title: Aorto-iliac aneurysm infected by Brucella: distinctive presentation patterns of a rare entity.
abstract: There is currently a lack of information on presentation patterns and the appropriate investigation and treatment of aortic brucellosis. Herein a case affecting the iliac component of an aorto-iliac aneurysm, managed successfully with in situ graft repair, is reported. A review of the literature identified 25 cases, with the infrarenal abdominal aorta (65%) followed by the ascending thoracic aorta (23%) being mostly affected; only our case involved the iliacs. Aortic brucellosis affected mostly older men, caused pain more often than fever (in 73% and 57%, respectively), and involved frequently the spine or the aortic valve (n = 14, 56%). Preoperative diagnosis was made more often in the presence of fever (67% versus 18% in afebrile patients, P = 0.021). In situ aneurysm repair in the form of open (54%) or endovascular (8%) grafting was mostly performed. Mortality was 12% and graft infection was 13% at two years. In conclusion, aortic brucellosis has unique presentation patterns, usually affecting an abnormal or aneurysmal aorta and/or due to a contiguous spinal or aortic valve infection. Acute symptomatology with pain and/or fever occurs very often and should raise suspicion for aortic infection. Despite the seriousness of aortic involvement, mortality and reinfection rates are within acceptable levels.
authors.affiliation: Department of Vascular Surgery kakkos@upatras.gr.
authors.forename: S K
authors.initials: SK
authors.lastname: Kakkos
authors.affiliation: Department of Vascular Surgery.
authors.forename: S
authors.initials: S
authors.lastname: Papadoulas
authors.affiliation: Department of Vascular Surgery.
authors.forename: G
authors.initials: G
authors.lastname: Lampropoulos
authors.affiliation: Department of Internal Medicine.
authors.forename: M
authors.initials: M
authors.lastname: Marangos
authors.affiliation: Department of Radiology, University Hospital of Patras, Patras, Greece.
authors.forename: C
authors.initials: C
authors.lastname: Kalogeropoulou
authors.affiliation: Department of Vascular Surgery.
authors.forename: I A
authors.initials: IA
authors.lastname: Tsolakis
mesh_terms: D000328:Adult; D000368:Aged; D000785:Aneurysm, Infected / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D002002:Brucella / Q000472:pathogenicity*; D002006:Brucellosis / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D017543:Iliac Aneurysm / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Brucella; aneurysm repair; aortic infection