Salmonella Mycotic Aneurysm of the Aortic Arch: Case Report and Review

Abstract

Salmonella mycotic aneurysms of the thoracic aorta are exceedingly rare. We describe what we believe is only the third reported case involving the aortic arch. The patient was treated with surgical intervention and a prolonged course of antibiotics, which resulted in long-term survival. We review 13 previously reported cases of salmonella mycotic aneurysms of the thoracic aorta. The overall outcome was abysmal, with 10 of 13 patients dying within 1 month after the diagnosis was made. We discuss the pathogenesis, clinical presentation, diagnostic approach, and management (including surgical intervention and duration of antibiotic therapy) of this condition on the basis of the findings in these cases.

Risk Factors for Primary Bacteremia and Endovascular Infection in Patients without Acquired Immunodeficiency Syndrome Who Have Nontyphoid Salmonellosis

“…Salmonella infection may manifest in 5 different clinical forms: asymptomatic chronic carrier state, gastroenteritis, enteric fever, bacteremia, and extraintestinal localized complications [7]. A feared complication is the development of endovascular infection (e.g., infective endocarditis and infected aortic aneurysm), and the prognosis for patients with this condition is poor [8][9][10][11][12]. Endovascular infections are rare complications of salmonellosis.…”

Arteriovenous fistula secondary to iliac mycotic aneurysm: helical CT findings

“…In the postantibiotic era, Salmonella species and Staphylococcus aureus are the predominant infecting organisms [3,4,6,8]. Group B streptococci rarely cause mycotic aneurysms [4], and, to our knowledge, the present case is the first with associated arteriovenous fistula.…”

“…Mycotic aneurysms are localized abnormal dilatations of the arterial walls that develop secondary to an infectious process that causes wall destruction [6]. Mycotic aneurysms of the aorta occur infrequently and account for 2.6 -3% of all abdominal aortic aneurysms [3,5,7,8].…”

Infected Aortic Aneurysms

“…The most common causative agent was the Salmonella species, which is responsible for 50% (11/22) of the cases, and the authors found that the prognosis of medically treated Salmonella-infected aneurysms was better than that of non-Salmonella infected cases. However, the prognosis of medically treated Salmonella-infected aortic aneurysm remains a subject of debate as most of the early reports from Western countries showed an extremely dismal result [38,110,111] (see more details in Section 7.1). The authors concluded that although the results of antibiotic treatment alone in patients with infected aortic aneurysm remained poor, it could still be an alternative treatment, especially in Salmonella-infected patients with very high surgical risks.…”

“…Infected aortic aneurysms caused by Salmonella species were thought to be more virulent and tend to have a worse outcome, in view of the higher risk of early aneurysm rupture and prosthetic graft infection [110,111,[128][129][130][131][132]. In 2010, Kan and colleagues compared the surgical outcomes of 41 cases of infected aortic aneurysms identified from relevant literature reports and institute cases from 1990 to 2008 and found that Salmonella infection was a risk factor of postoperative aneurysm-related morbidity and mortality [71]; however, the type of procedures (i.e., traditional open repair versus EVAR) was not.…”