Exploring infectious aneurysms through a series of cases in a tertiary care unit in South India

Infectious aneurysm is an aneurysm of the arteries originating from endogenous bacteraemia due to bacterial or fungal origin. The major vessels involved are femoral, aorta, then intracranial visceral arteries and pulmonary arteries. These aneurysms are identified by their fusiform shape, multiple, distal location involving the entire wall of the vessel and changing morphology on repeat imaging studies. The study aims to discuss the clinical presentation & management of post infectious aneurysms.

This is a retrospective study of 11 case series of postinfectious aneurysms over a period of 10 years admitted at a tertiary care hospital. The detailed clinical data that included the clinical presentation, diagnostic and treatment was studied from the hospital medical records department and laboratory information system.

Among the 11 patients diagnosed with aneurysms, 4 presented with intracranial, 4 with intra pulmonary and 3 with intra-abdominal aortic aneurysms involvement. Source was either of bacterial cause such as E.coli, Streptococcus gallolyticus, Salmonella Typhi, M. tuberculosis, Klebsiella pneumoniae, Methicillin Resistant S. aureus, S. hominis or fungal origin being Aspergillus spp. All of them had elevated C-reactive protein level, ESR and confirmed by positive cultures or Xpert Tb. Management of mycotic aneurysm includes imaging studies along with laboratory workup, endovascular intervention with intravenous antibiotics, or a combination of these.

High index of suspicion in patients presenting with fever, elevated C-reactive protein, ESR, total counts with sudden development of atypical aneurysms requires timely blood culture pre and post procedure. Definitive surgical/endovascular under antibiotic coverage at the earliest is a prerequisite in the management to prevent re-rupture.