Fungal aneurysms are caused by bacteria or fungi in the bloodstream and can occur in various arteries. Those with heart disease, valve conditions, or who use IV drugs are at higher risk. Symptoms include pain, fever, and weakness. Treatment involves antibiotics and surgery. Prevention involves monitoring underlying conditions.
A mycotic aneurysm is an aneurysm that becomes infected due to the buildup of bacteria or fungi in the bloodstream. It can also be a pre-existing aneurysm that becomes infected. Fungal aneurysms are a common complication of bacterial or infective endocarditis, a condition in which a heart vessel becomes infected due to bacteria in the bloodstream. This type of aneurysm commonly occurs within the thoracic aorta, but can also occur in the arteries of the neck, arm, thigh, and abdomen.
Individuals with heart disease or heart valve conditions are at a higher risk of getting a fungal aneurysm, especially if they have artificial heart valves. Intravenous, or IV, drug users are another group at high risk for fungal aneurysms due to the increased likelihood of contracting staph bacteria in the bloodstream, which can travel to the heart. Some dental procedures can expose a patient to bacteria that can infect the arteries and walls of the heart, which is why patients are asked to tell the dentist about any heart conditions before having the dental work done.
Symptoms of a fungal aneurysm include pain in the neck, arm, or abdomen. Fever, fatigue, nausea, and weakness may also occur. As with any type of aneurysm, a rupture can be fatal. Signs of a possible rupture include high blood pressure, elevated heart rate, and lightheadedness. Upon prompt medical attention, a computed tomography, or CT, scan, and ultrasound are done to determine the location, size, and extent of the aneurysm and to determine the most effective course of treatment.
Treating a fungal aneurysm can be risky. Antibiotics to fight infection are given for four to six weeks. Serial angiography can be used to monitor the effectiveness of antibiotics. While medications may seem to shrink a fungal aneurysm, there is still a chance it will grow and new ones can form.
Surgery is a necessity in most cases. Depending on the patient’s location, degree of infection, and immune system status, extraanatomical reconstruction or in situ endovascular reconstruction may be performed—the former being more common than the latter. Extraanatomical reconstruction requires multiple operations involving aortal or arterial dissection, excision of infected tissue, and extraanatomical bypass graft through an uninfected plane.
In situ endovascular reconstruction is considered when extraanatomical reconstruction is too risky due to a fungal aneurysm being too close to the heart, such as in an ascending aorta. This procedure involves the in situ insertion of a homograph aortic duct composed of cryopreserved aortic tissue. In situ reconstruction has received increased attention in recent years due to reduced postoperative infection rates and improved survival rates.
Typically, the only way to prevent a fungal aneurysm is to closely monitor the underlying conditions that may be causing it to develop. Although fungal aneurysms are potentially fatal, recovery is possible. Recurring or constant pain that doesn’t go away or gets worse, a spike in blood pressure or heart rate that doesn’t slow at rest, or a fever that lasts more than five to seven days are symptoms that shouldn’t be ignored.
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