YERSINIA ENTEROCOUTICA AND MYCOTIC ANEURYSM

Abstract

A 55-year-old man presented to the emergency department with a 5-day history of lower back pain and fevers. On admission, the white cell count was 24.7 x IOY'L, erythrocyte sedimentation rate (ESR) was 116mmh and a computed tomography (CT) scan revealed a right lower pole renal mass and a 4-cm infrarenal abdominal aortic aneurysm (AAA). Blood cultures were taken and the patient started on gentamicin and ceftriaxone.Two days after admission a right nephrectomy was performed. Frozen-section study could not distinguish between a neoplastic or infective mass. The renal mass was contiguous with the aneurysm which was not resected due to the high degree of technical difficulty and the possibility that the invasive mass was neoplastic.One day later the aortic aneurysm ruptured and the patient returned to the operating theatre after massive transfusion and cardiopulmonary resuscitation. Antibiotics were changed to ticarcillin clavulanate and gentamicin. Postoperatively the patient was haemodynamically stable for several days but died as a result of haemorrhage. Yersinia enterocolitica serogroup 3 biotype 4 was isolated from the original blood cultures and also from intra-operative aortic and renal specimens. The final kidney histology was consistent with tubulo-papillary renal cell carcinoma and the aortic wall showed severe atheroma and calcification but no carcinoma.

Yersinia enterocolitica: a rare cause of infected aortic aneurysm successfully treated with antibiotics and endovascular repair

“…(Moneta et al, 1998). Y. enterocolitica is a rare cause of infected aortic aneurysm, with only 14 cases reported in the literature so far (Donald et al, 1996;Hagensee, 1994;Knudsen et al, 1993;La Scola et al, 1997;Mason et al, 2014;Mercie et al, 1996;Prentice et al, 1993;Tame et al, 1998;Van Noyen et al, 1987;Van Steen et al, 1989). To our knowledge, this is the first reported case of an aortic aneurysm infected with Y. entercolitica in New Zealand and only the second in Australasia (Tame et al, 1998).…”

“…However, with the rise of endovascular treatment options, more clinicians are opting to treat patients with endovascular insertion of a stent. The efficacy of this intervention, however, remains unproven and contentious (Kan et al, 2007(Kan et al, , 2010Razavi & Razavi, 2008), with many clinicians concerned that placing a prosthetic graft into an area of active infection will lead to persistent graft infection and further complications such as aortic rupture (Kan et al, 2007;Tame et al, 1998).…”

Yersinia enterocolitica in Italy: A Case of Septicemia and Abdominal Aortic Aneurysm Infection

“…There has been an increasing body of evidence showing that Y. enterocolitica serogroups O:3 and O:9 are a cause of mycotic aneurysm and septicaemia, mainly in males over 50 years, with risk factors for cardiovascular disease ( 10 , 14 ). Herein, we report a case of Y. enterocolitica serogroup O:9 (biogroup 2) septicemia in a patient with an AAA.…”

Y. enterocolitica and Y. pseudotuberculosis

“…Mycotic aneurysm due to Y. enterocolitica is a disease of middle aged and elderly men (Plotkin and O'Rourke, 1981;Tame et al, 1998) who in most cases have bacteremia without any of the above risk factors for systemic yersiniosis. Yersinia enterocolitica (particularly serogroup O:9; La Scola et al, 1997) may be a more common cause of mycotic aneurysm (Prentice et al, 1993) than other better-recognized vasculotrophic bacteria (Buckels et al, 1985) such as Salmonella and Brucella species.…”