A Case of Infective Abdominal Aortic Aneurysm due to Haemophilus influenzae Type B

Abstract

Infective or mycotic aneurysm is rare but a life-threatening disease. To our knowledge, the incidence of this disease is 0.65 to 2% of all aortic aneurysms. [1][2][3] This disease has an increased tendency to grow rapidly and to rupture. Patients with this disease have severe comorbidities and coexisting sepsis. Conventional surgical treatment, which consists of a radical operation with resection of the aneurysm, extensive local debridement, and revascularization by in situ reconstruction or extra-anatomic bypass is the gold standard but carries a high mortality. Recently, some authors have described that endovascular aneurysm repair (EVAR) for infective abdominal aortic aneurysm (IAAA) was effective in perioperative and mid-term results. 3,4 Salmonella and staphylococcal species are predominant in the cause of IAAA, however, in this case, we detected Haemophilus influenzae. We reported this very rare case with the review of the English literature. Case ReportA 69-year-old man had fever (over 39°C) and, 10 days later, he had severe abdominal and back pain. He consulted nearby doctor and was introduced to our hospital. At the time of initial examination, he did not have fever (36.7°C). On the physical examination, he complained of the spontaneous pain and tenderness at lower abdomen. In laboratory evaluation, white blood cell count and C-reactive protein (CRP) level were elevated, 9700/μL and 12.87 mg/dL, respectively. Furthermore, the level of glycated hemoglobin was 6.2% and he had mild diabetes mellitus. Blood culture result was negative.Abdominal-enhanced computed tomography (CT) scan demonstrated a 35-mm saccular aneurysm of the infrarenal aorta surrounded by inflammatory findings (►Fig. 1A-C). He was diagnosed as having IAAA. First, we treated him with intravenous antibiotic administration for a week. The antibiotic was cefazolin sodium (2 g/day) to cover staphylococcal and Salmonella species. Just before operation, the value of white blood cell count and CRP had decreased down to 6200/μL and 2.54 mg/dL, respectively. We thought that preoperative antibiotic therapy was effective. We performed operation on day 8 after antibiotic administration, and resected the saccular aneurysm with extensive local debridements and irrigation. Revascularization was made in situ reconstruction with expanded polytetrafluoroethylene graft, and entire AbstractInfective abdominal aortic aneurysm (IAAA) is relatively rare, but a case which is caused by Haemophilus influenzae type B is very rare. We experienced one IAAA case due to H. influenzae type B. The patient was 69-year-old man presenting with severe abdominal and back pain and elevated C-reactive protein (CRP), as inflammatory marker. The patient was found to have saccular aneurysm infrarenal aorta on computed tomography scanning. First, we started to treat him with antibiotic agent and second, we operated him at day 8 after admission with expanded polytetrafluoroethylene graft. Revascularization was made in situ reconstruction. As the result of culture with aneurysm wall,...

A Rare Case of Ruptured Infrarenal Aortic Aneurysm Infected with Haemophilus influenzae Type B

“…Although a small sample size, the present report, along with previously reported cases ( 4 , 6 , 8 ), suggest that the organism results in more subtle and insidious infections than Salmonella and Staphylococcus species. This favours a low threshold for suspecting infected aortic aneurysms.…”

“…The most common species implicated are Salmonella and Staphylococcus ( 1 – 3 ). Furthermore, patients with infected aneurysms are generally severely comorbid and present with coexisting sepsis ( 4 ).…”

“…Children in North America are routinely vaccinated against type B, which is one of the most virulent encapsulated strains ( 5 ). There are only four previous cases in English literature of infected aneurysms caused by H influenzae type B from Europe and Asia ( 4 , 6 – 8 ). To our knowledge, this represents the first reported case in North America.…”

Case Report: Trans-axillary Artery Access for Rescue Stent Implantation in an Infant With Retrograde Non-passable Aortic Coarctation

“…Despite our case clearly describes a severe congenital CoA complicated by pulmonary infection, we would like to point out the interesting correlation between Haemophilus influenzae infections and aortic aneurysm or aortitis, which have been reported previously (16,17).…”