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Propionibacterium acnes: pathogen in central nervous system shunt infection. Report of three cases including immune
Abstract:
Propionibacterium acnes is a pleomorphic gram-positive anaerobic rod usually isolated as a contaminant from skin. We report three cases of P. acnes infection of central nervous system shunts for hydrocephalus. The organism was seen repeatedly on gram stain in a specimen of shunt fluid in all three cases; initially, it was regarded as a contaminant. In addition, two of the patients had precipitins to extracts of their organism. Serum from normal control subjects had no such precipitins. One of the patients had an immune-complex glomerulonephritis--an entity not previously associated with anaerobic organisms. All three patients recovered after removal of the shunt and treatment with antibiotics. P. acnes is a significant pathogen in patients with central nervous system shunts.
Insights
Propionibacterium acnes, typically a skin contaminant, can cause serious central nervous system shunt infections. Prompt diagnosis and treatment involving shunt removal and antibiotics lead to recovery.
Area of Science:
- Microbiology
- Infectious Diseases
- Neurosurgery
Background:
- Propionibacterium acnes (P. acnes) is a common skin bacterium often considered a contaminant.
- Central nervous system (CNS) shunts are used to treat hydrocephalus.
Observation:
- Three cases of CNS shunt infection by P. acnes are presented.
- The organism was initially overlooked as a contaminant in shunt fluid Gram stains.
- Two patients developed specific precipitins against P. acnes extracts.
Findings:
- P. acnes can act as a significant pathogen in CNS shunt infections.
- One patient presented with immune-complex glomerulonephritis, a novel association with anaerobic organisms.
- All patients successfully recovered after shunt removal and antibiotic therapy.
Implications:
- P. acnes should be considered a potential pathogen in CNS shunt infections.
- Diagnostic vigilance is crucial to avoid misinterpreting P. acnes as a contaminant.
- This highlights a new association between anaerobic bacterial infections and glomerulonephritis.