Clostridium septicum-infected aortic aneurysm or graft is a deadly diagnosis

A non-toxic recombinant Clostridium septicum α toxin induces protective immunity in mice and rabbits

Clostridium septicum alpha toxin (CSA) plays significant roles in ruminant's braxy. Genetically engineered CSA has been shown to function as a potential vaccine candidate in the prevention of the disease caused by Clostridium septicum. In the present study, we synthesized a non-toxic recombinant, rCSAm4/TMD by introducing four amino acid substitutions (C86L/N296A/H301A/W342A) and 11-amino-acid deletion (residues 212 to 222). Compared to recombinant CSA, rCSAm4/TMD showed no cytotoxicity to MDCK cells and was not fatal to mice. Moreover, rCSAm4/TMD could protect immunized mice against 5 × mouse LD100 (100% lethal dose) of crude CSA without obvious pathological change. Most importantly, rabbits immunized with rCSAm4/TMD produced high titers of neutralizing antibodies which protected the rabbits against crude CSA challenge. These data suggest that genetically detoxified rCSAm4/TMD is a potential subunit vaccine candidate against braxy.

Abdominal aortic endograft infection with Clostridium difficile

OBJECTIVES

The increase in endovascular aortic aneurysm repair has led to increasing incidence of aortic endograft infections. Additionally, more atypical organisms are being identified as pathogens. We report on a rare aortic endograft infection to further characterize and understand these infections.

METHODS

We report a Clostridium difficile culture-positive aortic endograft infection in an 82-year-old male 3 years after endovascular abdominal aortic aneurysm repair.

RESULTS

The patient underwent successful open, complete explant of his endograft and in-situ repair using a rifampin-soaked Dacron graft. He continues to do well.

CONCLUSIONS

Aortic endograft infections are a complex problem further complicated by rare and virulent infections. Unless the patient is at prohibitive risk, the management of infected aortic endografts is surgical graft explant and in-situ or extra-anatomic reconstruction due to the exceedingly high mortality rate with non-operative management.

Prospects of conservative treatment for Clostridium septicum–associated aortitis

Clostridium septicum bacteremia is a rare (72 cases reported) aneurysm-inducing disease that has resulted in a 6-month mortality of 100% when treated conservatively. We report the case of a patient who was completely symptom free at 6 months of follow-up but who ultimately died at 8.9 months after aortic rupture. In compliance with the patient’s choice, a long-time antibiotic regimen was applied, instead of the surgical approach recommended by our surgical department. The use of an antibiotic regimen represents an option for patients unfit for surgery or as a bridge to surgery for damage control; however, aortic repair represents the only curative approach. Definitive antibiotic treatment is limited to a palliative approach for patients with C. septicum aortitis and has been accompanied by 100% 1-year mortality (90-day mortality, 84.2%).

Mycotic Aortic Arch Aneurysm Caused by Clostridium perfringens

We report a case of a 79-year-old man for a mycotic aortic arch aneurysm caused by Clostridium perfringens. The patient who had been hospitalized for cholangitis two months prior revisited the hospital for fever and left precordial pain. He was suspected of an infected aortic aneurysm in the distal arch due to emphysematous changes observed. After antibiotics treatment, the emphysematous changes disappeared. However, he underwent urgent total arch replacement due to a new ulcer-like projection and enlargement of the aortic aneurysm, which were observed at that time. Clostridium-infected infectious aneurysms require not only treatment for vascular lesions but also scrutiny of complications, such as cancer.