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Zhang Y, Wang H, Bai L, Li X, Liu L, Wang L. Endovascular Repair and Prognosis of Patients with Brucella abortus Infection-Induced Aorto-Iliac Aneurysm. J Inflamm Res 2024; 17:2353-2363. [PMID: 38645876 PMCID: PMC11032661 DOI: 10.2147/jir.s450573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 04/09/2024] [Indexed: 04/23/2024] Open
Abstract
Objective To establish the endovascular repair and prognosis of patients with aorto-iliac aneurysm and Brucella abortus infection. Methods From September 2018 to September 2021, seven cases of Brucella abortus infection with aorto-iliac aneurysm were treated by the endovascular aneurysm repair (EVAR) procedure. Clinical and imaging data were collected to evaluate the therapeutic results, including body temperature, blood culture, imaging manifestations, stent patency and endoleak during the postoperative and follow-up periods. Results Except for one patient who died of acute hematemesis and hematochezia just after the admission, seven patients were treated successfully. The aneurysms were completely excluded, and all stent grafts were patent. Patients were followed up for 12-32 months, with an average follow-up of 18.5 ± 9.1 months. There were no cases of endoleak, infection recurrence, gluteal muscle ischemia or spinal cord ischemia during the follow-up period. Conclusion It is feasible to treat Brucella abortus-infected aneurysms with the EVAR procedure. The results were optimistic in the short and medium-term. The application of sensitive antibiotics before and after the operation is the cornerstone of endovascular therapy. However, the long-term results require further follow-up.
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Affiliation(s)
- Yujing Zhang
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, People’s Republic of China
| | - Haiqian Wang
- Department of Outpatient, General Hospital of Ningxia Medical University, Yinchuan, 750004, People’s Republic of China
| | - Lei Bai
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, People’s Republic of China
| | - Xiaodong Li
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, People’s Republic of China
| | - Li Liu
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, People’s Republic of China
| | - Liang Wang
- Department of Interventional Therapy and Vascular Surgery, Dongguan People’s Hospital, Dongguan, 523059, People’s Republic of China
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Li X, Li X, Cheng Z. Brucellosis involving the aorta and iliac arteries: a systematic review of 130 cases. Front Bioeng Biotechnol 2023; 11:1326246. [PMID: 38098968 PMCID: PMC10720085 DOI: 10.3389/fbioe.2023.1326246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/13/2023] [Indexed: 12/17/2023] Open
Abstract
Objective: Brucellosis, the most common bacterial zoonosis, poses a serious threat to public health in endemic regions. Cardiovascular complications of brucellosis, mostly pericarditis or endocarditis, are the leading cause of brucellosis-related death. Complications involving the aorta and iliac arteries are extremely rare but can be life-threatening. Our objective was to identify and review all reported cases of aortic and iliac involvement in brucellosis to provide a deep, up-to-date understanding of the clinical characteristics and management of the disease. Methods: Online searches in PubMed, Web of Science, China National Knowledge Infrastructure, and the Chinese Wanfang database were conducted to collect articles reporting cases of brucellosis with aortic and iliac artery involvement. All data in terms of patient demographics, diagnostic methods, clinical manifestations, and treatment regimens and outcomes were extracted and analyzed in this systematic review. Results: A total of 79 articles were identified, reporting a total of 130 cases of brucellosis with aortic and iliac artery involvement. Of the 130 cases, 110 (84.5%) were male individuals and 100 (76.9%) were over 50 years old. The patients had an overall mortality rate of 12.3%. The abdominal aorta was most commonly involved, followed by the ascending aorta, iliac artery, and descending thoracic aorta. Arteriosclerosis, hypertension, and smoking were the most common comorbidities. There were 71 patients (54.6%) who presented with systemic symptoms of infection at the time of admission. Endovascular therapy was performed in 56 patients (43.1%), with an overall mortality rate of 3.6%. Open surgery was performed in 52 patients (40.0%), with an overall mortality rate of 15.4%. Conclusion: Aortic and iliac involvement in brucellosis is extremely rare but can be life-threatening. Its occurrence appears to be associated with the male gender, an older age, arteriosclerosis, and smoking. Although the number of reported cases in developing countries has increased significantly in recent years, its incidence in these countries may still be underestimated. Early diagnosis and therapeutic intervention are critical in improving patient outcomes. Endovascular therapy has become a preferred surgical treatment in recent years, and yet, its long-term complications remain to be assessed.
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Affiliation(s)
- Xiao Li
- Department of Vascular Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, China
| | - Xiaoyu Li
- Department of Otolaryngology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Zhihua Cheng
- Department of Vascular Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, China
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Ma H, Yang Y, Liu H, Sun X, Li Y, Guo M. Brucella-infected abdominal aortic aneurysm: management strategies for an uncommon aneurysm. Front Med (Lausanne) 2023; 10:1271217. [PMID: 38020135 PMCID: PMC10652764 DOI: 10.3389/fmed.2023.1271217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Objective The occurrence of Brucella-induced abdominal aortic aneurysms is an exceedingly rare phenomenon, yet it stands as one of the most severe complications within this context. The combined utilization of serological testing and imaging diagnostics has been validated as an effective approach for the identification of Brucella-induced abdominal aortic aneurysms. Presently, the predominant therapeutic strategies encompass antibiotic treatment and surgical intervention. Nonetheless, ongoing controversies persist concerning the establishment of diagnostic criteria, the optimal timing and selection of antibiotic regimens, and the nuanced decision between open surgical procedures and endovascular interventions. Through a meticulous analysis of cases originating from our institution as well as a comprehensive review of previously documented instances, we aim to engage in a detailed discourse on the salient diagnostic and therapeutic facets surrounding Brucella-induced abdominal aortic aneurysms. Methods We conducted a retrospective summary of three cases involving Brucella-induced abdominal aortic aneurysms treated within our institution. Furthermore, we performed a comprehensive PubMed search, without imposing restrictions on language or publication year, to identify pertinent literature pertaining to Brucella-induced abdominal aortic aneurysms. The selection criteria primarily focused on case reports delineating occurrences of abdominal aortic aneurysms attributed to Brucella infection. Results We present three distinct cases of Brucella-induced abdominal aortic aneurysms managed at our institution, providing comprehensive insights into the employed diagnostic and therapeutic approaches. Additionally, over the past five decades, a total of 24 cases in 23 publications of Brucella-induced abdominal aortic aneurysms have been reported on PubMed. The earliest report dates back to 1976. Conclusion Our analysis suggests that Brucella-induced abdominal aortic aneurysm is characterized by a remarkably low incidence but is associated with a substantial risk of life-threatening complications. The integration of serological and imaging assessments assumes pivotal importance in facilitating prompt diagnosis of this condition. The prompt initiation of targeted antibiotic therapy is recommended, and the selection of appropriate surgical strategies should be guided by considerations including aneurysm dimensions and morphological attributes. The timely identification and intervention carry utmost significance in retarding disease advancement and ameliorating unfavorable clinical outcomes.
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Affiliation(s)
- Huibo Ma
- Department of Vascular Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yuling Yang
- Department of Infectious Diseases, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Huanhuan Liu
- Department of General Surgery, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Xiaozhi Sun
- Department of Vascular Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yongxin Li
- Department of Vascular Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Mingjin Guo
- Department of Vascular Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Eidt JF, Parrott ME, Gucwa AL, B Chu TH, Bettacchi C, Mb Musser J. The Role of Feral Swine in Human Aortic Infection With Brucella Species. Vasc Endovascular Surg 2023; 57:941-948. [PMID: 37313853 DOI: 10.1177/15385744231183786] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Brucellosis is one of the most common zoonotic infections in the world. Human infections are the result of direct exposure to infected animals or ingestion of unprocessed dairy products. While Brucella sp. infection has largely been eliminated from commercial cattle and swine with aggressive vaccination, there is a significant prevalence of Brucella sp. infection in the expanding population of feral swine in the US. We report the surgical treatment of a ruptured mycotic aneurysm of the abdominal aorta due to Brucella suis in a woman living in a rural community with a large population of feral swine. Vascular surgeons should be aware that brucellosis can result in arterial infection and should be considered in the differential diagnosis in patients with a history of exposure to feral swine or the ingestion of unprocessed dairy products.
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Affiliation(s)
- John F Eidt
- Baylor Scott and White Heart and Vascular Hospital, Texas A&M Health Science University, Dallas, TX, USA
| | - Megan E Parrott
- General Surgery Residency Program, Baylor University Medical Center, Dallas, TX, USA
| | - Angela L Gucwa
- Doctors Community Medical Center, Luminis Health, Annapolis, MD, USA
| | - Tuan-Hung B Chu
- Baylor Scott and White Heart and Vascular Hospital, Texas A&M Health Science University, Dallas, TX, USA
| | - Chris Bettacchi
- North Texas Infectious Disease Consultants, Division of Infectious Disease, Baylor University Medical Center, Dallas, TX, USA
| | - Jeffrey Mb Musser
- Department of Veterinary Pathobiology, Texas A&M University College of Veterinary Medicine, College Station TX, USA
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Jiang J, Shao W, Shen S, Li G, Liu Y, Ding X, Su Q. Endovascular Stent Graft Repair for Mycotic Aorto-Iliac Aneurysm Due to Brucella. J Endovasc Ther 2023:15266028231155139. [PMID: 36802851 DOI: 10.1177/15266028231155139] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
PURPOSE Brucella aneurysms are very rare but life-threatening, and a standard treatment approach has yet to be established. The current study aimed to assess the safety and efficacy of endovascular treatment for Brucella aneurysms. MATERIALS AND METHODS The clinical data of 15 Brucella aortic-iliac aneurysm patients who underwent endovascular repair at 2 hospitals from January 2012 to December 2021 were retrospectively collected and analyzed. RESULTS Fifteen patients (12 men and 3 women) with a mean age of 59.3 years were included. Fourteen patients (93.3%) had a history of exposure to animals (cattle and sheep). All patients had aortic or iliac pseudoaneurysms, 9 abdominal aortic aneurysms (AAAs), 4 iliac aneurysms, and 2 AAA combined with iliac aneurysms. Endovascular aneurysm repair (EVAR) was performed in all patients without conversion to open surgery. Six cases were treated for emergency surgery due to aneurysm rupture. The immediate technique success rate was 100%, with no postoperative death. Two cases had the iliac artery ruptured again after operation because of lack of antibiotic treatment and was given endovascular treatment again. Once brucellosis is diagnosed, antibiotic treatment with doxycycline and rifampicin was initiated for all the patients until 6 months after operation. All patients survived over a median follow-up period of 45 months. Follow-up computed tomography angiography showed that all stent grafts remained patent, with no endoleak. CONCLUSION EVAR combined with antibiotics treatment is feasible, safe, and effective for Brucella aneurysms and represents a promising treatment option for these Brucella aneurysms. CLINICAL IMPACT Brucella aneurysms are very rare but life-threatening, and a standard treatment approach has yet to be established. The traditional operation management strategy is surgical resection and debridement of the infected aneurysm and the surrounding tissues. However, open surgical management in these patients causes severe trauma with high surgical risks and mortality (13.3%-40%). We tried to treat Brucella aneurysms with endovascular therapy, and the technique success and survival rate of the operation reached 100%. EVAR combined with antibiotics treatment is feasible, safe, and effective for Brucella aneurysms and represents a promising treatment option for some mycotic aneurysms.
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Affiliation(s)
- Jianjun Jiang
- Department of Vascular Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Wenchong Shao
- Department of Vascular Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Shuohao Shen
- Department of Vascular Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Guangzhen Li
- Department of Vascular Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Yang Liu
- Department of Vascular Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Xiangjiu Ding
- Department of Vascular Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Qingbo Su
- Department of Vascular Surgery, Qilu Hospital of Shandong University, Jinan, China
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Perry J, Alslaim H, Agarwal G. Brucella aortitis managed with debridement, extra-anatomical bypass, and long-term antimicrobial therapy. Vascular 2023; 31:178-181. [PMID: 34854325 DOI: 10.1177/17085381211058572] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This report aims to review the management and outcomes of Brucella-associated mycotic aortic aneurysms. METHODS This is a retrospective chart review at a tertiary-level healthcare system. IRB approval was waived per policy. RESULTS We describe a case of Brucella aortitis acquired from habitual contact with wild hogs. Clinical presentation included lower back pain and elevated white blood cell count. Diagnosis was confirmed with imaging showing an infrarenal abdominal aortic aneurysm and serology revealing elevated Brucella antibodies titers. The patient was initially managed with endovascular aortic repair and combined oral and intravenous antibiotics therapy. He then underwent explanation and extra-anatomical bypass due to symptomatic periaortic infection and interval development of type I endoleak. The patient was asymptomatic after his final operation at 24 months of follow-up and remained on suppressive oral antibiotic therapy. CONCLUSIONS An aortic aneurysm secondary to Brucella is a rare entity. A detailed history of long-term exposure to animals may be a clue to obtain serologic testing. Operative debridement and re-establishing of reliable blood flow combined with long-term antibiotic suppression are the mainstay of treatment.
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Affiliation(s)
- John Perry
- Division of Vascular and Endovascular Surgery, Department of General Surgery, 2569Cleveland Clinic Lerner College of Medicine of Case, Western Reserve University, Cleveland, OH, USA
| | - Hossam Alslaim
- Division of Vascular and Endovascular Surgery, Department of Surgery, 1421Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Gautam Agarwal
- Division of Vascular and Endovascular Surgery, Department of Surgery, 1421Medical College of Georgia at Augusta University, Augusta, GA, USA
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7
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Wang L, Wang Y, Ma T, Yuan J, Wang H, Ren Y, Zhang J. Brucella Infectious Aneurysm: A Retrospective Study of 14 Cases and Review of the Literature - Case Report and Literature Review. Infect Drug Resist 2023; 16:87-104. [PMID: 36636379 PMCID: PMC9830056 DOI: 10.2147/idr.s393060] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/16/2022] [Indexed: 01/07/2023] Open
Abstract
Objective To analyze the clinical characteristics and treatment process of 14 patients with aneurysm due to brucellosis, summarize the morbidity characteristics, and improve the knowledge and diagnosis of the disease. Methods The clinical data of patients with aneurysms who were diagnosed to have brucellosis through Rose Bengal Test (RBT), Serum Agglutination Test (SAT), blood culture, and computed tomography angiography from January 2012 to November 2022 in Bethune Hospital, Shanxi Province, China, were retrospectively analyzed, and their clinical characteristics and disease regression findings were summarized. Results Of the 14 patients, 13 were men, and 1 was a woman; the youngest patient was 48-year-old, and the oldest patient was of 74 years. All had a history of smoking. The sites of lesion occurrence included the abdominal aorta (5 patients), abdominal aorta +iliac artery (5 patients), iliac artery (2 patients), thoracic aorta and brachial artery were less common (1 case each). Symptoms in the patients mostly began with abdominal pain, which was accompanied by fever, nausea, and vomiting. Six patients had a clear history of livestock exposure. Fourteen patients showed elevated D-dimer and C-reactive protein levels and decreased hemoglobin and albumin levels. Thirteen of the 14 cases were treated surgically, there were no complications of surgery, and 3 patients were readmitted with recurrence of brucellosis, it is related to the treatment that did not reach the early stage, combination, full dose and full course of treatment, with a mean recurrence time of 8 months. In the telephone follow-up, the patient's recovery proceeded well. Conclusion The present study revealed that the recurrence in male gender, advanced age, smoking and irregular treatment is higher. On the contrast, early intervention, a combination of adequate course of anti-infection treatment and timely surgery can improve the prognosis.
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Affiliation(s)
- Lin Wang
- Department of Infection, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, People’s Republic of China
| | - Yan Wang
- Department of Infection, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, People’s Republic of China,Correspondence: Yan Wang, Department of Infection, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, People’s Republic of China, Tel +8613513635015, Email
| | - Tongqiang Ma
- Department of Vascular Surgery, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, People’s Republic of China
| | - Jianwei Yuan
- Department of Infection, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, People’s Republic of China
| | - Hongxia Wang
- Department of Infection, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, People’s Republic of China
| | - Yuan Ren
- School of Public Health, Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Jianwei Zhang
- Department of Infection, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, People’s Republic of China
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Aortic and iliac involvement in brucellosis –a rare but life-threatening manifestation: A review of the literature. Eur J Vasc Endovasc Surg 2022; 63:743-750. [DOI: 10.1016/j.ejvs.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 01/14/2022] [Accepted: 02/06/2022] [Indexed: 11/18/2022]
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9
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Li S, Wang Q. Brucellosis relapse causing thoracic aortic ulcers and aneurysm formation: a case report. BMC Infect Dis 2022; 22:43. [PMID: 35012454 PMCID: PMC8751343 DOI: 10.1186/s12879-021-07005-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 12/22/2021] [Indexed: 01/18/2023] Open
Abstract
Background Brucellosis is an infectious disease caused by Brucella spp, which can involve the cardiovascular, digestive, and respiratory systems. Cardiovascular involvement is a rare occurrence, it has an extremely high mortality rate. Case presentation A 67-year-old Chinese man presented with thoracic aortic multiple ulcers and partial aneurysm formation that caused symptoms of left waist and left buttock pain. The man was admitted to our hospital due to abdominal aorta pseudoaneurysms 5 years ago. The diagnosis was made by thoracic computed tomography angiography (CTA), previous history, and positive culture of Brucella, and the patient was successfully treated by thoracic aortic covered stent-graft implantation and specific medical treatment. Conclusions People who have a history of contact with cattle and sheep, should beware of the possibility of Brucella infection. If chest and abdominal pain occur, timely medical treatment is recommended, aortic aneurysm, the disease with a high risk of death, can be identified or excluded by CTA. Early treatment and prevention of disease progression are more beneficial to patients.
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Affiliation(s)
- Shuai Li
- Department of Infectious Disease, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Qiang Wang
- Department of Infectious Disease, Shanxi Provincial People's Hospital, Taiyuan, China.
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Rapidly Growing Aneurysm with Ulcer-like Projection Complicated with Bacteroides ovatus Bacteremia. REPORTS 2021. [DOI: 10.3390/reports4030028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The incidence of anaerobic bacteremia has been increasing over the past several decades. Further, antibiotic resistance in Bacteroides is a pertinent issue. A 76-year-old man was brought to our hospital with complaints of fever, chills, and abdominal pain. Empiric antibiotics induced minimal relief. The blood culture was positive for multi-drug resistant Bacteroides ovatus. Our patient developed a periaortic abscess in the abdominal aorta and a thoracic aortic aneurysm with ulcer-like projection (ULP), which rapidly increased in size. He was transferred to the tertiary medical institution for surgical drainage. This case suggests that bacteremia can exacerbate aneurysms with ulcerative lesions. Anaerobic bacteremia is a possible differential diagnosis when periaortic abscess formation is present. Early surgical consultation and appropriate antibiotic selection are crucial in anaerobic bacteremia treatment.
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11
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Willems SA, Buntinx M, Gelinck LBS, van Schaik J, Eefting D. Ruptured Aneurysm of the Common Iliac Artery Caused by Brucella melitensis: A Case Report. EJVES Vasc Forum 2021; 52:26-29. [PMID: 34382029 PMCID: PMC8339252 DOI: 10.1016/j.ejvsvf.2021.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/16/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Brucella is a genus of aerobic Gram negative bacteria that causes the disease brucellosis. It is considered a zoonotic infection transmitted to humans by ingestion of unpasteurised dairy products. Although aortic involvement is rarely seen, it can be a life threatening complication of this disease. This case report describes a ruptured aneurysm of the common iliac artery (CIA) due to secondary infection by Brucella melitensis. Report A 79 year old man with a known isolated aneurysm of the CIA presented with acute abdominal pain. Contrast enhanced computed tomography (CT) revealed rupture of the aneurysm. The patient underwent prompt endovascular repair. Several weeks after an uneventful recovery, the patient presented with spiking fever and abdominal discomfort. CT revealed an abscess anterior to the CIA. Blood and pus cultures grew B. melitensis. In recurrent re-admissions, conservative antibiotic therapy proved to be insufficient. Eventually, neo-aorto-iliac system (NAIS) reconstruction using bilateral femoral veins was performed to provide definitive treatment four months after initial presentation. Conclusion Although Brucella infected aneurysms are rare, they are associated with life threatening disease. Diagnosing this type of brucellar infection can be challenging owing to the long incubation time needed for blood and tissue cultures. Definitive treatment of these aneurysms often needs open surgery and antibiotics for complete treatment. Vigilant surveillance is required to monitor for post-operative complications such as graft infection, recurrent (false) aneurysm, and abscess formation. Brucella species are a genus of aerobic Gram negative bacteria. Infected aneurysms caused by Brucella species are rare. Although rare, this clinical condition is associated with life threatening disease. Treatment consists of open surgery combined with antibiotic therapy. Endovascular procedures can be used as bridge to surgery or as palliative therapy.
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Affiliation(s)
- Siem A Willems
- Department of Surgery, Haaglanden Medical Centre, The Hague, The Netherlands
| | - Maren Buntinx
- Department of Surgery, Haaglanden Medical Centre, The Hague, The Netherlands
| | - Luc B S Gelinck
- Department of Internal Medicine, Haaglanden Medical Centre, The Hague, The Netherlands
| | - Jan van Schaik
- Department of Vascular Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Daniël Eefting
- Department of Surgery, Haaglanden Medical Centre, The Hague, The Netherlands.,Department of Vascular Surgery, Leiden University Medical Centre, Leiden, The Netherlands
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Culture-Negative Mycotic Aortic Aneurysms Probably Have a Less Severe Clinical Nature Than Culture-Positive Counterparts. Ann Vasc Surg 2021; 75:150-161. [PMID: 33831517 DOI: 10.1016/j.avsg.2021.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/14/2021] [Accepted: 03/01/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Mycotic aortic aneurysm constitutes a potentially devastating disease that necessitates prompt suspicion and diagnosis. There is no exact consensus for treatment, but removal of infected tissues and prolonged use of antimicrobials based on the identified causative microorganisms seem widely acceptable and have been similarly practiced worldwide. However, some patients still show no identified microorganisms. In this study, we sought to determine whether there are any clinical significance or differences of note in culture-negative mycotic aortic aneurysms. METHODS Between October 2003 and August 2018, 71 patients were identified as treated for mycotic aortic aneurysms at a single tertiary institution. Review of medical records and imaging studies were completed to collect the following information: demographics, previous medical/surgical history regarding potential infection sources, laboratory and radiologic findings, clinical presentations, treatment method, and morbidity and mortality rates. For analysis, patients were categorized into two groups: the blood and/or tissue culture-positive (CP) group and the blood and/or tissue culture-negative (CN) group. The latter was further divided as CN with identified microorganism by molecular biologic methods [CN(+)] and CN with no identified microorganism [CN(-)]. RESULTS More patients in the CP group were symptomatic than were in the CN(+) group (100% vs. 80%; P = 0.034). However, identification of causative microorganisms did not result in a difference in symptom status upon comparing the [CP + CN(+)] and [CN(-)] groups. Inflammatory markers were the most elevated in the CP group and least elevated in the CN(-) group. The aneurysm growth rate seemed slower in the CN(-) group than in the CN(+) and CP groups (1.3 vs. 3.4 vs. 9 mm/month respectively). Aneurysm rupture at initial presentation was more prevalent in the CP group (33.3%). 18F-Fluorodeoxyglucose-positron emission tomography showed increased uptake regardless of whether or not the microorganisms were identified. Early mortality and disease-specific mortality rates during the follow-up period were higher in the CP group but without statistical significance. CONCLUSIONS Compared with the CP group, the CN groups appeared clinically less severe, and also exhibited a relatively less devastating course as exhibited by the slower aneurysm expansion rate and smaller number of ruptured aneurysms at the initial presentation.
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13
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Alsheef M, Alsaleh S, Alanezi N, Bakhsh N, AlDosary R, AlSharif L, Mian A, Ahsan A, AlFayyad I. Descending Thoracic Aortic Aneurysm due to Brucella melitensis. Case Rep Infect Dis 2019; 2019:4939452. [PMID: 31662924 PMCID: PMC6778929 DOI: 10.1155/2019/4939452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 08/14/2019] [Indexed: 11/17/2022] Open
Abstract
Brucellosis is an endemic infection mainly in the Middle East and the Mediterranean region that can involve any system. However, cardiovascular involvement commonly seen as endocarditis is a rare occurrence, but it is one of the main causes of mortality and morbidity. Brucella mycotic aneurysms are extremely rare and carry a higher morbidity and mortality. Here, we present a case of Brucella mycotic aneurysms in the descending aorta complicated by an aortoesophageal fistula in a 52-year-old diabetic man. The diagnosis was made by thoracic CT angiogram showing a saccular aneurysm arising from the descending aorta and two positive cultures of Brucella melitensis. Transthoracic and transesophageal echocardiograms ruled out infective endocarditis. Aortoesophageal fistula complicating a Brucella mycotic aneurysm in the absence of evidence of endocarditis has not yet been reported in the literature.
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Affiliation(s)
- Mohammed Alsheef
- Department of Internal Medicine, King Fahad Medical City, P.O. Box 59046, Riyadh 11525, Saudi Arabia
| | - Saud Alsaleh
- King Fahad Medical City, P.O. Box 604, Riyadh 11321, Saudi Arabia
| | - Nahar Alanezi
- Department of Internal Medicine, King Fahad Medical City, P.O. Box 59046, Riyadh 11525, Saudi Arabia
| | - Nizar Bakhsh
- Department of Internal Medicine, King Fahad Medical City, P.O. Box 59046, Riyadh 11525, Saudi Arabia
| | - Rana AlDosary
- Department of Internal Medicine, King Fahad Medical City, P.O. Box 59046, Riyadh 11525, Saudi Arabia
| | - Lina AlSharif
- Department of Internal Medicine, King Fahad Medical City, P.O. Box 59046, Riyadh 11525, Saudi Arabia
| | - Arshad Mian
- Department of Internal Medicine, King Fahad Medical City, P.O. Box 59046, Riyadh 11525, Saudi Arabia
| | - Azeem Ahsan
- Infectious Disease, King Fahad Medical City, P.O. Box 59046, Riyadh 11525, Saudi Arabia
| | - Isamme AlFayyad
- Research Center, King Fahad Medical City, P.O. Box 59046, Riyadh 11525, Saudi Arabia
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14
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Wang M, Zhu Q, Yang Q, Li W, Wang X, Liu W, Zhou B, Li Z, Yang H. Intestinal brucellosis associated with celiac artery and superior mesenteric artery stenosis and with ileum mucosa and submucosa thickening: A case report. Medicine (Baltimore) 2017; 96:e5893. [PMID: 28079834 PMCID: PMC5266196 DOI: 10.1097/md.0000000000005893] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
RATIONALE Brucellosis is a multisystem infection found worldwide that has a broad range of characteristics, which range from acute fever and hepatomegaly to chronic infections that most commonly affect the central nervous system, cardiovascular system, or skeletal system. Gastrointestinal and splanchnic artery involvements in brucellosis are relatively uncommon. PATIENT CONCERNS We report a case of brucellosis in an adolescent presenting as intermittent abdominal pain, diarrhea, and fever, with intestinal tract involvement. And stenosis of the celiac artery and the superior mesenteric artery was found after exposed to risk factors of Brucella infection. Splanchnic vessels stenosis and an endothelial lesion may exacerbate the prevalent symptom of abdominal pain, as a form of colic pain, occurring after eating. DIAGNOSES The patient was diagnosed as brucellosis. The narrowing of the SMA and CA was suspected to be vasculitis secondary to the brucellosis. INTERVENTIONS The patient was treated with minocycline and rifampicin for 12 weeks totally. OUTCOMES The gastrointestinal manifestations of brucellosis recovered rapidly under intensive treatment. However, follow-up imaging revealed that the superior mesenteric artery and celiac artery stenosis was unimproved. LESSONS In brucellosis, gastrointestinal manifestations may be the only observable features of the disease. Splanchnic arterial stenosis is a rare complication of brucellosis. Sonography and computed tomography may be useful for both diagnosis and follow-up.
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Affiliation(s)
- Miaoqian Wang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences
| | - Qingli Zhu
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences
| | - Qian Yang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences
| | - Wenbo Li
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences
| | | | - Wei Liu
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences
| | - Baotong Zhou
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences
| | - Zhenghong Li
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences
| | - Hong Yang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences
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15
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Alhaizaey A, Alassiri M, Alghamdi M, Alsharani M. Mycotic aortic aneurysm due to brucellosis. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2016; 2:50-52. [PMID: 31193364 PMCID: PMC6526309 DOI: 10.1016/j.jvsc.2016.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 03/23/2016] [Indexed: 11/17/2022]
Abstract
Brucellosis is a multisystem zoonotic disease. Mycotic aneurysm due to Brucella is rare and has no clear management approach. Here, we present two cases of mycotic aortic aneurysm due to Brucella. The first patient was treated with surgical resection of a symptomatic infrarenal abdominal aortic aneurysm combined with lifelong doxycycline and rifampicin. The second patient improved with conservative treatment including a 6-month course of antibiotics and regular clinical and radiologic monitoring. Through these cases, we hope to draw attention to this serious adverse effect of Brucella and the importance of management of its local arterial complications, especially in endemic areas.
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Affiliation(s)
- Abdullah Alhaizaey
- Division of Vascular Surgery, Aseer Central Hospital, King Khalid University, Abha, Saudi Arabia
| | - Mohammed Alassiri
- Division of Vascular Surgery, Aseer Central Hospital, King Khalid University, Abha, Saudi Arabia
| | - Musaed Alghamdi
- Division of Vascular Surgery, Aseer Central Hospital, King Khalid University, Abha, Saudi Arabia
| | - Mushabab Alsharani
- Division of Vascular Surgery, Aseer Central Hospital, King Khalid University, Abha, Saudi Arabia
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