Report of a Case of Streptococcus agalactiae Mycotic Aneurysm and Review of the Literature

Abstract

A unique case of mycotic aneurysm of the abdominal aorta caused by Streptococcus agalactiae in an afebrile patient presenting with abdominal pain is described. Although this bacterium is associated with a variety of infections in human beings, aortitis is uncommon. Chronic alcoholism and diabetes mellitus are the 2 major predisposing conditions for group B Streptococci infection and both were present in this case. The abdominal pain and elevated inflammatory markers in the absence of fever were elusive in presentation; however, the diagnosis of mycotic aneurysm was established by abdominal computed tomography scan. The patient was treated successfully by resection of the diseased aorta and aortic allograft replacement. Culture of the excised tissue grew Streptococcus agalactiae sensitive to penicillin G and (other commonly tested antibiotics) fluoroquinolones. A prolonged course of moxifloxacin (for 6 months) was administered due to the persistence of elevated inflammatory markers and was remarkably well tolerated. Sixteen months after stopping the antibiotics, the patient is doing well, and the control imaging studies are satisfactory.

Endovascular management of a mycotic group A streptococcal abdominal aortic dissection

“…Other rarer pathogens such as Listeria monocytogenes, Clostridium septicum, Streptococcus milleri and group B streptococcus have also been reported. 1 – 7 We have presented a case of aortitis secondary to group A haemolytic streptococcus, which, to the best of our knowledge, has not been previously reported in the literature.…”

Cryopreserved venous allograft in the treatment of a mycotic abdominal aortic aneurysm caused by group B Streptococcus

“…8 In total, there have been nine previously reported cases of mycotic AAAs due to GBS infection. [8][9][10][11][12][13][14][15][16] Only one of these was from North America. 12 Before the advent of antibiotics, the most common cause of mycotic AAAs was infectious endocarditis.…”

“… 8 In total, there have been nine previously reported cases of mycotic AAAs due to GBS infection. 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 Only one of these was from North America. 12…”

Streptococcus pyogenesPericarditis with Resultant Pulmonary Trunk Compression Secondary to Mycotic Pseudoaneurysm

“…Mycotic pseudoaneuryms are rarely described following purulent pericardial effusions and only comprise a small minority of all aneurysms (0.7%) [ 15 ]. Hematogenous seeding of a damaged atherosclerotic wall is the most frequently described pathogenesis for infected aortic aneurysms [ 16 ], with staphylococcal and salmonella spp. being the most common [ 17 ].…”