05%), diarrhea ≥5 times a day (50.44%), moderate fever (24.96%) and increased fecal leukocytes (41.42%). From 1998 to 2017, infected specimens from clinical cases were dominated by Salmonella enterica serovar Typhimurium (S. Typhimurium) (21.59%) followed by Salmonella enterica serovar Enteritis (S. Enteritidis) (16.81%), Salmonella enterica serotype London (6.55%) and Salmonella group B (13.10%). Other species included Salmonella enterica serovar Thompson, Salmonella enterica serovar Saintpaul, Salmonella group D, Salmonella group C, Salmonella enterica serovar Choleraesuis and Salmonella enterica serovar Aberdeen. The PFGE classification of Salmonella serovars in 2008–2017 demonstrated that S. Enteritidis had 9 PFGE banding patterns and S. Typhimurium 16 with varying degrees of similarity among S. Enteritidis and S. Typhimurium. The results of antibiotic susceptibility tests for the 330 Salmonella strains revealed that fosfomycin had the highest sensitivity rate (97.5%) followed by levofloxacin and ceftriaxone (81%), and ampicillin/sulbactam (78.2%). The resistance to piperacillin and ciprofloxacin was 60.9 and 50.61%, respectively. Conclusion The features of onset, epidemiological characteristics and molecular subtyping of Salmonella were conducive to clinical diagnosis, rational use of antibiotics and improved therapeutic efficacy.
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Affiliation(s)
- Xulin Qi
- Department of Infection, Jinshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Pei Li
- Institute of Antibiotics, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Xiaogang Xu
- Institute of Antibiotics, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Yiqun Yuan
- Department of Infection, Jinshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Shurui Bu
- Department of Infection, Jinshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Dongfang Lin
- Institute of Antibiotics, Huashan Hospital Affiliated to Fudan University, Shanghai, China
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Gardini G, Zanotti P, Pucci A, Tomasoni L, Caligaris S, Paro B, Gavazzi E, Albano D, Bonardelli S, Maroldi R, Giubbini R, Castelli F. Non-typhoidal Salmonella aortitis. Infection 2019; 47:1059-1063. [PMID: 31321641 DOI: 10.1007/s15010-019-01344-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/12/2019] [Indexed: 10/26/2022]
Abstract
Non-typhoidal Salmonella (NTS) spp. causes about 40% of all infective aortitis and it is characterized by high morbidity and mortality. Human infection occurs by fecal-oral transmission through ingestion of contaminated food, milk, or water (inter-human or zoonotic transmission). Approximately 5% of patients with NTS gastroenteritis develop bacteremia and the incidence of extra-intestinal focal infection in NTS bacteremia is about 40%. The organism can reach an extra-intestinal focus through blood dissemination, direct extension from the surrounding organs and direct bacterial inoculation (e.g. invasive medical procedures). Medical and surgical interventions are both needed to successfully control the infection. Here, we report a case of abdominal sub-renal aortitis caused by Salmonella enterica serovar Enteritidis in an 80-year-old man.
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Affiliation(s)
- Giulia Gardini
- Department of Infectious and Tropical Diseases, ASST Spedali Civili and University of Brescia, Brescia, Italy.
| | - Paola Zanotti
- Department of Infectious and Tropical Diseases, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Alessandro Pucci
- Department of Vascular Surgery, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Lina Tomasoni
- Department of Infectious and Tropical Diseases, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Silvio Caligaris
- Department of Infectious and Tropical Diseases, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Barbara Paro
- Department of Vascular Surgery, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | | | - Domenico Albano
- Department of Nuclear Medicine, ASST Spedali Civili, Brescia, Italy
| | - Stefano Bonardelli
- Department of Vascular Surgery, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Roberto Maroldi
- Department of Radiology, ASST Spedali Civili, Brescia, Italy
| | | | - Francesco Castelli
- Department of Infectious and Tropical Diseases, ASST Spedali Civili and University of Brescia, Brescia, Italy
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Aftab S, Uppaluri SAS. Mycotic pseudoaneurysm of the aortic isthmus secondary to salmonella infection causing a diagnostic dilemma. J Radiol Case Rep 2019; 13:17-27. [PMID: 31565178 DOI: 10.3941/jrcr.v13i4.3571] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Mycotic pseudoaneurysms usually arise from an infectious arteritis or mycotic aneurysms secondary to weakening and destruction of the arterial wall resulting in a contained rupture. We report a case of a mycotic pseudoaneurysm affecting the aortic isthmus of the thoracic aorta which is an extremely rare infection. To our knowledge no case report of mycotic pseudoaneurysm of the aortic isthmus secondary to salmonella infection has thus far been described. The specific case we present is also unique in that it posed a diagnostic imaging dilemma where the initial imaging revealed a periaortic mass which could not be accurately characterized and only on subsequent imaging reveal itself to be a thrombosed mycotic pseudoaneurysm. We hope that our case report highlights to the medical community the high degree of suspicion one should have regarding pseudoaneurysms when dealing with a complex mass intimately related to a vascular structure.
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Affiliation(s)
- Syed Aftab
- Department of Diagnostic Radiology, Sengkang General Hospital Singapore, Singapore
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27
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Surgical management of ruptured mycotic aortic aneurysm induced by Klebsiella pneumoniae. Chin Med J (Engl) 2019; 132:89-91. [PMID: 30628964 PMCID: PMC6629311 DOI: 10.1097/cm9.0000000000000021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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28
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Rodney SR, Anand V, Vishnu M, Raj S, Chaudhari H, S Sravan CP, Lende V, Davra D, Jain P, Vishal H, Krishna KS, Nishan B. Emergency endovascular management of ruptured mycotic aneurysm of the iliac artery using “bare stent-graft technique”. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2019. [DOI: 10.4103/ijves.ijves_92_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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29
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Shen G, Shen X, Pu W, Zhang G, Lerner A, Gao B. Imaging of cerebrovascular complications of infection. Quant Imaging Med Surg 2018; 8:1039-1051. [PMID: 30598881 DOI: 10.21037/qims.2018.11.08] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Cerebrovascular complications may occur in infectious diseases in the setting of infective endocarditis, central nervous system (CNS) infections, systemic bacteremia and sepsis. Cerebrovascular complications of infections include vasculitis, mycotic aneurysms, and thrombophlebitis. Infectious vasculitis of the CNS may cause cerebral hemorrhage, infarction or ischemia. Ruptured aneurysms may endanger the patient's life. Infectious thrombophlebitis may cause intracranial pressure to increase and lead to cerebral hemorrhage. These cerebrovascular complications are associated with a poor prognosis and often cause irreversible neurological deficits. Cerebrovascular events secondary to infection are not easily distinguishable from the more common cerebral infarct and non-infectious vasculitis. In addition, the clinical manifestations of cerebrovascular complications of infections are non-specific and highly variable. Therefore, early imaging, antibiotics, and anticoagulation may be lifesaving the patient's life and prevent disability. The main focus of this article is to review imaging analysis of the cerebrovascular complications of infections and imaging features that help differentiate them from non-infectious vascular diseases.
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Affiliation(s)
- Guiquan Shen
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Xudong Shen
- Department of Radiology, Enshi Central Hospital, Enshi 445000, China
| | - Wei Pu
- Department of Radiology, Guizhou Provincial People's Hospital, Guiyang 550002, China
| | - Gang Zhang
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai 264000, China
| | - Alexander Lerner
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Bo Gao
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China.,Department of Radiology, Yantai Yuhuangding Hospital, Yantai 264000, China
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