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Tang K, Ford B, Grasso SL, Swisher J. Infectious aortitis and managing it at a community military hospital. BMJ Case Rep 2024; 17:e257509. [PMID: 38538095 PMCID: PMC10982747 DOI: 10.1136/bcr-2023-257509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Infectious aortitis is a rare disease process which can be of fungal, viral or bacterial aetiology. This disease process is often incidentally found during concomitant infectious processes, likely due to haematogenous spread. Common sources are from cardiac, genitourinary and gastroenterologic sources. CT imaging of the aorta is essential in identifying physiological changes-wall thickness changes, ectasia and stenosis. We present a case of a female in her early 60s with a medical history of cardiomyopathy with heart failure and reduced ejection fraction, who was initially admitted for acute cholecystitis complicated by the development of gallstone pancreatitis. Imaging evaluation incidentally noted findings consistent with aortitis with a penetrating ulcer, and blood cultures were positive for Staphylococcus aureus bacteraemia, confirming her diagnosis of infectious aortitis. She was started on intravenous antibiotics, required preoperative nutritional optimisation, and subsequently underwent an open aortic resection and aortoiliac reconstruction with rifampin-soaked Dacron graft.
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Affiliation(s)
- Kelly Tang
- General Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Brandon Ford
- General Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Samuel L Grasso
- General Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Jonathan Swisher
- General Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA
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2
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Czerny M, Grabenwöger M, Berger T, Aboyans V, Della Corte A, Chen EP, Desai ND, Dumfarth J, Elefteriades JA, Etz CD, Kim KM, Kreibich M, Lescan M, Di Marco L, Martens A, Mestres CA, Milojevic M, Nienaber CA, Piffaretti G, Preventza O, Quintana E, Rylski B, Schlett CL, Schoenhoff F, Trimarchi S, Tsagakis K, Siepe M, Estrera AL, Bavaria JE, Pacini D, Okita Y, Evangelista A, Harrington KB, Kachroo P, Hughes GC. EACTS/STS Guidelines for Diagnosing and Treating Acute and Chronic Syndromes of the Aortic Organ. Ann Thorac Surg 2024:S0003-4975(24)00077-8. [PMID: 38416090 DOI: 10.1016/j.athoracsur.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Martin Czerny
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany.
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Austria; Medical Faculty, Sigmund Freud Private University, Vienna, Austria.
| | - Tim Berger
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France; EpiMaCT, Inserm 1094 & IRD 270, Limoges University, Limoges, France
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy; Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julia Dumfarth
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - John A Elefteriades
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - Christian D Etz
- Department of Cardiac Surgery, University Medicine Rostock, University of Rostock, Rostock, Germany
| | - Karen M Kim
- Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin/Dell Medical School, Austin, Texas
| | - Maximilian Kreibich
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - Luca Di Marco
- Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andreas Martens
- Department of Cardiac Surgery, Klinikum Oldenburg, Oldenburg, Germany; The Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carlos A Mestres
- Department of Cardiothoracic Surgery and the Robert WM Frater Cardiovascular Research Centre, The University of the Free State, Bloemfontein, South Africa
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Christoph A Nienaber
- Division of Cardiology at the Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Gabriele Piffaretti
- Vascular Surgery Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Bartosz Rylski
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Santi Trimarchi
- Department of Cardiac Thoracic and Vascular Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Medicine Essen, Essen, Germany
| | - Matthias Siepe
- EACTS Review Coordinator; Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Anthony L Estrera
- STS Review Coordinator; Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston, Houston, Texas
| | - Joseph E Bavaria
- Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Davide Pacini
- Division of Cardiac Surgery, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | - Yutaka Okita
- Cardio-Aortic Center, Takatsuki General Hospital, Osaka, Japan
| | - Arturo Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Instituto del Corazón, Quirónsalud-Teknon, Barcelona, Spain
| | - Katherine B Harrington
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Puja Kachroo
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Duke University, Durham, North Carolina
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3
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Czerny M, Grabenwöger M, Berger T, Aboyans V, Della Corte A, Chen EP, Desai ND, Dumfarth J, Elefteriades JA, Etz CD, Kim KM, Kreibich M, Lescan M, Di Marco L, Martens A, Mestres CA, Milojevic M, Nienaber CA, Piffaretti G, Preventza O, Quintana E, Rylski B, Schlett CL, Schoenhoff F, Trimarchi S, Tsagakis K. EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ. Eur J Cardiothorac Surg 2024; 65:ezad426. [PMID: 38408364 DOI: 10.1093/ejcts/ezad426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/15/2023] [Accepted: 12/19/2023] [Indexed: 02/28/2024] Open
Affiliation(s)
- Martin Czerny
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Austria
- Medical Faculty, Sigmund Freud Private University, Vienna, Austria
| | - Tim Berger
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France
- EpiMaCT, Inserm 1094 & IRD 270, Limoges University, Limoges, France
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
- Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Julia Dumfarth
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - John A Elefteriades
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Christian D Etz
- Department of Cardiac Surgery, University Medicine Rostock, University of Rostock, Rostock, Germany
| | - Karen M Kim
- Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin/Dell Medical School, Austin, TX, USA
| | - Maximilian Kreibich
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - Luca Di Marco
- Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andreas Martens
- Department of Cardiac Surgery, Klinikum Oldenburg, Oldenburg, Germany
- The Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carlos A Mestres
- Department of Cardiothoracic Surgery and the Robert WM Frater Cardiovascular Research Centre, The University of the Free State, Bloemfontein, South Africa
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Christoph A Nienaber
- Division of Cardiology at the Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Gabriele Piffaretti
- Vascular Surgery Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Bartosz Rylski
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Santi Trimarchi
- Department of Cardiac Thoracic and Vascular Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Medicine Essen, Essen, Germany
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Yoshida S, Manerikar A, Zhu M, Mehta C. Successful surgical treatment of Stanford type A aortic dissection due to Salmonella aortitis. J Cardiothorac Surg 2023; 18:233. [PMID: 37452382 PMCID: PMC10349517 DOI: 10.1186/s13019-023-02318-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Salmonella spp. cause infectious aortitis through the hematogenous spread of an intestinal Salmonella infection. Salmonella aortitis can result in extensive tissue damage in the aorta leading to complications including dissection, abscess formation, pseudoaneurysms, and rupture, which require early diagnosis and treatment with both surgery and antibiotic therapy. CASE PRESENTATION We report a case of Salmonella aortitis complicated by Stanford type A aortic dissection. A 62-year-old man with a history of heroin use presented with chest pain, epigastric pain and vomiting. The computed tomography scan showed Stanford type A aortic dissection without malperfusion. At the time of surgery, an aortic dissection with purulent fluid and contained rupture was noted in the ascending aorta. Fluid culture was consistent with Salmonella. A composite valve-graft conduit aortic root replacement with ascending aorta and hemiarch replacement was performed. The patient recovered well and was discharged on long-term antibiotics. CONCLUSIONS This rare case of a Stanford type A aortic dissection with contained rupture due to Salmonella aortitis was successfully treated with emergent surgery and antibiotic therapy.
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Affiliation(s)
- Shohei Yoshida
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, 676 North St. Clair, Suite 7-300, Chicago, IL, 60611, USA
| | - Adwaiy Manerikar
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, 676 North St. Clair, Suite 7-300, Chicago, IL, 60611, USA
| | - Mengou Zhu
- Division of Internal Medicine, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, IL, USA
| | - Christopher Mehta
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, 676 North St. Clair, Suite 7-300, Chicago, IL, 60611, USA.
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5
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Tinévez C, Lehours P, Ranc AG, Belaroussi Y, Velardo F, Dubois D, Neuwirth C, Pailhoriès H, Dorel M, Hery-Arnaud G, Join-Lambert O, Gras E, Corvec S, Codde C, Fournier D, Boijout H, Doat V, Bouard L, Lagneaux AS, Pichon M, Couzigou C, Letellier C, Lemaignen A, Bille E, Bérard X, Caradu C, Webster C, Neau D, Cazanave C, Puges M. Multicenter Retrospective Study of Vascular Infections and Endocarditis Caused by Campylobacter spp., France. Emerg Infect Dis 2023; 29:484-492. [PMID: 36823023 PMCID: PMC9973684 DOI: 10.3201/eid2903.221417] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
The incidence of campylobacteriosis has substantially increased over the past decade, notably in France. Secondary localizations complicating invasive infections are poorly described. We aimed to describe vascular infection or endocarditis caused by Campylobacter spp. We included 57 patients from a nationwide 5-year retrospective study on Campylobacter spp. bacteremia conducted in France; 44 patients had vascular infections, 12 had endocarditis, and 1 had both conditions. Campylobacter fetus was the most frequently involved species (83%). Antibiotic treatment involved a β-lactam monotherapy (54%) or was combined with a fluoroquinolone or an aminoglycoside (44%). The mortality rate was 25%. Relapse occurred in 8% of cases and was associated with delayed initiation of an efficient antimicrobial therapy after the first symptoms, diabetes, and coexistence of an osteoarticular location. Cardiovascular Campylobacter spp. infections are associated with a high mortality rate. Systematically searching for those localizations in cases of C. fetus bacteremia may be warranted.
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6
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Carrer M, Vignals C, Berard X, Caradu C, Battut AS, Stenson K, Neau D, Lazaro E, Mehlen M, Barret A, Nyamankolly E, Lifermann F, Rispal P, Illes G, Rouanes N, Caubet O, Poirot-Mazeres S, Vareil MO, Alleman L, Millon A, Huvelle U, Valour F, Ferry T, Cazanave C, Puges M. Retrospective Multicenter Study Comparing Infectious and Noninfectious Aortitis. Clin Infect Dis 2023; 76:e1369-e1378. [PMID: 35792621 DOI: 10.1093/cid/ciac560] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/27/2022] [Accepted: 07/01/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Determining the etiology of aortitis is often challenging, in particular to distinguish infectious aortitis (IA) and noninfectious aortitis (NIA). This study aims to describe and compare the clinical, biological, and radiological characteristics of IA and NIA and their outcomes. METHODS A multicenter retrospective study was performed in 10 French centers, including patients with aortitis between 1 January 2014 and 31 December 2019. RESULTS One hundred eighty-three patients were included. Of these, 66 had IA (36.1%); the causative organism was Enterobacterales and streptococci in 18.2% each, Staphylococcus aureus in 13.6%, and Coxiella burnetii in 10.6%. NIA was diagnosed in 117 patients (63.9%), mainly due to vasculitides (49.6%), followed by idiopathic aortitis (39.3%). IA was more frequently associated with aortic aneurysms compared with NIA (78.8% vs 17.6%, P < .001), especially located in the abdominal aorta (69.7% vs 23.1%, P < .001). Crude and adjusted survival were significantly lower in IA compared to NIA (P < .001 and P = .006, respectively). In the IA cohort, high American Society of Anesthesiologists score (hazard ratio [HR], 2.47 [95% confidence interval {CI}, 1.08-5.66]; P = .033) and free aneurysm rupture (HR, 9.54 [95% CI, 1.04-87.11]; P = .046) were significantly associated with mortality after adjusting for age, sex, and Charlson comorbidity score. Effective empiric antimicrobial therapy, initiated before any microbial documentation, was associated with a decreased mortality (HR, 0.23, 95% CI, .08-.71]; P = .01). CONCLUSIONS IA was complicated by significantly higher mortality rates compared with NIA. An appropriate initial antibiotic therapy appeared as a protective factor in IA.
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Affiliation(s)
- Mathilde Carrer
- Infectious and Tropical Diseases Department, Centre hospitalier universitaire Bordeaux, Bordeaux, France
| | - Carole Vignals
- Infectious and Tropical Diseases Department, Centre hospitalier universitaire Bordeaux, Bordeaux, France
| | - Xavier Berard
- Department of Vascular Surgery, Centre hospitalier universitaire Bordeaux, Bordeaux, France
| | - Caroline Caradu
- Department of Vascular Surgery, Centre hospitalier universitaire Bordeaux, Bordeaux, France
| | - Anne-Sophie Battut
- Department of Vascular Surgery, Clinique Mutualiste de Pessac, Pessac, France
| | - Katherine Stenson
- St George's University Hospitals NHS Foundation Trust, Imperial College Healthcare, London, United Kingdom
| | - Didier Neau
- Infectious and Tropical Diseases Department, Centre hospitalier universitaire Bordeaux, Bordeaux, France
| | - Estibaliz Lazaro
- Internal Medicine and Infectious Disease Department, Centre hospitalier universitaire Bordeaux, Bordeaux, France
| | - Maxime Mehlen
- Infectious and Tropical Diseases Department, Centre hospitalier universitaire Bordeaux, Bordeaux, France
| | - Amaury Barret
- Internal Medicine and Infectious Diseases Department, Centre hospitalier Arcachon, Arcachon, France
| | - Elsa Nyamankolly
- Infectious and Tropical Diseases Department, Centre hospitalier Dax, Dax, France
| | | | - Patrick Rispal
- Infectious and Tropical Diseases Department, Centre hospitalier Agen, Agen, France
| | - Gabriela Illes
- Infectious and Tropical Diseases Department, Centre hospitalier Mont de Marsan, Mont de Marsan, France
| | - Nicolas Rouanes
- Polyvalent Medicine Department, Centre hospitalier Périgueux, Périgueux, France
| | - Olivier Caubet
- Internal Medicine Department, Centre hospitalier Libourne, Libourne, France
| | | | - Marc-Olivier Vareil
- Infectious and Tropical Diseases Department, Centre hospitalier Bayonne, Bayonne, France
| | - Laure Alleman
- Infectious and Tropical Diseases Department, Centre hospitalier Bayonne, Bayonne, France
| | - Antoine Millon
- Department of Vascular Surgery, Centre hospitalier universitaire Lyon, Lyon, France
| | - Ugo Huvelle
- Department of Vascular Surgery, Centre hospitalier universitaire Lyon, Lyon, France
| | - Florent Valour
- Infectious and Tropical Diseases Department, Centre hospitalier universitaire Lyon, Lyon, France
| | - Tristan Ferry
- Infectious and Tropical Diseases Department, Centre hospitalier universitaire Lyon, Lyon, France
| | - Charles Cazanave
- Infectious and Tropical Diseases Department, Centre hospitalier universitaire Bordeaux, Bordeaux, France
| | - Mathilde Puges
- Infectious and Tropical Diseases Department, Centre hospitalier universitaire Bordeaux, Bordeaux, France
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7
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Corniquet M, Khalifé M, Lellouch AG, Bel A, Bellenfant F, Julia P, Alsac JM, El Batti S, Ben Abdallah I. Ruptured infective native thoracic aortic aneurysm treated by endovascular repair as a bridge therapy to open repair. JOURNAL DE MEDECINE VASCULAIRE 2023; 48:36-40. [PMID: 37120270 DOI: 10.1016/j.jdmv.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/14/2023] [Indexed: 05/01/2023]
Abstract
We report the case of a 70-year-old woman who presented with a ruptured infective native thoracic aortic aneurysm (INTAA), associated with spondylodiscitis and posterior mediastinitis. She underwent a staged hybrid repair: urgent thoracic endovascular aortic repair was first performed as a bridge therapy in the context of septic shock. Allograft repair using cardiopulmonary bypass was performed five days later. Given the complexity of INTAA, multidisciplinary teamwork was paramount to determine the most appropriate treatment strategy, including procedure planning with multiple operators as well as perioperative care. Therapeutic alternatives are discussed.
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Affiliation(s)
- M Corniquet
- Department of cardiovascular surgery, Hôpital Européen Georges-Pompidou (HEGP), Université Paris Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 20, rue Leblanc, 75015 Paris, France; Inserm, UMR S 1140, Fondation Alain Carpentier, Laboratoire de Recherches Biochirugicales, 75015 Paris, France.
| | - M Khalifé
- Department of orthopedic surgery, HEGP, Université Paris Cité, AP-HP, 20, rue Leblanc, 75015 Paris, France.
| | - A G Lellouch
- Department of plastic surgery, HEGP, Université Paris Cité, AP-HP, 20, rue Leblanc, 75015 Paris, France.
| | - A Bel
- Department of cardiovascular surgery, Hôpital Européen Georges-Pompidou (HEGP), Université Paris Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 20, rue Leblanc, 75015 Paris, France; Inserm, UMR S 1140, Fondation Alain Carpentier, Laboratoire de Recherches Biochirugicales, 75015 Paris, France.
| | - F Bellenfant
- Department of anesthesiology and critical care, HEGP, Université Paris Cité, AP-HP, 20, rue Leblanc, 75015 Paris, France.
| | - P Julia
- Department of cardiovascular surgery, Hôpital Européen Georges-Pompidou (HEGP), Université Paris Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 20, rue Leblanc, 75015 Paris, France.
| | - J-M Alsac
- Department of cardiovascular surgery, Hôpital Européen Georges-Pompidou (HEGP), Université Paris Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 20, rue Leblanc, 75015 Paris, France; Inserm, UMR S 1140, Fondation Alain Carpentier, Laboratoire de Recherches Biochirugicales, 75015 Paris, France.
| | - S El Batti
- Department of cardiovascular surgery, Hôpital Européen Georges-Pompidou (HEGP), Université Paris Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 20, rue Leblanc, 75015 Paris, France; Inserm, UMR S 1140, Fondation Alain Carpentier, Laboratoire de Recherches Biochirugicales, 75015 Paris, France.
| | - I Ben Abdallah
- Department of cardiovascular surgery, Hôpital Européen Georges-Pompidou (HEGP), Université Paris Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 20, rue Leblanc, 75015 Paris, France; Inserm, UMR S 1140, Fondation Alain Carpentier, Laboratoire de Recherches Biochirugicales, 75015 Paris, France.
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8
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Ramon A, Greigert H, Ornetti P, Bonnotte B, Samson M. Mimickers of Large Vessel Giant Cell Arteritis. J Clin Med 2022; 11:jcm11030495. [PMID: 35159949 PMCID: PMC8837104 DOI: 10.3390/jcm11030495] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/15/2022] [Accepted: 01/17/2022] [Indexed: 01/27/2023] Open
Abstract
Giant cell arteritis (GCA) is a large-vessel granulomatous vasculitis occurring in patients over 50-year-old. Diagnosis can be challenging because there is no specific biological test or other diagnoses to consider. Two main phenotypes of GCA are distinguished and can be associated. First, cranial GCA, whose diagnosis is usually confirmed by the evidence of a non-necrotizing granulomatous panarteritis on temporal artery biopsy. Second, large-vessel GCA, whose related symptoms are less specific (fever, asthenia, and weight loss) and for which other diagnoses must be implemented if there is neither cephalic GCA nor associated polymyalgia rheumatica (PMR) features chronic infection (tuberculosis, Coxiella burnetti), IgG4-related disease, Erdheim Chester disease, and other primary vasculitis (Behçet disease, relapsing polychondritis, or VEXAS syndrome). Herein, we propose a review of the main differential diagnoses to be considered regarding large vessel vasculitis.
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Affiliation(s)
- André Ramon
- Rheumatology Department, Dijon-Bourgogne University Hospital, 21000 Dijon, France;
- INSERM, EFS BFC, UMR 1098, RIGHT Graft-Host-Tumor Interactions/Cellular and Genetic Engineering, Bourgogne Franche-Comté University, 21000 Dijon, France; (H.G.); (B.B.); (M.S.)
- Correspondence:
| | - Hélène Greigert
- INSERM, EFS BFC, UMR 1098, RIGHT Graft-Host-Tumor Interactions/Cellular and Genetic Engineering, Bourgogne Franche-Comté University, 21000 Dijon, France; (H.G.); (B.B.); (M.S.)
- Internal Medicine and Clinical Immunology Department, Dijon-Bourgogne University Hospital, 21000 Dijon, France
- Vascular Medicine Department, Dijon-Bourgogne University Hospital, 21000 Dijon, France
| | - Paul Ornetti
- Rheumatology Department, Dijon-Bourgogne University Hospital, 21000 Dijon, France;
- INSERM, CIC 1432, Clinical Investigation Center, Plurithematic Module, Technological Investigation Platform, Dijon-Bourgogne University Hospital, 21000 Dijon, France
- INSERM UMR 1093-CAPS, Bourgogne Franche-Comté University, UFR des Sciences et Du Sport, 21000 Dijon, France
| | - Bernard Bonnotte
- INSERM, EFS BFC, UMR 1098, RIGHT Graft-Host-Tumor Interactions/Cellular and Genetic Engineering, Bourgogne Franche-Comté University, 21000 Dijon, France; (H.G.); (B.B.); (M.S.)
- Internal Medicine and Clinical Immunology Department, Dijon-Bourgogne University Hospital, 21000 Dijon, France
| | - Maxime Samson
- INSERM, EFS BFC, UMR 1098, RIGHT Graft-Host-Tumor Interactions/Cellular and Genetic Engineering, Bourgogne Franche-Comté University, 21000 Dijon, France; (H.G.); (B.B.); (M.S.)
- Internal Medicine and Clinical Immunology Department, Dijon-Bourgogne University Hospital, 21000 Dijon, France
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9
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Tinévez C, Velardo F, Ranc AG, Dubois D, Pailhoriès H, Codde C, Join-Lambert O, Gras E, Corvec S, Neuwirth C, Melenotte C, Dorel M, Lagneaux AS, Pichon M, Doat V, Fournier D, Lemaignen A, Bouard L, Patoz P, Hery-Arnaud G, Lemaitre N, Couzigou C, Guillard T, Recalt E, Bille E, Belaroussi Y, Neau D, Cazanave C, Lehours P, Puges M. Retrospective multicentric study on Campylobacter spp. bacteremia in France: the Campylobacteremia study. Clin Infect Dis 2021; 75:702-709. [PMID: 34849656 DOI: 10.1093/cid/ciab983] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Campylobacter spp. bacteremia is a severe infection. A nationwide 5-year retrospective study was conducted to characterize its clinical features and prognostic factors. METHODS Patients diagnosed with Campylobacter spp. bacteremia in 37 French hospitals participating in the surveillance network of the National Reference Center for Campylobacter and Helicobacter were included from January 1, 2015, to December 31, 2019. The goal was to analyze the effects of a delay of appropriate antibiotic therapy and other risk factors on 30-day mortality, antibiotic resistance, patient characteristics and prognosis according to the Campylobacter species. FINDINGS Among the 592 patients, Campylobacter jejuni and Campylobacter fetus were the most commonly identified species (42.9 and 42.6%, respectively). The patients were elderly (median age 68 years), and most had underlying conditions, mainly immunodepression (43.4%), hematologic malignancies (25.9%), solid neoplasms (23%) and diabetes (22.3%). C. jejuni and Campylobacter coli were associated with gastrointestinal signs, and C. fetus was associated with secondary localizations. Among the 80 patients (13.5%) with secondary localizations, 12 had endocarditis, 38 vascular, 24 osteo-articular and 9 ascitic fluid infections. The thirty-day mortality rate was 11.7%, and an appropriate antibiotic treatment was independently associated with 30-day survival (odds ratio [OR]=0.47, 95% CI [0.24-0.93], p=0.03). The median efficient therapy initiation delay was quite short (2 days, IQR [0-4]) but it had no significant impact on 30-day mortality (p=0.78). INTERPRETATION Campylobacter spp. bacteremia mainly occurred in elderly immunocompromised individuals with variable clinical presentations according to the species involved. Appropriate antimicrobial therapy was associated with improved 30-day survival.
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Affiliation(s)
- Claire Tinévez
- CHU de Bordeaux, Infectious and Tropical Diseases Department, F-33000 Bordeaux, France
| | - Fanny Velardo
- INSERM, Bordeaux Population Health Research Center, ISPED, University of Bordeaux, F-33000 Bordeaux, France
| | - Anne-Gaëlle Ranc
- CHU de Lyon Sud, Bacteriology Department, F-69310 Pierre-Bénite, France
| | - Damien Dubois
- CHU de Toulouse, Bacteriology Department, F-31059 Toulouse, France
| | | | - Cyrielle Codde
- CHU de Limoges, Infectious and Tropical Diseases Department, F-87000 Limoges, France
| | | | - Emmanuelle Gras
- Hôpital Européen Georges-Pompidou, Infectious and Tropical Diseases Department, F-75015 Paris, France
| | - Stéphane Corvec
- CHU de Nantes, Bacteriology Department, F-44093 Nantes, France
| | | | - Cléa Melenotte
- CHU de Marseille, Bacteriology Department, F-13005 Marseille, France
| | - Marie Dorel
- CHU de Rennes, Infectious Diseases and Intensive Care Department, F-35033 Rennes, France
| | | | - Maxime Pichon
- CHU de Poitiers, Infectious Agents Department, Bacteriology, F-86021 Poitiers, France
| | - Violaine Doat
- CH Pierre Oudot, Biology Department, F-38300 Bourguoin-Jallieu, France
| | - Damien Fournier
- CHU de Besançon, Bacteriology Department, F-25000 Besançon, France
| | - Adrien Lemaignen
- CHRU de Tours, Infectious and Tropical Diseases Department, F-37000 Tours, France
| | - Leslie Bouard
- CHD Vendée, Biology Department, F-85000 La Roche-Sur-Yon, France
| | - Pierre Patoz
- CH de Tourcoing, Biology Department, F-59208 Tourcoing, France
| | | | - Nadine Lemaitre
- CHU d'Amiens, Bacteriology Department, F-80000 Amiens, France
| | | | - Thomas Guillard
- CHU de Reims, Bacteriology Department, F-51092 Reims, France
| | - Elise Recalt
- CHU de Strasbourg, Bacteriology Department, F-67200 Strasbourg, France
| | - Emmanuelle Bille
- CH Necker-Enfants malades, Bacteriology Department, F-75015 Paris, France
| | - Yaniss Belaroussi
- INSERM, Bordeaux Population Health Research Center, ISPED, University of Bordeaux, F-33000 Bordeaux, France
| | - Didier Neau
- CHU de Bordeaux, Infectious and Tropical Diseases Department, F-33000 Bordeaux, France
| | - Charles Cazanave
- CHU de Bordeaux, Infectious and Tropical Diseases Department, F-33000 Bordeaux, France
| | - Philippe Lehours
- CHU de Bordeaux, National Reference Center for Campylobacter and Helicobacter, Bacteriology Department, F-33000 Bordeaux, France.,Univ. Bordeaux, INSERM, UMR1053 Bordeaux Research in Translational Oncology, BaRITOn, 33076, Bordeaux, France
| | - Mathilde Puges
- CHU de Bordeaux, Infectious and Tropical Diseases Department, F-33000 Bordeaux, France
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10
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Salmonella Aortitis Related to Rheumatoid Arthritis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2021. [DOI: 10.1097/ipc.0000000000001047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Ramkumar R, Shiraev T, Loa J, Qasabian R. A case of clostridium septicum aortitis. ANZ J Surg 2021; 92:1539-1541. [PMID: 34694691 DOI: 10.1111/ans.17319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/28/2021] [Accepted: 10/05/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Jacky Loa
- Royal Prince Alfred Hospital, Camperdown, Australia
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12
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de Mornac D, Agard C, Hardouin JB, Hamidou M, Connault J, Masseau A, Espitia-Thibault A, Artifoni M, Ngohou C, Perrin F, Graveleau J, Durant C, Pottier P, Néel A, Espitia O. Risk factors for symptomatic vascular events in giant cell arteritis: a study of 254 patients with large-vessel imaging at diagnosis. Ther Adv Musculoskelet Dis 2021; 13:1759720X211006967. [PMID: 34249150 PMCID: PMC8239952 DOI: 10.1177/1759720x211006967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/10/2021] [Indexed: 12/14/2022] Open
Abstract
Aims To identify factors associated with vascular events in patients with giant cell arteritis (GCA). Methods We performed a retrospective study of GCA patients diagnosed over a 20-year-period, who all underwent vascular imaging evaluation at diagnosis. Symptomatic vascular events were defined as the occurrence of any aortic event (aortic dissection or symptomatic aortic aneurysm), stroke, myocardial infarction, limb or mesenteric ischemia and de novo lower limbs arteritis stage 3 or 4. Patients with symptomatic vascular event (VE+) and without were compared, and risk factors were identified in a multivariable analysis. Results Thirty-nine (15.4%) of the 254 included patients experienced at least one symptomatic vascular event during follow-up, with a median time of 21.5 months. Arterial hypertension, diabetes, lower limbs arteritis or vascular complication at diagnosis were more frequent in VE+ patients (p < 0.05), as an abnormal computed tomography (CT)-scan at diagnosis (p = 0.04), aortitis (p = 0.01), particularly of the descending thoracic aorta (p = 0.03) and atheroma (p = 0.03). Deaths were more frequent in the VE+ group (37.1 versus 10.3%, p = 0.0003). In multivariable analysis, aortic surgery [hazard ratio (HR): 10.46 (1.41-77.80), p = 0.02], stroke [HR: 22.32 (3.69-135.05), p < 0.001], upper limb ischemia [HR: 20.27 (2.05-200.12), p = 0.01], lower limb ischemia [HR: 76.57 (2.89-2027.69), p = 0.009], aortic atheroma [HR: 3.06 (1.06-8.82), p = 0.04] and aortitis of the descending thoracic aorta on CT-scan at diagnosis [HR: 4.64 (1.56-13.75), p = 0.006] were independent predictive factors of a vascular event. Conclusion In this study on GCA cases with large vessels imaging at diagnosis, aortic surgery, stroke, upper or lower limb ischemia, aortic atheroma and aortitis of the descending thoracic aorta on CT-scan, at GCA diagnosis, were independent predictive factors of a vascular event. Plain language summary Risk factors for symptomatic vascular events in giant cell arteritisThis study was performed to identify the risk factors for developing symptomatic vascular event during giant cell arteritis (GCA) because these are poorly known.We performed a retrospective study of GCA patients diagnosed over a 20-year-period, who all underwent vascular imaging evaluation at diagnosis.Patients with symptomatic vascular event (VE+) and without (VE-) were compared, and risk factors were identified in a multivariable analysis.Thirty-nine patients experienced at least one symptomatic vascular event during follow-up, with a median time of 21.5 months.Arterial hypertension, diabetes, lower limbs arteritis or vascular complication at diagnosis were significantly more frequent in VE+ patients, as an abnormal CT-scan at diagnosis, aortitis, particularly of the descending thoracic aorta and atheroma. Deaths were more frequent in the VE+ group.Among 254 GCA patients, 39 experienced at least one vascular event during follow-up.Aortic surgery, stroke, upper and lower limb ischemia were vascular event risk factors.Aortic atheroma and descending thoracic aorta aortitis on CT-scan were vascular event risk factors.This study on GCA cases with large vessels imaging at diagnosis, showed that aortic surgery, stroke, upper or lower limb ischemia, aortic atheroma and aortitis of the descending thoracic aorta on CT-scan, at GCA diagnosis, were independent predictive factors of a vascular event.
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Affiliation(s)
| | | | | | | | | | - Agathe Masseau
- Department of Internal Medicine, CHU Nantes, Nantes, France
| | | | | | - Chan Ngohou
- Department of Medical Information, Nantes University Hospital, Nantes, France
| | - François Perrin
- Department of Internal Medicine, Saint-Nazaire Hospital, France
| | - Julie Graveleau
- Department of Internal Medicine, Saint-Nazaire Hospital, France
| | - Cécile Durant
- Department of Internal Medicine, CHU Nantes, Nantes, France
| | - Pierre Pottier
- Department of Internal Medicine, CHU Nantes, Nantes, France
| | - Antoine Néel
- Department of Internal Medicine, CHU Nantes, Nantes, France
| | - Olivier Espitia
- Department of Internal Medicine, CHU Nantes, 1 place Alexis Ricordeau, Nantes, 44093, France
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