Department of Surgery, Haga Teaching Hospital, The Hague, The Netherlands.
Department of Surgery, Haga Teaching Hospital, The Hague, The Netherlands; Department of Vascular Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
Eur J Vasc Endovasc Surg. 2022 May;63(5):743-750. doi: 10.1016/j.ejvs.2022.02.004. Epub 2022 Feb 11.
Brucellosis is the most common zoonosis worldwide. Although cardiovascular complications in human brucellosis comprise only 3% of morbidity, they are the principal cause of death. Endocarditis covers the majority of these cases. Infected aneurysms and ulcerative processes of the aorta are rare but can be life threatening as well. Currently, limited information is available about aortic and iliac involvement in brucellosis.
A PubMed, Web of Science, and AccessMedicine search (without restriction on language or year of publication) was performed to identify relevant articles on aortic and iliac involvement in brucellosis. Case reports were eligible for inclusion if they reported on thoracic, abdominal, or iliac aortic pathology caused by Brucella.
Seventy-one cases were identified over the last 70 years, with an overall mortality rate of 22%. Most of the patients were male (86%) and had a history of Brucella exposure (66%). Approximately one quarter (23%) contracted Brucella while travelling in a (hyper)endemic region. Almost half of the infections were located in the abdominal aorta (49%), followed by the ascending (37%) and descending (13%) thoracic aorta. Infected aneurysms (61%) and ulcerative processes (16%) were seen most frequently. Aortic rupture was present in 31% of cases and occurred mainly in the abdominal (49%) and descending thoracic aorta (44%). The majority of all patients (59%) underwent open surgery combined with long term antibiotics. Over the past 15 years, a trend towards endovascular treatment was observed.
Although aortic and iliac involvement in brucellosis is rare, it can be a life threatening manifestation. Due to low awareness, this infection may represent an under reported disease. The therapeutic cornerstone in these cases remains open surgery combined with antibiotics. The role of endovascular treatment is yet to be decided, in which the condition of the patient and the risks of long term complications need to be considered.
布鲁氏菌病是全球最常见的动物源性传染病。虽然人类布鲁氏菌病的心血管并发症仅占发病率的 3%，但却是主要的死亡原因。心内膜炎占此类病例的大多数。感染性动脉瘤和主动脉溃疡性病变虽然罕见，但也可能危及生命。目前，有关布鲁氏菌病主动脉和髂动脉受累的信息有限。
我们对 PubMed、Web of Science 和 AccessMedicine 进行了检索（无语言或出版年份限制），以确定关于布鲁氏菌病主动脉和髂动脉受累的相关文章。如果病例报告报告了由布鲁氏菌引起的胸、腹或髂主动脉病理学改变，则符合纳入标准。
在过去的 70 年中，共发现了 71 例病例，总死亡率为 22%。大多数患者为男性（86%），有布鲁氏菌暴露史（66%）。约四分之一（23%）的患者在布鲁氏菌流行（高流行）地区旅行时感染了布鲁氏菌。近一半的感染位于腹主动脉（49%），其次是升主动脉（37%）和降主动脉（13%）。感染性动脉瘤（61%）和溃疡性病变（16%）最为常见。31%的病例存在主动脉破裂，主要发生在腹主动脉（49%）和降主动脉（44%）。大多数患者（59%）接受了开放性手术联合长期抗生素治疗。在过去 15 年中，观察到一种倾向于血管内治疗的趋势。
尽管布鲁氏菌病主动脉和髂动脉受累罕见，但它可能是一种危及生命的表现。由于认识不足，这种感染可能是一种报告不足的疾病。在这些病例中，治疗的基石仍然是开放性手术联合抗生素。血管内治疗的作用仍有待确定，需要考虑患者的病情和长期并发症的风险。
