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Late-Onset Prosthetic Endocarditis with Paraaortic Abscess Caused by Cutibacterium acnes

Cutibacterium acnes, an integral component of the skin’s customary bacterial flora, represents a Gram-positive anaerobic bacterium characterized by its low virulence. Despite its low virulence, the pathogen can cause profound-seated infections as well as infections linked to medical devices. We repo...

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Autores principales: Velollari, Ornela, Reinhardt, Christian Malte, Knorr, Maike, Schnitzler, Katharina, Graafen, Dirk, Miederer, Matthias, von Bardeleben, Ralph Stephan, Münzel, Thomas, Schmidt, Kai-Helge, Giebels, Christian, Schäfers, Hans-Joachim, Hobohm, Lukas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10606402/
https://www.ncbi.nlm.nih.gov/pubmed/37888140
http://dx.doi.org/10.3390/idr15050059
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author Velollari, Ornela
Reinhardt, Christian Malte
Knorr, Maike
Schnitzler, Katharina
Graafen, Dirk
Miederer, Matthias
von Bardeleben, Ralph Stephan
Münzel, Thomas
Schmidt, Kai-Helge
Giebels, Christian
Schäfers, Hans-Joachim
Hobohm, Lukas
author_facet Velollari, Ornela
Reinhardt, Christian Malte
Knorr, Maike
Schnitzler, Katharina
Graafen, Dirk
Miederer, Matthias
von Bardeleben, Ralph Stephan
Münzel, Thomas
Schmidt, Kai-Helge
Giebels, Christian
Schäfers, Hans-Joachim
Hobohm, Lukas
author_sort Velollari, Ornela
collection PubMed
description Cutibacterium acnes, an integral component of the skin’s customary bacterial flora, represents a Gram-positive anaerobic bacterium characterized by its low virulence. Despite its low virulence, the pathogen can cause profound-seated infections as well as infections linked to medical devices. We report a case study of a prosthesis endocarditis accompanied by a paraaortic abscess caused by C. acnes, a development occurring five years prior to composite aortic root and valve replacement. At the point of admission, the patient presented with a combination of symptoms hinting at a subacute progression, such as weight loss, chest pain, and limitations of cardiopulmonary functionality. An anaerobic pathogen, namely C. acnes, was detected in a singular blood culture vial. Since first-line imaging modalities such as echocardiography did not reveal any signs of inflammation, and in the case of a suspected diagnosis for IE, did not show high pretest probability, further diagnostic imaging such as 18F-FDG PET CT was put to use. Here, a highly elevated glucose metabolism around the aortic valve ring was detected, pointing to an inflammatory process. The patient received adjusted intravenous antibiotic therapy over a course of six weeks; he then underwent surgical therapy via re-replacement of the aortic root and valve using a composite conduit. Advanced microbiological analyses, including the amplification of PCR and valve sequencing via 16S rDNA, mainly detected one pathogen: C. acnes. Delayed onset with mild symptoms and laboratory findings is characteristic of infective endocarditis by C. acnes. Due to its high rate of complications, mortality, and morbidity, an infection should not be disregarded as contamination. Recommendations from different studies underline a combination of a positive blood culture and microbiological evidence to differentiate between contamination and true infection in the case of an infection involving C. acnes. Serial blood cultures with prolonged incubation, advanced microbiological analyses, and modified Duke criteria including second-line imaging techniques should be utilized for further evaluation.
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spelling pubmed-106064022023-10-28 Late-Onset Prosthetic Endocarditis with Paraaortic Abscess Caused by Cutibacterium acnes Velollari, Ornela Reinhardt, Christian Malte Knorr, Maike Schnitzler, Katharina Graafen, Dirk Miederer, Matthias von Bardeleben, Ralph Stephan Münzel, Thomas Schmidt, Kai-Helge Giebels, Christian Schäfers, Hans-Joachim Hobohm, Lukas Infect Dis Rep Case Report Cutibacterium acnes, an integral component of the skin’s customary bacterial flora, represents a Gram-positive anaerobic bacterium characterized by its low virulence. Despite its low virulence, the pathogen can cause profound-seated infections as well as infections linked to medical devices. We report a case study of a prosthesis endocarditis accompanied by a paraaortic abscess caused by C. acnes, a development occurring five years prior to composite aortic root and valve replacement. At the point of admission, the patient presented with a combination of symptoms hinting at a subacute progression, such as weight loss, chest pain, and limitations of cardiopulmonary functionality. An anaerobic pathogen, namely C. acnes, was detected in a singular blood culture vial. Since first-line imaging modalities such as echocardiography did not reveal any signs of inflammation, and in the case of a suspected diagnosis for IE, did not show high pretest probability, further diagnostic imaging such as 18F-FDG PET CT was put to use. Here, a highly elevated glucose metabolism around the aortic valve ring was detected, pointing to an inflammatory process. The patient received adjusted intravenous antibiotic therapy over a course of six weeks; he then underwent surgical therapy via re-replacement of the aortic root and valve using a composite conduit. Advanced microbiological analyses, including the amplification of PCR and valve sequencing via 16S rDNA, mainly detected one pathogen: C. acnes. Delayed onset with mild symptoms and laboratory findings is characteristic of infective endocarditis by C. acnes. Due to its high rate of complications, mortality, and morbidity, an infection should not be disregarded as contamination. Recommendations from different studies underline a combination of a positive blood culture and microbiological evidence to differentiate between contamination and true infection in the case of an infection involving C. acnes. Serial blood cultures with prolonged incubation, advanced microbiological analyses, and modified Duke criteria including second-line imaging techniques should be utilized for further evaluation. MDPI 2023-10-18 /pmc/articles/PMC10606402/ /pubmed/37888140 http://dx.doi.org/10.3390/idr15050059 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Velollari, Ornela
Reinhardt, Christian Malte
Knorr, Maike
Schnitzler, Katharina
Graafen, Dirk
Miederer, Matthias
von Bardeleben, Ralph Stephan
Münzel, Thomas
Schmidt, Kai-Helge
Giebels, Christian
Schäfers, Hans-Joachim
Hobohm, Lukas
Late-Onset Prosthetic Endocarditis with Paraaortic Abscess Caused by Cutibacterium acnes
title Late-Onset Prosthetic Endocarditis with Paraaortic Abscess Caused by Cutibacterium acnes
title_full Late-Onset Prosthetic Endocarditis with Paraaortic Abscess Caused by Cutibacterium acnes
title_fullStr Late-Onset Prosthetic Endocarditis with Paraaortic Abscess Caused by Cutibacterium acnes
title_full_unstemmed Late-Onset Prosthetic Endocarditis with Paraaortic Abscess Caused by Cutibacterium acnes
title_short Late-Onset Prosthetic Endocarditis with Paraaortic Abscess Caused by Cutibacterium acnes
title_sort late-onset prosthetic endocarditis with paraaortic abscess caused by cutibacterium acnes
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10606402/
https://www.ncbi.nlm.nih.gov/pubmed/37888140
http://dx.doi.org/10.3390/idr15050059
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