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Servito M, Fernández AL, Culhane S, Amador-Godoy Y, El-Diasty M. Occult prosthetic aortic valve endocarditis caused by Propionibacterium acnes: a case report. Ann R Coll Surg Engl 2022; 104:e216-e218. [PMID: 35446155 PMCID: PMC9246548 DOI: 10.1308/rcsann.2021.0334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We present an unusual case of occult mechanical aortic valve endocarditis caused by Propionibacterium acnes (P. acnes), which occurred five years after the initial cardiac surgical procedure. The only potential source of this infection from the patient's past medical history was a gastric band removal followed by a gastric bypass surgery, which was performed two years prior to her redo cardiac procedure. The patient's main presenting symptom was progressive dyspnoea with worsening of gradients across the mechanical aortic valve. Of note, she had no cardinal symptoms of infection. The patient underwent redo bioprosthetic aortic valve replacement with aortic root replacement. Prosthetic valve cultures grew P. acnes, while blood cultures remained negative. She was started on intravenous antibiotics for six weeks and her postoperative course was uneventful. She remained symptom-free six months postoperatively. This case opens the discussion for the importance of administering antibiotics prophylaxis for endocarditis in patients with prosthetic heart valves undergoing gastric procedures.
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Affiliation(s)
- M Servito
- Kingston Health Science Centre, Kingston, Ontario, Canada
| | - AL Fernández
- Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - S Culhane
- Kingston Health Science Centre, Kingston, Ontario, Canada
| | - Y Amador-Godoy
- Kingston Health Science Centre, Kingston, Ontario, Canada
| | - M El-Diasty
- Kingston Health Science Centre, Kingston, Ontario, Canada
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Abdelhamid AA, Kobayashi T, Tholany J, Sekar P. Recurrent Cutibacterium acnes prosthetic valve endocarditis. BMJ Case Rep 2021; 14:14/7/e243878. [PMID: 34326116 PMCID: PMC8323374 DOI: 10.1136/bcr-2021-243878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 29-year-old man with a history of congenital aortic stenosis and mechanical aortic valve replacement with previous Cutibacterium acnes prosthetic valve endocarditis (PVE) presented with a 2-week history of fevers and night sweats. Transoesophageal echocardiogram revealed a 0.6 cm×0.5 cm vegetation on the mechanical aortic valve. An anaerobic blood culture became positive for C. acnes 6 days after the blood cultures were obtained. He did not have any surgical intervention. He was successfully treated with 6 weeks of ceftriaxone, followed by chronic suppression with oral doxycycline. Despite its low virulence, a growing number of C. acnes PVE cases have been reported, owing to its biofilm production. When clinical suspicion is high, extending culture incubation duration beyond the standard 5 days might be helpful. Most cases are treated with surgical repair or replacement in conjunction with antibiotics, but medical therapy alone has been documented as being successful.
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Affiliation(s)
| | - Takaaki Kobayashi
- Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Joseph Tholany
- Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Poorani Sekar
- Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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3
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Endocarditis protésica por Propionibacterium acnes. CIRUGIA CARDIOVASCULAR 2021. [DOI: 10.1016/j.circv.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Bacterial DNA detected on pathologically changed heart valves using 16S rRNA gene amplification. Folia Microbiol (Praha) 2018; 63:707-711. [DOI: 10.1007/s12223-018-0611-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 05/11/2018] [Indexed: 12/19/2022]
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Gharamti AA, Kanafani ZA. Cutibacterium (formerly Propionibacterium) acnes infections associated with implantable devices. Expert Rev Anti Infect Ther 2017; 15:1083-1094. [PMID: 29125405 DOI: 10.1080/14787210.2017.1404452] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Cutibacterium acnes (C. acnes), a Gram-positive biofilm-forming rod implicated in acne vulgaris, is increasingly recognized for its role in implant-associated infections. The diagnosis of C. acnes implant-associated infections remains challenging. The optimal treatment is a combination of both surgical intervention and antibiotic therapy. Areas covered: In this review, we discuss the different types of implant-associated infections caused by C. acnes. We also highlight the clinical manifestations pertaining to the various sites of infection, and identify several risk factors previously reported in the literature. We then cover the diagnostic laboratory markers, such as IL-6 and AD-1, optimizing C. acnes recovery in culture, and the specific molecular techniques. Finally, we examine the various effective antibiotic regimens and identify some preventive methods against C. acnes infections. Expert commentary: Biomarkers such as IL-6 and AD-1 should be further investigated for the diagnosis of C. acnes implant-associated infections. The use of 16S rRNA gene sequencing and other molecular techniques should be further explored in this setting. Longer incubation periods should be requested whenever C. acnes infection is suspected. If the clinical suspicion is high, sonication of the excised implant should be encouraged. Research should focus on developing effective anti-biofilm agents. Finally, preventive methods such as hair removal prior to surgery should be further explored.
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Affiliation(s)
- Amal A Gharamti
- a Division of Infectious Diseases, Department of Internal Medicine , American University of Beirut Medical Center , Beirut , Lebanon
| | - Zeina A Kanafani
- a Division of Infectious Diseases, Department of Internal Medicine , American University of Beirut Medical Center , Beirut , Lebanon
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Olmos C, Vilacosta I, López J, Sarriá C, Ferrera C, San Román JA. Actualización en endocarditis protésica. CIRUGIA CARDIOVASCULAR 2017. [DOI: 10.1016/j.circv.2016.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Srivastava S, Bhargava A. Biofilms and human health. Biotechnol Lett 2015; 38:1-22. [PMID: 26386834 DOI: 10.1007/s10529-015-1960-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/09/2015] [Indexed: 01/25/2023]
Abstract
A biofilm can be defined as a surface-attached (sessile) community of microorganisms embedded and growing in a self-produced matrix of extracellular polymeric substances. These biofilm communities can be found in medical, industrial and natural environments, and can also be engineered in vitro for various biotechnological applications. Biofilms play a significant role in the transmission and persistence of human disease especially for diseases associated with inert surfaces, including medical devices for internal or external use. Biofilm infections on implants or in-dwelling devices are difficult to eradicate because of their much better protection against macrophages and antibiotics, compared to free living cells, leading to severe clinical complications often with lethal outcome. Recent developments in nanotechnology have provided novel approaches to preventing and dispersing biofilm related infections and potentially providing a novel method for fighting infections that is nondrug related.
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Affiliation(s)
- Shilpi Srivastava
- Amity Institute of Biotechnology, Amity University Uttar Pradesh (Lucknow Campus), Gomti Nagar Extension, Lucknow, 226010, India
| | - Atul Bhargava
- Amity Institute of Biotechnology, Amity University Uttar Pradesh (Lucknow Campus), Gomti Nagar Extension, Lucknow, 226010, India.
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San Román JA, Vilacosta I, López J, Sarriá C. Critical Questions About Left-Sided Infective Endocarditis. J Am Coll Cardiol 2015; 66:1068-76. [DOI: 10.1016/j.jacc.2015.07.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 07/12/2015] [Accepted: 07/13/2015] [Indexed: 12/18/2022]
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Propionibacterium acnes Recovered from Atherosclerotic Human Carotid Arteries Undergoes Biofilm Dispersion and Releases Lipolytic and Proteolytic Enzymes in Response to Norepinephrine Challenge In Vitro. Infect Immun 2015. [PMID: 26216428 DOI: 10.1128/iai.00510-15] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In the present study, human atherosclerotic carotid arteries were examined following endarterectomy for the presence of the Gram-positive bacterium Propionibacterium acnes and its potential association with biofilm structures within the arterial wall. The P. acnes 16S rRNA gene was detectable in 4 of 15 carotid artery samples, and viable P. acnes was one among 10 different bacterial species recoverable in culture. Fluorescence in situ hybridization analysis of 5 additional atherosclerotic carotid arteries demonstrated biofilm bacteria within all samples, with P. acnes detectable in 4 samples. We also demonstrated that laboratory-grown cultures of P. acnes biofilms were susceptible to induction of a biofilm dispersion response when challenged with physiologically relevant levels of norepinephrine in the presence of iron-bound transferrin or with free iron. The production and release of lipolytic and proteolytic extracellular enzymes by P. acnes were shown to increase in iron-induced dispersed biofilms, and these dispersion-induced P. acnes VP1 biofilms showed increased expression of mRNAs for the triacylglycerol lipases PPA2105 and PPA1796 and the hyaluronate lyase PPA380 compared to that in untreated biofilms. These results demonstrate that P. acnes can infect the carotid arteries of humans with atherosclerosis as a component of multispecies biofilms and that dispersion is inducible for this organism, at least in vitro, with physiologically relevant levels of norepinephrine resulting in the production and release of degradative enzymes.
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Kumaran D, Kalab M, Rood IGH, de Korte D, Ramirez-Arcos S. Adhesion of anaerobic bacteria to platelet containers. Vox Sang 2014; 107:188-91. [DOI: 10.1111/vox.12141] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 01/20/2014] [Accepted: 02/04/2014] [Indexed: 11/28/2022]
Affiliation(s)
- D. Kumaran
- Canadian Blood Services; Ottawa ON Canada
| | - M. Kalab
- Agriculture and Agri-Food Canada; Ottawa ON Canada
| | - I. G. H. Rood
- Sanquin Blood Supply Foundation; Amsterdam the Netherlands
| | - D. de Korte
- Sanquin Blood Supply Foundation; Amsterdam the Netherlands
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Kurz M, Kaufmann BA, Baddour LM, Widmer AF. Propionibacterium acnes prosthetic valve endocarditis with abscess formation: a case report. BMC Infect Dis 2014; 14:105. [PMID: 24568204 PMCID: PMC4015906 DOI: 10.1186/1471-2334-14-105] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 02/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Endocarditis due to Propionibacterium acnes is a rare disease. Scant data on treatment of these infections is available and is based on case reports only. If the disease is complicated by abscess formation, surgical intervention combined with an antibiotic therapy might improve clinical outcome. In some cases, cardiac surgeons are reluctant to perform surgery, since they consider the intervention as high risk. Therefore, a conservative therapy is required, with little, if any evidence to choose the optimal antibiotic. We report the first case of a successfully treated patient with P. acnes prosthetic valve endocarditis without surgery. CASE PRESENTATION We report the case of a 29-year-old patient with a prosthetic valve endocarditis and composite graft infection with abscess formation of the left ventricular outflow tract due to P. acnes. Since cardiac surgery was considered as high risk, the patient was treated intravenously with ceftriaxone 2 g qd and rifampin 600 mg bid for 7 weeks and was switched to an oral therapy with levofloxacin 500 mg bid and rifampin 600 mg bid for an additional 6 months. Two sets of blood cultures collected six weeks after completion of treatment remained negative. The patient is considered to be cured based on absence of clinical signs and symptoms, normal laboratory parameters, negative radiology scans and negative blood cultures, determined at site visits over two years after completion of treatment. CONCLUSION To our knowledge, this is the first successfully managed patient with P. acnes prosthetic valve endocarditis with abscess formation of the left ventricular outflow tract who was treated with antibiotics alone without a surgical intervention. A six month treatment with a rifampin and levofloxacin combination was chosen, based on the excellent activity against stationary-phase and adherent bacteria.
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Affiliation(s)
| | | | | | - Andreas F Widmer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
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12
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Portillo ME, Corvec S, Borens O, Trampuz A. Propionibacterium acnes: an underestimated pathogen in implant-associated infections. BIOMED RESEARCH INTERNATIONAL 2013; 2013:804391. [PMID: 24308006 PMCID: PMC3838805 DOI: 10.1155/2013/804391] [Citation(s) in RCA: 188] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 08/20/2013] [Accepted: 10/04/2013] [Indexed: 12/16/2022]
Abstract
The role of Propionibacterium acnes in acne and in a wide range of inflammatory diseases is well established. However, P. acnes is also responsible for infections involving implants. Prolonged aerobic and anaerobic agar cultures for 14 days and broth cultures increase the detection rate. In this paper, we review the pathogenic role of P. acnes in implant-associated infections such as prosthetic joints, cardiac devices, breast implants, intraocular lenses, neurosurgical devices, and spine implants. The management of severe infections caused by P. acnes involves a combination of antimicrobial and surgical treatment (often removal of the device). Intravenous penicillin G and ceftriaxone are the first choice for serious infections, with vancomycin and daptomycin as alternatives, and amoxicillin, rifampicin, clindamycin, tetracycline, and levofloxacin for oral treatment. Sonication of explanted prosthetic material improves the diagnosis of implant-associated infections. Molecular methods may further increase the sensitivity of P. acnes detection. Coating of implants with antimicrobial substances could avoid or limit colonization of the surface and thereby reduce the risk of biofilm formation during severe infections. Our understanding of the role of P. acnes in human diseases will likely continue to increase as new associations and pathogenic mechanisms are discovered.
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Affiliation(s)
| | - Stéphane Corvec
- Service de Bactériologie-Hygiène, CHU de Nantes, Institut de Biologie, Nantes Cedex, France
- Université de Nantes, EA3826, Thérapeutiques Cliniques et Expérimentales des Infections, 1 rue G. Veil, 44000 Nantes, France
| | - Olivier Borens
- Orthopedic Septic Surgical Unit, Department of Surgery and Anesthesiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Andrej Trampuz
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Free University and Humboldt University, Charitéplatz 1, 10117 Berlin, Germany
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13
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14
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Mesado D, Sarriá C, Bustamante J, Rodríguez JE, Domínguez L, Olivera MJ. Constrictive infectious pericarditis caused by Propionibacterium acnes. ACTA ACUST UNITED AC 2013; 66:407-9. [PMID: 24775828 DOI: 10.1016/j.rec.2012.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 10/21/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Daniel Mesado
- Servicios de Medicina Interna-Infecciosas, Hospital de la Princesa, Madrid, Spain.
| | - Cristina Sarriá
- Servicios de Medicina Interna-Infecciosas, Hospital de la Princesa, Madrid, Spain
| | - Juan Bustamante
- Servicio de Cirugía Cardiaca, Hospital de la Princesa, Madrid, Spain
| | - José E Rodríguez
- Servicio de Cirugía Cardiaca, Hospital Ruber Internacional, Madrid, Spain
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Cornér A, Kaartinen K, Aaltonen S, Räisänen-Sokolowski A, Helin H, Honkanen E. Membranoproliferative glomerulonephritis complicating Propionibacterium acnes infection. Clin Kidney J 2012; 6:35-39. [PMID: 27818749 PMCID: PMC5094392 DOI: 10.1093/ckj/sfs165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 10/25/2012] [Indexed: 11/21/2022] Open
Abstract
Background Propionibacterium acnes (P. acnes) is a common microbe of the skin and mucosal surfaces rarely considered a true pathogen. However, it has been reported to cause serious infections. Subsequent ongoing low-grade antigenaemia may, in turn, lead to an immune-mediated glomerulonephritis with various renal histologies including that of membranoproliferative glomerulonephritis (MPGN). Methods Here, we describe two cases of P. acnes infection-induced MPGN and their treatment. Results Both patients were successfully treated by the eradication of the infection. One patient also received immunosuppressive medication prior to the correct diagnosis. Conclusions A vigorous exclusion of infection is warranted in MPGN type I or immune-complex-mediated MPGN and may sometimes yield a diagnosis of secondary MPGN.
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Affiliation(s)
- Anja Cornér
- Department of Nephrology , Helsinki University Central Hospital , Helsinki , Finland
| | - Kati Kaartinen
- Department of Nephrology , Helsinki University Central Hospital , Helsinki , Finland
| | - Sari Aaltonen
- Department of Nephrology , Helsinki University Central Hospital , Helsinki , Finland
| | - Anne Räisänen-Sokolowski
- Transplantation Laboratory, HUSLAB, Department of Pathology , Helsinki University Central Hospital , Helsinki , Finland
| | - Heikki Helin
- Transplantation Laboratory, HUSLAB, Department of Pathology , Helsinki University Central Hospital , Helsinki , Finland
| | - Eero Honkanen
- Department of Nephrology , Helsinki University Central Hospital , Helsinki , Finland
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Ferrera C, Vilacosta I, Fernández C, López J, Olmos C, Sarriá C, Revilla A, Vivas D, Sáez C, Rodríguez E, San Román JA. Reassessment of blood culture-negative endocarditis: its profile is similar to that of blood culture-positive endocarditis. Rev Esp Cardiol 2012; 65:891-900. [PMID: 22771081 DOI: 10.1016/j.recesp.2012.04.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 04/10/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES Left-sided infective endocarditis with blood culture-negative has been associated with delayed diagnosis, a greater number of in-hospital complications and need for surgery, and consequently worse prognosis. The aim of our study was to review the current situation of culture-negative infective endocarditis. METHODS We analyzed 749 consecutive cases of left-sided infective endocarditis, in 3 tertiary hospitals from June 1996 to 2011 and divided them into 2 groups: group I (n=106), blood culture-negative episodes, and group II (n=643) blood culture-positive episodes. We used Duke criteria for diagnosis until 2002, and its modified version by Li et al. thereafter. RESULTS Age, sex, and comorbidity were similar in both groups. No differences were found in the proportion of patients who received antibiotic treatment before blood culture extraction between the 2 groups. The interval from symptom onset to diagnosis was similar in the 2 groups. The clinical course of both groups during hospitalization was similar. There were no differences in the development of heart failure, renal failure, or septic shock. The need for surgery (57.5% vs 55.5%; P=.697) and mortality (25.5% vs 30.6%; P=.282) were similar in the 2 groups. CONCLUSIONS Currently, previous antibiotic therapy is no longer more prevalent in patients with blood culture-negative endocarditis. This entity does not imply a delayed diagnosis and worse prognosis compared with blood culture-positive endocarditis. In-hospital clinical course, the need for surgery and mortality are similar to those in patients with blood culture-positive endocarditis. Full English text available from:www.revespcardiol.org.
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Affiliation(s)
- Carlos Ferrera
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, España.
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Perry A, Lambert P. Propionibacterium acnes: infection beyond the skin. Expert Rev Anti Infect Ther 2012; 9:1149-56. [PMID: 22114965 DOI: 10.1586/eri.11.137] [Citation(s) in RCA: 161] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Propionibacterium acnes is a Gram-positive bacterium that forms part of the normal flora of the skin, oral cavity, large intestine, the conjunctiva and the external ear canal. Although primarily recognized for its role in acne, P. acnes is an opportunistic pathogen, causing a range of postoperative and device-related infections. These include infections of the bones and joints, mouth, eye and brain. Device-related infections include those of joint prostheses, shunts and prosthetic heart valves. P. acnes may play a role in other conditions, including inflammation of the prostate leading to cancer, SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome, sarcoidosis and sciatica. If an active role in these conditions is established there are major implications for diagnosis, treatment and protection. Genome sequencing of the organism has provided an insight into the pathogenic potential and virulence of P. acnes.
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Affiliation(s)
- Alexandra Perry
- Eurofins Agroscience Services Ltd, Slade Lane, Wilson, Melbourne, Derbyshire, DE73 8AG, UK
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Ali H, Rood IG, de Korte D, Ramírez-Arcos S. Strict anaerobic Staphylococcus saccharolyticus isolates recovered from contaminated platelet concentrates fail to multiply during platelet storage. Transfusion 2012; 52:916-7. [DOI: 10.1111/j.1537-2995.2011.03510.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pozo E, Vilacosta I, Cañadas MV, del Trigo M, Silva J, Rodríguez E. Endarteritis infecciosa crónica por Propionibacterium acnes sobre tubo prótesico aórtico. Rev Esp Cardiol 2012; 65:194-5. [DOI: 10.1016/j.recesp.2011.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 04/25/2011] [Indexed: 11/29/2022]
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Satake K, Ohsawa I, Kobayashi N, Osaki K, Toyoda H, Horikoshi S, Tomino Y. Three cases of PR3-ANCA positive subacute endocarditis caused by attenuated bacteria (Propionibacterium, Gemella, and Bartonella) complicated with kidney injury. Mod Rheumatol 2011; 21:536-41. [PMID: 21400245 DOI: 10.1007/s10165-011-0434-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 02/07/2011] [Indexed: 11/24/2022]
Abstract
Subacute bacterial endocarditis (SBE) associated with antiproteinase-3 antineutrophil cytoplasmic antibodies (PR3-ANCA) has previously been reported in 10 cases of Streptococcus viridans and in 1 case of Escherichia faecalis infection. Most of these patients had hypocomplementemia and were positive for several autoantibodies. The infections in most of these patients showed good responses to antibiotic treatment. We report three patients with ANCA-positive SBE, which was induced by attenuated slow-growing intracellular pathogens; these patients had severe complications, such as acute kidney injury, cerebral embolism, and aortic valve destruction.
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Affiliation(s)
- Kenji Satake
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo, 113-8421, Japan
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