Mycotic Aneurysms: Uncommon Pathogens and Treatment Conundrums
This article has been Reviewed by the following groups
Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Introduction Mycotic aneurysms, characterized by vessel wall dilation resulting from infections including bacteria, fungi, and viruses, are a rare yet severe consequence of systemic infections.These aneurysms, accounting for 0.6% of Western countries' aneurysms, carry a higher risk of rupture compared to uninfected conditions. While the femoral artery, aorta, and intracranial visceral arteries are commonly affected, pathogens causing mycotic aneurysms vary across regions. Diagnostic challenges arise from nonspecific symptoms such as fever, pulsatile mass, local discomfort, and arterial inflammation. Materials & Methods: The case series involves three patients diagnosed with mycotic aneurysms due to unusual pathogens. We describe each patient's clinical presentation, medical history, physical examination findings, laboratory results, imaging studies, and the diagnostic process leading to the identification of the causative pathogens. Results The first case depicts a 70-year-old male with a ruptured infra-renal abdominal aortic pseudoaneurysm caused by Salmonella Paratyphi A. The second case involves a 66-year-old male with a Streptococcus pneumoniae-associated descending thoracic aortic pseudoaneurysm. The third case pertains to a 70-year-old male with a ruptured descending thoracic aortic aneurysm into the esophagus due to Pseudomonas aeruginosa infection. Each case highlights unique clinical features, laboratory findings, imaging results, and the management approaches undertaken. Conclusion Mycotic aneurysms, stemming from infections involving diverse pathogens, pose diagnostic challenges due to their nonspecific symptoms. Early identification and intervention are essential to mitigate the severe complications associated with these aneurysms. The presented cases underscore the need for a comprehensive approach to diagnosis and management, ensuring optimal outcomes for patients affected by mycotic aneurysms.
Article activity feed
-
I am pleased to tell you that your article has now been accepted for publication in Access Microbiology.
-
-
-
The reviewers have highlighted minor concerns with the work presented. Please ensure that you address their comments.
-
Comments to Author
Many thanks to the authors for their revised manuscript. It does in fact read much better. They have addressed all of my comments appropriately, but I do have further small suggestions before recommending publication which a thorough proof-read by the authors would have prevented; Lines 4 and 33 - 'mycotic' - Common 'm' Line 43 - Italicise 'Salmonella' Lines 63-64 - Do not italicize 'were isolated in one patient each' Lines 87 and 108 - References remain missing Line 106 - 'With a clinical working diagnosis of possible tuberculosis due to abdominal symptoms and the high prevalence of tuberculosis in our region, CECT…'
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Stro…
Comments to Author
Many thanks to the authors for their revised manuscript. It does in fact read much better. They have addressed all of my comments appropriately, but I do have further small suggestions before recommending publication which a thorough proof-read by the authors would have prevented; Lines 4 and 33 - 'mycotic' - Common 'm' Line 43 - Italicise 'Salmonella' Lines 63-64 - Do not italicize 'were isolated in one patient each' Lines 87 and 108 - References remain missing Line 106 - 'With a clinical working diagnosis of possible tuberculosis due to abdominal symptoms and the high prevalence of tuberculosis in our region, CECT…'
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
-
-
Comments to Author
Many thanks for the authors for their work. For the most part, they have addressed the Reviewers' comments adequately. However, I do have some lingering comments which can serve to improve the manuscript further. - There remains some issues with punctuation and capitalisation throughout the manuscript. Please correct. - Some bacterial species are formatted incorrectly. Please correct. - Do not use the ampersand in the manuscript, spell out the word. - There are a few missing references, Error! Reference source not found. Please correct. - Please elaborate the leucocyte differential, not everyone would know the order of leucocytes reported. - Please state that antimicrobial susceptibility testing using broth microdilution… - Line 81: …
Comments to Author
Many thanks for the authors for their work. For the most part, they have addressed the Reviewers' comments adequately. However, I do have some lingering comments which can serve to improve the manuscript further. - There remains some issues with punctuation and capitalisation throughout the manuscript. Please correct. - Some bacterial species are formatted incorrectly. Please correct. - Do not use the ampersand in the manuscript, spell out the word. - There are a few missing references, Error! Reference source not found. Please correct. - Please elaborate the leucocyte differential, not everyone would know the order of leucocytes reported. - Please state that antimicrobial susceptibility testing using broth microdilution… - Line 81: 'every 12-hours' - What was the outcome of Patient 1? Did he die? Discharged home? - Line 105: Why was the working diagnosis of tuberculosis? He presented with abdominal pain… - Line 129: Relieved by what medications? Analgesics? Herbal supplements? - A lot of the Discussion is repeated from the Introduction. This makes your work unnecessarily lengthy and a lot of the Discussion can be significantly shortened.
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
-
The reviewers have highlighted minor concerns with the work presented. Please ensure that you address their comments.
-
-
Comments to Author
Many thanks for your case series. Very interesting. Your cases are described very well and discussion is very comprehensive. I have only a few suggestions which you may see fit to address; Line 79 - How was antimicrobial susceptibility performed? Automated broth-microdilution? Line 110 - What do you mean by D9-D11? Are those anatomical landmarks? Line 134 & 139 - D again, is D supposed to represent the Thoracic? As in Thoracic vertebrae? Please clarify. Line 140 - Inj, I presume you mean intravenous? Did Case 3 have any significant past medical history? Were there any hypotheses on how these patients became infected with the pathogens in the first place? There are also a few grammatical errors across the manuscript which would benefit from a thorough proof-read.
Please rate the quality of …
Comments to Author
Many thanks for your case series. Very interesting. Your cases are described very well and discussion is very comprehensive. I have only a few suggestions which you may see fit to address; Line 79 - How was antimicrobial susceptibility performed? Automated broth-microdilution? Line 110 - What do you mean by D9-D11? Are those anatomical landmarks? Line 134 & 139 - D again, is D supposed to represent the Thoracic? As in Thoracic vertebrae? Please clarify. Line 140 - Inj, I presume you mean intravenous? Did Case 3 have any significant past medical history? Were there any hypotheses on how these patients became infected with the pathogens in the first place? There are also a few grammatical errors across the manuscript which would benefit from a thorough proof-read.
Please rate the quality of the presentation and structure of the manuscript
Very good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
-
Many thanks for your submission. Please find below a few comments from our reviewers. They mainly pertain to punctuation and some grammatical errors which I invite you to review and re-submit accordingly.
-
Comments to Author
There should be no reference number in the abstract. Line 4,5,7,8, 10, and 11: There should be no reference number in the abstract. Line 35: … by fungus.(1,2) It is a rare…→… by fungus (1,2). It is a rare … Line 38: … as arteriosclerosis(1,2,4). The vessels …→… as arteriosclerosis (1,2,4). The vessels … Line 40: … mesenteric, splenic).(1,2) The …→… mesenteric, splenic)(1,2). The … Line 42: … failure.(1,6) The etiological …→… failure (1,6). The etiological … Line 44: … countries.(1,2,6) Fever, …→… countries (1,2,6). Fever, … Line 46: … signs(1,2,6). Because …→… signs (1,2,6). Because … Line 48: … or rupture.(5) To reduce …→… or rupture (5). To reduce … Line 63: … Salmonella Paratyphi A, …→… Salmonella Paratyphi A: A should be written italically. Line 86: … hematoma. (Figure 1) The final …→… hematoma …
Comments to Author
There should be no reference number in the abstract. Line 4,5,7,8, 10, and 11: There should be no reference number in the abstract. Line 35: … by fungus.(1,2) It is a rare…→… by fungus (1,2). It is a rare … Line 38: … as arteriosclerosis(1,2,4). The vessels …→… as arteriosclerosis (1,2,4). The vessels … Line 40: … mesenteric, splenic).(1,2) The …→… mesenteric, splenic)(1,2). The … Line 42: … failure.(1,6) The etiological …→… failure (1,6). The etiological … Line 44: … countries.(1,2,6) Fever, …→… countries (1,2,6). Fever, … Line 46: … signs(1,2,6). Because …→… signs (1,2,6). Because … Line 48: … or rupture.(5) To reduce …→… or rupture (5). To reduce … Line 63: … Salmonella Paratyphi A, …→… Salmonella Paratyphi A: A should be written italically. Line 86: … hematoma. (Figure 1) The final …→… hematoma (Figure 1). The final … Line 105: … lymphadenopathy.(Figure 2) Paired …→… lymphadenopathy (Figure 2). Paired ... Line 139: … level of D10-D11 vertebra.(Figure 3) →… level of D10-D11 vertebra (Figure 3). Line 148: … causative agents.(1,2) While being …→… causative agents (1,2). While being … Line 156: … with arteriosclerosis.(1,2) The …→… with arteriosclerosis (1,2). The … Line 161: … as in our cases. (1,6) →… as in our cases (1,6). Line 164: … inflammation.(1,2,4) However, …→… inflammation (1,2,4). However, … Line 165: … unknown origin.(5) This …→… unknown origin (5). This … Line 167: … or rupture.(1) The presented …→… or rupture (1). The presented … Line 173: managed through thoracic endovascular aortic aneurysm repair (TEVAR). Case 3 underscores the → managed through TEVAR Case 3 … Line 180: … surgical intervention.(1,2) Notably, …→… surgical intervention (1,2). Notably, … Line 181: … in these cases.(7) Elective …→… in these cases (7). Elective … Line 189: … of patients(8,9). This …→… of patients (8,9). This … Line 192: … abdominal aorta.(1,9,10) The …→… abdominal aorta (1,9,10). The … Line 195: … is present.(11) NTS vascular …→… is present (11). NTS vascular … Line 198: … with lower risk (-1).(12) The signs …→… with lower risk (-1)(12). The signs … Line 200: … rupture.(1,2) Other complications …→… rupture (1,2). Other complications … Line 202: … are not addressed.(13) Diagnosis …→… are not addressed (13). Diagnosis … Line 209: … surgery.(9,11,14) In a study …→… surgery (9,11,14). In a study … Line 211: … mortality (40%).(14) Surgical …→… mortality (40%) (14). Surgical … Line 216: … relapsing bacteraemia. (8,9,14) → … relapsing bacteraemia (8,9,14). Line 219: … widely reported.(7,15) Case …→… widely reported (7,15). Case … Line 222: … in our case.(7) The case …→… in our case (7). The case … Line 230: … notably valuable.(7) Rising …→… notably valuable (7). Rising … Line 234: … fatal outcome.(7,15-17) Case …→… fatal outcome (7,15-17). Case … Line 235: the effectiveness of thoracic endovascular aortic aneurysm repair (TEVAR) in managing mycotic → the effectiveness of TEVAR in managing mycotic Line 238: … upto 6 weeks. (7,15-17) → … upto 6 weeks (7,15-17). Line 242: … such as grafts.(18-22) Case …→… such as grafts (18-22). Case … Line 250: … medical history.(23) In this …→… medical history (23). In this …
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
-