title: Multiple peripheral pneumococcal mycotic aneurysms without aortic involvement: a unique case confirmed with the novel use of a molecular diagnostic technique.
abstract: 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.
authors.affiliation: Leeds Vascular Institute, Microbiology Department, Leeds General Infirmary, Leeds, United Kingdom.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Dickinson
authors.forename: Duncan J
authors.initials: DJ
authors.lastname: Parry
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Sandoe
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Gough
mesh_terms: D000368:Aged; D000785:Aneurysm, Infected / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D017542:Aneurysm, Ruptured / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology / Q000601:surgery; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004269:DNA, Bacterial / Q000302:isolation & purification*; D005263:Femoral Artery / Q000382:microbiology / Q000473:pathology; D006801:Humans; D008297:Male; D008586:Meningitis, Pneumococcal / Q000150:complications* / Q000188:drug therapy; D025202:Molecular Diagnostic Techniques; D010400:Penicillin G / Q000627:therapeutic use; D011018:Pneumonia, Pneumococcal / Q000150:complications* / Q000188:drug therapy; D016133:Polymerase Chain Reaction; D011150:Popliteal Artery / Q000382:microbiology / Q000473:pathology; D013296:Streptococcus pneumoniae / Q000235:genetics*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures; D014680:Veins / Q000637:transplantation
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D010400:Penicillin G