Mycotic aneurysm

Other names| mycotic aneurysm or microbial arteritis
File:Mycotic pulmonary artery aneurysm, ruptured (4860663580).jpg
Ruptured mycotic pulmonary artery aneurysm

An infected aneurysm[1] is an aneurysm arising from bacterial infection of the arterial wall. It can be a common complication of the hematogenous spread of bacterial infection.[2]

## Contents

* 1 Cause
* 2 Treatment
* 3 History
* 4 Complications
* 5 References

## Cause

Intracranial mycotic aneurysms (ICMAs) complicate about 2% to 3% of infective endocarditis (IE) cases, although as many as 15% to 29% of patients with IE have neurologic symptoms.[3] Staphylococcus and Salmonella spp. are the most common organisms that cause mycotic aneurysms of the aorta.[4][5] Anaerobic bacteria such as Bacteroides and Clostridium spp. can also cause aortic mycotic aneurysms.[5] Aortic aneurysm is a rare complication of Mycobacterium tuberculosis infection, most commonly from direct extension of adjacent lesions, but also as a result of hematogenous dissemination.[6]

## Treatment

Mycotic abdominal aorta aneurysm (MAAA) is a rare and life-threatening condition. Because of its rarity, there is a lack of adequately powered studies and consensus on its treatment and follow up. A management protocol on the management of mycotic abdominal aortic aneurysm was recently published in the Annals of Vascular Surgery by Premnath et al.[7]

## History

William Osler first used the term "mycotic aneurysm" in 1885 to describe a mushroom-shaped aneurysm in a patient with subacute bacterial endocarditis. This may create considerable confusion, since "mycotic" is typically used to define fungal infections. However, mycotic aneurysm is still used for all extracardiac or intracardiac aneurysms caused by infections, except for syphilitic aortitis.[8]

The term "infected aneurysm" proposed by Jarrett and associates[9] is more appropriate, since few infections involve fungi.[10] According to some authors, a more accurate term might have been endovascular infection or infective vasculitis, because mycotic aneurysms are not due to a fungal organism.[3]

## Complications

Mycotic aneurysms account for 2.6% of aortic aneurysms.[8] For the clinician, early diagnosis is the cornerstone of effective treatment. Without medical or surgical management, catastrophic hemorrhage or uncontrolled sepsis may occur. However, symptomatology is frequently nonspecific during the early stages, so a high index of suspicion is required to make the diagnosis.[10]

## References

1. ↑ Greenfield, Lazar J, and Michael W. Mulholland. Greenfield's Surgery: Scientific Principles and Practice. Philadelphia: Wolters Kluwer Health/Nut Williams & Wilkins, 2011. Print. Page 1563
2. ↑ "Mycotic aortic aneurysm presenting initially as an aortic intramural air pocket". AJR Am J Roentgenol 185 (2): 463–5. 2005. doi:10.2214/ajr.185.2.01850463. PMID 16037521.
3. ↑ 3.0 3.1 "Archived copy". http://www.gundersenhealth.org/upload/docs/Research/MedJournal/Vol6No1Endocarditis.pdf.
4. ↑ Napiórkowska-Baran, Katarzyna; Rosada, Tomasz; Alska, Ewa; Wawrzeńczyk, Adam; Bartuzi, Zbigniew (2021). "Treatment of Ruptured Infected Abdominal Aortic Aneurysm Caused by Salmonella spp.: A Case Report". Infectious Diseases and Therapy 10 (3): 1799-1805. doi:10.1007/s40121-021-00492-w. PMID 34254250.
5. ↑ 5.0 5.1 Brook, Itzhak (2009). "Anaerobic Bacteria as a Cause of Mycotic Aneurysm of the Aorta: Microbiology and Antimicrobial Therapy" (in en). Current Cardiology Reviews 5 (1): 36–39. doi:10.2174/157340309787048095. PMID 20066146.
6. ↑ Shi, Y.; Guo, W.; Hu, W.; Li, X.; Shangguan, Y.; Feng, X.; Hu, M.; Xia, J. et al. (2022). "Aortic Involvement in Disseminated Tuberculosis - Challenges beyond the Diagnosis". Infection and Drug Resistance 15: 2633-2688. doi:10.2147/IDR.S361168. PMID 35634580.
7. ↑ Premnath, Sivaram; Zaver, Vasudev; Hostalery, Aurelien; Rowlands, Timothy; Quarmby, John; Singh, Sanjay (2021-07-01). "Mycotic Abdominal Aortic Aneurysms – A Tertiary Centre Experience and Formulation of a Management Protocol" (in English). Annals of Vascular Surgery 74: 246–257. doi:10.1016/j.avsg.2020.12.025. ISSN 0890-5096. PMID 33508457. https://www.annalsofvascularsurgery.com/article/S0890-5096(21)00079-0/abstract.
8. ↑ 8.0 8.1 Bayer AS, Scheld WM. Endocarditis and intravascular infections. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 5th ed. Philadelphia: Churchill Livingstone; 2000:888-892.
9. ↑ Jarrett F, Darling RC, Mundth ED, Austen WG. Experience with infected aneurysms of the abdominal aorta. Arch Surg. 1975;110:1281-1286.
10. ↑ 10.0 10.1 Mycotic (Infected) Aneurysm Caused by Streptococcus pneumoniae. Khosrow Afsari, et al. Infect Med. 2001;18(6) http://www.medscape.com/viewarticle/410168

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