From the Guidelines
Yes, tuberculosis can cause mycotic aneurysms, typically through direct extension from adjacent infected tissues or via hematogenous spread from a distant tuberculosis focus, as described in the pathogenesis of mycotic aneurysms 1. The formation of mycotic aneurysms in tuberculosis patients can occur through several mechanisms, including septic microemboli to the vasa vasorum, direct extension from a contiguous focus, hematogenous infection of the intimae, or direct blood vessel contamination or trauma 1.
- Key factors contributing to the development of mycotic aneurysms in tuberculosis include:
- Infection of the arterial wall by Mycobacterium tuberculosis
- Weakening of the vessel wall due to inflammation
- Eventual dilation of the vessel, leading to aneurysm formation
- The most commonly affected vessels are the aorta, particularly the descending thoracic and abdominal segments, though other arteries can also be involved.
- Management of tuberculous mycotic aneurysms typically involves a combination of standard antituberculous therapy and surgical intervention to repair or replace the affected vessel segment, as the risk of rupture is high and can be fatal if left untreated 1.
- Early diagnosis and treatment are crucial for patients with tuberculosis who develop unexplained chest, back, or abdominal pain, as these symptoms may indicate possible vascular complications, including mycotic aneurysms 1.
From the Research
Tuberculosis and Mycotic Aneurysms
- Tuberculosis (TB) can cause mycotic aneurysms, which are rare but potentially life-threatening complications of the disease 2, 3, 4, 5, 6.
- Mycotic aneurysms are typically defined as aneurysms that are infected, and in the case of TB, the infection can spread to the vascular wall through direct erosion or hematogenous dissemination 4, 6.
- The aorta is the most commonly affected artery, but other arteries such as the iliac, femoral, and popliteal arteries can also be involved 2, 3, 4, 5, 6.
Clinical Presentation and Diagnosis
- Patients with mycotic aneurysms due to TB may present with symptoms such as fever, night sweats, and weight loss, as well as localized symptoms such as pain or swelling at the site of the aneurysm 2, 3, 4, 5, 6.
- Diagnosis is typically made using a combination of imaging studies such as CT angiography, as well as laboratory tests to confirm the presence of TB 2, 3, 4, 5, 6.
Treatment and Outcome
- Treatment of mycotic aneurysms due to TB typically involves a combination of medical and surgical therapy, including anti-tubercular medications and surgical repair or resection of the aneurysm 2, 3, 4, 5, 6.
- The outcome of treatment is generally favorable, but the mortality rate remains high due to complications such as aneurysmal rupture and septicemia 6.