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)

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.

Aneurismas micóticos popliteos bilaterales asociados con endocarditis bacteriana / Bilateral Mycotic Popliteal Aneurysms Associated with Infective Endocarditis

En la era posantibiótica, los aneurismas micóticos en arterias periféricas son una complicación poco frecuente de endocarditis infecciosa. El compromiso de la arteria poplítea es excepcional y más frecuente en hombres. El diagnóstico temprano, utilizando los métodos de imágenes ante una elevada sospecha clínica, tiene implicaciones pronósticas. El tamaño del aneurisma, la presencia de trombosis y el estado general del paciente son factores importantes para decidir un tratamiento oportuno. En esta presentación se describe el caso de un paciente de 48 años con aneurismas poplíteos bilaterales con punto de partida en una endocarditis mitroaórtica por Staphylococcus aureus meticilinorresistente, con embolias sépticas múltiples.

Mycotic aneurysms are a rare complication of infective endocarditis in the post-antibiotic era. The involvement of the popliteal artery is an exception and is more common in men. When the clinical suspicion is high, early diagnosis using image tests has prognostic implications. The aneurysm size, the presence of thrombosis and the patient's general condition are important factors to decide the adequate treatment. We describe the case of a 48-year old male patient with bilateral aneurysms of the popliteal arteries originating from endocarditis of the mitral and aortic valves caused by methicillin-resistant Staphylococcus aureus with multiple septic emboli.

A Case of Infective Endocarditis with Mycotic Aneurysms / 대한내과학회지

Cerebral mycotic aneurysms have been noted in 2-10% of cases of bacterial endocarditis and account for 2.5-6.2% of all intracerebral aneurysms. Mycotic aneurysms were reported to occur more frequently in the course of acute endocarditis rather than late in the course of subacute disease. Symptomatic mycotic aneurysms are now uncommon. Early or late hemorrhage correlates better with the presence of pyogenic arteritis and uncontrolled S, aureus infection. Early cerebral hemorrhage is usually associated with S. aureus arteritis, is not amenable to surgery, and carries a high mortality. Control of the infection dramatically decreases the risk of embolism in infective endocarditis patients. Recurrent emboli are not common after adequate antimicrobial treatment of the underlying infection. Recently, we experienced a case of infective endocarditis in which angiographically demonstrated mycotic aneurysm had been resolved with adequate antibiotic therapy.