Mycotic aneurysm
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]
Overview
Mycotic aneurysm is an aneurysm that results from an infectious process that involves the arterial wall.[1] A person with a mycotic aneurysm has a bacterial infection in the wall of an artery, resulting in the formation of an aneurysm. The most common locations include arteries in the abdomen, thigh, neck, and arm. A mycotic aneurysm can result in sepsis, or life-threatening bleeding if the aneurysm ruptures. Less than 3% of abdominal aortic aneurysms are mycotic aneurysms.[2]
Historical Perspective
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.[3] The term "infected aneurysm," proposed by Jarrett and associates[4] is more appropriate, since few infections involve fungi.[5] 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.[6]
Classification
Pathophysiology
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Common Causes
Causes by Organ System
| Cardiovascular | No underlying causes |
| Chemical/Poisoning | No underlying causes |
| Dental | No underlying causes |
| Dermatologic | No underlying causes |
| Drug Side Effect | No underlying causes |
| Ear Nose Throat | No underlying causes |
| Endocrine | Diabetes mellitus |
| Environmental | No underlying causes |
| Gastroenterologic | No underlying causes |
| Genetic | No underlying causes |
| Hematologic | No underlying causes |
| Iatrogenic | No underlying causes |
| Infectious Disease | Acinetobacter, aspergillus, bacteroides, brucella, burkholderia pseudomallei, campylobacter, candida, clostridium perfringens, clostridium septicum, clostridium, corynebacterium, coxiella burnetii, cryptococcus, e. coli, group B streptococcal infection, haemophilus influenzae, klebsiella, lactococcus cremoris, listeria, melioidosis, methicillin-resistant staphylococcus aureus, mycobacterium tuberculosis, peptostreptococcus, propionibacterium acnes, pseudallescheria boydii, pseudomonas, rothia dentocariosa, salmonella, staphylococcus aureus, staphylococcus epidermidis, streptococcus pneumoniae, syphilis, treponema pallidum, vancomycin-intermediate staphylococcus aureus, yersinia |
| Musculoskeletal/Orthopedic | No underlying causes |
| Neurologic | No underlying causes |
| Nutritional/Metabolic | No underlying causes |
| Obstetric/Gynecologic | No underlying causes |
| Oncologic | No underlying causes |
| Ophthalmologic | No underlying causes |
| Overdose/Toxicity | No underlying causes |
| Psychiatric | No underlying causes |
| Pulmonary | No underlying causes |
| Renal/Electrolyte | No underlying causes |
| Rheumatology/Immunology/Allergy | No underlying causes |
| Sexual | No underlying causes |
| Trauma | No underlying causes |
| Urologic | No underlying causes |
| Miscellaneous | No underlying causes |
Causes in Alphabetical Order
Differentiating mycotic aneurysm from other diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications, and Prognosis
Mycotic aneurysms account for 2.6% of aortic aneurysms.[3] 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.[5]
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.[6]
Diagnosis
History and Symptoms
Physical Examination
Imaging Studies
Treatment
Antimicrobial Regimen
- Empiric antimicrobial therapy[8]
- Preferred regimen: Vancomycin 2 g/day IV divided q6-12h targeting trough concentration of 15-20 μg/mL for 6 weeks (for critically ill patient, start with a loading dose of 25 mg/kg followed by 15 mg/kg q12h) AND (Ceftriaxone 2 g IV q24h for 6 weeks OR Piperacillin-Tazobactam 3.375 g IV q6h for 6 weeks OR Ciprofloxacin 400 mg IV q12h for 6 weeks)
- Alternative regimen: Consider substituting Daptomycin for Vancomycin. Consider Cefepime, Imipenem-Cilastatin, Meropenem, or Ertapenem for Gram-negative bacteria.
References
- ↑ emedicine > Cerebral Aneurysm Author: Jonathan L Brisman. Coauthors: Emad Soliman, Abraham Kader, Norvin Perez. Updated: Sep 23, 2010
- ↑ http://www.freemd.com/mycotic-aneurysm/overview.htm Author: Stephen J. Schueler, MD; Coauthors: John H. Beckett, MD; D. Scott Gettings, MD. Updated November 13, 2011
- ↑ 3.0 3.1 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.
- ↑ Jarrett F, Darling RC, Mundth ED, Austen WG. Experience with infected aneurysms of the abdominal aorta. Arch Surg. 1975;110:1281-1286.
- ↑ 5.0 5.1 Mycotic (Infected) Aneurysm Caused by Streptococcus pneumoniae. Khosrow Afsari, et al. Infect Med. 2001;18(6)http://www.medscape.com/viewarticle/410168
- ↑ 6.0 6.1 http://www.gundersenhealth.org/upload/docs/Research/MedJournal/Vol6No1Endocarditis.pdf
- ↑ 7.0 7.1 Gomes MN, Choyke PL, Wallace RB (1992). "Infected aortic aneurysms. A changing entity". Ann Surg. 215 (5): 435–42. PMC 1242469. PMID 1616380.
- ↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.