Infectious Aortitis: A Life-Threatening Endovascular Complication of Nontyphoidal Salmonella Bacteremia

Abstract

A 65-year-old Japanese man living in the United States presented with pyrexia and chills associated with intermittent lower abdominal and back pain for 5 days. He denied recent travel, rash, diarrhea, or rectal bleeding. Physical examination revealed spiking pyrexia, and routine laboratory tests revealed mild leukocytosis and neutrophilia. Abdominal CT with contrast showed findings highly compatible with aortitis. Comprehensive autoimmune evaluation was negative. Salmonella enterica serotype Enteritidis was isolated from blood cultures. IV antibiotics were administered, but the patient continued to experience low-grade pyrexia and mild leukocytosis, and follow-up abdominal CT showed progressive aortic inflammation. The patient therefore underwent resection of the affected aortic segment with in-situ graft replacement and lifelong suppressive antibiotics. The patient is asymptomatic with no complications at 18 weeks of follow-up. This case report illustrates that patients with infectious aortitis from nontyphoidal Salmonella may (1) present with nonspecific and nonlocalizing symptoms and signs except for sepsis; (2) have diagnostic blood cultures and abdominal CT findings; and (3) typically require aggressive, prolonged IV antibiotic therapy and surgery for potential cure of this life-threatening infection.

Salmonella Aortitis in an Elderly Male, a Rare but Deadly Cause of Abdominal Pain: A Case Report

“…4,6 Infectious causes are particularly rare, but early identification is critical given a mortality rate approaching 100% without surgical intervention. [1][2][3] Pathogens involved in infectious aortitis are Staphylococcus aureus (the most common,) non-typhoidal salmonella as seen in our patient, Streptococcus pneumonia, and group A streptococcus. Less common infectious causes include tuberculosis and syphilis.…”

“…Mortality rates approach 100% without surgical intervention. [1][2][3] Symptoms are frequently vague and include abdominal and back pain, fevers, vomiting, and diarrhea. An initial workup in the emergency department (ED) using computed tomography (CT) with intravenous (IV) contrast may not be adequate to make the diagnosis.…”

Iron-Uptake Systems of Chicken-Associated Salmonella Serovars and Their Role in Colonizing the Avian Host

“…Data related to epidemiology has been obtained from a variety of published case reports and outbreak analysis. [ 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 ].…”

Correlation between Pathogenic Determinants Associated with Clinically Isolated Non-Typhoidal Salmonella

“…The pathogen utilizes a large variety of virulence factors, including plasmid virulence genes, cell surface structure, flagella proteins, and pathogenicity islands (SPIs) to trigger disease by invading the host and escaping host defenses [ 15 , 16 ]. Salmonella is recognized to bind to host cell targets, to be engulfed, and to migrate through the host blood or lymphatic circulatory systems, resulting in bacteremia, septicemia, more complicated forms of the disease [ 17 , 18 , 19 ] and long-lasting carriage [ 20 ]. To invade a host cell, Salmonella injects invasion signaling molecules through the type III secretion system encoded by the SPI-1 which, in turn, activate the host cell signaling pathways that lead to the internalization of the pathogen and, subsequently, the reconstruction of the cytoskeleton actin protein [ 19 , 21 ].…”