Mycotic aneurysm

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List of terms related to Mycotic aneurysm

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

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2

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]

References

  1. emedicine > Cerebral Aneurysm Author: Jonathan L Brisman. Coauthors: Emad Soliman, Abraham Kader, Norvin Perez. Updated: Sep 23, 2010
  2. 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. 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.
  4. Jarrett F, Darling RC, Mundth ED, Austen WG. Experience with infected aneurysms of the abdominal aorta. Arch Surg. 1975;110:1281-1286.
  5. 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. 6.0 6.1 http://www.gundersenhealth.org/upload/docs/Research/MedJournal/Vol6No1Endocarditis.pdf
  7. 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.
  8. Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.

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