Endocarditis caused by Propionibacterium species: a report of three cases and a review of clinical features and diagnostic difficulties

Abstract

Propionibacterium species are members of the normal flora of skin and the mouth but their pathogenic potential is often overlooked. Three fatal cases of endocarditis caused by Propionibacterium species over an 8-year period are reported, and a review is presented of a further 33 cases from the world literature. In most cases, infection was protracted, with minimal signs in the early stages. Fourteen cases (42.4%) involved native valves, 16 (48.5%) involved prosthetic valves and three (9.1%) were associated with other intracardiac prosthetic material. Intracardiac abscesses were commonly encountered, with Propionibacterium endocarditis occurring in 28.6% of native valve infections and 52.9% of prosthetic valve infections. A very high proportion of all of the cases (70.6%) required surgical intervention. Several factors appeared to delay institution of appropriate therapy and may have contributed to abscess formation, including an indolent clinical course, negative or delayed culture results, and the tendency to consider this organism as a blood-culture contaminant. The authors recommend careful clinical evaluation before disregarding a blood-culture isolate of Propionibacterium spp. as a skin contaminant, and consideration of this bacterium as a potential cause of apparently culture-negative endocarditis.

Human oral, gut, and plaque microbiota in patients with atherosclerosis

“…All three of these genera have been described as normal inhabitants of the healthy oral microbiota (30). Furthermore, they have also been implicated in endocarditis (31)(32)(33), and recent data suggest that the transmission of Granulicatella from the oral cavity could cause infective endocarditis (31). Interestingly, the oral and atherosclerotic plaque microbiotas have similar levels of diversity (PD).…”

Screening of platelet concentrates for bacterial contamination: spectrum of bacteria detected, proportionof transfused units, and clinical follow-up

“…The clinical significance of Propionbacterium acnes has been questioned. However, there are well-documented cases of infections in various clinical settings including endocarditis, arthritis, lung infections, and abscesses in spleen and brain [19][20][21]. In particular, it can cause silent late chronic infections in prosthetic joints [21].…”

Propionibacterium acnes and Staphylococcus lugdunensis Cause Pyogenic Osteomyelitis in an Intramedullary Nail Model in Rabbits

“…Historically, microorganisms, such as P. acnes and CoNS, have been considered contaminants from the skin rather than causative agents of osteomyelitis (3)(4)(5). Reports from the Patrick laboratory at Queen's University Belfast in the late 1990s (11,34) revealed the isolation and detection of these microbes in significant numbers from aseptically loosened failed implants by the use of ultrasound to dislodge adherent biofilms.…”

“…One of the most common causative microorganisms is Staphylococcus aureus, which causes an acute infection characterized by fever, localized swelling, and osteolysis (1,2). In contrast, the exact role played by other less virulent members of the skin microbiota in medical device-related infections, including the Gram-positive anaerobic-to-aerotolerant bacterium Propionibacterium acnes and coagulase-negative staphylococci (CoNS), has historically been less clear; these organisms were previously dismissed as contaminants when cultured from clinical specimens (3)(4)(5).…”