Infected aortic aneurysm caused by Helicobacter cinaedi: case series and systematic review of the literature

Abstract

Background Helicobacter cinaedi is rarely identified as a cause of infected aneurysms; however, the number of reported cases has been increasing over several decades, especially in Japan. We report three cases of aortic aneurysm infected by H. cinaedi that were successfully treated using meropenem plus surgical stent graft replacement or intravascular stenting. Furthermore, we performed a systematic review of the literature regarding aortic aneurysm infected by H. cinaedi. Case presentation We present three rare cases of infected aneurysm caused by H. cinaedi in adults. Blood and tissue cultures and 16S rRNA gene sequencing were used for diagnosis. Two patients underwent urgent surgical stent graft replacement, and the other patient underwent intravascular stenting. All three cases were treated successfully with intravenous meropenem for 4 to 6 weeks. Conclusions These cases suggest that although aneurysms infected by H. cinaedi are rare, clinicians should be aware of H. cinaedi as a potential causative pathogen, even in immunocompetent patients. Prolonged incubation periods for blood cultures are necessary for the accurate detection of H. cinaedi.

Determining Infected Aortic Aneurysm Treatment Using Focused Detection of Helicobacter cinaedi

“…Infected aortic aneurysms caused by H. cinaedi are increasingly being recognized, especially in Japan, although the detection rate remains low ( 3 ). One study reported 734 cases of infected aortic aneurysms caused by various organisms, including Salmonella , Staphylococcus , Streptococcus , and Escherichia coli , but not H. cinaedi ( 1 ).…”

“…Because nonsurgical treatment has been shown to be effective, open surgery during the acute phase of infection might be overindicated. Endovascular stent grafting, a less invasive treatment than the standard vascular replacement procedure, followed by use of appropriate antimicrobial agents might successfully complete treatment ( 3 ). This treatment is beneficial among aging patients, and it is hoped that the presence of these bacteria in infected aortic aneurysms will be widely recognized, with treatment and diagnosis proceeding simultaneously.…”

“…Moreover, determining surgical treatment in each case requires carefully considering the causative bacterium and the patient’s medical background ( 2 ). Recently, several cases of infected aortic aneurysms caused by Helicobacter cinaedi , a rare, difficult-to-detect causative bacterium have been reported ( 3 ).…”

Aneurisma infeccioso primário da aorta: série de casos e revisão da literatura

“… 2 The following etiologic agents have been reported: gram-positive bacteria such as Staphylococcus sp. , 2 , 4 , 6 - 8 , 11 , 14 , 19 Enterococcus sp. , 11 Streptococcus sp.…”

“…, 11 Streptococcus sp. 2 , 8 , 11 , 18 , 19 and Clostridium sp. , 11 and gram-negative bacteria such as Salmonella sp.…”