1
|
Maruyama T, Imura H, Dohi M. Infected Aortic Aneurysm Secondary to Pyogenic Flexor Tenosynovitis from Streptococcus pyogenes. Intern Med 2024; 63:1505-1509. [PMID: 37813616 PMCID: PMC11157323 DOI: 10.2169/internalmedicine.2411-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/15/2023] [Indexed: 10/11/2023] Open
Abstract
Infected aortic aneurysms are rare, and have a high mortality rate. Although not a major pathogen, Streptococcus pyogenes has been reported to cause infected aortic aneurysms. In the present case, the patient was hospitalized for pyogenic flexor tenosynovitis with S. pyogenes bacteremia. Despite drainage of the abscess around the flexor tendon and effective antimicrobial therapy, infected aneurysms developed in the abdomen and ascending aorta. Because of their rapid enlargement, these aneurysms were treated with in situ reconstruction. Although rare, the possibility that S. pyogenes is the causative pathogen of infected aortic aneurysms should be considered.
Collapse
Affiliation(s)
- Takahiro Maruyama
- Department of Infectious Diseases, Rakuwakai Otowa Hospital, Japan
- Department of Intensive Care, Hyogo Prefectural Amagasaki General Medical Center, Japan
| | - Haruki Imura
- Department of Infectious Diseases, Rakuwakai Otowa Hospital, Japan
| | - Masahiro Dohi
- Department of Cardiac Surgery, Rakuwakai Otowa Hospital, Japan
| |
Collapse
|
2
|
Ngiam JN, Quek LHH, Kwan J, Yong E, Tan GSE. Abdominal aortic mycotic aneurysm as a sequela of invasive Group A streptococcal infection. QJM 2023; 116:455-457. [PMID: 36645253 DOI: 10.1093/qjmed/hcad008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 01/17/2023] Open
Affiliation(s)
- Jinghao Nicholas Ngiam
- From the Division of Infectious Diseases, Department of Medicine, National University Health System, Singapore 119228
| | - Lawrence Han Hwee Quek
- Vascular and Interventional Radiology, Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433
| | - Justin Kwan
- Vascular and Interventional Radiology, Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433
| | - Enming Yong
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433
| | - Glorijoy Shi En Tan
- Department of Infectious Diseases, National Centre for Infectious Diseases, Tan Tock Seng Hospital, Singapore 308433
| |
Collapse
|
3
|
Infectious Aneurysms Caused by Streptococcus Pyogenes in Children. Pediatr Infect Dis J 2022; 41:e442-e444. [PMID: 35895891 DOI: 10.1097/inf.0000000000003651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We describe the detailed clinical course of rapidly enlarging infective aneurysms during the treatment of endocarditis and purulent pericarditis caused by Streptococcus pyogenes . We show that S. pyogenes aneurysms can enlarge rapidly within 1-2 days. Moreover, we highlight the benefit of transporting patients to a facility offering multidisciplinary treatment, even if vital signs stabilize to the point.
Collapse
|
4
|
Taniguchi S, Sato Y, Shimatani N, Torii Y, Sekimizu M, Kamiya Y, Matsubara K, Obara H, Sasaki J. Infected abdominal aorta aneurysm secondary to streptococcal toxic shock syndrome due to Streptococcus pyogenes: a case report from Japan. Acute Med Surg 2020; 7:e617. [PMID: 33364037 PMCID: PMC7750026 DOI: 10.1002/ams2.617] [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: 06/10/2020] [Revised: 10/31/2020] [Accepted: 11/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background Infected aortic aneurysm secondary to streptococcal toxic shock syndrome caused by Streptococcus pyogenes is uncommon and associated with high mortality. Case presentation A 75‐year‐old man with metastatic lung cancer and an abdominal aortic aneurysm presented with high fever for 3 days. He was diagnosed with septic shock and was admitted to our hospital. The blood culture was positive for S. pyogenes, and streptococcal toxic shock syndrome was diagnosed. During treatment, enhanced computed tomography revealed an increase in the size of the abdominal aortic aneurysm, leading to the diagnosis of an infected aortic aneurysm. Replacement of the aneurysm with a synthetic graft was carried out successfully. The patient gradually recovered after the surgery. Conclusion We successfully managed an infected aortic aneurysm secondary to streptococcal toxic shock syndrome. Infected aortic aneurysms should be considered in patients with a medical history of aortic aneurysms and presenting with streptococcal toxic shock syndrome.
Collapse
Affiliation(s)
- Shiho Taniguchi
- Department of Emergency and Critical Care Medicine Keio University School of Medicine Tokyo Japan
| | - Yukio Sato
- Department of Emergency and Critical Care Medicine Keio University School of Medicine Tokyo Japan
| | - Naotaka Shimatani
- Department of Emergency and Critical Care Medicine Keio University School of Medicine Tokyo Japan
| | - Yosaku Torii
- Department of Otorhinolaryngology, Head and Neck Surgery Keio University School of Medicine Tokyo Japan
| | - Mariko Sekimizu
- Department of Otorhinolaryngology, Head and Neck Surgery Keio University School of Medicine Tokyo Japan
| | - Yuki Kamiya
- Department of Surgery Keio University School of Medicine Tokyo Japan
| | - Kentaro Matsubara
- Department of Surgery Keio University School of Medicine Tokyo Japan
| | - Hideaki Obara
- Department of Surgery Keio University School of Medicine Tokyo Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine Keio University School of Medicine Tokyo Japan
| |
Collapse
|
5
|
Watanabe N, Koyama S, Tabira M, Matsuno J, Taji Y, Kobayashi K, Yoshitake A, Mitsutake K, Ebihara Y. Infected aortic aneurysm caused by Streptococcus pyogenes: A case report. J Infect Chemother 2020; 27:647-649. [PMID: 33277175 DOI: 10.1016/j.jiac.2020.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/29/2020] [Accepted: 11/07/2020] [Indexed: 11/25/2022]
Abstract
We reported the case with infected abdominal aortic aneurysm (AAA) caused by Streptococcus (S.) pyogenes. A seventy-seven-year-old man, who had the history of uncontrolled diabetes mellitus (DM), complained fever and abdominal pain. Abdominal computed tomography scan revealed the aneurysm above common iliac artery with false lumen. On admission, laboratory tests found marked elevation of inflammatory biomarkers. Thereby the infected AAA was suspected and blood culture was taken. The administration of meropenem (MEPM) and daptomycin (DAP) was started. Next day he underwent abdominal aortic replacement with prosthetic graft and debridement because of persistent abdominal pain and the enlargement of aneurysm. S. pyogenes in blood culture samples was identified by Matrix Assisted Laser Desorption/Ionization Time of Flight Mass Spectrometry. Same result was obtained from the tissue samples of the resected AAA. Then the diagnosis of infected AAA caused by S. pyogenes was made. Since isolated S. pyogenes showed the susceptibility to antibiotics tested including penicillin, antibiotics were changed to ampicillin (ABPC) for the de-escalation of antibiotics. He had kept the administration of ABPC for 4 weeks and transferred to another hospital for the further treatment of DM. The aneurysms by S. pyogenes are extremely rare, but we should note that S. pyogenes could induce the aneurysms.
Collapse
Affiliation(s)
- Noriyuki Watanabe
- Clinical Laboratory, Saitama Medical University International Medical Center, Saitama, Japan
| | - Sachie Koyama
- Clinical Laboratory, Saitama Medical University International Medical Center, Saitama, Japan
| | - Mayu Tabira
- Clinical Laboratory, Saitama Medical University International Medical Center, Saitama, Japan
| | - Junpei Matsuno
- Clinical Laboratory, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yoshitada Taji
- Clinical Laboratory, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kiyoko Kobayashi
- Department of Laboratory Medicine, Saitama Medical University International Medical Center, Saitama, Japan
| | - Akihiro Yoshitake
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kotaro Mitsutake
- Department of Infectious Diseases and Infection Control, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yasuhiro Ebihara
- Department of Laboratory Medicine, Saitama Medical University International Medical Center, Saitama, Japan.
| |
Collapse
|
6
|
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: 31] [Impact Index Per Article: 6.2] [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.
Collapse
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
| |
Collapse
|
7
|
Someili A, Shroff A. An Unusual Case of Streptococcus pyogenes Causing Ruptured Aortic Mycotic Aneurysm. Case Rep Infect Dis 2019; 2019:3035494. [PMID: 31467741 PMCID: PMC6701359 DOI: 10.1155/2019/3035494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/03/2019] [Accepted: 07/15/2019] [Indexed: 01/18/2023] Open
Abstract
A 70-year-old male with a complex past medical history presents with confusion and slurred speech for 24 hours. His exam was unremarkable, and his CT head was negative. Both his C-reactive protein and white blood cell count were elevated. As part of the delirium workup, blood cultures were done which grew Streptococcus pyogenes with no obvious source. He was treated with appropriate antibiotics. To determine the source, a white blood cell scan was done, which showed increased localization within a left-sided upper mediastinum mass. Subsequently, chest CT scan with contrast showed an acute type B aortic dissection with mycotic aneurysm. Consequently, he was taken urgently for surgical management. He completed 6 weeks of penicillin G and was discharged to a rehabilitation center. This case illustrates both a rare entity, mycotic aneurysm secondary to Streptococcus pyogenes, and the importance of getting an Infectious Diseases consult in the setting of an unknown source of bacteremia.
Collapse
Affiliation(s)
- Ali Someili
- Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Anjali Shroff
- Division of Infectious Diseases, Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| |
Collapse
|
8
|
Ogura N, Tomari K, Takayama T, Tonegawa N, Okawa T, Matsuoka T, Nakayashiro M, Matsumora T. Group A streptococcus endocarditis in children: 2 cases and a review of the literature. BMC Infect Dis 2019; 19:102. [PMID: 30704409 PMCID: PMC6357504 DOI: 10.1186/s12879-019-3736-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 01/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infective endocarditis (IE) is defined as endocarditis caused by microorganisms (bacteria or fungi) involving either the heart or great vessels. The clinical course of IE can be complicated by cardiac dysfunction and bacterial embolization to virtually any organ. Staphylococcus aureus and viridans group streptococci are the most common causative organisms, whereas group A Streptococcus (GAS) is less common. Although some GAS serotypes have been associated with severe disease, there are few reports of IE associated with GAS serotypes. Here, we report two cases of GAS endocarditis and review the associated literature. CASE PRESENTATIONS Patient 1 was a previously healthy 14-year-old girl who developed bacteremia and disseminated intravascular coagulation secondary to left foot cellulitis. She was administered intravenous antibiotics. Two of three blood cultures grew Streptococcus pyogenes (T6 M6, emm6.104). Three days later, a new systolic ejection murmur was heard and echocardiography showed mitral regurgitation with mitral valve vegetation. Because of the resultant severity of the mitral regurgitation, she underwent mitral valve repair after 10 weeks of antibiotic treatment. Patient 2 was a 17-month old boy who presented with a fever. He had a history of spontaneous closure of a ventricular septal defect (VSD). He was started on intravenous antibiotics for possible bacteremia. Two consecutive blood cultures with an interval of more than 12 h grew S. pyogenes (T4 M4, emm4.0). Five days later, echocardiography showed vegetation on a membranous ventricular septal aneurysm. The patient responded well to antibiotics, and recovered fully with no complications. CONCLUSIONS Although both patients developed GAS endocarditis, patient 1 did not have any predisposing conditions for IE, and patient 2 had a only a low-risk predisposing condition, a VSD that had closed spontaneously at five months of age. We found twelve reports in the literature of GAS endocarditis with information on serotypes. All patients in these reports had GAS endocarditis caused by serotypes generally associated with milder infections, but no specific risk trends were identified. A greater accumulation of cases is necessary to more clearly elucidate the association between GAS IE and specific serotypes.
Collapse
Affiliation(s)
- Nao Ogura
- Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Department of General Pediatrics, Okinawa, Japan
| | - Kouki Tomari
- Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Department of General Pediatrics, Okinawa, Japan.
| | - Tomotada Takayama
- Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Department of General Pediatrics, Okinawa, Japan
| | - Naoya Tonegawa
- Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Department of General Pediatrics, Okinawa, Japan
| | - Teppei Okawa
- Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Department of General Pediatrics, Okinawa, Japan
| | - Takashi Matsuoka
- Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Department of General Pediatrics, Okinawa, Japan
| | - Mami Nakayashiro
- Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Department of Pediatric Cardiology, Okinawa, Japan
| | - Tsutomu Matsumora
- Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Department of General Pediatrics, Okinawa, Japan
| |
Collapse
|
9
|
Streptococcus pyogenes Pericarditis with Resultant Pulmonary Trunk Compression Secondary to Mycotic Pseudoaneurysm. Case Rep Cardiol 2018; 2018:3514797. [PMID: 30186637 PMCID: PMC6116405 DOI: 10.1155/2018/3514797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 06/23/2018] [Indexed: 12/20/2022] Open
Abstract
Purulent pericarditis is a rare disease in the era of antibiotics, with Streptococcus pyogenes being a possible, though uncommon etiology. Even more uncommon are mycotic aneurysms secondary to group A strep purulent pericarditis and bacteremia. We report a case of an 18-year-old female with a history of strep pharyngitis develop Streptococcus pyogenes purulent pericarditis with subsequent ventricular fibrillation (VF). Following initial stabilization, she ultimately developed a 4.8 cm mycotic aneurysm of the ascending aorta, with resultant compression of the pulmonary trunk and right pulmonary arteries.
Collapse
|
10
|
Infrarenal Infected Aortic Aneurysm Caused by Streptococcus pyogenes. Case Rep Surg 2017; 2017:9329504. [PMID: 28503338 PMCID: PMC5414497 DOI: 10.1155/2017/9329504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 02/28/2017] [Indexed: 11/21/2022] Open
Abstract
Infectious aneurysm is a rare entity associated with significant morbidity and mortality. Current knowledge on pathogenesis, outcome, diagnosis, management, and follow-up remains debatable. We report the case of a patient with Streptococcus pyogenes aneurysm who was successfully treated with a homograft implant and discuss microbiological characteristics, diagnostic methods, and treatment options currently available for this serious disease.
Collapse
|
11
|
Watanabe N, Bandoh S, Ishii T, Negayama K, Kadowaki N, Yokota K. Infective endocarditis and infected aneurysm caused by Streptococcus dysgalactiae subsp. equisimilis: a case report. Clin Case Rep 2017; 5:187-192. [PMID: 28174648 PMCID: PMC5290507 DOI: 10.1002/ccr3.829] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 08/02/2016] [Accepted: 12/08/2016] [Indexed: 11/22/2022] Open
Abstract
Endocarditis caused by Streptococcus dysgalactiae subsp. equisimilis (SDSE) is rare. Infected aneurysm is one of the most serious complications of infective endocarditis. However, no reports have described SDSE‐related infected aneurysm. We herein report a successfully treated case of SDSE‐associated infective endocarditis with an infected aneurysm.
Collapse
Affiliation(s)
- Naoki Watanabe
- Department of Infectious Disease Kagawa University Kagawa Japan; Department of Internal Medicine Hematology Rheumatology and Respiratory Medicine Kagawa University Kagawa Japan
| | - Shuji Bandoh
- Department of Internal Medicine Hematology Rheumatology and Respiratory Medicine Kagawa University Kagawa Japan
| | - Tomoya Ishii
- Department of Internal Medicine Hematology Rheumatology and Respiratory Medicine Kagawa University Kagawa Japan
| | - Kiyoshi Negayama
- Department of Clinical Laboratory Faculty of Medicine Kagawa University Kagawa Japan
| | - Norimitsu Kadowaki
- Department of Internal Medicine Hematology Rheumatology and Respiratory Medicine Kagawa University Kagawa Japan
| | - Kyoko Yokota
- Department of Infectious Disease Kagawa University Kagawa Japan
| |
Collapse
|