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Aortic bypass graft infection due to Aspergillus: report of a case and review
J M Aguado1, R Valle, R Arjona
1Department of Internal Medicine Infectious Diseases Unit, Hospital Marqués de Valdecilla, Santander, Spain.
Abstract:
Aspergillus is a rare cause of aortic graft infection. A recent case is reported and a review of seven other cases described in the literature since 1966 is presented. Infections of both thoracic and abdominal aortic grafts have been reported. Infection occurred from 5 weeks to 3 years after surgery. Underlying immunosuppressive disorders were not present. The most common presenting symptoms were back pain, fever, and embolic phenomena. Pseudoaneurysm of the vascular prosthesis with contiguous vertebral osteomyelitis was frequently seen. Blood cultures were always negative. Laboratory findings were nonspecific. The diagnosis was not anticipated in any case. Aspergillus was isolated in culture of specimens of the vertebral bone, excised graft, or peripheral emboli. Aspergillus fumigatus was the species most frequently isolated. Infection may have occurred intraoperatively as a result of contamination with airborne fungal spores. Optimal treatment included early removal of the graft with extraanatomical bypass plus prolonged antifungal therapy. Delayed surgical intervention and medical therapy alone were associated with high mortality rates. Aspergillar vascular infection should be suspected in patients with aortic grafts who develop persistent back pain, fever, or arterial embolization, and whose blood cultures are sterile.
Insights
Aspergillus fungal infections rarely cause aortic graft issues. Early graft removal with antifungal therapy is crucial for survival, as delayed treatment leads to high mortality.
Area of Science:
- Medical Mycology
- Vascular Surgery
- Infectious Diseases
Background:
- Aspergillus species are an uncommon cause of aortic graft infections.
- This review examines one recent case and seven previously reported cases since 1966.
Observation:
- Infections affected both thoracic and abdominal aortic grafts, occurring 5 weeks to 3 years post-surgery.
- Common symptoms included back pain, fever, and embolic phenomena, often with pseudoaneurysm and vertebral osteomyelitis.
- Blood cultures were consistently negative, and diagnosis was frequently unexpected.
Findings:
- Aspergillus, primarily Aspergillus fumigatus, was identified in cultures from bone, graft, or emboli.
- Intraoperative contamination with airborne fungal spores is a potential source of infection.
- Negative blood cultures and nonspecific lab findings complicate diagnosis.
Implications:
- Suspect Aspergillus vascular infection in aortic graft patients with unexplained fever, back pain, or emboli.
- Optimal management involves prompt graft excision, extra-anatomical bypass, and extended antifungal treatment.
- Delayed intervention or medical management alone is associated with poor outcomes.