1
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Kumaran D, Ramirez-Arcos S. Cutibacterium acnes contamination does not enhance the proinflammatory profile of platelet concentrates. Transfusion 2024; 64:1437-1446. [PMID: 38922882 DOI: 10.1111/trf.17931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/08/2024] [Accepted: 06/08/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Cutibacterium acnes, a common anaerobic platelet concentrate (PC) contaminant, has been associated with rare mild adverse transfusion reactions and is often considered a harmless commensal. Notably, C. acnes can cause chronic infections and has been shown to induce the release of proinflammatory cytokines by immune cells. Since elevated concentrations of proinflammatory factors in PCs have been linked to noninfectious adverse reactions, this study aimed to assess whether C. acnes could elicit the release and accumulation of proinflammatory factors during PC storage, thereby enhancing the risk of such reactions. STUDY DESIGN/METHODS Four ABO-matched buffy coat PCs were pooled and split into six units, each were inoculated with either saline (negative control), a Staphylococcus aureus isolate (positive control, 30 colony forming units [CFU]/unit), or four C. acnes PC isolates (10 CFU/mL) and stored at 20-24°C with agitation. Bacterial counts, platelet activation, and concentration of proinflammatory factors were assessed on days 0, 3, and 5. N = 3. RESULTS C. acnes counts remained stable, while S. aureus proliferated reaching 108CFU/mL by the end of PC storage. By day 5, no significant differences in platelet activation or proinflammatory cytokine profiles were observed in C. acnes-contaminated PCs compared to the negative control (p > .05), while there was a significant increase (p ≤ .05) in sCD40L concentration (day 3), and platelet activation and IL-8 concentration (day 5) in S. aureus-contaminated units. DISCUSSION C. acnes contamination does not promote the accumulation of proinflammatory factors in the absence of proliferation during storage and may not enhance the risk of inflammatory reactions when transfused to patients.
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Affiliation(s)
- Dilini Kumaran
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
- Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
| | - Sandra Ramirez-Arcos
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
- Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
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2
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Cuervo G, Quintana E, Regueiro A, Perissinotti A, Vidal B, Miro JM, Baddour LM. The Clinical Challenge of Prosthetic Valve Endocarditis: JACC Focus Seminar 3/4. J Am Coll Cardiol 2024; 83:1418-1430. [PMID: 38599718 DOI: 10.1016/j.jacc.2024.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 04/12/2024]
Abstract
During the past 6 decades, there have been numerous changes in prosthetic valve endocarditis (PVE), currently affecting an older population and increasing in incidence in patients with transcatheter-implanted valves. Significant microbiologic (molecular biology) and imaging diagnostic (fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography) advances have been incorporated into the 2023 Duke-International Society for Cardiovascular Infectious Diseases infective endocarditis diagnostic criteria, thus increasing the diagnostic sensitivity for PVE without sacrificing specificity in validation studies. PVE is a life-threatening disease requiring management by multidisciplinary endocarditis teams in cardiac centers to improve outcomes. Novel surgical options are now available, and an increasing set of patients may avoid surgical intervention despite indication. Selected patients may complete parenteral or oral antimicrobial treatment at home. Finally, patients with prosthetic valves implanted surgically or by the transcatheter approach are candidates for antibiotic prophylaxis before invasive dental procedures.
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Affiliation(s)
- Guillermo Cuervo
- Department of Infectious Diseases, Hospital Clinic, August Pi I Sunyer Institute of Biomedical Research (IDIBAPS), University of Barcelona, Barcelona, Spain; Biomedical Network Research Center for Infectious Diseases (CIBERINFEC), Carlos III Health Institute, Madrid, Spain
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Ander Regueiro
- Department of Cardiology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Andrés Perissinotti
- Department of Nuclear Medicine, Hospital Clinic, August Pi I Sunyer Institute of Biomedical Research (IDIBAPS) and Biomedical Research Networking Center of Bioengineering, Biomaterials, and Nanomedicine (CIBER-BBN), Carlos III Health Institute, Barcelona, Spain
| | - Barbara Vidal
- Department of Cardiology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Jose M Miro
- Department of Infectious Diseases, Hospital Clinic, August Pi I Sunyer Institute of Biomedical Research (IDIBAPS), University of Barcelona, Barcelona, Spain; Biomedical Network Research Center for Infectious Diseases (CIBERINFEC), Carlos III Health Institute, Madrid, Spain.
| | - Larry M Baddour
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Departments of Medicine and Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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3
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Ziegler R, Arnold H, Bertram R, Geißdörfer W, Pauschinger M, Fischlein T, Pollari F, Steinmann J. Microbiologic diagnostics and pathogen spectrum in infective endocarditis of surgically treated patients: a five-year, retrospective, monocentric study. Infection 2023; 51:1523-1530. [PMID: 37024627 DOI: 10.1007/s15010-023-02030-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/26/2023] [Indexed: 04/08/2023]
Abstract
PURPOSE The spectrum of causative organisms in infective endocarditis (IE) has changed significantly in the last decades. Reliable pathogen detection is crucial for appropriate antimicrobial therapy for IE. The aim of the study was to evaluate the diagnostic value of microbiological methods for detecting the causative microorganism of IE and to analyze the spectrum of pathogens. METHODS A total of 224 cases (211 unique patients, some with multiple surgeries) were included into this retrospective study. Patients were diagnosed with IE according to the modified Duke criteria from January 2016 to July 2021 and underwent heart valve surgery in a tertiary hospital. Pathogen detection was performed by blood culture, microbiological culture and 16S rDNA PCR of explanted heart valve material. RESULTS A causative pathogen of IE was detected in 95.5% (n = 214) of cases. Blood cultures were positive in 83.3%, while a pathogen in the examined heart valve samples was identified in 32.6% by culture and in 88.2% by 16S rDNA PCR. A microorganism was identified by 16S rDNA PCR in 61.1% of blood culture negative cases but only in 19.4% by heart valve culture. The most common pathogens were Staphylococcus aureus (27%), viridans group streptococci (20%), enterococci (19%) and coagulase-negative staphylococci (CoNS 8%). Cutibacterium acnes (7%) was detected in prosthetic valve IE cases only. CONCLUSION Blood culture as a comparatively non-invasive and straightforward technique remains an important and reliable method for initial detection of the causative organism in IE. Diagnostic stewardship programs should broadly emphasize proper collection of blood cultures, particularly sampling prior to any antibiotic treatment. Additionally, molecular testing using 16S rDNA tissue PCR can be used with culture techniques to increase the diagnostic yield, especially in the case of a negative blood culture.
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Affiliation(s)
- Renate Ziegler
- Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Paracelsus Medical University, Klinikum Nürnberg, Nuremberg, Germany.
| | - Hendrik Arnold
- Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Paracelsus Medical University, Klinikum Nürnberg, Nuremberg, Germany
- Department of Hematology and Medical Oncology, Paracelsus Medical University, Klinikum Nürnberg, Nuremberg, Germany
| | - Ralph Bertram
- Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Paracelsus Medical University, Klinikum Nürnberg, Nuremberg, Germany
| | - Walter Geißdörfer
- Mikrobiologisches Institut-Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Pauschinger
- Department of Cardiology, Paracelsus Medical University, Klinikum Nürnberg, Nuremberg, Germany
| | - Theodor Fischlein
- Department of Cardiac Surgery, Cardiovascular Center, Paracelsus Medical University Nuremberg, Klinikum Nürnberg, Nuremberg, Germany
| | - Francesco Pollari
- Department of Cardiac Surgery, Cardiovascular Center, Paracelsus Medical University Nuremberg, Klinikum Nürnberg, Nuremberg, Germany
| | - Joerg Steinmann
- Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Paracelsus Medical University, Klinikum Nürnberg, Nuremberg, Germany
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4
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Both A, Huang J, Hentschke M, Tobys D, Christner M, Klatte TO, Seifert H, Aepfelbacher M, Rohde H. Genomics of Invasive Cutibacterium acnes Isolates from Deep-Seated Infections. Microbiol Spectr 2023; 11:e0474022. [PMID: 36976006 PMCID: PMC10100948 DOI: 10.1128/spectrum.04740-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 03/03/2023] [Indexed: 03/29/2023] Open
Abstract
Cutibacterium acnes, formerly known as Propionibacterium acnes, is a commensal of the human pilosebaceous unit but also causes deep-seated infection, especially in the context of orthopedic and neurosurgical foreign materials. Interestingly, little is known about the role of specific pathogenicity factors for infection establishment. Here, 86 infection-associated and 103 commensalism-associated isolates of C. acnes were collected from three independent microbiology laboratories. We sequenced the whole genomes of the isolates for genotyping and a genome-wide association study (GWAS). We found that C. acnes subsp. acnes IA1 was the most significant phylotype among the infection isolates (48.3% of all infection isolates; odds ratio [OR] = 1.98 for infection). Among the commensal isolates, C. acnes subsp. acnes IB was the most significant phylotype (40.8% of all commensal isolates; OR = 0.5 for infection). Interestingly, C. acnes subsp. elongatum (III) was rare overall and did not occur at all in infection. The open reading frame-based GWAS (ORF-GWAS) did not show any loci with a strong signal for infection association (no P values of ≤0.05 after adjustment for multiple testing; no logarithmic OR [logOR] of ≥|2|). We concluded that all subspecies and phylotypes of C. acnes, possibly with the exception of C. acnes subsp. elongatum, are able to cause deep-seated infection given favorable conditions, most importantly related to inserted foreign material. Genetic content appears to have a small effect on the likelihood of infection establishment, and functional studies are needed to understand the individual factors contributing to deep-seated infections caused by C. acnes. IMPORTANCE Opportunistic infections emerging from human skin microbiota are of ever-increasing importance. Cutibacterium acnes, being abundant on the human skin, may cause deep-seated infections (e.g., device-associated infections). Differentiation between invasive (i.e., clinically significant) C. acnes isolates and sole contaminants is often difficult. Identification of genetic markers associated with invasiveness not only would strengthen our knowledge related to pathogenesis but also could open ways to selectively categorize invasive and contaminating isolates in the clinical microbiology lab. We show that in contrast to other opportunistic pathogens (e.g., Staphylococcus epidermidis), invasiveness is apparently a broadly distributed ability across almost all C. acnes subspecies and phylotypes. Thus, our work strongly supports an approach in which clinical significance is judged from clinical context rather than by detecting specific genetic traits.
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Affiliation(s)
- Anna Both
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jiabin Huang
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - David Tobys
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Martin Christner
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Till Orla Klatte
- Department for Trauma Surgery and Orthopedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Martin Aepfelbacher
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Holger Rohde
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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5
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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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6
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Oberbach A, Schlichting N, Hagl C, Lehmann S, Kullnick Y, Friedrich M, Köhl U, Horn F, Kumbhari V, Löffler B, Schmidt F, Joskowiak D, Born F, Saha S, Bagaev E. Four decades of experience of prosthetic valve endocarditis reflect a high variety of diverse pathogens. Cardiovasc Res 2022; 119:410-428. [PMID: 35420122 DOI: 10.1093/cvr/cvac055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/04/2022] [Accepted: 03/23/2022] [Indexed: 01/18/2023] Open
Abstract
Prosthetic valve endocarditis (PVE) remains a serious condition with a high mortality rate. Precise identification of the PVE-associated pathogen/s and their virulence is essential for successful therapy, and patient survival. The commonly described PVE-associated pathogens are staphylococci, streptococci and enterococci, with Staphylococcus aureus being the most frequently diagnosed species. Furthermore, multi-drug resistance pathogens are increasing in prevalence, and continue to pose new challenges mandating a personalized approach. Blood cultures in combination with echocardiography are the most common methods to diagnose PVE, often being the only indication, it exists. In many cases, the diagnostic strategy recommended in the clinical guidelines does not identify the precise microbial agent and to frequently, false negative blood cultures are reported. Despite the fact that blood culture findings are not always a good indicator of the actual PVE agent in the valve tissue, only a minority of re-operated prostheses are subjected to microbiological diagnostic evaluation. In this review, we focus on the diversity and the complete spectrum of PVE-associated bacterial, fungal and viral pathogens in blood, and prosthetic heart valve, their possible virulence potential, and their challenges in making a microbial diagnosis. We are curious to understand if the unacceptable high mortality of PVE is associated with the high number of negative microbial findings in connection with a possible PVE. Herein, we discuss the possibilities and limits of the diagnostic methods conventionally used and make recommendations for enhanced pathogen identification. We also show possible virulence factors of the most common PVE-associated pathogens and their clinical effects. Based on blood culture, molecular biological diagnostics, and specific valve examination, better derivations for the antibiotic therapy as well as possible preventive intervention can be established in the future.
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Affiliation(s)
- Andreas Oberbach
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany.,Fraunhofer Institute for Cell Therapy and Immunology, Department of Diagnostics, Leipzig, Germany
| | - Nadine Schlichting
- Fraunhofer Institute for Cell Therapy and Immunology, Department of Diagnostics, Leipzig, Germany.,Institute of Clinical Immunology, University of Leipzig, Leipzig, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany.,Munich Heart Alliance, Partner Site German Centre for Cardiovascular Disease (DZHK), Munich, Germany
| | - Stefanie Lehmann
- Fraunhofer Institute for Cell Therapy and Immunology, Department of Diagnostics, Leipzig, Germany.,Institute of Clinical Immunology, University of Leipzig, Leipzig, Germany
| | - Yvonne Kullnick
- Fraunhofer Institute for Cell Therapy and Immunology, Department of Diagnostics, Leipzig, Germany.,Institute of Clinical Immunology, University of Leipzig, Leipzig, Germany
| | - Maik Friedrich
- Fraunhofer Institute for Cell Therapy and Immunology, Department of Diagnostics, Leipzig, Germany.,Institute of Clinical Immunology, University of Leipzig, Leipzig, Germany
| | - Ulrike Köhl
- Fraunhofer Institute for Cell Therapy and Immunology, Department of Diagnostics, Leipzig, Germany.,Institute of Clinical Immunology, University of Leipzig, Leipzig, Germany
| | - Friedemann Horn
- Fraunhofer Institute for Cell Therapy and Immunology, Department of Diagnostics, Leipzig, Germany.,Institute of Clinical Immunology, University of Leipzig, Leipzig, Germany
| | - Vivek Kumbhari
- Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Florida, USA
| | - Bettina Löffler
- Institute of Medical Microbiology, Jena University Hospital, Jena, Germany
| | - Frank Schmidt
- Proteomics Core, Weill Cornell Medical Centre Qatar, Doha, Qatar
| | - Dominik Joskowiak
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Frank Born
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Shekhar Saha
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Erik Bagaev
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
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7
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Dalen H, Graven T, Slagsvold KH, Krogstad LE, Saxhaug LM, Tannvik TD, Holte E, Nordhaug DO, Karlsen Ø, Thorstensen A, Wahba A, Winnerkvist AM. Complete embolization of a mechanical aortic valve during trail running—a case report with a lucky ending. Eur Heart J Case Rep 2022; 6:ytac107. [PMID: 35474681 PMCID: PMC9026221 DOI: 10.1093/ehjcr/ytac107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/03/2021] [Accepted: 02/21/2022] [Indexed: 11/14/2022]
Abstract
Background Complete embolization of a prosthetic heart valve is extremely rare and dangerous. This case reports a total embolization of a mechanical aortic valve and contributes to the literature regarding the diagnostic challenges related to infective endocarditis and follow-up after valvular surgery. Case summary A 28-year-old male 11.5 years status-post a mechanical aortic valve replacement presented with acute onset of chest pain and dyspnoea while jogging. The patient lost consciousness and went into cardiopulmonary arrest with acute pulmonary oedema and circulatory shock. An echocardiogram revealed an empty aortic annulus, and a chest radiograph showed an embolized valve in the aortic arch. The patient underwent emergent removal of the embolized valve and replacement with a new mechanical aortic valve. The patient survived with minimal sequelae. At a 3-month follow-up, he had resumed work, and the only sequelae were mild left ventricular dysfunction and minor vision loss. Although he experienced no warning signs or symptoms, the most likely aetiology for embolization of the valvular prosthesis was infective endocarditis, which was revealed by re-evaluation of an echocardiogram recorded 1 month before the presentation which demonstrated a subtle motion abnormality of the valve. Conclusions We present a case of a late complete embolization of a mechanical aortic valve most likely caused by asymptomatic infective endocarditis. The case illustrates the challenges in follow-up after valvular surgery and highlights the ultimate benefit of a well-functioning pre-hospital to hospital chain.
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Affiliation(s)
- Havard Dalen
- Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Box 8905, 7491 Trondheim, Norway
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Torbjørn Graven
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Katrine H Slagsvold
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Box 8905, 7491 Trondheim, Norway
- Clinic of Cardiothoracic Surgery, St. Olavs University Hospital, Trondheim, Norway
| | - Lars Erik Krogstad
- Clinic of Cardiothoracic Surgery, St. Olavs University Hospital, Trondheim, Norway
| | - Lars Mølgaard Saxhaug
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Box 8905, 7491 Trondheim, Norway
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Tomas D Tannvik
- Clinic of Anaesthesia and Intensive Care, St. Olavs University Hospital, Trondheim, Norway
| | - Espen Holte
- Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Box 8905, 7491 Trondheim, Norway
| | - Dag Ole Nordhaug
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Box 8905, 7491 Trondheim, Norway
- Clinic of Cardiothoracic Surgery, St. Olavs University Hospital, Trondheim, Norway
| | - Øystein Karlsen
- Clinic of Anaesthesia and Intensive Care, St. Olavs University Hospital, Trondheim, Norway
| | - Anders Thorstensen
- Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Box 8905, 7491 Trondheim, Norway
| | - Alexander Wahba
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Box 8905, 7491 Trondheim, Norway
- Clinic of Cardiothoracic Surgery, St. Olavs University Hospital, Trondheim, Norway
| | - Anders M Winnerkvist
- Clinic of Cardiothoracic Surgery, St. Olavs University Hospital, Trondheim, Norway
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8
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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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9
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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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10
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Da Silva RC, Kesiena O, Singireddy S, Madeo J. Pleural and Pericardial Infection Due to Cutibacterium acnes in a Splenectomized Patient: A Case Report of an Underreported Systemic Infection. Cureus 2021; 13:e13668. [PMID: 33824819 PMCID: PMC8018225 DOI: 10.7759/cureus.13668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Infectious pericarditis does not always present with all the classic findings. Some of the traditional signs of fever, pleuritic chest pain, and frictional rub may be missing. This presents a diagnostic challenge, thus clinical suspicion is important. The most common cause of infectious pericarditis is viral. However, bacterial pericarditis may occur with severe complications such as constrictive pericarditis, pericardial effusion, cardiac tamponade, left ventricular pseudoaneurysm, and aortic mycotic aneurysm. The purpose of this presentation is to increase awareness of Cutibacterium acnes (C. acnes) as a cause of bacterial pericarditis. This case report highlights C. acnes as a prevalent cause of both pleural and pericardial infections. The diagnosis can be challenging, considering that this bacterium is difficult to isolate, slow growing, and causes indolent illness. Prolonged incubation time may be required. In addition to the more traditional causes of bacterial pericarditis, namely Staphylococcus and Streptococcus species, C acnes appears to play an important role. It should not be considered a contaminant as it may require further investigation.
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Affiliation(s)
- Rafael C Da Silva
- Internal Medicine, Piedmont Athens Regional Medical Center, Athens, USA
| | - Onoriode Kesiena
- Internal Medicine, Piedmont Athens Regional Medical Center, Athens, USA
| | | | - Jennifer Madeo
- Infectious Disease, Piedmont Athens Regional Medical Center, Athens, USA
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11
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Alexis SL, Malik AH, George I, Hahn RT, Khalique OK, Seetharam K, Bhatt DL, Tang GHL. Infective Endocarditis After Surgical and Transcatheter Aortic Valve Replacement: A State of the Art Review. J Am Heart Assoc 2020; 9:e017347. [PMID: 32772772 PMCID: PMC7660802 DOI: 10.1161/jaha.120.017347] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Prosthetic valve endocarditis (PVE) after surgical aortic valve replacement and transcatheter aortic valve replacement (TAVR) carries significant morbidity/mortality. Our review aims to compare incidence, predisposing factors, microbiology, diagnosis, management, and outcomes of PVE in surgical aortic valve replacement/TAVR patients. We searched PubMed and Embase to identify published studies from January 1, 2015 to March 13, 2020. Key words were indexed for original reports, clinical studies, and reviews. Reports were evaluated by 2 authors against a priori inclusion/exclusion criteria. Studies were included if they reported incidence and outcomes related to surgical aortic valve replacement/TAVR PVE and excluded if they were published pre-2015 or included a small population. We followed the Cochrane methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for all stages of the design and implementation. Study quality was based on the Newcastle-Ottawa Scale. Thirty-three studies with 311 to 41 025 patients contained relevant information. The majority found no significant difference in incidence of surgical aortic valve replacement/TAVR PVE (reported as 0.3%-1.2% per patient-year versus 0.6%-3.4%), but there were key differences in pathogenesis. TAVR has a specific set of infection risks related to entry site, procedure, and device, including nonstandardized protocols for infection control, valve crimping injury, paravalvular leak, neo-leaflet stress, intact/calcified native leaflets, and intracardiac hardware. With the expansion of TAVR to lower risk and younger patients, a better understanding of pathogenesis, patient presentation, and guideline-directed treatment is paramount. When operative intervention is necessary, mortality remains high at 20% to 30%. Unique TAVR infection risks present opportunities for PVE prevention, therefore, further investigation is imperative.
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Affiliation(s)
- Sophia L. Alexis
- Department of Cardiovascular SurgeryMount Sinai Medical CenterNew YorkNY
| | - Aaqib H. Malik
- Department of MedicineWestchester Medical CenterValhallaNY
| | - Isaac George
- Division of Cardiac SurgeryColumbia University Medical CenterNew YorkNY
| | - Rebecca T. Hahn
- Division of CardiologyColumbia University Medical CenterNew YorkNY
| | - Omar K. Khalique
- Division of CardiologyColumbia University Medical CenterNew YorkNY
| | | | - Deepak L. Bhatt
- Brigham and Women’s Hospital Heart & Vascular CenterHarvard Medical SchoolBostonMA
| | - Gilbert H. L. Tang
- Department of Cardiovascular SurgeryMount Sinai Medical CenterNew YorkNY
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12
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Martin DR, Witten JC, Tan CD, Rodriguez ER, Blackstone EH, Pettersson GB, Seifert DE, Willard BB, Apte SS. Proteomics identifies a convergent innate response to infective endocarditis and extensive proteolysis in vegetation components. JCI Insight 2020; 5:135317. [PMID: 32544089 DOI: 10.1172/jci.insight.135317] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 06/10/2020] [Indexed: 02/06/2023] Open
Abstract
Infective endocarditis is a life-threatening infection of heart valves and adjacent structures characterized by vegetations on valves and other endocardial surfaces, with tissue destruction and risk of embolization. We used high-resolution mass spectrometry to define the proteome of staphylococcal and non-staphylococcal vegetations and Terminal Amine Isotopic Labeling of Substrates (TAILS) to define their proteolytic landscapes. These approaches identified over 2000 human proteins in staphylococcal and non-staphylococcal vegetations. Individual vegetation proteomes demonstrated comparable profiles of quantitatively major constituents that overlapped with serum, platelet, and neutrophil proteomes. Staphylococcal vegetation proteomes resembled one another more than the proteomes of non-staphylococcal vegetations. TAILS demonstrated extensive proteolysis within vegetations, with numerous previously undescribed cleavages. Several proteases and pathogen-specific proteins, including virulence factors, were identified in most vegetations. Proteolytic peptides in fibronectin and complement C3 were identified as potential infective endocarditis biomarkers. Overlap of staphylococcal and non-staphylococcal vegetation proteomes suggests a convergent thrombotic and immune response to endocardial infection by diverse pathogens. However, the differences between staphylococcal and non-staphylococcal vegetations and internal variance within the non-staphylococcal group indicate that additional pathogen- or patient-specific effects exist. Pervasive proteolysis of vegetation components may arise from vegetation-intrinsic proteases and destabilize vegetations, contributing to embolism.
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Affiliation(s)
- Daniel R Martin
- Department of Biomedical Engineering, Lerner Research Institute
| | - James C Witten
- Department of Thoracic and Cardiovascular Surgery, Miller Family Heart and Vascular Institute
| | - Carmela D Tan
- Department of Pathology, Robert J. Tomsich Pathology & Laboratory Medicine Institute, and
| | - E Rene Rodriguez
- Department of Pathology, Robert J. Tomsich Pathology & Laboratory Medicine Institute, and
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Miller Family Heart and Vascular Institute
| | - Gosta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Miller Family Heart and Vascular Institute
| | | | - Belinda B Willard
- Proteomics and Metabolomics Core, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Suneel S Apte
- Department of Biomedical Engineering, Lerner Research Institute
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13
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Lodhi SH, Abbasi A, Ahmed T, Chan A. Acne on the Valve: Two Intriguing Cases of Cutibacterium Acnes Endocarditis. Cureus 2020; 12:e8532. [PMID: 32665879 PMCID: PMC7352884 DOI: 10.7759/cureus.8532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/09/2020] [Indexed: 01/28/2023] Open
Abstract
Cutibacterium acnes is a skin commensal which is most often regarded as a contaminant when detected on blood cultures. In rare instances, it may be the causative pathogen in severe systemic illnesses. Subacute endocarditis, especially of prosthetic valves and devices, is an important grave pathology caused by Cutibacterium acnes. Herein we report two cases of prosthetic valve endocarditis with varied presentations as valve dehiscence with a "rocking" prosthetic valve apparatus in one encounter and as a septic embolic stroke in the second encounter. Although a rare cause of endocarditis, it becomes an especially important entity in patients with prosthetic devices and should be high in the list of differentials.
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Affiliation(s)
- Samra Haroon Lodhi
- Internal Medicine, King Edward Medical University, Lahore, PAK
- Internal Medicine, Mayo Hospital, Lahore, PAK
| | - Ayesha Abbasi
- Internal Medicine, King Edward Medical University, Lahore, PAK
- Internal Medicine, Mayo Hospital, Lahore, PAK
| | - Taha Ahmed
- Internal Medicine, Cleveland Clinic Foundation, Cleveland, USA
| | - Albert Chan
- Cardiovascular Medicine, Cleveland Clinic Fairview Hospital, Cleveland, USA
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14
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Elston MJ, Dupaix JP, Opanova MI, Atkinson RE. Cutibacterium acnes (formerly Proprionibacterium acnes) and Shoulder Surgery. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2019; 78:3-5. [PMID: 31773103 PMCID: PMC6874694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Infection is a rare but serious complication of shoulder arthroplasty. The most prevalent cause of patient infections is Cutibacterium acnes (formerly Proprionibacterium acnes), a commensal skin bacterial species. Its presentation is often non-specific and can occur long after shoulder arthroplasty, leading to delay in diagnosis. This bacterium is difficult to culture, typically taking 14 to 17 days for a positive culture and often does not exhibit abnormal results on a standard laboratory workup for infection (eg, ESR, CRP, and synovial WBC count). Male patients are at particularly high-risk due to having a greater number of sebaceous follicles than females. While it is difficult to diagnose, early diagnosis can lead to decreased morbidity, appropriate treatment, and improved clinical outcomes. Current options for treatment include antibiotics, one stage implant exchange, or two stage implant exchange, although success rates of each are not currently well described. A better understanding of the prevention, diagnosis, and treatment of C. acnes infection could lead to better patient outcomes from shoulder arthroplasty.
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Affiliation(s)
| | | | - Maria I. Opanova
- Mariya I. Opanova MBBS; 1356 Lusitana St., 6th Fl., Honolulu, HI 96813;
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15
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Oberbach A, Schlichting N, Friedrich M, Lehmann S, Kullnick Y, Pichlmaier M, Hagl C, Bagaev E. Quantification of Multiple Bacteria in Calcified Structural Valvular Heart Disease. Semin Thorac Cardiovasc Surg 2019; 32:255-263. [PMID: 31605771 DOI: 10.1053/j.semtcvs.2019.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/03/2019] [Indexed: 11/11/2022]
Abstract
Genome studies of heart valve tissue (HVT) in patients with structural valvular heart disease (sVHD) and acute infective endocarditis (aIE) showed polymicrobial infections. Subject of this study is the quantification of bacterial DNA in HVT of sVHD in comparison to aIE. It will be examined whether the bacterial DNA concentration can be used as surrogate marker to differentiate chronic and acute infections. DNA was isolated from HVT of 100 patients with sVHD and 23 microbiologically positively tested patients with aIE. Selected pathogens (Cutibacterium acnes, Enterococcus faecalis, Enterococcus faecium, Staphylococcus aureus, Streptococcus pyogenes, Streptococcus agalactiae, Clostridium difficile, and Klebsiella pneumoniae) were quantified using TaqMan-qPCR. Polymicrobial infiltration of HVT was investigated by immunohistologic methods. Of 100 sVHD patients, 94 tested positive for bacteria by 16S-rDNA and 72 by TaqMan-qPCR. In 29% of the sVHD cohort and in 70% of the aIE cohort, a coinfection with more than 2 bacteria was observed as indication of a polymicrobial infection. The most common pathogens in the sVHD patients were C. acnes (59%; 5-4074 pg/mL), E. faecalis (16%, 174-2781 pg/mL), and S. aureus (15%, 8-105 pg/mL). The DNA concentration of E. faecalis (P = 0.0285) and S. aureus (P = 0.0149) is significantly lower in the sVHD cohort than in the aIE cohort. sVHD is associated with bacterial infection and infiltration of the HVT in a majority of cases. TaqMan-qPCR is a valid instrument for the specific detection of bacteria in HVT and allows discrimination between sVHD and aIE for E. faecalis and S. aureus.
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Affiliation(s)
- Andreas Oberbach
- Department of Cardiac Surgery, Ludwig Maximilians University, Munich, Germany; Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany; Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
| | - Nadine Schlichting
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany; Department of Visceral, Transplantation, Thoracic and Vascular Surgery, Leipzig University Hospital, Leipzig, Germany
| | - Maik Friedrich
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany; Institute of Clinical Immunology, University of Leipzig, Leipzig, Germany
| | - Stefanie Lehmann
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany; Department of Internal Medicine, University of Leipzig, Leipzig, Germany
| | - Yvonne Kullnick
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | | | - Christian Hagl
- Department of Cardiac Surgery, Ludwig Maximilians University, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Erik Bagaev
- Department of Cardiac Surgery, Ludwig Maximilians University, Munich, Germany
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- CardiOmics Group Including Vivek Kumbhari, MD, Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland
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- Clinical Microbiology Group Including Sandra Gräber and Arne C. Rodloff, MD, Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
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- Clinical Management Group Including Maximilian Luehr, MD, Miriam Gruhle, Marion Alber, Sven Peters, MD, Felix Kur, MD, Gerd Juchem, MD, and Alexey Dashkevich, MD, Department of Cardiac Surgery, Ludwig Maximilians University, Munich, Germany
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16
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Propionibacterium acnes Pacemaker Endocarditis in a Patient With a Redundant Loop of the Ventricular Lead. Clin Nucl Med 2019; 45:e55-e56. [DOI: 10.1097/rlu.0000000000002686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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[Febrile myalgia revealing Propionibacterium acnes endocarditis]. Rev Med Interne 2019; 40:613-616. [PMID: 31229357 DOI: 10.1016/j.revmed.2019.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/15/2019] [Accepted: 05/30/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Propionibacterium acnes endocarditis is rare and difficult to diagnose. We report a case of Propioniacterium acnes endocarditis revealed by a lower limb fasciitis. CASE REPORT A 54-year-old patient presented with recurrent febrile myalgia of the lower limbs, that appeared three years after an aortic surgery (aortic valve sparing reimplentation and ascending aortic prosthesis implantation). Computer tomography showed fasciitis of both legs. Positron emission tomography showed 18Fluorodeoxyglucose intake of the aortic prosthesis and in muscles of the lower limbs. Ten days after blood sample drawing, cultures showed the presence of Propionibacterium acnes. The aortic prosthesis was surgically removed, whose culture confirmed infection by Propionibacterium acnes. The diagnosis of infective endocarditis revealed by lower limb emboli was made. Evolution was favorable. CONCLUSION In patients with vascular prostheses, Propionibacterium acnes infection must be evoked face to an atypical inflammatory process. Very prolonged blood culture incubation is needed to identify the pathogen.
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18
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Both A, Klatte TO, Lübke A, Büttner H, Hartel MJ, Grossterlinden LG, Rohde H. Growth of Cutibacterium acnes is common on osteosynthesis material of the shoulder in patients without signs of infection. Acta Orthop 2018; 89:580-584. [PMID: 29947288 PMCID: PMC6202769 DOI: 10.1080/17453674.2018.1489095] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Cutibacterium acnes, formerly known as Propionibacterium acnes, is often isolated from deep tissues of the shoulder. It is recognized as an important causative agent of foreign-material associated infections. However, the incidence and significance of its detection in tissues from patients without clinical evidence for infection is unclear. We assessed the incidence of C. acnes colonization of osteosynthesis material in asymptomatic patients, and evaluated the short-term outcome in relation to the microbiological findings. Patients and methods - We microbiologically analyzed osteosynthesis material of 34 asymptomatic patients after surgery on the clavicle. Material obtained from 19 asymptomatic patients after osteosynthesis of the fibula served as a control group. Patients were clinically followed up for 3-24 months after removal of the osteosynthesis material. Results - Bacteria were recovered from devices in 29 of 34 patients from the clavicle group. 27 of 29 positive samples grew C. acnes. Isolation of C. acnes was more common in male than in female patients. No bacterial growth was observed on foreign material from patients in the fibula group. All patients remained asymptomatic at follow-up. Interpretation - Growth of C. acnes is common on osteosynthesis material of the shoulder, especially in males. Samples were positive irrespective of clinical signs of infection. Therefore, detection of C. acnes in this clinical setting is of questionable clinical significance. The high positivity rate in asymptomatic patients discourages routine sampling of material in cases without clinical evidence for infection.
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Affiliation(s)
- Anna Both
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene;
| | | | - Andreas Lübke
- Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany;
| | - Henning Büttner
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene;
| | | | - Lars G Grossterlinden
- Zentrum für Orthopädie, Unfall- und Wirbelsäulenchirurgie, Asklepios Klinik Altona, Hamburg, Germany
| | - Holger Rohde
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene; ,Correspondence:
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19
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Yamamoto R, Miyagawa S, Hagiya H, Kimura K, Nishi I, Yamamoto N, Yoshida H, Akeda Y, Tomono K, Toda K, Sawa Y. Silent Native-valve Endocarditis Caused by Propionibacterium acnes. Intern Med 2018; 57:2417-2420. [PMID: 29607974 PMCID: PMC6148182 DOI: 10.2169/internalmedicine.9833-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
We describe a rare case of Propionibacterium acnes native-valve endocarditis that silently progressed in a 67-year-old man with hybrid dialysis. The patient was scheduled for kidney transplantation, and pre-operative investigation incidentally detected a vegetative structure at his native mitral valve that had increased in size. He underwent cardiac surgery and P. acnes was detected in cultures of a resected cardiac valve specimen and blood. This case highlights that P. acnes can silently cause infective endocarditis in a native-valve, and that physicians should consider the possibility of infection when P. acnes is isolated in blood cultures.
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Affiliation(s)
- Rintaro Yamamoto
- Department of Cardiovascular Surgery, Osaka University Hospital, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Hospital, Japan
| | - Hideharu Hagiya
- Division of Infection Control and Prevention, Osaka University Hospital, Japan
| | - Keigo Kimura
- Laboratory for Clinical Investigation, Osaka University Hospital, Japan
| | - Isao Nishi
- Laboratory for Clinical Investigation, Osaka University Hospital, Japan
| | - Norihisa Yamamoto
- Division of Infection Control and Prevention, Osaka University Hospital, Japan
| | - Hisao Yoshida
- Division of Infection Control and Prevention, Osaka University Hospital, Japan
| | - Yukihiro Akeda
- Division of Infection Control and Prevention, Osaka University Hospital, Japan
| | - Kazunori Tomono
- Division of Infection Control and Prevention, Osaka University Hospital, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Hospital, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Hospital, Japan
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20
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Polyudova TV, Eroshenko DV, Korobov VP. Plasma, serum, albumin, and divalent metal ions inhibit the adhesion and the biofilm formation of Cutibacterium (Propionibacterium) acnes. AIMS Microbiol 2018; 4:165-172. [PMID: 31294208 PMCID: PMC6605019 DOI: 10.3934/microbiol.2018.1.165] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 02/26/2018] [Indexed: 01/24/2023] Open
Abstract
Adhesion and biofilm formation of human skin bacteria C. acnes on plasma, serum and albumin-coated polystyrene or in the presence of these blood components were studied. The proteins which were pre-adsorbed to polystyrene surface or added to the medium simultaneously with bacterial cells reduced C. acnes adhesion and biofilm formation by 2-5 times to compare to the control. The role of calcium, magnesium and zinc on C. acnes attachment was also assessed. Calcium (1 and 10 mM) had the inhibitory effect on C. acnes adhesion, whereas zinc (1 and 10 mM) diminished the biofilm formation of C. acnes. We also observed that C. acnes cells did not bind to erythrocytes. Thus, we suggest that bacteria C. acnes preferably colonize the plasma-poor environment due to the inhibitory effect of blood components, in particular, albumin, calcium, and zinc.
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Affiliation(s)
- Tatyana V Polyudova
- Laboratory of microorganisms' biochemical development, Institute of Ecology and Genetics of Microorganisms, Ural Branch of Russian Academy of Sciences, Perm, Russia.,Faculty of Soil Science, Agrochemistry, Ecology and Merchandising, Perm State Agro-Technological University, Perm, Russia
| | - Daria V Eroshenko
- Laboratory of microorganisms' biochemical development, Institute of Ecology and Genetics of Microorganisms, Ural Branch of Russian Academy of Sciences, Perm, Russia.,Chemical Engineering Faculty, Perm National Research Polytechnic University, Perm, Russia
| | - Vladimir P Korobov
- Laboratory of microorganisms' biochemical development, Institute of Ecology and Genetics of Microorganisms, Ural Branch of Russian Academy of Sciences, Perm, Russia.,Chemical Engineering Faculty, Perm National Research Polytechnic University, Perm, Russia
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21
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Verkaik N, Schurink C, Melles D. Antibiotic treatment of Propionibacterium acnes endocarditis. Clin Microbiol Infect 2018; 24:209. [DOI: 10.1016/j.cmi.2017.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 07/09/2017] [Indexed: 11/28/2022]
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22
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Obayashi Y, Izumi C, Nakagawa Y. Man in his 50s with chest pain and dyspnoea. Heart 2018; 104:868. [PMID: 29382690 DOI: 10.1136/heartjnl-2017-312477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 12/13/2017] [Accepted: 12/26/2017] [Indexed: 11/04/2022] Open
Abstract
CLINICAL INTRODUCTION A man in his 50s with sudden-onset chest pain and dyspnoea was transferred to the emergency room. He had a history of aortic valve replacement due to aortic regurgitation with a mechanical valve 6 years previously. Heart rate was 90 bpm, and blood pressure was too low to measure. In the emergency room, he presented with severe dyspnoea and a chest X-ray showed severe lung congestion (figure 1A). ECG showed complete left bundle branch block. His respiratory status rapidly worsened, and he went into cardiopulmonary arrest. After cardiopulmonary resuscitation, transthoracic echocardiography was performed (figure 1B, online supplementary video 1).DC1SP110.1136/heartjnl-2017-312477.supp1Supplementary file 1 heartjnl;104/10/868/F1F1F1Figure 1(A) Chest X-ray. (B) Colour Doppler image from apical five-chamber view. QUESTION What is the most likely cause of the patient's cardiopulmonary arrest?Myocardial infarction in left main trunkAortic dissectionProsthetic valve thrombosisProsthetic valve embolisationPulmonary embolism.
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Affiliation(s)
- Yuki Obayashi
- Department of Cardiology, Tenri Hospital, Tenri, Nara, Japan
| | - Chisato Izumi
- Department of Cardiology, Tenri Hospital, Tenri, Nara, Japan
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23
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Petersson F, Kilsgård O, Shannon O, Lood R. Platelet activation and aggregation by the opportunistic pathogen Cutibacterium (Propionibacterium) acnes. PLoS One 2018; 13:e0192051. [PMID: 29385206 PMCID: PMC5792000 DOI: 10.1371/journal.pone.0192051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 01/16/2018] [Indexed: 11/19/2022] Open
Abstract
Cutibacterium (Propionibacterium) acnes, considered a part of the skin microbiota, is one of the most commonly isolated anaerobic bacteria from medical implants in contact with plasma. However, the precise interaction of C. acnes with blood cells and plasma proteins has not been fully elucidated. Herein, we have investigated the molecular interaction of C. acnes with platelets and plasma proteins. We report that the ability of C. acnes to aggregate platelets is dependent on phylotype, with a significantly lower ability amongst type IB isolates, and the interaction of specific donor-dependent plasma proteins (or concentrations thereof) with C. acnes. Pretreatment of C. acnes with plasma reduces the lag time before aggregation demonstrating that pre-deposition of plasma proteins on C. acnes is an important step in platelet aggregation. Using mass spectrometry we identified several plasma proteins deposited on C. acnes, including IgG, fibrinogen and complement factors. Inhibition of IgG, fibrinogen or complement decreased C. acnes-mediated platelet aggregation, demonstrating the importance of these plasma proteins for aggregation. The interaction of C. acnes and platelets was visualized using fluorescence microscopy, verifying the presence of IgG and fibrinogen as components of the aggregates, and co-localization of C. acnes and platelets in the aggregates. Here, we have demonstrated the ability of C. acnes to activate and aggregate platelets in a bacterium and donor-specific fashion, as well as added mechanistic insights into this interaction.
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Affiliation(s)
- Frida Petersson
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Ola Kilsgård
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Immunotechnology, Faculty of Engineering Lund, Lund University, Lund, Sweden
| | - Oonagh Shannon
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Rolf Lood
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- * E-mail:
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24
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Garric M, Moulis G, Boumaza X, Paricaud K, Astudillo L, Porte L, Lansalot-Matras P, Bos F, Pugnet G, Sailler L. Endocardite infectieuse à Propionibacterium acnes révélée par des myalgies. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25
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Mestrovic T, Profozic Z, Neuberg M. eComment. Towards better understanding and management of Propionibacterium acnes in cases of prosthetic valve endocarditis. Interact Cardiovasc Thorac Surg 2017; 23:154-5. [PMID: 27325658 DOI: 10.1093/icvts/ivw167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tomislav Mestrovic
- Clinical Microbiology and Parasitology Unit, Polyclinic "Dr. Zora Profozic", Zagreb, Croatia Department of Biomedical Sciences, University Centre Varazdin, University North, Varazdin, Croatia
| | - Zora Profozic
- Clinical Microbiology and Parasitology Unit, Polyclinic "Dr. Zora Profozic", Zagreb, Croatia
| | - Marijana Neuberg
- Department of Biomedical Sciences, University Centre Varazdin, University North, Varazdin, Croatia
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26
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van Valen R, Verkaik NJ, Mokhles MM, Bogers AJJC. eReply. Towards better understanding and management of Propionibacterium acnes in cases of prosthetic valve endocarditis. Interact Cardiovasc Thorac Surg 2017; 23:155. [PMID: 27325659 DOI: 10.1093/icvts/ivw221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Richard van Valen
- Cardiothoracic Surgery and Medical Microbioliogy and Infectious Diseases, Erasmus M.C, Rotterdam, Netherlands
| | - Nelianne J Verkaik
- Cardiothoracic Surgery and Medical Microbioliogy and Infectious Diseases, Erasmus M.C, Rotterdam, Netherlands
| | - Mostafa M Mokhles
- Cardiothoracic Surgery and Medical Microbioliogy and Infectious Diseases, Erasmus M.C, Rotterdam, Netherlands
| | - Ad J J C Bogers
- Cardiothoracic Surgery and Medical Microbioliogy and Infectious Diseases, Erasmus M.C, Rotterdam, Netherlands
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Basic-Jukic N, Furic-Cunko V, Juric I, Katalinic L, Rukavina A, Kocman M, Knezevic T. Acute Peritonitis Caused by Propionibacterium Acnes in a Peritoneal Dialysis Patient. BANTAO JOURNAL 2017. [DOI: 10.1515/bj-2017-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Propionibacterium acnes is a gram-positive human skin commensal that is involved in the pathogenesis of acne and prefers anaerobic growth conditions. It has been considered as a low virulence pathogen in different clinical conditions. We present the case of acute peritonitis caused by Propionibacterium acnes in a peritoneal dialysis patient.
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Affiliation(s)
- Nikolina Basic-Jukic
- Department of nephrology, arterial hypertension, dialysis and transplantation, University hospital centre Zagreb, Zagreb , Croatia
| | - Vesna Furic-Cunko
- Department of nephrology, arterial hypertension, dialysis and transplantation, University hospital centre Zagreb, Zagreb , Croatia
| | - Ivana Juric
- Department of nephrology, arterial hypertension, dialysis and transplantation, University hospital centre Zagreb, Zagreb , Croatia
| | - Lea Katalinic
- Department of nephrology, arterial hypertension, dialysis and transplantation, University hospital centre Zagreb, Zagreb , Croatia
| | - Ana Rukavina
- Department of nephrology, arterial hypertension, dialysis and transplantation, University hospital centre Zagreb, Zagreb , Croatia
| | - Monika Kocman
- Department of nephrology, arterial hypertension, dialysis and transplantation, University hospital centre Zagreb, Zagreb , Croatia
| | - Tamara Knezevic
- Department of nephrology, arterial hypertension, dialysis and transplantation, University hospital centre Zagreb, Zagreb , Croatia
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Computed tomography fistulography of the sternum. A case report on interprofessional collaboration between radiologist and surgeon. Int J Surg Case Rep 2017; 41:97-98. [PMID: 29055879 PMCID: PMC5651541 DOI: 10.1016/j.ijscr.2017.08.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 08/07/2017] [Accepted: 08/08/2017] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Trans sternal fistula can occur after sternotomy/heart surgery. Diagnosing this can be difficult. PRESENTATION OF CASE In this report, we present a unique case of a patient with infection of an ascending aortic prosthetic graft. This patient was oozing from the wound despite several revisions. Many fistulographies were performed before fistulography with surgeon and radiologist revealed a trans sternal fistula. DISCUSSION Infection with Propionibacterium acnes is often difficult to diagnose. This is in line with the present case, where a surgeon guided fistulography had to be performed followed by appropriate redo surgery with succesful subsequent sternal wound healing. CONCLUSION Our case demonstrates the importance of performing a fistulography with the presence of a surgeon, to obtain the best possible result.
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Kvich L, Jensen PØ, Justesen US, Bjarnsholt T. Incidence of Propionibacterium acnes in initially culture-negative thioglycollate broths-a prospective cohort study at a Danish University Hospital. Clin Microbiol Infect 2016; 22:941-945. [PMID: 27521804 DOI: 10.1016/j.cmi.2016.07.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/08/2016] [Accepted: 07/31/2016] [Indexed: 11/19/2022]
Abstract
The aim of this study was to prospectively investigate the incidence of Propionibacterium acnes in thioglycollate broths reported as culture-negative at the Department of Clinical Microbiology, Rigshospitalet, to evaluate whether 5 days of incubation was enough to find all relevant cases. Five hundred thioglycollate broths reported as culture-negative after 5 days were consecutively collected and incubated for at least a further 9 days (at least 14 days of incubation in total). Only tissue samples from sterile sites of the body (n = 298), bone tissue (n = 197) and foreign material (n = 5) were included in this study. Samples were divided into two groups: infected group and control group. This made it possible to compare findings between groups, thereby making it possible to estimate the level of true-positive findings and contamination. Samples from 296 participants were included in this study. After exclusion criteria were met, P. acnes was cultured from ten out of 151 patients (6.6%) in the infected group and from one out of 138 participants (0.7%) in the control group. This resulted in more findings of P. acnes in the infected group on day 14 than on day 5 (p 0.002). Furthermore, P. acnes was cultured more often from bone tissue and tissue surrounding foreign materials on day 14 than on day 5 (p 0.04). Clinical microbiology laboratories should consider incubating thioglycollate broths for at least 14 days to find all relevant cases of P. acnes, especially when it comes to bone tissue and tissue surrounding foreign materials.
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Affiliation(s)
- L Kvich
- Department of Clinical Microbiology, Copenhagen University Hospital-Rigshospitalet, Denmark
| | - P Ø Jensen
- Department of Clinical Microbiology, Copenhagen University Hospital-Rigshospitalet, Denmark
| | - U S Justesen
- Department of Clinical Microbiology, Copenhagen University Hospital-Rigshospitalet, Denmark
| | - T Bjarnsholt
- Department of Clinical Microbiology, Copenhagen University Hospital-Rigshospitalet, Denmark; Department of International Health, Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
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