Aortitis Due toSalmonella: Report of 10 Cases and Comprehensive Review of the Literature

Abstract

We describe ten cases of aortitis due to Salmonella that were treated at the University of Toronto-affiliated Hospitals between 1978 and 1997. Predisposing conditions included hypertension, diabetes mellitus, and myelodysplastic syndrome. Main presenting symptoms were fever and abdominal and back pain. The most frequent site involved was the abdominal aorta, followed by the thoracic aorta. All but one patient were treated with intravenous bactericidal antibiotics; seven also underwent surgery, four with axillobifemoral grafts and three with in situ grafts. Four of seven patients died within 1 month of the surgical procedure (three patients with in situ grafts and one patient with axillobifemoral graft). We also reviewed the pathogenesis, clinical and laboratory characteristics, and treatment of 140 cases of aortitis due to Salmonella reported in the literature since 1948. The use of bactericidal antibiotics, together with early surgical intervention and long-term suppressive antibiotic therapy, has led to improved survival.

Isolation of Salmonella enterica serotype choleraesuis resistant to ceftriaxone and ciprofloxacin

“…A prospective case-control study is urgently called for. According to a review of 140 cases of aortitis due to Salmonella reported in the literature since 1948, the most common site of infection is the abdominal aorta, more precisely its infrarenal portion (131). The most common clinical features consisted of fever, abdominal pain, and/or back pain, the last of which may be related to the site of involvement (131).…”

“…According to a review of 140 cases of aortitis due to Salmonella reported in the literature since 1948, the most common site of infection is the abdominal aorta, more precisely its infrarenal portion (131). The most common clinical features consisted of fever, abdominal pain, and/or back pain, the last of which may be related to the site of involvement (131). A computed tomographic (CT) scan with contrast enhancement is considered the method of choice to diagnose mycotic aneurysm because of its ability to detect early changes in the arterial wall and the periaortic tissue (63,131).…”

“…The most common clinical features consisted of fever, abdominal pain, and/or back pain, the last of which may be related to the site of involvement (131). A computed tomographic (CT) scan with contrast enhancement is considered the method of choice to diagnose mycotic aneurysm because of its ability to detect early changes in the arterial wall and the periaortic tissue (63,131). These changes include a periaortic soft tissue density with rim enhancement (Fig.…”

“…MR angiography produces images in the transverse, sagittal, and coronal planes, which display the entire thoracic or abdominal aorta in one plane. The availability of these multiple views facilitates the diagnosis of mycotic aneurysm and the determination of its extent and in many cases reveals the presence of branch vessel involvement (27,131,150). Figure 2 shows an MR angiogram of a patient with a mycotic aneurysm at the infrarenal portion of the abdominal aorta.…”

“…Mycotic aneurysm caused by Salmonella was almost uniformly fatal in previous times; however, multiple publications of case reports and case series found that early surgical intervention has greatly increased survival (3,27,63,105,131,142,150). Most surgeons consider the excision of an infected vessel with extra-anatomic vascular reconstruction to be the surgery of choice for abdominal mycotic aneurysm (142).…”