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Pneumococcal Aortitis in the Antibiotic Era

Pneumococcal Aortitis in the Antibiotic Era Abstract The pneumococcus remains in the antibiotic era a formidable pathogen, capable of atypical, lethal clinical presentations. We report two fatal cases of thoracic aortitis caused by Streptococcus pneumoniae in the setting of bacteremic illness from this pathogen. One case occurred in an aortic graft and the other arose in a native aorta. We also discuss the indolent clinical presentation and the diagnostic failure of transesophageal echocardiography and leukocyte scintigraphy. Persistent pyrexia with atypical chest pain and unexplained blood loss should alert clinicians to the possibility of this uncommon, yet lethal complication of pneumococcal disease (Arch Intern Med. 1995;155:1678-1680) References 1. Finley JC, Davidson M, Parkinson AJ, Sullivan RW. Pneumococcal endocarditis in Alaska natives: a population-based experience, 1978 through 1990. Arch Intern Med . 1992;152:1641-1645.Crossref 2. Grandsen WR, Eykyn SJ, Phillips I. Pneumococcal bacteraemia: 325 episodes diagnosed at St. Thomas's Hospital. BMJ . 1985;290:505-508.Crossref 3. Revell STR Jr. Primary mycotic aneurysms. Ann Intern Med . 1945;22:431-440.Crossref 4. Gelabert HA, Quinones-Baldrich WJ. Mycotic aneurysm of the suprarenal aorta secondary to Streptococcus pneumoniae: an unusual pathogen. Ann Vasc Surg . 1991;5:529-532.Crossref 5. Worrell JT, Buja LM, Reynolds RC. Pneumococcal aortitis with rupture of the aorta: report of a case and review of the literature. Am J Clin Pathol . 1988;89:565-568. 6. Saphir O, Cooper GW. Acute suppurative aortitis superimposed on syphilitic aortitis: report of a case. Arch Pathol . 1927;4:543-545. 7. Reifenstein BW. Two cases of mycotic aneurysm, gonococcal and pneumococcal in origin. Am J Med Sci . 1924;168:381-388.Crossref 8. Brunner MC, Mitchell RS, Baldwin JC, et al. Prosthetic graft infection: limitations of indium white blood cell scanning. J Vasc Surg . 1986;5:193-197. 9. Ben-Haim S, Seabold JE, Hanes DR, Rooholamini SA. Leukocyte scintigraphy in the diagnosis of mycotic aneurysm. J Nucl Med . 1992;33: 1486-1493 10. Gomes MN, Choyke PL. Infected aortic aneurysms: CT diagnosis. J Thorac Cardiovasc Surg . 1992;103:684-689. 11. Johansen K, Devin J. Mycotic aortic aneurysms: a reappraisal. Arch Surg . 1983;118:583-588.Crossref 12. Pasic M, Carrel T, Von Segesser L, Turina M. In situ repair of mycotic aneurysms of the ascending aorta. J Thorac Cardiovasc Surg . 1993;105: 321-326. 13. Gomes MN, Choyke PL, Wallace RB. Infected aortic aneurysms: a changing entity. Ann Surg . 1992; 215:435-442.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1995.00430150172018
Publisher site
See Article on Publisher Site

Abstract

Abstract The pneumococcus remains in the antibiotic era a formidable pathogen, capable of atypical, lethal clinical presentations. We report two fatal cases of thoracic aortitis caused by Streptococcus pneumoniae in the setting of bacteremic illness from this pathogen. One case occurred in an aortic graft and the other arose in a native aorta. We also discuss the indolent clinical presentation and the diagnostic failure of transesophageal echocardiography and leukocyte scintigraphy. Persistent pyrexia with atypical chest pain and unexplained blood loss should alert clinicians to the possibility of this uncommon, yet lethal complication of pneumococcal disease (Arch Intern Med. 1995;155:1678-1680) References 1. Finley JC, Davidson M, Parkinson AJ, Sullivan RW. Pneumococcal endocarditis in Alaska natives: a population-based experience, 1978 through 1990. Arch Intern Med . 1992;152:1641-1645.Crossref 2. Grandsen WR, Eykyn SJ, Phillips I. Pneumococcal bacteraemia: 325 episodes diagnosed at St. Thomas's Hospital. BMJ . 1985;290:505-508.Crossref 3. Revell STR Jr. Primary mycotic aneurysms. Ann Intern Med . 1945;22:431-440.Crossref 4. Gelabert HA, Quinones-Baldrich WJ. Mycotic aneurysm of the suprarenal aorta secondary to Streptococcus pneumoniae: an unusual pathogen. Ann Vasc Surg . 1991;5:529-532.Crossref 5. Worrell JT, Buja LM, Reynolds RC. Pneumococcal aortitis with rupture of the aorta: report of a case and review of the literature. Am J Clin Pathol . 1988;89:565-568. 6. Saphir O, Cooper GW. Acute suppurative aortitis superimposed on syphilitic aortitis: report of a case. Arch Pathol . 1927;4:543-545. 7. Reifenstein BW. Two cases of mycotic aneurysm, gonococcal and pneumococcal in origin. Am J Med Sci . 1924;168:381-388.Crossref 8. Brunner MC, Mitchell RS, Baldwin JC, et al. Prosthetic graft infection: limitations of indium white blood cell scanning. J Vasc Surg . 1986;5:193-197. 9. Ben-Haim S, Seabold JE, Hanes DR, Rooholamini SA. Leukocyte scintigraphy in the diagnosis of mycotic aneurysm. J Nucl Med . 1992;33: 1486-1493 10. Gomes MN, Choyke PL. Infected aortic aneurysms: CT diagnosis. J Thorac Cardiovasc Surg . 1992;103:684-689. 11. Johansen K, Devin J. Mycotic aortic aneurysms: a reappraisal. Arch Surg . 1983;118:583-588.Crossref 12. Pasic M, Carrel T, Von Segesser L, Turina M. In situ repair of mycotic aneurysms of the ascending aorta. J Thorac Cardiovasc Surg . 1993;105: 321-326. 13. Gomes MN, Choyke PL, Wallace RB. Infected aortic aneurysms: a changing entity. Ann Surg . 1992; 215:435-442.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Aug 7, 1995

References