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Infectious Aortitis.

Elizabeth A Foote1, Russell G Postier, Ronald A Greenfield

  • 1Department of Medicine, University of Oklahoma Health Sciences Center, 1140 Williams Pavilion, 920 Stanton Young Boulevard, Oklahoma City, OK 73104, USA. Michael-Bronze@ouhsc.edu.

Current Treatment Options in Cardiovascular Medicine
|June 7, 2005
PubMed
Summary

Infectious aortitis, often affecting older men with atherosclerosis, requires prompt diagnosis and combined antimicrobial and surgical treatment to reduce high mortality rates. Early intervention is crucial to prevent aneurysm rupture and ensure pathogen eradication.

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Area of Science:

  • Vascular Surgery
  • Infectious Diseases
  • Radiology

Background:

  • Infectious aortitis stems from septic embolization, aneurysm seeding, or contiguous infection.
  • Historically linked to infective endocarditis, now commonly involves Salmonella and Staphylococcus aureus.
  • Diagnosis is suspected in older men with atherosclerosis presenting with fever, abdominal pain, mass, and leukocytosis.

Purpose of the Study:

  • To outline the diagnostic considerations for infectious aortitis.
  • To discuss current treatment strategies, emphasizing combined medical and surgical approaches.
  • To highlight the importance of early intervention and long-term follow-up.

Main Methods:

  • Review of diagnostic criteria and clinical presentation.
  • Analysis of common causative pathogens, including Salmonella species and Staphylococcus aureus.

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  • Evaluation of imaging modalities, primarily computed tomography.
  • Assessment of treatment outcomes for medical versus combined surgical and antimicrobial therapy.

    • Main Results:

    • Computed tomography is the preferred imaging modality for diagnosis.
    • Combined surgical treatment with antimicrobial therapy demonstrates lower mortality than medical treatment alone.
    • Empiric antibiotics targeting S. aureus and gram-negative rods are recommended before microbiologic confirmation.
    • Early surgical debridement and revascularization are critical to prevent aneurysm rupture and reduce mortality.

    Conclusions:

    • Infectious aortitis necessitates a high index of suspicion in at-risk populations.
    • Prompt diagnosis and aggressive management, including early surgery and prolonged antibiotics, are essential for favorable outcomes.
    • Long-term follow-up with serial imaging and blood cultures is indicated to prevent recurrence.