Involvement of the Aorta in Brucellosis: The Forgotten, Life-Threatening Complication. A Systematic Review

Abstract

Human brucellosis is a disease of protean manifestations, and has been implicated in complications and focal disease in many human organ systems. However, little is collectively known about the background, the course, the clinical characteristics, the diagnostic issues raised, and the short- and long-term therapeutic approaches in patients with aortic involvement as a complication of brucellosis. With the aim to glean from the literature useful information to better understand and manage this complication, a computerized search without language restriction was conducted using PubMed and SCOPUS. An article was considered eligible for inclusion in the systematic review if it reported data on patients with involvement of the aorta due to a Brucella infection. The epidemiologic and clinical characteristics of 44 cases of brucellar aortic involvement found through the systematic review of the literature were analyzed together with those of two new cases that we treated in the recent past. This complication involved the ascending thoracic aorta in 18 cases (in 16 of them as a consequence of brucellar endocarditis), and the descending thoracic aorta or the abdominal aorta in the remaining 30 cases. In the latter it was associated with spondylodiscitis of the lumbar spine in 13 cases. History of or symptoms indicative of brucellosis were not universally present. Brucellar aortic involvement represents a possibly underdiagnosed and underreported complication with major morbidity and mortality potential. Experience with novel invasive therapeutic approaches remains limited. Early suspicion through detailed history and diagnosis, aided by advances in aortic imaging, would allow for better planning of therapeutic interventions.

In the Literature

“…The findings described in these studies are consistent with the observations recently made by Prado-Calleros and colleagues who identified 480 cases in a systematic literature review [1]. Lessons to be learned from the studies described here include the high incidence of S. aureus as a cause of descending mediastinitis in infants and, to a lesser extent, in adults, as well as the higher frequency of anaerobic infection in the latter group.…”

“…A review of brucellar aortitis published in 2012 identified 46 cases with 18 having involvement of the ascending aorta; with 16 of the 18 had aortic valve endocarditis [1]. Of note is that the infection was complicated by the presence of lumbar spondylodiscitis in 13/30 whose vascular infection involved the descending thoracic or abdominal aorta; 12 of the 13 had abdominal aortitis.…”

Contained rupture of a mycotic infrarenal aortic aneurysm infected withCampylobacter fetus

“…The most commonly cultured organisms include Staphylococcus (30%), Streptococcus (10%) and Salmonella (10%) 1–4. Other microorganisms such as Brucella can be responsible for aortitis 5 . C. fetus is a very rare cause of mycotic aneurysm especially in the elderly with other underlying pathologies 3.…”

Brucella aortitis: an underdiagnosed and under‐reported disease

“…2 This complication involved the ascending thoracic aorta in 18 cases (in 16 of them as a consequence of brucellar endocarditis), and the descending thoracic aorta or the abdominal aorta in the remaining 30 cases. In the latter, it was associated with spondylitis of the lumbar spine in 13 cases.…”

“…Actually, in a recent paper appeared on PubMed in October 2012: we analyzed the epidemiologic and clinical characteristics of 46 cases of brucellar aortic involvement. 2 This complication involved the ascending thoracic aorta in 18 cases (in 16 of them as a consequence of brucellar endocarditis), and the descending thoracic aorta or the abdominal aorta in the remaining 30 cases. In the latter, it was associated with spondylitis of the lumbar spine in 13 cases.…”