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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.
Abstract:
Although arterial infection due to Salmonella is rare, it remains one of the most common causes of primary mycotic aneurysms. The presentation is one of sepsis, cultures positive for Salmonella and rapid expansion or rupture of the aneurysm. The authors' experience at Victoria Hospital, London, Ont., includes two cases of aneurysms infected with Salmonella--one aneurysm of the aorta and the other of the common femoral artery. Both patients were treated by excision of the aneurysm, extra-anatomic reconstruction in an area remote from the infected field and long-term administration of appropriate antibiotics. One patient was alive and well 36 months after resection. The other died of multiple organ failure 10 days after resection. From a review of the English and French literature since 1948, 64 cases of abdominal aortic aneurysms infected with Salmonella were found; half of the patients survived the perioperative period. The diagnosis of mycotic aneurysm must be considered in any patient with an aneurysm and culture specimens positive for Salmonella. The authors favour wide débridement of the infected aneurysm with extra-anatomic reconstruction. This view is supported by a review of the literature. The appropriate antibiotic therapy is bactericidal rather than bacteriostatic.
Insights
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.