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.

Anterior cervical discectomy and fusion (ACDF) represents one of the most commonly performed spine surgeries. Dysphagia secondary to esophageal injury during retraction is one of the most common complications, and usually leads to self-limiting dysphagia. However, actual perforation and violation of the esophageal tissue is much rarer and can lead to delayed deep infections. Prevertebral abscess\' are one of the most feared complications after ACDF, as they can lead to severe tissue swelling, osteomyelitis, hardware failure, and even death. Due to their rarity, a gold standard of workup and treatment is still unknown. A healthy 47-year-old female presents 9 months after a C4-C7 ACDF done at an outside institution with a large prevertebral abscess, osteomyelitis, hardware failure, and pseudoarthrosis secondary to esophagopharyngeal defect and prominent hardware. Overall, the patient underwent eight surgeries, and required an extended course of intravenous (IV) antibiotics, multiple diagnostic procedures, and complex soft tissue coverage using an anterolateral thigh free flap. Currently, the patient is doing well 6 months from her last procedure without any complications or plan for future surgery. This was an extremely rare case of a late occurring prevertebral abscess after ACDF. Dysphagia in the late postoperative setting should be evaluated carefully and thoroughly for any esophageal perforation and deep infection. As exemplified in this case, even partial thickness injuries to the esophageal-pharyngeal anatomy due to hardware irrigation can lead to catastrophic complications over time. Safe removal of all hardware anteriorly to avoid continued irritation of the esophagopharyngeal mucosa should be prioritized. If anterior hardware is necessary for stability, implants with the smallest footprint should be utilized. Early collaboration with ENT colleagues should be a priority and can provide crucial diagnostic and therapeutic interventions. Complex closure with a free flap was shown to be an effective way to provide successful definitive soft tissue coverage.

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) is often performed for the treatment of degenerative cervical spine. While this procedure is highly successful, 0.1-1.6% of early and late postoperative infection have been reported although the rate of late infection is very low.
METHODS: Here, we report a case of 59-year-old male patient who developed deep cervical abscess 30 days after anterior cervical discectomy and titanium cage bone graft fusion (autologous bone) at C3/4 and C4/5. The patient did not have esophageal perforation. The abscess was managed through radical neck dissection approach with repated washing and removal of the titanium implant. Staphylococcus aureus was positively cultured from the abscess drainage, for which appropriate antibiotics including cefoxitin, vancomycin, levofloxacin, and cefoperazone were administered postoperatively. In addition, an external Hallo frame was used to support unstable cervical spine. The patient\'s deep cervical infection was healed 3 months after debridement and antibiotic administration. His cervial spine was stablized 11 months after the surgery with support of external Hallo Frame.
CONCLUSIONS: This case suggested that deep cervical infection should be considered if a patient had history of ACDF even in the absence of esophageal perforation.

Primary total hip replacement has become a routine procedure these days. With improvement in surgical techniques and implant designs, the survival rate of prosthesis has increased significantly but unfortunately, prosthetic infections though uncommon continue to be a threatening complication. We present a detailed review of the literature along with a case report of infected total hip prosthesis in a 36-year-old female who had been operated 6 years back. The causative organism was found to be Actinomyces israelii which was related to an infected intrauterine device used for contraception that had been forgotten after being implanted 8 years earlier.

BACKGROUND: Infection of following total hip arthroplasties can be classified based on the timing of infection. Late infections with Actinomyces israelii are extremely rare with only 3 previously reported cases in literature. We present another case of a late infection with Actinomyces israelii in a total hip arthroplasty 9 years following implantation.
METHODS: A 71-year-old male with diabetes mellitus presented with right hip pain 9 years following a total hip arthroplasty. Physical examination revealed localised pain and biochemical investigations showed elevated inflammatory markers. X-rays were suspicious for infection and a collection around the prosthesis was confirmed by MRI scan. The patient underwent debridement and removal of prosthesis. Peri-operative specimen cultures isolated Actinomyces israelii. The patient responded to a combination of vancomycin followed by ciprofloxacin and linezolid therapy before undergoing a successful second-stage reimplantation surgery.
CONCLUSIONS: This is the first reported case of late haematogenous infection by Actinomyces israelii in a total hip arthroplasty in a patient with diabetes mellitus as the only risk factor. The patient was successfully treated with antibiotic therapy and two-stage reimplantation arthroplasty.