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Propionibacterium infection associated with bovine pericardium dural allograft. Case report
Garni Barkhoudarian1, Julian T Hoff, B Gregory Thompson
1Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan 48109-0338, USA.
Abstract:
Propionibacteria are known to play a part in postneurosurgical infections, primarily those involving ventricular shunts. Nevertheless, little is known about the association between dural allografts and propionibacterium infections. Two patients underwent craniotomy for supratentorial meningiomas and each received a dural allograft. Both patients subsequently presented with delayed epidural fluid collections several weeks after surgery. Propionibacterium species was cultured in samples from both patients. The allografts were removed and the patients were treated with appropriate antibiotic agents; one patient underwent an interval craniectomy. Both patients demonstrated neuroimaging and clinical improvement after surgery and antiobiotic therapy. These cases demonstrate the association of propionibacterium infections with dural allografts. Furthermore, in patients with latent and indolent infections, Propionibacterium spp. should be suspected and treated appropriately.
Insights
Propionibacteria can cause delayed infections after brain surgery involving dural allografts. Early detection and treatment of these Propionibacteria infections are crucial for patient recovery.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Microbiology
Background:
- Propionibacteria are recognized pathogens in postneurosurgical infections, particularly those linked to ventricular shunts.
- The role of Propionibacteria in dural allograft infections remains under-explored.
Observation:
- Two patients developed delayed epidural fluid collections weeks after craniotomy for supratentorial meningiomas, with dural allografts used in both procedures.
- Cultures from both patients yielded Propionibacteria species.
Findings:
- The study identified a direct association between Propionibacteria infections and the use of dural allografts.
- Surgical removal of infected allografts, coupled with appropriate antibiotic therapy, led to positive clinical and neuroimaging outcomes.
Implications:
- These cases highlight Propionibacteria as a potential cause of indolent infections associated with dural allografts.
- Clinicians should consider Propionibacteria in the differential diagnosis of delayed post-neurosurgical infections, even with subtle presentations.
