[en] A unique case of mycotic aneurysm of the abdominal aorta caused by Streptococcus agalactiae in an afebrile patient presenting with abdominal pain is described. Although this bacterium is associated with a variety of infections in human beings, aortitis is uncommon. Chronic alcoholism and diabetes mellitus are the 2 major predisposing conditions for group B Streptococci infection and both were present in this case. The abdominal pain and elevated inflammatory markers in the absence of fever were elusive in presentation; however, the diagnosis of mycotic aneurysm was established by abdominal computed tomography scan. The patient was treated successfully by resection of the diseased aorta and aortic allograft replacement. Culture of the excised tissue grew Streptococcus agalactiae sensitive to penicillin G and (other commonly tested antibiotics) fluoroquinolones. A prolonged course of moxifloxacin (for 6 months) was administered due to the persistence of elevated inflammatory markers and was remarkably well tolerated. Sixteen months after stopping the antibiotics, the patient is doing well, and the control imaging studies are satisfactory.
Disciplines :
Immunology & infectious disease
Author, co-author :
Chandrikakumari, Kavitha; Centre Hospitalier Universitaire de Liège - CHU > Maladies infectieuses et médecine interne générale
Giot, Jean-Baptiste ; Centre Hospitalier Universitaire de Liège - CHU > Maladies infectieuses et médecine interne générale
de Leval, Laurence ; Centre Hospitalier Universitaire de Liège - CHU > Anatomie pathologique
Creemers, Etienne ; Centre Hospitalier Universitaire de Liège - CHU > Chirurgie cardio-vasculaire
Leonard, Philippe ; Centre Hospitalier Universitaire de Liège - CHU > Maladies infectieuses et médecine interne générale
Mukeba, Didier
Moutschen, Michel ; Université de Liège - ULiège > Département des sciences cliniques > Immunopathologie - Transplantation
Frippiat, Frédéric ; Centre Hospitalier Universitaire de Liège - CHU > Maladies infectieuses et médecine interne générale - Direction médicale
Language :
English
Title :
Report of a case of Streptococcus agalactiae mycotic aneurysm and review of the literature.
Publication date :
2008
Journal title :
International Journal of Surgical Pathology
ISSN :
1066-8969
Publisher :
Westminster Publications, Glen Head, United States - New York
Fry RM Fatal infections by haemolytic Streptococcus group B. Lancet. 1938 ; 1: 199-201.
Baddour LM, Wilson WR Mandell, Douglas, and Bennett's principles and practice of infectious diseases. In: Infections of Prosthetic Valve and Other Cardiovascular Devices. Mandell GL, Bennett JE, Dolin R, eds. 6 th ed. Philadelphia, PA: Elsevier Churchill Livingstone ; 2005: 1005-1009.
Edwards MS, Baker CJ Mandell, Douglas, and Bennett's principles and practice of infectious diseases. In: Streptococcus agalactiae (Group B Streptococcus). Mandell GL, Bennett JE, Dolin R, eds. 6 th ed. Philadelphia, PA: Elsevier Churchill Livingstone ; 2005: 2423-2434.
Osler W. The Gulstonian lectures on malignant endocarditis. Br Med J. 1885 ; 1: 467-470.
Chan FY, Crawford ES, Coselli JS, et al. In situ prosthetic graft replacement for mycotic aneurysm of the aorta. Ann Thorac Surg. 1989 ; 47: 193-203.
AHA scientific statement. Infective endocarditis. Diagnosis, antimicrobial therapy, and management of complications. Circulation. 2005 ; 111: e394 - e433.
Blackett RL, Hill SF, Bowler I., et al. Mycotic aneurysm of the aorta due to group B Streptococcus (Streptococcus agalactiae). Eur J Vasc Surg. 1989 ; 3: 177-179.
Burnet NG, Wilkinson RC, Evans DS Mycotic aneurysm caused by group B Streptococcus: a cautionary tale of management problems and a rare organism. Br J Clin Pract. 1990 ; 44: 372-374.
Akashi Y., Ikehara Y., Yamamoto A., et al. Purulent pericarditis due to group B Streptococcus and mycotic aneurysm of the ascending aorta. Jpn Circ J. 2000 ; 64: 83-86.
Andreasen DA, Dimcecski G., Nielsen H. Mycotic aneurysm of the aorta caused by group B Streptococcus. Scand J Infect Dis. 2001 ; 34: 208-209.
Samore MH, Wessolossky MA, Lewis SML, et al. Frequency, risk factors and outcome for bacteremia after percutaneous transluminal coronaryangioplasty. Am J Cardiol. 1997 ; 79: 873-877.
Hsu RB, Tsay YG, Wang SS, et al. Surgical treatment for primary infected aneurysm of the descending thoracic aorta, abdominal aorta, and illiac arteries. J Vasc Surg. 2002 ; 36: 746-750.
Knosella C., Weng Y., Yankah C., et al. Using aortic allograft material to treat mycotic aneurysm of the thoracic aorta. Ann Thorac Surg. 1996 ; 61: 1146-1152.
Rapport d'Activité. Streptococcus agalactiae Laboratoire de Référence [in French], Liège, Belgium: Centre Hospitalier Universitaire de Liege ; 2005-2006.