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Arteritis due to Salmonella with aneurysm formation: two cases
F Flamand1, K A Harris, G DeRose
1Division of Vascular Surgery, Victoria Hospital, London, Ont.
Summary
Salmonella infections are a rare but common cause of mycotic aneurysms, often presenting as sepsis. Surgical intervention with antibiotic therapy offers a chance of survival for patients with these arterial infections.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Microbiology
Background:
- Salmonella is a rare cause of arterial infections but a common cause of primary mycotic aneurysms.
- Mycotic aneurysms present with sepsis, positive Salmonella cultures, and rapid aneurysm expansion or rupture.
Observation:
- Two cases of Salmonella-infected aneurysms (aorta and common femoral artery) were treated with excision, extra-anatomic reconstruction, and antibiotics.
- One patient survived 36 months post-resection; the other died of organ failure 10 days post-resection.
- Literature review identified 64 cases of Salmonella-infected abdominal aortic aneurysms, with a 50% perioperative survival rate.
Findings:
- Diagnosis requires considering mycotic aneurysm in patients with aneurysms and Salmonella-positive cultures.
- Wide debridement and extra-anatomic reconstruction are favored surgical approaches.
- Bactericidal antibiotics are recommended over bacteriostatic therapy.
Implications:
- Early diagnosis and aggressive surgical management are crucial for improving outcomes in Salmonella-infected aneurysms.
- Extra-anatomic reconstruction minimizes risks associated with operating in infected fields.
- Effective antibiotic selection is vital for eradicating Salmonella from arterial infections.