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Pneumococcal aortitis in the antibiotic era

J P Ioannidis1, F Merino, M S Drapkin

  • 1Division of Geographic Medicine and Infectious Diseases, New England Medical Center Hospitals, Boston, Mass, USA.

Archives of Internal Medicine
|August 7, 1995
PubMed
Summary
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Streptococcus pneumoniae can cause fatal thoracic aortitis, even with antibiotic treatment. This rare complication affects both native and grafted aortas, often presenting subtly.

Area of Science:

  • Infectious Diseases
  • Cardiovascular Medicine
  • Pathogen Research

Background:

  • Streptococcus pneumoniae is a significant pathogen during the antibiotic era.
  • Atypical and lethal presentations of pneumococcal infections are well-documented.
  • Thoracic aortitis is a rare but severe vascular complication.

Observation:

  • Two fatal cases of thoracic aortitis caused by Streptococcus pneumoniae bacteremia are presented.
  • One case involved an aortic graft, while the other affected a native aorta.
  • The clinical presentation was indolent, with diagnostic challenges.

Findings:

  • Transesophageal echocardiography and leukocyte scintigraphy failed to diagnose the aortitis in both cases.
  • The pathogen identified was Streptococcus pneumoniae, leading to fatal thoracic aortitis.

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  • The complication occurred in both prosthetic and native aortic tissues.
  • Implications:

    • Clinicians should consider thoracic aortitis as a rare complication of pneumococcal disease.
    • Persistent fever, atypical chest pain, and unexplained bleeding warrant investigation for this condition.
    • Early recognition and diagnosis are crucial for managing this lethal complication of pneumococcal infections.