Multiple peripheral pneumococcal mycotic aneurysms without aortic involvement: A unique case confirmed with the novel use of a molecular diagnostic technique

• Published in: Journal of vascular surgery 2007-06, Vol.45 (6), p.1253-1255
• Main Authors: Dickinson, Karen J., BSc, MRCS, Parry, Duncan J., MD, FRCSEd, Sandoe, Jonathan A., PhD, MRCPath, Gough, Michael J., ChM, FRCS
• Format: Article
• Language: English
• Subjects: Aged; Aneurysm, Infected - complications; Aneurysm, Infected - diagnosis; Aneurysm, Infected - drug therapy; Aneurysm, Infected - microbiology; Aneurysm, Infected - surgery; Aneurysm, Ruptured - drug therapy; Aneurysm, Ruptured - microbiology; Aneurysm, Ruptured - pathology; Aneurysm, Ruptured - surgery; Anti-Bacterial Agents - therapeutic use; Bacterial diseases; Bacterial endocarditis, myocarditis and pericarditis. Bacterial diseases of the aorta, limb vessels and lymphatic vessels; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Diseases of the aorta; DNA, Bacterial - isolation & purification; Femoral Artery - microbiology; Femoral Artery - pathology; Human bacterial diseases; Humans; Infectious diseases; Male; Medical sciences; Meningitis, Pneumococcal - complications; Meningitis, Pneumococcal - drug therapy; Molecular Diagnostic Techniques; Penicillin G - therapeutic use; Pneumonia, Pneumococcal - complications; Pneumonia, Pneumococcal - drug therapy; Polymerase Chain Reaction; Popliteal Artery - microbiology; Popliteal Artery - pathology; Streptococcus pneumoniae - genetics; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Vascular Surgical Procedures; Veins - transplantation
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2007.01.039

Mycotic aneurysms confer a high morbidity and mortality. Streptococcus pneumoniae aneurysms usually affect the aorta and are rare, although bacterial cultures from aneurysm tissue may be difficult following prior antimicrobial therapy. We report a unique case of mycotic femoral and popliteal artery aneurysms following pneumococcal pneumonia and meningitis, which were managed by resection, revascularization with autologous vein, and intravenous benzylpenicillin. Although blood and aneurysm sac cultures were negative, arterial wall S pneumoniae DNA was detected by polymerase chain reaction (PCR). Appropriate molecular diagnostic techniques can facilitate diagnosis and direct antimicrobial therapy; an important consideration with increasing antimicrobial resistance.