Surgical Treatment of Ruptured Infectious Femoral Pseudoaneurysms Caused By Intravenous Drug Abuse: A Nonemergent (Postponed) Operation Pattern May Be a Possible Alternative

Objective: To evaluate the possibility of surgical treatment of ruptured infectious femoral pseudoaneurysms caused by intravenous drug abuse in a nonemergent operation pattern, with retrospective analysis of clinical data and experience at a single center.Methods: Clinical data of 85 consecutive patients presenting with groin area active or recent hemorrhage due to a ruptured infectious femoral artery pseudoaneurysm related to drug abuse who were treated in the First Hospital of Changsha, China, from July 2008 to June 2020 were collected and analyzed.Results: A total of 74.1% of patients presented with active hemorrhage, and 36.5% presented with significant hypotension at admission. The average interval between arrival and operation was 34.7±4.7 hours. Vital physiological parameters and overall situation improved significantly after sufficient preoperative preparation. Satisfactory hemostasis can be achieved by bandage compression or local skin suture. No case was transferred to urgent operation due to severe bleeding, and 1 postoperative death case was observed in the cohort. The main operative- and postoperative-related indicators were satisfactory and close to those in the emergent operation pattern.Conclusion: While emergent or urgent operation is the mainstream surgical treatment for ruptured infectious femoral pseudoaneurysms, nonemergent (postponed) operation with sufficient preoperative preparation might also be an acceptable and comparable choice in some cases.

The Clinical Characteristics and Incidence of Pulmonary Tuberculosis of 7632 HIV Patients in Yunnan Province from 2005 to 2017

Objective: To analyze the age and gender distribution characteristics of 7,632 HIV/AIDS patients at the onset of HIV infection-related high-risk intravenous drug abuse and sexual contact in Yunnan province. Methods: Data were collected from the database of Chinese Medicine Treatment of AIDS Pilot Project in Yunnan province. Gender, age and demographics of HIV/AIDS patients were analyzed. Results: The patients were almost in relatively high educational background. The number of male intravenous drug users (12.90%) was more than female, and the earliest average age was 10-14 years. The percentages of men in 10-19 years and 35-59 years were more than that of women. No obvious difference was found in heterosexual sexual contact in both men (48.11%) and women (51.89%), and the earliest ages was 15-19 years in males and 10-14 years in females. The percentage of males at 10-34 years old was less than that of females, just opposite to the age of 35-85 years. Homosexual contact was more in males (92.73%) than that in females (7.27%). The earliest homosexual sexual contact associated with HIV infection was 15-19 years in males and 25-29 years in females. Among 128 AIDS patients with pulmonary tuberculosis infection, intravenous drug abuse accounted for the highest proportion (76.56%) of the three high-risk behaviors related to HIV infection. Conclusions: Reducing risk behaviors and preventing intravenous drug abuse could be effective in preventing AIDS. Compared with other high-risk behaviors, patients with intravenous drug use and AIDS are at greater risk of contracting tuberculosis.

Case Report: A 46-Year-Old Man With Giant Pseudoaneurysm of the Left Superficial Femoral Artery

Introduction: Pseudoaneurysm is a complication caused by vascular injury, which is more common in firearm injuries, stab wounds, iatrogenic injuries, etc. Clinically, femoral pseudo-artery caused by intravenous drug abuse is not uncommon, but giant pseudoaneurysms are relatively rare. Case presentation: A 46-year-old man presented with a 6-month history of a pulsating mass in the left groin, which was aggravated with pain for 3 days. The patient has a history of intravenous drug use for more than half a year. Six months ago, the patient found a lump in the left groin, and no special treatment was given.Three days ago, the mass in the patient's left groin suddenly enlarged with severe pain. The patient then came to our hospital for treatment, and ultrasound revealed a pseudoaneurysm in the left femoral artery.CTA of the lower extremity arteries suggested a huge pseudoaneurysm in the left femoral artery. To avoid the rupture of the huge pseudoaneurysm of the left superficial femoral artery, we implemented emergency interventional surgery. The operation was successful and the patient recovered well after the operation.Conclusions: In order to avoid the rupture of a huge pseudoaneurysm of the femoral artery, emergency interventional surgery is an option. However, considering that pseudoaneurysms caused by intravenous drug abuse are often associated with fungal infections, surgery is still the best choice.

Surgical treatment of infective endocarditis in intravenous drug abusers

Background Despite current progress in antibiotic therapy and medical management, infective endocarditis remains a serious condition presenting with high mortality rates. It also is a life-threatening complication in patients with a history of chronic intravenous drug abuse. In this study, we analyzed our institutional experience on the surgical therapy of infective endocarditis in patients with active intravenous drug abuse. The aim of the study is to identify the predictive factors of mortality and morbidity in this subgroup of patients. Methods Between 2007 and 2020, a total of 24 patients (7 female, mean age 38.5 ± 8.7) presenting with active intravenous drug abuse underwent a surgical treatment for the infective endocarditis at out center. The primary endpoint was survival at 30th day after the surgery. The secondary composite endpoint included freedom from death, recurrent endocarditis, re-do surgery, and postoperative stroke during the follow-up period. Mean follow-up was 4.2 ± 4.3 years. Results Staphylococcus species was the most common pathogen detected in the preoperative blood cultures. Infection caused by Enterococcus species as well as liver function impairment were identified as mortality predictor factors. Logistic EuroSCORE and EusoSCORE-II were also predictive factors for mortality in univariate analysis. Survival at 1 and 3 years was 78 and 72% respectively. Thirty-day survival was 88%. 30-day freedom from combined endpoint was 83% and after 1 and 3 years, 69 and 58% of the patients respectively were free from combined endpoint. Five patients (20.8%) were readmitted with recurrent infective endocarditis. Conclusion In patients presenting with active intravenous drug abuse, treatment of infective endocarditis should be performed as aggressively as possible and should be followed by antibiotic therapy to avoid high mortality rates and recurrent endocarditis. Early intervention is advisable in patients with an infective endocarditis and enterococcus species in the preoperative blood cultures, liver function deterioration as well as cardiac function impairment. Attention should be also payed to addiction treatment, due to the elevated relapse rate in patients who actively inject drugs. However, larger prospective studies are necessary to support our results. As septic shock is the most frequent cause of death, new treatment options, e.g. blood purification should be evaluated.

Case report: isolated pulmonary valve endocarditis in a 39-year-old patient with intravenous drug abuse

Background Isolated pulmonary valve endocarditis is a very rare form of right-sided infective endocarditis. Due to the anatomy, in most cases, just the tricuspid valve is involved. Diagnosis can be challenging because of non-specific symptoms (fever, dyspnoea, haemoptysis, and pleuritic chest pain) and difficulty of detection by echocardiography. Risk factors include intravenous drug abuse, congenital heart disorders, alcohol abuse, male sex and central venous catheters, or pacemaker leads. Case summary A 39-year-old homeless male patient, who was a current intravenous drug user, presented with fever, dyspnoea, and haemoptysis. The chest X-ray showed bilateral infiltrates. Empiric antibiotic treatment was initiated. Blood cultures showed the presence of Streptococcus dysgalactiae. Atypical causes of pneumonia were excluded. Systemic embolism was suspected, and a computed tomography scan of brain, thorax, and abdomen was performed. Multiple septic embolic lesions were detected in both lungs. Echocardiography revealed an isolated pulmonary valve endocarditis. Penicillin G and gentamycin were administered intravenously for a duration of 6 and 2 weeks, respectively. The patient was discharged in stable condition but did not return for outpatient clinical appointments. Discussion To detect rare causes of right-sided infective endocarditis, repeated echocardiograms with special focus on the pulmonary valve may be required. Usually, antibiotic treatment alone leads to recovery. In special situations (heart failure, septic shock, or large vegetation size) surgery is required. Due to the high risk of postoperative complications, surgery in intravenous drug users should be avoided if possible.

Uncommon Pathogen, Lactobacillus, Causing Infective Endocarditis: Case Report and Review

Lactobacillus is not a common pathogen; however, it can contribute to opportunistic infections such as infective endocarditis (IE). Nonetheless, it has been reported as case reports in correlation with increased probiotic use, dental caries, and intravenous drug abuse.