Endocarditis infecciosa y eritema multiforme minor

El eritema multiforme es una reacción inmunomediada que envuelve la piel y algunas veces a la mucosa. Las infecciones y medicamentos constituyen las causas más comunes. Típicamente se presenta como lesiones "en diana" sobreelevadas con centro pálido y borde eritematoso o lesiones atípicas como vesículas o ampollas. Se presenta el caso de una mujer de 68 años que acude por tumoración a nivel del antebrazo derecho con signos inflamatorios más fiebre, se constata por ecografía aneurisma micótico en dicho miembro y se realiza ecocardiografía transtorácica donde se observan vegetaciones en válvulas aortica y mitral. Durante la internación presenta aparición de lesiones ampollosas con bordes eritematosos distribuidas en tronco y brazos con biopsia que informa erupción liquenoide ampollosa compatible con eritema multiforme minor.

Erythema multiforme is an immune-mediated reaction that involves the skin and sometimes the mucosa. Infections and medications are the most common causes. Typically presents as raised "target" lesions with a pale center and erythematous border or atypical lesions such as vesicles or bullae. We present the case of a 68-year-old woman who presented with a tumor on the right forearm with inflammatory signs plus fever, a mycotic aneurysm was confirmed by ultrasound in the limb and a transthoracic echocardiography was performed where vegetations were observed on the aortic and mitral valves. During hospitalization, she presented bullous lesions with erythematous borders distributed on the trunk and arms with a biopsy that reported bullous lichenoid eruption compatible with erythema multiforme minor.

Salmonella enteritidis abdominal aorta mycotic aneurysm presented with acute cholestatic jaundice: A case report and literature review

@#Mycotic aneurysm is one of the extra-intestinal manifestations of Salmonella Enteritidis infection. The diagnosis of this condition is challenging owed to its variation in clinical presentations. We presented a case of a 54-year-old man with underlying diabetes mellitus and chronic smokers presented with acute right flank pain and fever associated with mild jaundice. The initial laboratory investigations suggested features of obstructive jaundice and urinary tract infection. The contrast enhancing computed tomography of the abdomen revealed the presence of saccular mycotic aneurysm located at the infrarenal abdominal aorta. The blood culture grew Salmonella Enteritidis which was susceptible to ceftriaxone, trimethoprim-sulfamethoxazole, ciprofloxacin, ampicillin, and amoxicillin-clavulanic acid. Intravenous ceftriaxone was initiated, and he underwent open surgery and artery repair at day 8 of admission. He responded well to the treatment given and subsequently discharged home after completed three weeks of intravenous ceftriaxone.

In Situ Replacement for a Mycotic Aneurysm on the Porcelain Aorta Using the Superficial Femoral Artery as a Vascular Graft / 日本心臓血管外科学会雑誌

Infected thoracic aortic aneurysms are rare. Standard treatment methods have not yet been established for medical treatment, timing of surgery, or surgical techniques. In this study, we report a case in which an ascending aortic reconstruction using an autologous superficial femoral artery was successfully performed for an infected pseudoaneurysm of the thoracic aorta without the use of artificial materials. The patient was a 78-year-old man with bacteremia caused by Staphylococcus aureus and an infected pseudoaneurysm of the thoracic aorta. The patient underwent replacement of the ascending aorta and coronary artery bypass grafting. The patient was discharged from the hospital with no recurrence of infection and no abnormality of the reconstructed aorta.

A Case of Placement of the Reversed Gore Exclucder Contralateral Leg for Isolated Left Iliac Mycotic Artery Aneurysm / 日本心臓血管外科学会雑誌

A 49-year-old female with ruptured left common iliac mycotic arterial aneurysm (Lt. CIAA) was brought to our hospital as an emergency case. In Japan, endovascular treatment is unsuitable for the treatment of mycotic aneurysms, but findings from a Swedish national database showed that there was no difference in the long-term prognosis lasting over 10 years. Therefore, we performed endovascular aortic repair (EVAR) and saved the patient's life. The diameter of the proxymal sealing zone was larger than that of the distal zone. We used the Gore Excluder leg, which was inverted and implanted to match the caliber. Percutaneous abscess drainage was also performed on postoperative day 7 when hemostasis was confirmed for early infection control. The patient was discharged at 8 weeks postoperatively. After discharge from the hospital, oral antibiotics were continued until 6 months after the surgery. Six months postoperatively, contrast-enhanced computed tomography showed that the abscesses have disappeared. Blood samples that were taken at one month after the completion of antibiotics showed no evidence of the recurrence of infection and a curative course was achieved.

Aneurisma tuberculoso de aorta abdominal / Tuberculous Abdominal Aortic Aneurysm

El aneurisma micótico surge de la destrucción infecciosa de la pared arterial y se diagnostica cuando hay un aneurisma en el contexto de inflamación y hemocultivos o biopsia positivos, aunque esto no es un requisito excluyente. Los agentes etiológicos de mayor frecuencia son bacterias (Staphylococcus, Salmonella)2 pero también se han notificado hongos (Aspergillus niger). La tuberculosis puede afectar cualquier órgano de la economía, el compromiso arterial es una complicación rara y potencialmente mortal, puede ocurrir por extensión directa de un foco adyacente o por diseminación hematógena o linfangítica de lesiones primarias. El compromiso en los grandes vasos puede presentarse de diversas formas, incluyendo pólipos, aortoarteritis estenosante y formación de aneurismas o pseudoaneurismas, siendo esta última la más común. Presentamos el diagnóstico de aneurisma de aorta abdominal infrarrenal con trombo intramural y pseudoaneurisma de aorta renal izquierda como hallazgo incidental en una paciente con tuberculosis ganglionar.

The mycotic aneurysm arises from the infectious destruction of the arterial wall and is diagnosed when there is an aneurysm within the context of inflammation and positive blood cultures or biopsies, though this is not an essential requirement. The most common etiologic agents are bacteria (Staphylococcus, Salmonella)2, but fungi have also been reported (Aspergillus niger). Tuberculosis may affect any organ of the body; arterial compromise is a rare and potentially mortal complication that may occur by direct extension of an adjacent infected site or by bloodstream or lymphangitic dissemination of primary lesions. The great vessels may be compromised in different ways, including polyps, stenotic aortoarteritis and formation of aneurysms or pseudoaneurysms, being the latter the most common one. We present the diagnosis of infrarenal abdominal aortic aneurysm with intramural thrombus and left renal aortic pseudoaneurysm as incidental finding in a patient with nodal tuberculosis.

Aneurismas por Estreptococo Pneumoniae / Aneurysms by Streptococcal Pneumoniae

El Estreptococo Pneumoniae es un microorganismo patógeno capaz de causar en humanos diversas infecciones y procesos invasivos severos, siempre graves y potencialmente letales. El objetivo de este trabajo fue mostrar la infrecuente presencia del Estreptococo Pneumoniae en la aparición de los aneurismas micóticos aórticos y de arterias periféricas, una asociación muy particular que coloca al cirujano vascular ante una especial conducta terapéutica encaminada a erradicar la infección, evitar la ruptura y sustituir la arteria, para mantener la continuidad de la luz del vaso y prevenir situaciones graves de isquemia(AU)

Streptococcal Pneumoniae is a pathogenic microorganism capable of causing in humans various infections and severe, always serious and potentially lethal invasive processes. The objective of this work was to show the rare presence of Streptococcal Pneumoniae in the onset of aortic mycotic aneurysms and peripheral arteries, a very particular association that places the vascular surgeon in an special therapeutic behavior aimed at eradicating the infection, preventing ruptures and replacing the artery, to maintain the continuity of vessel's light and prevent serious ischemia's situations(AU)

Persistent mycotic superficial femoral artery pseudoaneurysm after endovascular treatment: a case report / Pseudoaneurisma micótico persistente da artéria femoral superficial após tratamento endovascular: relato de caso

Abstract Mycotic pseudoaneurysms of the superficial femoral artery (SFA) are rare and are usually secondary to colonization of an atherosclerotic plaque during an episode of bacteremia. We describe the case of a 68 year-old diabetic male who presented to the Emergency Department with pyrexia and a painful expanding mass in the left thigh. He had a history of diarrhea and had been treated 16 days earlier for an SFA pseudoaneurysm that had been excluded with a covered stent with no adjunctive antibiotic therapy. Angio CT showed an abscess surrounding femoral vessels and stent thrombosis. Under general anesthesia, we performed extensive debridement, removal of the endovascular material, SFA ligation, and empirical antibiotic therapy. Blood and tissue cultures were positive for Escherichia coli. At the 3-months follow up visit, the patient reported he had no claudication. In selected patients, mycotic pseudoaneurysms can be treated by SFA ligation.

Resumo Pseudoaneurismas micóticos da artéria femoral superficial (AFS) são raros, e geralmente são secundários à colonização de uma placa aterosclerótica durante bacteremia. Relatamos o caso de um paciente masculino diabético de 68 anos que chegou ao Serviço de Emergência com pirexia e massa expansiva dolorosa na coxa esquerda. Apresentava histórico de diarreia e havia sido tratado 16 dias antes para pseudoaneurisma da AFS, que foi excluído com stent coberto e sem antibioticoterapia adjuvante. A angiotomografia computadorizada demonstrou um abscesso ao redor dos vasos femorais e trombose do stent. Sob anestesia geral, realizamos desbridamento extenso, remoção do material endovascular, ligadura de AFS e antibioticoterapia empírica. Culturas de sangue e tecidos foram positivas para Escherichia coli. Na consulta de seguimento aos 3 meses, o paciente negou claudicação. Em pacientes selecionados, pseudoaneurismas micóticos podem ser tratados com ligadura de AFS.

Mycotic aortic aneurysm in a debilitated patient with compromised immunity; beware of Candida! / Aneurisma micótico da aorta em paciente debilitado com imunidade comprometida - um alerta para Cândida

Abstract Candida is a rare cause of infected aortic aneurysms. We report the case of a diabetic patient with end stage kidney disease who underwent repair of a leaking abdominal aortic aneurysm. He was on long-term antibiotic treatment for malignant otitis externa. Candida albicans was isolated from the culture of the excised aneurysm wall. An infected aortic aneurysm due to Candida has not been previously reported in a patient with malignant otitis externa. This case report aims to highlight that Candida should be suspected as a cause of infected aortic aneurysms in patients with debilitation and chronic immunosuppression. Management of such cases can be extremely challenging, especially in resource-poor settings, and we will be touching upon the advantages and disadvantages of various treatment options.

Resumo A cândida é uma causa rara de aneurismas da aorta infecciosos. Relatamos o caso de um paciente diabético com doença renal terminal, que foi submetido a reparo de aneurisma da aorta abdominal com vazamento. Ele estava em tratamento de longo prazo com antibióticos para otite externa maligna. A Candida albicans foi isolada da cultura da parede do aneurisma que sofreu a excisão. Não há relatos prévios de aneurisma da aorta infeccioso causado por cândida em pacientes com otite externa maligna. Este relato de caso visa reforçar que a cândida deve ser uma das suspeitas de causa de aneurisma da aorta infeccioso em pacientes debilitados e com imunossupressão crônica. O manejo desses casos pode ser extremamente desafiador, principalmente em contextos em que os recursos são escassos, e mencionaremos as vantagens e desvantagens das diversas opções de tratamento.

A Case of Fungal Mycotic Abdominal Aortic Aneurysm with Candida albicans Sepsis / 日本心臓血管外科学会雑誌

Background : Fungal mycotic aneurysm is rare ; however, special care and treatment are required for the deep fungal infection itself. Case : The patient was a 69-year-old man with a history of sepsis due to Candida albicans. He suffered from back pain and moderate fever. CT revealed saccular-form aneurysm at the infrarenal abdominal aorta. After emergent in situ bifurcated graft replacement of the infected aneurysm, antifungal treatment was attempted in reference to the antifungal drug sensitivity of C. albicans from intraoperative cultures and findings of fungal endophthalmitis in an ophthalmic examination. After an uneventful acute course, follow up CT images after 12 months postoperatively revealed pseudoaneurysm formation proximal to the site of graft anastomosis. Reoperation was planned with a trans-thoracic and transabdominal approach because of concerns about thoracoabdominal aortic infection. However, the reoperation displayed only inflammatory tissue around the graft and aortic tissue. Removal of the previous graft and reconstruction of the bilateral renal artery, and the pararenal abdominal aorta to the bilateral common iliac artery was performed. Intraoperative tissue cultures revealed no evidence of microorganisms. He returned home with oral antifungal treatment and is doing well at 8 months after the reoperation. Conclusions : Management of fungal mycotic aneurysms requires both surgical treatment and antifungal treatment. Antifungal agents should be selected based on the results of a susceptibility test and after examinations for metastatic comorbidities.

Embolización de un aneurisma micótico de la arteria mesentérica superior: reporte de un caso / Mycotic aneurysm of the superior mesenteric artery coil embolization: case report

Resumen Objetivo: Presentar un caso clínico infrecuente, con una resolución novedosa. Caso Clínico: Paciente con aneurisma micótico de la arteria mesentérica superior manejado satisfactoriamente en forma endovascular. Los aneurismas micóticos viscerales son entidades infrecuentes, con alta morbimortalidad. Es por ello que su manejo debe ser multidisciplinario y considerar diferentes factores al momento de tomar decisiones. En el contexto de la continua mejoría y disponibilidad de las técnicas endovasculares, estas han emergido como una opción terapéutica válida, con posiblemente menos complicaciones. Conclusión: La resolución endovascular del aneurisma micótico visceral es factible, pero su indicación y el manejo completo es aún caso a caso.

Objective: to discuss an infrequent vascular case with a novel resolution. Case Report: Superior mesenteric artery mycotic aneurysm successfully managed with coil embolization. A visceral mycotic aneurysm is an infrequent vascular pathology with high risk of complications and mortality. The endovascular management might offer a treatment option with lower morbimortality rates in selected cases. Conclusion: Endovascular resolution of mycotic visceral aneurysms is both feasible and secure but it must be done in a case to case basis.

Presence of mycotic microorganisms in raw milk from cooling tanks in the Boyacense highlands (Colombia) / Presencia de microorganismos micóticos en leche cruda de tanques de enfriamiento en el Altiplano Boyacense (Colombia) / Presença de microrganismos micóticos no leite cru de tanques de resfriamento no Altiplano Boyacense (Colômbia)

Abstract Yeasts and molds are germs that should not be found in milk samples because they are potentially pathogenic for both animals and humans. Due to its high handling during collection, storage, and transport, milk is susceptible to contamination with these microorganisms, so its detection in this food in these phases is relevant in order to prevent possible situations that compromise public health. The objective of the present work was to determine the presence of molds and yeasts in samples of milk cooling tanks in the Boyacense highlands. Samples were taken from 20 raw milk cooling tanks located in 20 different dairy municipalities of the department of Boyacá in order to determine the presence of molds and yeasts through Compact Dry YM®. 35% of the samples of milk did not present growth of molds or yeasts, meanwhile, in 25% yellow colony growth and its tonalities were found, which would correspond with mold colonies, in 5% determined the growth only of blue colonies, corresponding to yeast growth. In the remaining 35% growth of blue and yellow colonies was detailed. This shows that there is a high percentage of molds and yeasts in samples of refrigerated raw milk, a situation that could trigger a public health problem.

Resumen Las levaduras y los mohos son gérmenes que no se deben encontrar en muestras de leche porque son potencialmente patógenos tanto para los animales como para el ser humano. Debido a su alta manipulación durante la recolección, almacenamiento y transporte, la leche es susceptible de contaminación con estos microorganismos, por lo cual su detección en este alimento en estas fases, es relevante con el fin de prevenir posibles situaciones que comprometan la salud pública. El objetivo del presente trabajo fue determinar la presencia de mohos y levaduras en muestras de tanques de enfriamiento de leche en el Altiplano Boyacense. Se tomaron muestras de 20 tanques de enfriamiento de leche cruda ubicados en 20 diferentes municipios lecheros del departamento de Boyacá con el fin de determinar la presencia de mohos y levaduras a través de Compact Dry YM®. El 35% de las muestras de leche no presentó crecimiento de mohos ni de levaduras, por su parte, en el 25% se encontró crecimiento de colonias de color amarillo y sus tonalidades, lo que correspondería con colonias de mohos, en el 5% se determinó el crecimiento únicamente de colonias azules, correspondiente a crecimiento de levaduras. En el 35% restante se detalló un crecimiento de colonias azules y amarillas. Esto demuestra que existe un alto porcentaje mohos y levaduras en muestras de leche cruda refrigerada, situación que podría desencadenar un problema de salud pública.

Resumo Leveduras e fungos são germes que não devem ser encontrados em amostras de leite, pois são potencialmente patogênicos tanto para animais como para humanos. Devido ao seu alto manuseio durante a coleta, armazenamento e transporte, o leite é suscetível à contaminação com esses microrganismos, por isso sua detecção neste alimento nestas fases, é relevante para prevenir possíveis situações que comprometam a saúde pública. O objetivo do presente trabalho foi determinar a presença de bolores e leveduras em amostras de tanques de resfriamento de leite no Altiplano de Boyacense. Foram coletadas amostras de 20 tanques de resfriamento de leite cru, localizados em 20 diferentes municípios leiteiros do departamento de Boyacá, a fim de determinar a presença de bolores e leveduras através do Compact Dry YM®. 35% das amostras de leite não apresentaram crescimento de bolores ou leveduras, entretanto, em 25% de crescimento de colônia amarela e suas tonalidades foram encontradas, o que corresponderia às colônias de bolores, em 5% determinou o crescimento apenas das colônias azuis, correspondendo ao crescimento das leveduras. Isso mostra que há uma alta porcentagem de bolores e leveduras em amostras de leite cru refrigerado, situação que pode desencadear um problema de saúde pública.

A Case of EVAR for Mycotic Aneurysm Rupture / 日本心臓血管外科学会雑誌

We report a case of mycotic aneurysm treated with endovascular aneurysm repair (EVAR). An 80-year-old man was admitted to a local hospital with high fever and lower back pain. Pyogenic spondylitis and psoas muscle abscess were diagnosed. Klebsiella pneumoniae was confirmed by blood culture. Treatment with intravenous antibiotics was not effective and contrast computed tomography (CT) scan showed an enlargement of the abscess and an abdominal aortic rupture. The patient was immediately transferred to our hospital. Laboratory tests showed an elevated C-reactive protein (12.3 mg/dl) and WBC (10,400/μl). Mycotic abdominal aneurysm rupture was diagnosed by CT scan. He underwent an emergency EVAR with an Excluder® (aorta extender). Intraoperative angiography showed a ruptured abdominal aorta. After operation, he was treated with intravenous minocycline and ampicillin, and the size of the abscess reduced without any endoleak on enhanced CT imaging. After intravenous antibiotics therapy for 4 weeks, we switched to oral antibiotics (minocycline and ciprofloxacin) and continued them for 6 months. As of 2 years after the surgery, there are no signs of infection or recurrence.

Mycological Profile And Antifungal Sensitivity Of Infective Keratitis In A Tertiary Care Hospital Of Southern Odisha

Background: Infective keratitis is the second major cause of blindness next to cataract. Mycotic keratitis is an im-portant ophthalmologic problem especially in developing countries including India. Fungal infection involving cornea is a fatal condition which needs early diagnosis and treatment to save the patient’s eye. Though studies on mycotic keratitis have been reported from different part of India, to the best of our knowledge this study showing antifungal susceptibility is the first to be reported from Southern Odisha. Objective: The purpose of this study was to study epi-demiological characteristics, predisposing factors, fungal etiology and antifungal susceptibility of common fungal isolates in infective keratitis cases. Materials and Methods: A prospective study was conducted from November 2015 to October 2017 in the Department of Microbiology and Ophthalmology M.K.C.G Medical College and Hospi-tal .Relevant information was recorded using standard proforma of keratitis cases. Corneal scrapings were collected under strict aseptic conditions and subjected to10% KOH mount, Gram stain and culture. Identification of fungala-gents were done as per standard microbiological procedures. An antifungal sensitivity test was done by microbroth dilutions as per CLSI reference method. Results: Over a period of two years 149 patients of infective keratitis were evaluated. Microbiological diagnosis of mycotic keratitis was established in 39 (26.17%) cases. Filamentous fungi were isolated more often than yeasts. The most frequently encountered filamentous fungi and yeasts were Aspergil-lusspp. 14 (35.89%) and Candida albicans 7 (17.94%) respectively. Males were more commonly affected and were mostly in the age group of 46-60 years. Ocular trauma due to vegetative matter was the most common predisposing factor. Natamycin was the most effective antifungal against filamentous fungi and amphotericin B was most effective for Candida albicans. Conclusion: Because of serious consequences of mycotic keratitis, it is very important to know the exact etiological agents and effective antifungals to save the eye of the patients. So laboratory confirmation should be undertaken and fungal infection should be ruled out before prescribing antimicrobial agents.

Ruptured Mycotic Aneurysm of the Common Carotid Artery: A Case Report

Mycotic aneurysms of the common carotid artery (CCA) are very rare and warrant surgical treatment to prevent rupture and death. A 89-year-old man who complained of a sore throat and swelling of the right side of neck. He had no history of trauma or neck infection. Physical examination revealed hard and pulsatile mass. Computed tomography showed initially pseudoaneurysm rupture on the right CCA with surrounding inflammation. The emergency operation revealed mycotic aneurysm rupture with CCA necrosis and was successfully done by wide debridement and carotid artery resection with interposition bypass. The resected tissue and blood culture grew growth of Staphylococcus aureus group. We report a rare case of mycotic aneurysm of right CCA that treated by bypass interposition.

Mycotic aneurysm due to Salmonella species: clinical experiences and review of the literature

The mortality of patients with mycotic aneurysms is high, especially in East Asia, and infection by Salmonella species is the most common. Our study aimed to improve prognosis of adult mycotic aneurysms with early diagnosis and accurate treatment. Four adult patients with mycotic aneurysm caused by Salmonella were included and analyzed by single-center retrospective analysis. Cases reported in the literature during the past 10 years were also summarized. The average age of the 4 male patients was 61.25 years, while that of the 53 cases reported in the literature was 65.13 years. Hypertension, diabetes, and atherosclerosis were common complications. Most patients presented fever and experienced pain at the corresponding position of the aneurysm. Laboratory examination found an increased number of white blood cells accompanied by an increase in inflammatory markers. Most aneurysms were found in the abdominal aorta, while the rupture of an aneurysm was the most common complication. The mortality rates were 21.43 and 7.14% after open surgery or endovascular aneurysm repair (EVAR) intervention, respectively. The recurrence rates of infection were 0 and 17.85% for both treatments, respectively. The mortality rate of mycotic aneurysm caused by Salmonella infection was high in middle-aged males with hypertension, diabetes, and atherosclerosis. The possibility of a Salmonella-infected aneurysm should be considered in these high-risk groups presenting chills, fever, chest, and back pain. Open surgery was superior to EVAR treatment in the clearance of infected foci and the reduction of postoperative recurrence. The recurrence of postoperative infection can be prevented by intravenous antibiotic therapy for 6 weeks post-surgery.

Activador tisular del plasminógeno recombinante para el tratamiento de la vegetación intracardíaca en un lactante de muy bajo peso al nacer / Recombinant tissue plasminogen activator treatment for intracardiac vegetation in a very low birth weight infant

Las nuevas opciones de tratamiento prolongan la hospitalización y aumentan las infecciones intrahospitalarias bacterianas y fúngicas, pero también mejoran la sobrevida de los recién nacidos hospitalizados en la unidad de cuidados intensivos neonatales. Las infecciones fúngicas invasivas en neonatos están asociadas con una morbimortalidad significativa. También pueden diseminarse a órganos específicos y causar endocarditis, endoftalmitis, artritis séptica, nefropatía obstructiva y meningitis. En el caso de la endocarditis, se recomiendan tratamientos antimicóticos sistémicos agresivos y, en algunos casos, la intervención quirúrgica del neonato. Informamos el caso de un lactante prematuro, de bajo peso al nacer, con vegetación intracardíaca. Esta es una complicación rara y potencialmente mortal de infecciones fúngicas invasivas. El paciente recibió tratamiento con caspofungina y un activador tisular del plasminógeno recombinante, en vez de una intervención quirúrgica.

Developing treatment options have resulted in prolonged admission and increased bacterial and fungal nosocomial infections as well as improved survival in neonatal intensive care unit. Invasive fungal infections in newborns are associated with significant morbidity and mortality and can cause endorgan dissemination such as endocarditis, endophthalmitis, septic arthritis, obstructive nephropathy and meningitis. Endocarditis requires aggressive systemic antifungal therapy and sometimes surgical intervention in neonates. We report a low birth weight premature infant with intracardiac vegetation that is rare and a life-threatening complication of invasive fungal infections. He was treated with caspofungin and recombinant tissue plasminogen activator in stead of surgical intervention.

Infected Thoracic Aortic Aneurysm Concurrent with Endophthalmitis by Candida albicans: a Case Report / 대한의진균학회지

Candida species cause various invasive fungal diseases, including candidemia, endocarditis, endophthalmitis, peritonitis, osteomyelitis and arthritis, but infected (mycotic) aortic aneurysms caused by Candida species are very rare. So, we report a case of infected thoracic aortic aneurysm concurrent with endophthalmitis by Candida albicans in a 42-year-old man. The patient initially was diagnosed with candidial endophthalmitis and hospitalized for vitrectomy. On admission, he had chest CT taken and infected thoracic aortic aneurysm was detected. He treated with antifungal agent and resection and patch repair of aortic aneurysm. Two months later, a new aneurysm on the patch repair site was detected and thoracic endovascular aortic repair (TEVAR) was performed. After TEVAR and long-term antifungal therapy, his infected aortic aneurysm has been successfully treated.

Clinical effect of Fuke Xiaoyan prescription combined with nifuratel and nysfungin in senile mycotic vaginitis / 中国生化药物杂志

Objective To analyze the effect of Fuke Xiaoyan prescription combined with nifuratel and nysfungin in senile mycotic vaginitis. Methods 100 patients with senile mycotic vaginitis were randomly divided into the observation group and the control group ,50 cases in each group.The control group were treated with nifuratil nystatin alone.The observation group were treated with Fuke Xiaoyan prescription.The inflammatory factors of tumor necrosis factor (TNF-α), C-reactive protein (CRP), interleukin-6 (IL-6) and interleukin-8 (IL-8) and oxidative stress products of SOD, nitric oxide (NO), malondialdehyde (MDA) and endothelin-1 (ET-1) were determined before and after treatment in the two groups.Results The effective rates of the treatment group and the control group were 96.0% and 80.0% respectively.The clinical efficacy of the observation group was higher than that of the control group ( P<0.05 ) .The difference of the inflammatory factors between the two groups was statistically significant ( P<0.05 ) .The levels of SOD and NO in the two groups were significantly higher than those in the control group (P<0.05), but the levels of the inflammatory factors in the observation group were significantly lower than those in the control group ( P<0.05 ) .The levels of MDA and ET-1 in observation group were significantly lower than those in control group (P<0.05).Conclusion Fuke Xiaoyan prescription combined with nifuratil and nystatin has a good effect in the treatment of senile mycotic vaginitis.It can effectively relieve the inflammatory reaction and reduce the level of oxidative stress products , thus improving the patients'life quality.

Development of Mycotic Aneurysm of the Internal Iliac Artery Following Embolectomy of the Common Iliac Artery : Report of a Case Complicating Infective Endocarditis / 日本心臓血管外科学会雑誌

<p>A 23-year-old woman with mitral valve infective endocarditis complicated by embolism of the right common iliac artery underwent transfemoral embolectomy by a Fogarty catheter and mitral valve replacement. She developed occlusion of the right internal iliac artery, that was revealed by computed tomography on the 9th postoperative day. The occlusion was considered to result from migration of a part of the emboli from the right common iliac artery into the right internal iliac artery during the procedure of embolectomy. On the 16th postoperative day, she underwent repeat mitral valve replacement because of perivalvular leakage. Furthermore, after 2 weeks from the diagnosis of embolism of the right internal iliac artery, the embolic site showed aneurysmal formation finally requiring aneurysmectomy. Her recovery was uneventful. Our case is considered to be rare in that serial observations on computed tomography indicated the development of mycotic aneurysm at the site of septic embolism. In addition, care must be taken to prevent migration of emboli into branched arteries during the procedure of embolectomy for peripheral arterial septic embolism caused by infective endocarditis.</p>

TEVAR for Tuberculous Mycotic Thoracic Aortic Aneurysm after Intravesical Instillations of BCG Therapy / 日本心臓血管外科学会雑誌

<p>A 79-year-old man, who had a history of intravesical instillations of bacillus Calmette-Guérin (BCG) therapy for urinary bladder cancer, developed bloody sputum 4 years after BCG therapy. BCG was detected from the sputum by detailed examination. Medical therapy for tuberculosis (TB) was started, but bloody sputum continued. Computed tomography (CT) for the chest was performed to evaluate the state of TB, and surprisingly, found impending rupture of tuberculosis mycotic thoracic aneurysm. He was emergently transferred to our hospital. CT revealed that the aneurysm made a lump with surrounding lung and lymph nodes. It seemed to be quite difficult to dissect and to be quite high risk to perform graft replacement with pneumonectomy. On the other hand, TB infection was controlled with antibiotic therapy. Thus we chose debranch TEVAR for this complicated situation. His bloody sputum regressed soon after the procedure and disappeared during his hospitalization. He was discharged home on POD 13 without serious complication and continued to have antibiotic therapy under the instruction of his primary physician.</p>