Tuberculous aneurysms of the abdominal aorta

Abstract

Mycotic aneurysm secondary to tuberculous infection of the aorta is a rare and life-threatening disease. We report a single-center experience of three patients treated with a combination of surgical aortic replacement and prolonged antituberculosis therapy. The first case is a 34-year-old woman with a suprarenal abdominal aortic aneurysm, the second case is a 77-year-old man with an infrarenal abdominal aortic aneurysm and a right psoas abscess, the third case is a 37-year-old woman with an infrarenal abdominal aortic aneurysm. All patients had a favorable outcome with a mean follow-up of 6.2 years (range, 6 months-10 years). Early diagnosis and a combination of surgical intervention (aortic reconstruction and extensive excision of the infected field) and prolonged antituberculous drug therapy provide long-term survival without evidence of recurrence after tuberculous aortic involvement.

Primary Aortic Infections and Infected Aneurysms

“…4) They are usually due to direct extension to the vessel wall from a contiguous tuberculous focus in the lymphnode or vertebra. Hematogenous spread has also been suggested.…”

“…For tubercular infections of the aorta, good debridement and in situ reconstruction have been successful provided adequate anti tubercular treatment has been given for a period of six to nine months. 4) Some have advocated use of drains and irrigation with antibiotic solution to prevent reinfection. Appropriate antibiotic should be continued in the postoperative period.…”

Infected Aortic Aneurysms

“…Moreover, infected aortic aneurysms due to various fungal infections have also been reported, such as Candida, Cryptococcus, and Aspergillus [56][57][58]. Mycobacterium species could also result in infected aortic aneurysms [59,60], while Bacillus Calmette-Guérin-related abdominal aorta infection has also been reported in Ref. [61].…”

Mikotinės Aneurizmos: Literatūros Apžvalga

“…Dažniausi MA sukėlėjai yra bakterijos [8], tačiau galimi sukėlėjai gali būti ir grybelis, ir virusai [9,10,11]. Pagrindiniai ligos simptomai yra nespecifiniai -skausmas, bendras silpnumas, dėl to MA dažnai įtariama pavėluotai [12].…”

“…Pacientai, kurių kraujo pasėliai teigiami, gali turėti agresyvesnę infekciją, susijusią su bloga ligos prognoze, tačiau teigiamas kraujo pasėlis padeda parinkti tinkamą antibiotiką, o tai lemia geresnę ligos išeitį [5]. Vien antibiotikais gydytų pacientų su neplyšusia aortos aneurizma išgyvenamumas blogesnis nei gydytų ir chirurgiškai, ir medikamentais [10,20].…”