Silent Native-valve Endocarditis Caused by &lt;i&gt;Propionibacterium acnes&lt;/i&gt;

Yamamoto, Ryōta; Miyagawa, Shigeru; Hagiya, Hideharu; Kimura, Keigo; Nishi, Isao; Yamamoto, Naoki; Yoshida, Hisao; Akeda, Yukihiro; Tomono, Kazunori; Toda, Köichi; Sawa, Yoshiki

doi:10.2169/internalmedicine.9833-17

Cited by 10 publications

(5 citation statements)

References 25 publications

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“…Propionibacterium acnes has been implicated in the pathophysiology of prostate cancer 2 , sarcoidosis 3 , infective endocarditis 4 , infections involving prosthetic devices (such as prosthetic joints, central nervous system ventricular shunts, and cardiac implantable devices) 5 , and acne, the last of which is the focus of this review. P. acnes is a Gram-positive, non-spore-forming human skin commensal that prefers anaerobic growth conditions 6, 7 .…”

Section: Introductionmentioning

confidence: 99%

Recent advances in understanding Propionibacterium acnes (Cutibacterium acnes) in acne

2018

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The skin commensal Propionibacterium acnes, recently renamed Cutibacterium acnes, along with the other major pathophysiological factors of increased seborrhea, hyperkeratinization of the pilosebaceous unit, and inflammation, has long been implicated in the pathogenesis of acne. Recent advances have contributed to our understanding of the role of P. acnes in acne. Although there are no quantitative differences in P. acnes of the skin of patients with acne compared with controls, the P. acnes phylogenic groups display distinct genetic and phenotypic characteristics, P. acnes biofilms are more frequent in acne, and different phylotypes may induce distinct immune responses in acne. P. acnes plays a further important role in the homeostasis of the skin’s microbiome, interacting with other cutaneous commensal or pathogenic microorganisms such as Staphylococcus epidermidis, Streptococcus pyogenes, and Pseudomonas species. In the era of increasing antimicrobial resistance, the selection of acne treatment targeting P. acnes and the prevention of antibiotic resistance play a key role in improving outcomes in acne patients and public health.

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Section: Introductionmentioning

confidence: 99%

Recent advances in understanding Propionibacterium acnes (Cutibacterium acnes) in acne

2018

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“…Although primarily recognized for its role in acne, Cutibacterium acnes , can cause a range of postoperative and device‐related infections including those of cardiac shunts and prosthetics 26,27 . Cutibacterium acnes native valve endocarditis is rare 28,29,30,31,32 . To date, only four patients with Cutibacterium acnes mediated CIED infections have been reported 33,34,35,36 .…”

Section: Discussionmentioning

confidence: 99%

“… 26 , 27 Cutibacterium acnes native valve endocarditis is rare. 28 , 29 , 30 , 31 , 32 To date, only four patients with Cutibacterium acnes mediated CIED infections have been reported. 33 , 34 , 35 , 36 In most of those cases, the infection was indolent, difficult to diagnose and occurred after a long period following device implantation.…”

Section: Discussionmentioning

confidence: 99%

Atypical pathogens associated with cardiac implantable electronic device infections

Kohli

Hazra

Ahmed

et al. 2021

Pacing Clinical Electrophis

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Background Cardiovascular implantable electronic device (CIED) infections are associated with significant morbidity and mortality making the identification of the causative organism critical. The vast majority of CIED infections are caused by Staphylococcal species. CIED infections associated with atypical pathogens are rare and have not been systematically investigated. The objective of this study is to characterize the clinical course, management and outcome in patients with CIED infection secondary to atypical pathogens. Methods Medical records of all patients who underwent CIED system extraction at the University of Chicago Medical Center between January 2010 and November 2020 were retrospectively reviewed to identify patients with CIED infection. Demographic, clinical, infection‐related and outcome data were collected. CIED infections were divided into typical and atypical groups based on the pathogens isolated. Results Among 356 CIED extraction procedures, 130 (37%) were performed for CIED infection. Atypical pathogens were found in 5.4% (n = 7) and included Pantoea species (n = 2), Kocuria species (n = 1), Cutibacterium acnes (n = 1), Corynebacterium tuberculostearicum (n = 1), Corynebacterium striatum (n = 1), Stenotrophomonas maltophilia (n = 1), and Pseudozyma ahidis (n = 1). All patients with atypical CIED infections were successfully treated with total system removal and tailored antibiotic therapy. There were no infection‐related deaths. Conclusions CIED infections with atypical pathogens were rare and associated with good outcome if diagnosed early and treated with total system removal and tailored antimicrobial therapy. Atypical pathogens cultured from blood, tissue or hardware in patients with CIED infection should be considered pathogens and not contaminants.

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“… 4 , 12 Sterile cultures are typically discarded at 5 days incubation and even if C. acnes is isolated, it is often disregarded as a skin contaminant. 5 Given that positive cultures are key to the mDC, both these factors highlight the challenges, and ultimately delays, in diagnosis. 13 Molecular testing techniques, such as 16S rDNA PCR, are useful in direct evaluation of valve tissue when interpreted in clinical context.…”

Section: Discussionmentioning

confidence: 99%

“…3 Cutibacterium acnes (formerly Propionibacterium ) is an anaerobic Gram-positive bacillus that is a normal human skin commensal. 4 Isolation of C. acnes on blood culture is commonly disregarded as a skin contaminant, 5 but is an increasingly recognized cause of invasive infection, including IE. 4 If positive blood cultures are disregarded as contaminants, then the diagnosis of IE by modified Duke Criteria (mDC) is easily missed.…”

Section: Introductionmentioning

confidence: 99%

Recurrent strokes in an occult case of recurrent Cutibacterium acnes prosthetic valve infective endocarditis: a case report

Fry

Primus

Serafino-Wani

et al. 2021

European Heart Journal - Case Reports

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Background Infective endocarditis (IE) is a known but uncommon cause of cardioembolic stroke and there are rare but recognized cases of IE without an inflammatory response. Cutibacterium acnes is an increasingly recognized source of invasive infections, including IE, but diagnosis is challenging due to its low virulence and fastidious nature. Case summary A 47-year-old man presented with a multi-focal stroke suggestive of a cardioembolic source. Outpatient transoesophageal echocardiography (TOE) was concerning for vegetation or thrombus associated with his previous mitral valve repair. He remained clinically well, with no evidence of an inflammatory response and sterile blood cultures. Computed tomography–positron emission tomography (CT-PET) corroborated the TOE findings, however, given the atypical presentation, he was treated for valvular thrombus. Following discharge, he quickly re-presented with further embolic phenomena and underwent emergency mitral valve replacement. Intraoperative findings were consistent with prosthetic valve IE (PVE) and a 6-week course of antibiotics commenced. C. acnes was identified on molecular testing. Eighteen months later, he re-presented with further neurological symptoms. Early TOE and CT–PET were consistent with IE. Blood cultures grew C. acnes after prolonged incubation. Given the absence of surgical indications, he was managed medically, and the vegetation resolved without valvular dysfunction. He continues to be followed up in an outpatient setting. Discussion In patients presenting with multi-territory stroke, IE should be considered despite sterile blood cultures and absent inflammatory response. C. acnes is an increasingly recognized cause of PVE in this context, often requiring surgical intervention. A high index of suspicion and collaboration with an Endocarditis Team is therefore essential to diagnose and treat.

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Silent Native-valve Endocarditis Caused by <i>Propionibacterium acnes</i>

Cited by 10 publications

References 25 publications

Recent advances in understanding Propionibacterium acnes (Cutibacterium acnes) in acne

Recent advances in understanding Propionibacterium acnes (Cutibacterium acnes) in acne

Atypical pathogens associated with cardiac implantable electronic device infections

Recurrent strokes in an occult case of recurrent Cutibacterium acnes prosthetic valve infective endocarditis: a case report

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