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Propionibacterium Infections

Propionibacterium Infections

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Propionibacterium species are nonsporulating, gram-positive anaerobic bacilli that are considered commensal bacteria on the skin. They are usually nonpathogenic and are common contaminants of blood and body fluid cultures. These species are slow-growing and require at least 6 days for growth in culture. [1]

Propionibacterium species belong to the genera of coryneforms and are the best studied because of their association with acne vulgaris. Propionibacterium species, however, can also cause numerous other types of infections, including endocarditis, postoperative shoulder infections, and neurosurgical shunt infections. These are discussed later in the article and are classified as ”endovascular”, ”orthopedic”, ”neurosurgical”, and ”other” infections.

Propionibacterium acnes is found briefly on the skin of neonates, but true colonization begins during the 1-3 years prior to sexual maturity. During this time, numbers of P acnes rise from fewer than 10/cm2 to about 106/cm2, chiefly on the face and upper thorax. P acnes grows in the lipid-rich microenvironment of the hair follicle. In acne vulgaris, P acnes produces inflammatory mediators that result in acne papules, pustules, and nodulocystic lesions.

Propionibacterium granulosum is found in the same areas but at numbers about one hundredth of those of P acnes.

Both P acnes and P granulosum may be isolated from the gastrointestinal tract.

Propionibacterium avidum is found in the axilla rather than on exposed areas and increases in numbers at puberty.

Propionibacterium propionicus has been implicated as a less-common causative agent of a disease process similar to that of actinomycosis. The most common cause of actinomycosis is Actinomyces israeli infection. 

United States

Acne vulgaris is sufficiently common that it may be considered physiologic.

There are limited data in the literature quantifying the exact incidence of Propionibacterium endovascular, orthopedic, or neurosurgical shunt infections as frequently their pathogenic potential is overlooked given that it is considered to be of low virulence. The ability of P acnes to adhere to and form a biofilm, particularly on prosthetics, for example, is characteristic of the infections that it may cause.

International

As noted above, data are limited concerning the incidence of Propionibacterium species infections for numerous reasons.

A review performed in 2006 by Clayton et al looked at the world literature available for cases of endocarditis caused by Propionibacterium over the preceding 25 years. [2] In addition to 3 of their own cases, 36 additional cases were identified. Fourteen cases (42.4%) involved native valves, 16 (48.5%) involved prosthetic valves, and 3 (9.1%) were associated with intracardiac prosthetic material. Ten of the 14 (71.4%) patients with native valve infection had an underlying cardiac factor predisposing to infection. In this group, the valves most commonly affected were the mitral and aortic valves, while those with prosthetic valves were more likely to have aortic valve involvement rather than mitral valve involvement, partly because of the pattern of the valves replaced. Twenty-nine of the cases were due to P acnes, 3 were due to P granulosum, and 1 was an unspecified Propionibacterium species.

Propionibacterium species endovascular, orthopedic, and neurosurgical infections remain problematic, causing significant morbidity and mortality in affected patients.

Acne appears to be a familial condition and is less common in Japanese people than in the white American population.

Acne tends to develop at earlier ages in girls than boys. The peak of acne activity occurs during the mid-to-late teenaged period, and the incidence subsequently decreases. Acne is equally common in males and females, but tends to be more severe in males. [3]

Acne vulgaris is a chronic disease that involves the sebaceous follicles, primarily in adolescents. In some cases, it is present at birth, and mild cases of acne vulgaris may be observed in the neonatal period. During puberty, acne typically becomes a common problem. Acne develops in adolescents during adrenarche, when sex hormone levels and subsequent sebaceous gland stimulation occurs. In young individuals, the predominant lesions are comedones, and inflammatory lesions are less common.

Levy PY, Fenollar F, Stein A, et al. Propionibacterium acnes postoperative shoulder arthritis: an emerging clinical entity. Clin Infect Dis. 2008 Jun 15. 46(12):1884-6. [Medline].

Clayton JJ, Baig W, Reynolds GW, Sandoe JA. Endocarditis caused by Propionibacterium species: a report of three cases and a review of clinical features and diagnostic difficulties. J Med Microbiol. 2006 Aug. 55:981-7. [Medline].

Burton JL, Cunliffe WJ, Stafford I, Shuster S. The prevalence of acne vulgaris in adolescence. Br J Dermatol. 1971 Aug. 85(2):119-26. [Medline].

Sohail MR, Gray AL, Baddour LM, Tleyjeh IM, Virk A. Infective endocarditis due to Propionibacterium species. Clin Microbiol Infect. 2009 Apr. 15(4):387-94. [Medline].

Chaudhry R, Dhawan B, Pandey A, Choudhary SK, Kumar AS. Propionibacterium granulosum: a rare cause of endocarditis. J Infect. 2000 Nov. 41(3):284. [Medline].

Delyle LG, Vittecoq O, Bourdel A, Duparc F, Michot C, Le Loet X. Chronic destructive oligoarthritis associated with Propionibacterium acnes in a female patient with acne vulgaris: septic-reactive arthritis?. Arthritis Rheum. 2000 Dec. 43(12):2843-7. [Medline].

Millett PJ, Yen YM, Price CS, Horan MP, van der Meijden OA, Elser F. Propionibacterium acnes infection as an occult cause of postoperative shoulder pain: a case series. Clin Orthop Relat Res. 2011 Oct. 469(10):2824-30. [Medline]. [Full Text].

George R, Leibrock L, Epstein M. Long-term analysis of cerebrospinal fluid shunt infections. A 25-year experience. J Neurosurg. 1979 Dec. 51(6):804-11. [Medline].

Conen A, Walti LN, Merlo A, Fluckiger U, Battegay M, Trampuz A. Characteristics and treatment outcome of cerebrospinal fluid shunt-associated infections in adults: a retrospective analysis over an 11-year period. Clin Infect Dis. 2008 Jul 1. 47(1):73-82. [Medline].

Mandell GL, Bennett JE, Dolin R. Principles and Practice of Infectious Diseases. 6th ed. New York, NY: Churchill Livingstone; 2005.

Zaffiri L, Abdulmassih R, Boyaji S, Bagh I, Campbell AR, Loehrke ME. Brain abscess induced by Propionibacterium acnes in a patient with severe chronic sinusitis. New Microbiol. 2013 Jul. 36(3):325-9. [Medline].

Kunishima S, Inoue C, Kamiya T, Ozawa K. Presence of Propionibacterium acnes in blood components. Transfusion. 2001 Sep. 41(9):1126-9. [Medline].

Harada K, Tsuneyama K, Sudo Y, Masuda S, Nakanuma Y. Molecular identification of bacterial 16S ribosomal RNA gene in liver tissue of primary biliary cirrhosis: is Propionibacterium acnes involved in granuloma formation?. Hepatology. 2001 Mar. 33(3):530-6. [Medline].

Nishiwaki T, Yoneyama H, Eishi Y, et al. Indigenous pulmonary Propionibacterium acnes primes the host in the development of sarcoid-like pulmonary granulomatosis in mice. Am J Pathol. 2004 Aug. 165(2):631-9. [Medline]. [Full Text].

Takemori N, Nakamura M, Kojima M, Eishi Y. Successful treatment in a case of Propionibacterium acnes-associated sarcoidosis with clarithromycin administration: a case report. J Med Case Rep. 2014 Jan 15. 8(1):15. [Medline]. [Full Text].

Vohra A, Saiz E, Chan J, Castro J, Amaro R, Barkin J. Splenic abscess caused by Propionibacterium avidum as a complication of cardiac catheterization. Clin Infect Dis. 1998 Mar. 26(3):770-1. [Medline].

Butler-Wu SM, Burns EM, Pottinger PS, et al. Optimization of periprosthetic culture for diagnosis of Propionibacterium acnes prosthetic joint infection. J Clin Microbiol. 2011 Jul. 49(7):2490-5. [Medline]. [Full Text].

Underdahl JP, Florakis GJ, Braunstein RE, et al. Propionibacterium acnes as a cause of visually significant corneal ulcers. Cornea. 2000 Jul. 19(4):451-4. [Medline].

Klug D, Lacroix D, Savoye C, et al. Systemic infection related to endocarditis on pacemaker leads: clinical presentation and management. Circulation. 1997 Apr 15. 95(8):2098-107. [Medline].

Leyden JJ. Therapy for acne vulgaris. N Engl J Med. 1997 Apr 17. 336(16):1156-62. [Medline].

James HE, Walsh JW, Wilson HD, Connor JD, Bean JR, Tibbs PA. Prospective randomized study of therapy in cerebrospinal fluid shunt infection. Neurosurgery. 1980 Nov. 7(5):459-63. [Medline].

Sohail MR, Uslan DZ, Khan AH, et al. Management and outcome of permanent pacemaker and implantable cardioverter-defibrillator infections. J Am Coll Cardiol. 2007 May 8. 49(18):1851-9. [Medline].

Aldave AJ, Stein JD, Deramo VA, Shah GK, Fischer DH, Maguire JI. Treatment strategies for postoperative Propionibacterium acnes endophthalmitis. Ophthalmology. 1999 Dec. 106(12):2395-401. [Medline].

Winward KE, Pflugfelder SC, Flynn HW Jr, Roussel TJ, Davis JL. Postoperative Propionibacterium endophthalmitis. Treatment strategies and long-term results. Ophthalmology. 1993 Apr. 100(4):447-51. [Medline].

Ghosh M, Talwani R, Gilliam BL. Propionibacterium skull osteomyelitis treated with daptomycin. Clin Neurol Neurosurg. 2009 Sep. 111(7):610-2. [Medline].

Habif TP. Acne. Clinical Dermatology. St Louis, Mo: Mosby; 1996.

Sajeev Handa, MBBCh, BAO, LRCSI, LRCPI Director, Division of Hospital Medicine, Department of Medicine, Rhode Island Hospital

Sajeev Handa, MBBCh, BAO, LRCSI, LRCPI is a member of the following medical societies: Society of Hospital Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Aaron Glatt, MD Chairman, Department of Medicine, Chief, Division of Infectious Diseases, Hospital Epidemiologist, South Nassau Communities Hospital

Aaron Glatt, MD is a member of the following medical societies: American Association for Physician Leadership, American College of Chest Physicians, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Infectious Diseases Society of America, International AIDS Society, Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Mark R Wallace, MD, FACP, FIDSA Clinical Professor of Medicine, Florida State University College of Medicine; Clinical Professor of Medicine, University of Central Florida College of Medicine

Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, Florida Infectious Diseases Society

Disclosure: Nothing to disclose.

Joshua A Zeichner, MD Assistant Professor, Director of Cosmetic and Clinical Research, Mount Sinai School of Medicine; Chief of Dermatology, Institute for Family Health at North General

Joshua A Zeichner, MD is a member of the following medical societies: American Academy of Dermatology, National Psoriasis Foundation

Disclosure: Received consulting fee from Valeant for consulting; Received grant/research funds from Medicis for other; Received consulting fee from Galderma for consulting; Received consulting fee from Promius for consulting; Received consulting fee from Pharmaderm for consulting; Received consulting fee from Onset for consulting.

Propionibacterium Infections

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