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Cryopreserved venous allograft in the treatment of a mycotic abdominal aortic aneurysm caused by group B Streptococcus. J Vasc Surg Cases Innov Tech 2022; 8:9-12. [PMID: 35024523 PMCID: PMC8731693 DOI: 10.1016/j.jvscit.2021.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/29/2021] [Indexed: 11/22/2022] Open
Abstract
We report a case of a mycotic abdominal aortic aneurysm caused by invasive group B streptococcus. Given the anatomical suitability with healthy segments of aortoiliac vessels, in situ repair was performed. A cryopreserved femoral vein graft was chosen because of risks of graft reinfection and negated the need for bilateral femoral vein harvest. The patient remained clinically well and the graft patent with no concerns at 6 months of follow-up. A review of literature on group B Streptococcus aortitis was performed.
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Sasipattarapong P, Johnson E, Beckerman S, Sajed D. Emergency Department Diagnosis of Multiple Mycotic Aneurysms in an HIV-Positive Patient Using Point-of-Care Ultrasound. Cureus 2022; 14:e21620. [PMID: 35233305 PMCID: PMC8881232 DOI: 10.7759/cureus.21620] [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] [Accepted: 01/25/2022] [Indexed: 11/26/2022] Open
Abstract
We report the case of a transgender woman with HIV (CD4 349), shortness of breath, and chest pain, who was found to have multiple mycotic aortic aneurysms by point-of-care ultrasound (PoCUS). This report highlights the utility of point-of-care ultrasonography in the diagnosis and management of this rare clinical entity.Multiple mycotic aortic aneurysms and purulent pericarditis are uncommon. They have high morbidity and mortality and are associated with immunocompromised states (e.g., HIV). Diagnosis of the mycotic aneurysm, and its precursor, infectious aortitis, can be challenging, and delays in care can lead to poor outcomes. Often, as described in this case report, making the diagnosis requires a high clinical suspicion, multiple imaging modalities, and laboratory studies.
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D Valenti, Mistry H, Kimura S, Khanna A, Pran L. A case of Infective Native (Abdominal) Aortic Aneurysm Caused by Streptococcus Agalactiae: An Updated Literature Review Based on New Nomenclature. Ann Vasc Surg 2021; 75:531.e7-531.e13. [PMID: 33836232 DOI: 10.1016/j.avsg.2021.01.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 10/21/2022]
Abstract
The management of abdominal aortic aneurysms (AAA) has evolved significantly with the advent of endovascular strategies. Thus, there has been a decline in the number of open AAA repairs once an endovascular option is available. There have also been reports of successful endovascular management of infective native aortic aneurysms (INAA)1, previously called mycotic aneurysms2. The rarity of this condition makes its management a challenging one as there are no standard guidelines. The European Society of Vascular Surgery has suggested that the nomenclature be changed from mycotic aneurysms as this can be misleading to standardise reporting1. The authors' present a case of a 67-year old male who presented during the peak of the Corona Virus pandemic with constitutional gastrointestinal symptoms. He was subsequently diagnosed with an INAA and successfully managed with open Neo-Aorto Iliac System reconstruction with a homograft3. The report highlights various strategies used in the surgical approach and their benefits in the management of INAA. Furthermore, a literature review of Streptococcus (Streptococcus agalactiae) species as a rare cause of INAA and how these cases were managed are also highlighted.
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Affiliation(s)
- D Valenti
- Department of Vascular Surgery, King's College Hospital, London, United Kingdom
| | - H Mistry
- Department of Vascular Surgery, King's College Hospital, London, United Kingdom
| | - S Kimura
- Department of Vascular Surgery, King's College Hospital, London, United Kingdom
| | - A Khanna
- Department of Vascular Surgery, King's College Hospital, London, United Kingdom
| | - L Pran
- Department of Vascular Surgery, King's College Hospital, London, United Kingdom.
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Rajendra N, Sebastian J, Reddy A, Kumar A, Ayappan MK, Mathur K, Raju R. Mycotic aortic aneurysm caused by Acinetobacter baumannii complex: A rare case. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2021. [DOI: 10.4103/ijves.ijves_8_21] [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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Journeau L, de la Chapelle M, Guimard T, Ferfar Y, Saadoun D, Mahé I, Castier Y, Montravers P, Lescure X, Van Gysel D, Asseray N, Lascarrou JB, Ngohou C, Vandamme YM, Connault J, de Cepoy PD, Brochard J, Goueffic Y, Pistorius MA, Boutoille D, Espitia O. A strobe multicenter descriptive study of 55 infectious aortitis. Medicine (Baltimore) 2020; 99:e22422. [PMID: 33019420 PMCID: PMC7535642 DOI: 10.1097/md.0000000000022422] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Infectious aortitis (IA) is a rare and severe disease. The treatment classically associates open surgery with prolonged antibiotic therapy. This study aimed to describe clinical characteristics, medical and surgical supports in a large and current series of IA.We conducted a retrospective multicenter study of native aorta IA, between 2000 and 2019. Inclusion criteria were the presence of a microorganism on blood culture, aortic sample or any other validated technique and structural anomaly in imaging.We included 55 patients (85% men), with a median age of 65. Microbiology data substantially differed from previous studies with 12 Gram-negative rods IA, of which only 3 due to Salmonella spp., 24 Gram-positive cocci IA of which 12 Streptococcus spp., and 18 IA due to intracellular growth and/or fastidious microorganisms, of which 8 Coxiella burnetii, 3 Treponema pallidum, and 5 tuberculosis suspicious cases. Fifteen patients (27%) presented with thoracic IA, 31 (56%) with abdominal IA, and 9 (16%) with thoraco-abdominal IA. Eight patients had no surgery, 41 underwent open surgery, only 4 endovascular aneurysm repair, and 2 a combination of these 2 techniques. Nine patients died before 1-month follow-up. There was no difference in the mortality rate between the different types of germ or localization of IA.The variety of germs involved in IA increases. Positron emission tomography-computed tomography scan is a very useful tool for diagnosis. Surgery is still mainly done in open approach and a prospective multicenter study seems necessary to better determine the place of endovascular aneurysm repair versus open surgery.
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Affiliation(s)
- Louis Journeau
- Department of Internal Medicine, Hôpital Louis Mourier (AP-HP), Colombes
- Department of Internal Medicine, CHD René Dubos, Pontoise
| | | | | | - Yasmina Ferfar
- Department of Internal Medicine and Clinical Immunology, INSERM, UMR_S 959, CNRS, FRE3632, Groupe Hospitalier Pitié-Salpêtrière (AP-HP)
| | - David Saadoun
- Department of Internal Medicine and Clinical Immunology, INSERM, UMR_S 959, CNRS, FRE3632, Groupe Hospitalier Pitié-Salpêtrière (AP-HP)
| | - Isabelle Mahé
- Department of Internal Medicine, Hôpital Louis Mourier (AP-HP), Colombes
| | | | | | - Xavier Lescure
- Department of Infectious Diseases, Hôpital Bichat – Claude Bernard (AP-HP), Paris
| | - Damien Van Gysel
- Department of Medical Information, Hôpital Louis Mourier (AP-HP), Colombes
| | | | | | | | | | | | | | - Julia Brochard
- Department of Infectious Diseases, Saint-Nazaire Hospital, Saint-Nazaire
| | - Yann Goueffic
- Department of Vascular Surgery, CHU Nantes, Nantes, France
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Abstract
Isolated noninfectious ascending aortitis (I-NIAA) is increasingly diagnosed at histopathologic review after resection of an ascending aortic aneurysm. PubMed was searched using the term aortitis; publications addressing the issue were reviewed, and reference lists of selected articles were also reviewed. Eleven major studies investigated the causes of an ascending aortic aneurysm or dissection requiring surgical repair: the prevalence of noninfectious aortitis ranged from 2% to 12%. Among 4 studies of lesions limited to the ascending aorta, 47% to 81% of cases with noninfectious aortitis were I-NIAA, more frequent than Takayasu arteritis or giant cell arteritis. Because of its subclinical nature and the lack of "syndromal signs" as in Takayasu arteritis or giant cell arteritis, I-NIAA is difficult to diagnose before complications occur, such as an aortic aneurysm or dissection. Therefore, surgical specimens of dissected aortic tissue should always be submitted for pathologic review. Diagnostic certainty requires the combination of a standardized histopathologic and clinical investigation. This review summarizes the current knowledge on I-NIAA, followed by a suggested approach to diagnosis, management, and follow-up. An illustrative case of an uncommon presentation is also presented. More follow-up studies on I-NIAA are needed, and diagnosis and follow-up of I-NIAA may benefit from the development of diagnostic biomarkers.
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Koganti D, Ryan SP, Kwon J, Abai B, Dimuzio PJ, Salvatore DM. Atypical Mycotic Aortic Aneurysms. Ann Vasc Surg 2016; 36:296.e13-296.e18. [DOI: 10.1016/j.avsg.2016.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/15/2016] [Accepted: 04/04/2016] [Indexed: 12/21/2022]
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Lucchese G, Luciani GB, Faggian G. Infectious aortitis or acute aortic syndrome-that is the question. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:19. [PMID: 26855955 DOI: 10.3978/j.issn.2305-5839.2015.12.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Gianluca Lucchese
- Division of Cardiac Surgery, University of Verona, Verona 37126, Italy
| | | | - Giuseppe Faggian
- Division of Cardiac Surgery, University of Verona, Verona 37126, Italy
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Modification of the CpsA protein reveals a role in alteration of the Streptococcus agalactiae cell envelope. Infect Immun 2015; 83:1497-506. [PMID: 25644003 DOI: 10.1128/iai.02656-14] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The bacterial cell envelope is a crucial first line of defense for a systemic pathogen, with production of capsular polysaccharides and maintenance of the peptidoglycan cell wall serving essential roles in survival in the host environment. The LytR-CpsA-Psr proteins are important for cell envelope maintenance in many Gram-positive species. In this study, we examined the role of the extracellular domain of the CpsA protein of the zoonotic pathogen group B Streptococcus in capsule production and cell wall integrity. CpsA has multiple functional domains, including a DNA-binding/transcriptional activation domain and a large extracellular domain. We demonstrated that episomal expression of extracellularly truncated CpsA causes a dominant-negative effect on capsule production when expressed in the wild-type strain. Regions of the extracellular domain essential to this phenotype were identified. The dominant-negative effect could be recapitulated by addition of purified CpsA protein or a short CpsA peptide to cultures of wild-type bacteria. Changes in cell wall morphology were also observed when the dominant-negative peptide was added to wild-type cultures. Fluorescently labeled CpsA peptide could be visualized bound at the mid-cell region near the division septae, suggesting a novel role for CpsA in cell division. Finally, expression of truncated CpsA also led to attenuation of virulence in zebrafish models of infection, to levels below that of a cpsA deletion strain, demonstrating the key role of the extracellular domain in virulence of GBS.
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