Infected aortic aneurysm caused by Helicobacter cinaedi : case series and systematic review of the literature
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CASE REPORT
Open Access
Infected aortic aneurysm caused by Helicobacter cinaedi: case series and systematic review of the literature Takahiro Matsuo1* , Nobuyoshi Mori1, Atsushi Mizuno2,3,4, Aki Sakurai5, Fujimi Kawai6, Jay Starkey7, Daisuke Ohkushi8, Kohei Abe9, Manabu Yamasaki9, Joji Ito10, Kunihiko Yoshino9, Yumiko Mikami11, Yuki Uehara1,11 and Keiichi Furukawa1,12
Abstract Background: Helicobacter cinaedi is rarely identified as a cause of infected aneurysms; however, the number of reported cases has been increasing over several decades, especially in Japan. We report three cases of aortic aneurysm infected by H. cinaedi that were successfully treated using meropenem plus surgical stent graft replacement or intravascular stenting. Furthermore, we performed a systematic review of the literature regarding aortic aneurysm infected by H. cinaedi. Case presentation: We present three rare cases of infected aneurysm caused by H. cinaedi in adults. Blood and tissue cultures and 16S rRNA gene sequencing were used for diagnosis. Two patients underwent urgent surgical stent graft replacement, and the other patient underwent intravascular stenting. All three cases were treated successfully with intravenous meropenem for 4 to 6 weeks. Conclusions: These cases suggest that although aneurysms infected by H. cinaedi are rare, clinicians should be aware of H. cinaedi as a potential causative pathogen, even in immunocompetent patients. Prolonged incubation periods for blood cultures are necessary for the accurate detection of H. cinaedi. Keywords: Helicobacter cinaedi, Infected aneurysm, Japan, Case report
Background Helicobacter cinaedi is a gram-negative spiral rod that was first discovered in the rectal culture from a man who had had sex with a man with proctitis [1]. H. cinaedi was thought to cause infection only in immunocompromised individuals; however, it has also been observed as a causative pathogen in immunocompetent patients [2–4]. H. cinaedi can cause bacteremia, skin and soft tissue infection, and arterial infection [5, 6].
* Correspondence: [email protected] 1 Department of Infectious Diseases, St. Luke’s International Hospital, 9-1, Akashi-cho, Chuo-ku, Tokyo, Japan Full list of author information is available at the end of the article
Although infected (mycotic) aortic aneurysms are not common, they are difficult to treat and are associated with high morbidity and mortality. Mortality has been reported to be greater than 20%, usually attributable to delays in diagnosis and subsequent complications, such as rupture and sepsis [7–9]. Common pathogens include Staphylococcus aureus, Streptococcus pneumoniae, and non-typhoidal Salmonella followed by other gramnegative organisms such as Escherichia coli, Klebsiella, and Pseudomonas spp. [10, 11]. Mycobacterium spp., Treponema palladium, and Chlamydophila spp. have also been reported as causative pathogens, although rarely [12, 13].
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which pe
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