Scientific letter
Mycotic abdominal aortic aneurysm due to Listeria monocytogenes
Aneurisma micótico abdominal debido a Listeria monocytogenes
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José Revillo Pinilla" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Elena" "apellidos" => "Laín Miranda" "email" => array:1 [ 0 => "elenalainm@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Isabel" "apellidos" => "Ferrer Cerón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Desiré" "apellidos" => "Gil Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "M. José" "apellidos" => "Revillo Pinilla" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Microbiología, Hospital Universitario Miguel Servet, Zaragoza, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Infecciosos, Hospital Universitario Miguel Servet, Zaragoza, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Aneurisma micótico abdominal debido a <span class="elsevierStyleItalic">Listeria monocytogenes</span>" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Listeria monocytogenes</span> is a rare pathogen that principally affects neonates, pregnant women and immunosuppressed patients. It most commonly causes gastroenteritis in healthy adults and central nervous system infection in immunosuppressed patients. Cardiovascular infection due to <span class="elsevierStyleItalic">Listeria monocytogenes</span> is rare and tends to cause endocarditis.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> This article presents the case of a mycotic aortic aneurysm due to <span class="elsevierStyleItalic">Listeria monocytogenes</span>.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 76-year-old man with a history of hypertension, type 2 diabetes mellitus, dyslipidaemia and ischaemic heart disease attended the emergency department following 2 months of general discomfort, hyporexia, low back pain and 7<span class="elsevierStyleHsp" style=""></span>kg weight loss in the previous 2 weeks. The patient was afebrile and the physical examination revealed no significant findings. The vascular examination found distal pulses in both lower limbs. Bloods were normal, except for blood glucose at 460<span class="elsevierStyleHsp" style=""></span>mg/dl. The chest and abdominal X-rays were normal. After normalising the patient's blood glucose levels, he was discharged and referred to internal medicine with a diagnosis of constitutional syndrome to be investigated.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Internal medicine ordered a computed tomography scan (CT scan), which revealed an infrarenal saccular aortic aneurysm. He was admitted to the vascular surgery department, where a CT angiography confirmed the presence of aortic pseudoaneurysm on the left anterolateral side, 8<span class="elsevierStyleHsp" style=""></span>mm below the renal arteries.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Surgery was performed, with resection and placement of a straight graft (20<span class="elsevierStyleHsp" style=""></span>mm Silver Graft). Repeat blood cultures taken 6 and 3 days before surgery were negative and afebrile, and a transthoracic echocardiogram found no valve vegetation. An arterial tissue sample was taken during the surgery and sent to Microbiology. The culture in blood agar and chocolate agar showed growth of greyish colonies with beta-haemolysis, identified by Bruker<span class="elsevierStyleSup">®</span> MALDI-TOF mass spectrometry as <span class="elsevierStyleItalic">Listeria monocytogenes</span> with a score of 2.2. The infectious diseases department started intravenous treatment with ampicillin 2<span class="elsevierStyleHsp" style=""></span>g/4<span class="elsevierStyleHsp" style=""></span>h and gentamicin 240<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h. Gentamicin was suspended after 2 weeks, while intravenous ampicillin was maintained for one further week. Sequential therapy was then started with oral amoxicillin 1<span class="elsevierStyleHsp" style=""></span>g/8<span class="elsevierStyleHsp" style=""></span>h and the patient was discharged, continuing treatment at home for 3 more weeks. Patient outcome was satisfactory, remaining asymptomatic one year after surgery.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Mycotic aortic aneurysms account for just 1–3% of all aortic aneurysms and may manifest in a previously healthy aorta, although the presence of a prior aneurysm has been reported to be a predisposing factor.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> The microorganisms most commonly involved are <span class="elsevierStyleItalic">Salmonella</span> spp., <span class="elsevierStyleItalic">Streptococcus</span> spp. and <span class="elsevierStyleItalic">Staphylococcus</span> spp.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> Aneurysms infected by <span class="elsevierStyleItalic">Listeria monocytogenes</span> are very rare.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> This Gram-positive bacillus is usually transmitted through food. As the main infection pathway is the ingestion of contaminated food, it tends to produce self-limiting symptoms of gastroenteritis in healthy subjects.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> In rare cases, predominantly in immunosuppressed or elderly patients, it can lead to severe conditions such as sepsis, central nervous system infections and endocarditis.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> Nevertheless, cases have been reported in immunocompetent patients, and in the case presented here, the only immune deficiency was diabetes mellitus.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Diagnosis is established by contrast CT scan, together with <span class="elsevierStyleItalic">Listeria monocytogenes</span> isolation in blood cultures or arterial tissue biopsy.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> Blood cultures are negative in more than 50% of cases, while the pathogen is isolated in the biopsy in more than 75% of patients.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> In our case, the blood cultures were negative and <span class="elsevierStyleItalic">Listeria monocytogenes</span> was only isolated in the arterial tissue culture extracted during surgery.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The best therapeutic option is the combination of surgery (usually excision of the infected aorta segment and placement of an aortic prosthesis or graft), and prolonged antibiotic therapy.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> Ampicillin continues to be the treatment of choice, although trimethoprim-sulfamethoxazole, erythromycin, vancomycin or rifampicin are also appropriate treatment options. Treatment duration has not been fully established, but at least 6 weeks is recommended as recurrences have been reported in up to 15% of patients.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> The outcome of our patient was favourable 12 months after undergoing surgery and receiving intravenous ampicillin and gentamicin, followed by oral amoxicillin for a total of 6 weeks of treatment.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Finally, while excision and replacement by aortic prosthesis or aortic homograft is the most commonly-used procedure, use of endovascular prosthesis is also widely reported in the literature. Most of these cases are elderly patients with significant comorbidity or suprarenal involvement from South-east Asia (the majority involving <span class="elsevierStyleItalic">Salmonella</span> spp.). These cases go against the traditional “axiom” of not placing prosthetic material in sites of infection.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">8,9</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have not received any funding to complete this study.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Laín Miranda E, Ferrer Cerón I, Gil Pérez D, Revillo Pinilla MJ. Aneurisma micótico abdominal debido a <span class="elsevierStyleItalic">Listeria monocytogenes</span>. Enferm Infecc Microbiol Clin. 2017;35:269–270.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Listeria monocytogenes</span> causing endovascular infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Lamothe" 1 => "B. Simmons" 2 => "M. Gelfand" 3 => "P. Schoettle" 4 => "E. 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Yang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jvs.2011.07.077" "Revista" => array:6 [ "tituloSerie" => "J Vasc Surg" "fecha" => "2012" "volumen" => "55" "paginaInicial" => "55" "paginaFinal" => "60" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22051868" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0090" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endovascular therapy for infected aortic aneurysms" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "B. Kritpracha" 1 => "D. Premprabha" 2 => "J. Sungsiri" 3 => "W. Tantarattanapong" 4 => "S. Rookkapan" 5 => "P. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 1 | 5 |
| 2024 October | 7 | 6 | 13 |
| 2024 September | 16 | 7 | 23 |
| 2024 August | 16 | 3 | 19 |
| 2024 July | 14 | 2 | 16 |
| 2024 June | 11 | 2 | 13 |
| 2024 May | 10 | 8 | 18 |
| 2024 April | 16 | 6 | 22 |
| 2024 March | 11 | 5 | 16 |
| 2024 February | 23 | 3 | 26 |
| 2024 January | 34 | 6 | 40 |
| 2023 December | 25 | 9 | 34 |
| 2023 November | 12 | 3 | 15 |
| 2023 October | 16 | 1 | 17 |
| 2023 September | 10 | 1 | 11 |
| 2023 August | 21 | 1 | 22 |
| 2023 July | 7 | 5 | 12 |
| 2023 June | 30 | 2 | 32 |
| 2023 May | 47 | 0 | 47 |
| 2023 April | 44 | 2 | 46 |
| 2023 March | 19 | 3 | 22 |
| 2023 February | 16 | 8 | 24 |
| 2023 January | 11 | 52 | 63 |
| 2022 December | 42 | 2 | 44 |
| 2022 November | 31 | 11 | 42 |
| 2022 October | 9 | 9 | 18 |
| 2022 September | 18 | 15 | 33 |
| 2022 August | 13 | 11 | 24 |
| 2022 July | 13 | 5 | 18 |
| 2022 June | 9 | 6 | 15 |
| 2022 May | 13 | 6 | 19 |
| 2022 April | 20 | 7 | 27 |
| 2022 March | 32 | 12 | 44 |
| 2022 February | 20 | 8 | 28 |
| 2022 January | 39 | 4 | 43 |
| 2021 December | 36 | 9 | 45 |
| 2021 November | 21 | 9 | 30 |
| 2021 October | 13 | 7 | 20 |
| 2021 September | 15 | 8 | 23 |
| 2021 August | 25 | 6 | 31 |
| 2021 July | 16 | 5 | 21 |
| 2021 June | 16 | 11 | 27 |
| 2021 May | 26 | 8 | 34 |
| 2021 April | 27 | 10 | 37 |
| 2021 March | 9 | 5 | 14 |
| 2021 February | 15 | 6 | 21 |
| 2021 January | 30 | 12 | 42 |
| 2020 December | 11 | 10 | 21 |
| 2020 November | 27 | 10 | 37 |
| 2020 October | 16 | 10 | 26 |
| 2020 September | 25 | 10 | 35 |
| 2020 August | 36 | 7 | 43 |
| 2020 July | 10 | 11 | 21 |
| 2020 June | 9 | 9 | 18 |
| 2020 May | 18 | 8 | 26 |
| 2020 April | 6 | 1 | 7 |
| 2020 March | 13 | 0 | 13 |
| 2020 February | 11 | 2 | 13 |
| 2020 January | 16 | 8 | 24 |
| 2019 December | 24 | 8 | 32 |
| 2019 November | 14 | 4 | 18 |
| 2019 October | 9 | 3 | 12 |
| 2019 September | 11 | 4 | 15 |
| 2019 August | 7 | 0 | 7 |
| 2019 July | 6 | 21 | 27 |
| 2019 June | 14 | 20 | 34 |
| 2019 May | 31 | 10 | 41 |
| 2019 April | 10 | 12 | 22 |
| 2019 March | 0 | 4 | 4 |
| 2019 February | 3 | 4 | 7 |
| 2019 January | 3 | 2 | 5 |
| 2018 December | 2 | 1 | 3 |
| 2018 November | 2 | 3 | 5 |
| 2018 October | 3 | 3 | 6 |
| 2018 September | 2 | 0 | 2 |
| 2018 August | 1 | 0 | 1 |
| 2018 July | 8 | 1 | 9 |
| 2018 June | 7 | 1 | 8 |
| 2018 May | 14 | 3 | 17 |
| 2018 April | 2 | 1 | 3 |
| 2018 March | 2 | 0 | 2 |
| 2018 February | 6 | 0 | 6 |
| 2018 January | 8 | 0 | 8 |
| 2017 December | 5 | 0 | 5 |
| 2017 November | 9 | 3 | 12 |
| 2017 October | 10 | 2 | 12 |
| 2017 September | 1 | 0 | 1 |
| 2017 May | 1 | 0 | 1 |
| 2017 April | 1 | 0 | 1 |
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