Mycotic (Bacterial) Aneurysms of Intravascular Origin

Stengel, Alfred; Wolferth, Charles C.

doi:10.1001/archinte.1923.00110160074005

Cited by 221 publications

(81 citation statements)

References 3 publications

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“…This last patient was the only death occurring in our group due to postoperative mediastinitis (Table 11). (Shnider and Cotsonas, 1954;Stengel and Wolferth, 1923). Infective endocarditis today affects older people (Bayliss c' t al., 1983) and more recent series include patients over 50 or 60 years (Patel and Johnston, 1977;O'Connor PI al., 1972).…”

Section: Resultsmentioning

confidence: 99%

“…A high incidence of multiple aneurysms has been described (Stengel and Wolferth, 1923) occurring in 491217 (23%) cases, especially in aorta, middle cerebral artery, other intrxranial arteries, femonl artery, coronary,…”

Section: Discussionmentioning

confidence: 99%

“…Several mechanisms may be operating in their genesis (Nakata et al, 1968;Stengel and Wolferth, 1923;Weinstein, 1980;Wilson ef al., 1981): direct bacterial invasion of the arterial wall, embolic occlusion, and sterile infarction of the vasa vasorum, injury due to deposition of immune complexes. Experimental evidence supports the concept that disturbance of vasa vasorum may be a fundamental step in relation to bacteremia (Nakata et al, 1968).…”

Section: Introductionmentioning

confidence: 99%

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Extracranial mycotic aneurysms in infective endocarditis

Mansur

Grinberg

Leão

et al. 1986

Clinical Cardiology

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Nine of 217 (4.15%) patients with infective endocarditis who were followed from October 1978 to February 1984 had extracranial mycotic aneurysms (MA). Age range of patients was 6–43 years (mean of 24.8 years) and 7 were male. Etiologic agents were Streptococcus viridans (3 cases), Staphylococcus aureus (2 cases), Staphylococcus epidermidis (1 case), and Pseudomonas aeruginosa (1 case). Two patients had negative blood cultures. The MA involved the arteries of the limbs (5 cases), thoracic (3 cases), and abdominal (1 case) arteries. The diagnosis was made by means of physical examination (5 cases), chest roentgenogram (2 cases), ultrasound examination (1 case), and aortography (1 case), at hospital admission (2 cases), early or before antibiotic therapy (2 cases), and from two days to six months after finishing antibiotic therapy (5 cases). All but one patient were operated upon due to MA; bleeding occurred in three cases; surgery was an emergency procedure in one case and performed from 8 to 58 days after the diagnosis of the MA in the others. Signs of infection at surgery were found in one case. In the others, further antibiotic therapy was not administered. There were no limb losses in the peripheral MA. Four patients received surgical treatment for endocarditis. There was one in‐hospital death and another one 6 months later due to heart failure.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Extracranial mycotic aneurysms in infective endocarditis

Mansur

Grinberg

Leão

et al. 1986

Clinical Cardiology

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“…Most have been associated with Staphylococcus aureus, Salmonella species, Streptococcus pneumoniae, viridans group streptococci, and various Gram-negative species (4)(5)(6)(7)(8). In adults, both abdominal and thoracic aorta (usually atherosclerotic) infections have most commonly been reported (9-11).…”

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Extra-Aortic Mycotic Aneurysm Due to Group A Streptococcus after Pharyngitis

et al. 2013

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Mycotic aneurysms, especially outside the aorta, are uncommon, with group A Streptococcus a particularly rare cause. We report a case of extra-aortic mycotic aneurysm following a sore throat without demonstrable bacteremia where identification of the pathological organism was made by molecular diagnostic techniques after a standard laboratory culture was negative.A 58-year-old man was transferred to a tertiary vascular center from a district hospital. Ten days before admission, he had consulted his general practitioner because of a sore throat and was found to have an erythematous throat with tender cervical lymphadenopathy on examination. He was given a 7-day course of phenoxymethylpenicillin at 500 mg four times a day, but a throat swab was not taken at the time. Three days before admission, he had developed pain in his left groin, which increased in intensity and progressed to involve the thigh and left side of his abdomen. On the day of admission, anesthesia in the area innervated by the left anterior femoral cutaneous nerve and some mild left leg weakness had developed, impeding his mobility.His medical history included pancreatitis with a laparotomy for a suspected pseudocyst and laparoscopic cholecystectomy. Regular medication included omeprazole for long-standing gastritis. He was a former smoker for 5 years; gave up drinking alcohol several years ago, having consumed above-average amounts; and worked as a horticulturist.On examination on arrival, his temperature was 36.7°C, his blood pressure was 120/70 mmHg, and his pulse rate was 95 beats/ min. Generally, he appeared well with no abnormalities of the heart sounds and a clear respiratory examination on auscultation. Abdominal palpation revealed mild tenderness in the left iliac fossa with no evidence of peritonitis. Examination of the left groin identified a pulsatile, expansile mass, with a weak popliteal pulse and absent left posterior tibial and dorsalis pedis pulses, but the foot was warm and well perfused. Motor and sensory examination of the left lower limb revealed Medical Research Council grade 4 to 5 power throughout and mild paresthesia in the area innervated by the anterior femoral cutaneous nerve.Laboratory testing showed a leukocytosis of 15.6 ϫ 10 9 cells/ liter 3 and a C-reactive protein level of 331 mg/liter (normal range, Ͻ5 mg/liter). A computed tomography (CT) scan showed a very large left retroperitoneal hematoma (Fig. 1) displacing the left kidney anteriorly and originating from and contiguous with a large pseudoaneurysm (47 by 35 by 44 mm) at the common femoral artery bifurcation (Fig. 2). The femoral artery was not aneurysmal on a CT scan performed 9 months previously for suspected cholecystitis.He was commenced on intravenous amoxicillin-clavulanic acid at 1.2 g three times a day and underwent an emergency bypass from the left external iliac artery to the superficial femoral artery with an expanded polytetrafluoroethylene graft with ligation of the common and superficial femoral and profunda femoris arteries, reimplantation of t...

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“…o aneurisma micótico pode ser causado por vários agentes infecciosos, mas geralmente ocorre associado a endocardite bacteriana subaguda, sendo raro nas septicemias de outras origens 4 » 6 ' 21 .…”

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Múltiplos aneurismas micóticos intracranianos: registro de um caso

Valadares¹,

Souza²,

Hankinson³

et al. 1979

Arq. Neuro-Psiquiatr.

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Aneurisma micótfco é uma dilatação sacular em vaso sangüíneo causada por um agente infeccioso.Sua incidência é difícil de ser estimada, variando, segundo alguns autores, em torno de 2.5 a 6.2% entre os aneurismas cerebrais 12,16,20. o aneurisma micótico pode ser causado por vários agentes infecciosos, mas geralmente ocorre associado a endocardite bacteriana subaguda, sendo raro nas septicemias de outras origens 4 » 6 ' 21 .Tal associação poucas vezes oferece oportunidade para diagnóstico precoce, normalmente feito após a ocorrência de hemorragia subaracnoídea, freqüentemente fatal.Recentemente tratamos uma paciente com múltiplos aneurismas micóticos, no curso de uma endocardite bacteriana subaguda, causada por Staphylococus aureus.Sintomas gerais de infecção, sopro cardíaco, lesões dermatológicas típicas de embolização periférica, sinais de irritação meníngea e a presença de hematoma intracerebral diagnosticado mediante tomografia axial computorizada, permitiram o diagnóstico clínico antes do estudo angiográfico. Acreditamos que o diagnóstico precoce em muito facilitou o manuseio clínico do caso, permitindo de imediato a instituição de tratamento apropriado e melhor plano de investigação radiológca. OBSERVAÇÃO L.M., 31 anos, sexo feminino, solteira, estudante, internada em 4-06-1978, encontrava-se em perfeito estado de saúde até 15 dias antes de sua admissão, quando começou a sentir moderada cefaléia e dores generalizadas pelo corpo. Ao ser assistida por um clínico geral, foram prescritos repouso, analgésicos e tetraciclina. Após melhora inicial, a sintomatologia retornou ao final de 5 dias, acompanhada por queda do estado geral, palidez e febre.De imediato foi internada em hospital de Clínica Médica. Na ocasião, o exame físico evidenciou paciente emagrecida, pálida, prostrada, febril (temp, axilar 38.9 C), desorientada no tempo e espaço e com rigidez de nuca. Pressão arterial 160/80mmHg; pulso lOObpm.A paciente não mencionava qualquer

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Mycotic (Bacterial) Aneurysms of Intravascular Origin

Cited by 221 publications

References 3 publications

Extracranial mycotic aneurysms in infective endocarditis

Extracranial mycotic aneurysms in infective endocarditis

Extra-Aortic Mycotic Aneurysm Due to Group A Streptococcus after Pharyngitis

Múltiplos aneurismas micóticos intracranianos: registro de um caso

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