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.

Aneurisma coronariano micótico: relato de dois casos / Mycotic coronary aneurysm: report of two cases / Aneurisma coronario micotico: reporte de dos casos

O número de intervenções percutâneas com implante de stents tem aumentado dramaticamente nos últimos anos, apesar da frequência no uso do dispositivo nos relatos de infecções serem extremamente raros. Neste artigo relatamos dois casos de aneurisma micótico após implante de stents com diferentes apresentações clínicas e evolução.

The number of percutaneous interventions with stent implantation has increased dramatically in recent years, although the frequent use of this device in reports of infections is extremely rare. In this article we report two cases of mycotic aneurysm after implantation of stents with different clinical presentations and outcomes.

El número de intervenciones percutáneas con implantación de stents ha incrementado dramáticamente en los últimos años, a pesar del gran auge del dispositivo los reportes de infecciones son extremadamente raros. En el presente artículo reportamos dos casos de aneurismas micoticos luego de la implantación de stents con presentación y evolución clínicas diferentes.

Aneurisma infectado de artéria braquial após endocardite infecciosa de valva mitral / Infected aneurysm of brachial artery after mitral valve infective endocarditis

Apresentamos um caso de aneurisma infectado de artéria braquial em paciente com endocardite infecciosa por Streptococcus bovis. Homem de 49 anos de idade se apresentou com febre, dispnéia e sopro regurgitativo em foco mitral com irradiação para axila. O ecocardiograma demonstrou vegetação em valva mitral nativa. Após troca valvar mitral com implante de prótese biológica, observou-se massa pulsátil de cinco centímetros de diâmetro em fossa antecubital direita. Foi feito o diagnóstico de aneurisma infectado de artéria braquial, e o tratamento cirúrgico foi realizado com sucesso. O objetivo desse relato de caso é apresentar uma complicação pouco comum após endocardite infecciosa.

We present a case of brachial artery infected aneurysm in a patient with infective endocarditis caused by Streptococcus bovis. A 49-year-old man presented with fever dyspnea and a pansystolic murmur with irradiation to axilla. The echocardiogram revealed vegetation in native mitral valve. After mitral valve replacement with bioprosthesis, it was observed pulsatile mass of five centimeters in diameter at antecubital fossa of right upper limb. It was made the diagnosis of infected aneurysm of the brachial artery, and the surgery was performed successfully. The aim of this case report is to show a rare complication after infective endocarditis.

Aneurismas infecciosos / Infectious aneurysms

Los aneurismas micóticos de la circulación cerebral, son poco frecuentes y se asocian generalmente con endocarditis bacteriana. Se asocian a morbimortalidad elevada y su diagnóstico, auque se basa principalmente en datos clínicos además de algunas características angiográficas, tal como la localización y morfología, pueden ser un verdadero reto. Aunque muchos de estos aneurismas han presentado regresión con el manejo antibiótico, su comportamiento no es predecible en relación a su ruptura. Por tanto el objetivo del tratamiento, aunque difícil, debe ser la exclusión del aneurisma del árbol circulatorio ya sea mediante técnicas quirúrgicas o endovasculares.

Aneurisma micótico abdominal e embolia cerebral associados à endocardite infecciosa em paciente com doença valvar reumática crônica / Abdominal mycotic aneurysm and cerebral embolic event associated with infective endocarditis in a patient with chronic rheumatic valvar disease

Relatamos o caso de uma menina com doença valvar crônica devido à febre reumática que apresentou endocardite infecciosa e duas complicações: acidente vascular cerebral devido à embolia e aneurisma micótico da artéria mesentérica superior.

We report the case of a girl with chronic rheumatic valvar heart disease who developed infeccious endocarditis and two complications, ischemic stroke due to cerebral embolic event and mycotic aneurysm of the superior mesenteric artery.

Pseudo-aneurisma femoral micótico após onze anos de cateterismo / Mycotic femoral pseudoaneurysm after 11 years of catheterism

Relatamos o caso incomum de um alpinista de 52 anos que apresentava dor e edema em sua coxa direita, o que revelou ser um pseudoaneurisma micótico roto, sem histórico de trauma recente ou outra causa aparente. O paciente relatou uma história de infarto do miocárdio onze anos antes, com a realizacão de dois cateterismos femorais para cineangiocoronariografia. Ele negou qualquer episódio de febre ou diagnóstico de bacteremia naquele momento ou mais tarde, como também outra queixa durante esses onze anos. A raridade do caso, a aparência dessa complicacão extremamente tardia, juntamente com o tipo de atividade esportiva do paciente sugeriram-nos publicar o caso.

Cuadro clínico, criterios diagnósticos y complicaciones / Clinical picture, diagnostic criteria and complications

El diagnóstico de EI comienza con una cuidadosa historia y examen físico. El antecedente de endocarditis previa, valvulopatías previas (lesiones congénitas o adquiridas), manipulaciones dentales, genitourinarias, broncoscopias, drogadicción endovenosa o tatuajes en la piel, deben orientar a la puerta de entrada y bacteremia consecutiva. El diagnóstico puede basarse en la presencia de manifestaciones cardíacas o sistémicas. La presencia de un soplo cardíaco, reciente o que haya variado, asociado a fiebre, debe hacerse sospechar el diagnóstico, especialmente si existe una válvula protésica. Los criterios diagnósticos de Duke han sido un aporte para el diagnóstico de esta afección y para un manejo más oportuno y precoz de ella. Las complicaciones en la EI pueden afectar a cualquier órgano. Las complicaciones cardíacas son frecuentes y la insuficiencia cardíaca puede acarrear la muerte. La formación de abscesos intracardíacos con alteraciones en la conducción, pueden afectar el miocardio y pericardio, siendo necesaria la resolución quirúrgica. Las complicaciones extracardíacas, neurológicas, vasculares, renales y sépticas son comunes y habitualmente producidas por embolización de vegetaciones o complejos inmunes. A pesar de los avances en la detección y tratamiento de estas complicaciones, el manejo de este cuadro y su diagnóstico diferencial persiste difícil y es de alta letalidad.

Hepatic artery mycotic aneurysm of tubercular aetiology.

Hepatic artery aneurysm caused by tuberculosis is extremely rare, the commonest being atherosclerosis and vasculitis. A 13 year boy admitted with suspected disseminated tuberculosis had a hepatic bruit. Patient died of aneurysmal rupture before antemortem etiological diagnosis could be established. Postmortem examination revealed widespread tubercular lesions in the chest and abdomen and hepatic artery aneurysm.