PDF(Pubmed)
Abstract：
INTRODUCTION AND IMPORTANCE: endovascular repair is an alternative to open repair for abdominal aortic aneurysms (AAA), which lowers morbidity and mortality but may presents infectious complications. Endograft infection is a rare but serious life-threatening condition with a mortality rate up to 50 %. We reported a case of aortic endograft infection by Francisella tularensis, rare and highly virulent gram-negative coccobacillus known for use in bioterrorism. CASE PRESENTATION: A 79-year-old man presented with asthenia, weight loss, night sweats and one episode of fever. In 2007, he underwent aorto-bi-iliac endograft repair for AAA without any complication. The diagnostic workup showed some signs of inflammation, but negative blood cultures and no sign of infection on CT scan. The combination of positron emission tomography (PET) and white blood cell (WBC) scintigraphy led to the diagnosis of aortic endograft infection. The management was antimicrobial therapy and surgery. Perioperative analysis shows the presence of Francisella Tularensis. DISCUSSION AND CONCLUSIONS: Aortic endograft infection is a serious complication with a high mortality rate. Its diagnosis may be difficult, but the combination of WBC scintigraphy and PET scan may improve identification of the infection, even if blood cultures and CT scan are negative. The gold standard treatment is removal of the endograft, debridement, and in situ reconstruction along with antibacterial therapy.
摘要：
简介和重要性：腔内修复是腹主动脉瘤（AAA）开放修复的替代方法，降低发病率和死亡率，但可能会出现感染性并发症。移植物感染是一种罕见但严重的危及生命的疾病，死亡率高达50％。我们报道了一例主动脉内移植瘤Francisellatularensis感染，已知用于生物恐怖主义的罕见且高毒力的革兰氏阴性球杆菌。案例介绍：一名79岁的男子出现虚弱，减肥,盗汗和一次发烧。2007年，他接受了主动脉双髂内移植治疗AAA，没有任何并发症。诊断检查显示了一些炎症的迹象，但血培养阴性CT扫描无感染迹象.正电子发射断层扫描（PET）和白细胞（WBC）闪烁显像的结合导致了主动脉移植物感染的诊断。管理是抗菌治疗和手术。围手术期分析显示存在TularensisFrancisella。讨论和结论：主动脉内移植物感染是一种严重的并发症，死亡率高。它的诊断可能很困难，但是WBC闪烁显像和PET扫描的结合可以改善感染的识别，即使血培养和CT扫描均为阴性。金标准治疗是去除内移植物，清创术,和原位重建以及抗菌治疗。
