Case Report

Successful Management of Central Nervous System Infection Due to Propionibacterium acnes with Vancomycin and Doxycycline

Authors: Michael E. Fincher, MD, Mary Forsyth, MD, Scott Y. Rahimi, MD

Abstract

Propionibacterium acnes is an infrequent but increasingly recognized cause of neurosurgical infections. In this setting, it has been most commonly reported as complicating neurosurgical shunt procedures. The optimum therapy for central nervous system infections caused by P acnes has not been established. The authors report on a patient who had development of P acnes central nervous system infection after craniotomy for subdural hematoma. This case was successfully treated with prolonged therapy with vancomycin and doxycycline. Neurologic symptom improvement and radiographic resolution were documented on this regimen, and neurosurgical intervention was not required.


Key Points


* Propionibacterium acnes infection can follow craniotomy.


* Treatment of central nervous system Propionibacterium acnes infection is discussed.


* Use of antibiotics for treatment of cerebral empyema is described.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Beeler BA, Crowder JG, Smith JW, White A. Propionibacterium acnes: pathogen in central nervous system shunt infection. Am J Med 1976;61:935–938.
 
2. Jallo GI, Koslow M, Hanna BA, Carson LA. Propionibacterium as a cause of postneurosurgical infection in patients with dural allografts: report of three cases. Neurosurgery 1999;44:1138–1141.
 
3. Nishijima S, Kurokawa I, Katoh N, Watanabe K. The bacteriology of acne vulgaris and antimicrobial susceptibility of Propionibacterium acnes and Staphylococcus epidermidis isolated from acne lesions. J Dermatol 2000;27:318–323.
 
4. Leyden JJ. The evolving role of Propionibacterium acnes in acne. Semin Cutan Med Surg2001;20:139–143.
 
5. Skinner PR, Taylor AJ, Coakham H. Propionibacteria as a cause of shunt and postneurosurgical infections. J Clin Pathol 1978;31:1085–1089.
 
6. Collignon PJ, Munro R, Sorrell TC. Propionibacterium acnes infection in neurosurgical patients: experience with high-dose penicillin therapy. Med J Aust 1986;145:408–410.
 
7. Berenson CS, Bia FJ. Propionibacterium acnes causes postoperative brain abscesses unassociated with foreign bodies. Neurosurgery 1989;25:130–134.
 
8. Yoshikawa TT, Chow AW, Guze LB. Role of anaerobic bacteria in subdural empyema. Am J Med1975;58:99–104.
 
9. Suzuki T, Sano Y, Sasaki O, Kinoshita S. Ocular surface inflammation induced by Propionibacterium acnes. Cornea 2002;21:812–817.
 
10. Wada R, Kawamura C, Inoue S, et al. Granulomatous colitis associated with botryomycosis ofPropionibacterium acnes. Arch Pathol Lab Med 2001;125:1491–1493.
 
11. Vandenbos F, Roger PM, Mondain-Miton V, et al. Ventricular patch endocarditis caused byPropionibacterium acnes: advantages of gallium scanning. J Infect 2001;43:249–251.
 
12. Gutierrez-Diaz E, Montero-Rodriguez M, Mencia-Gutierrez E, et al. Propionibacterium acnes endophthalmitis in Ahmed glaucoma valve. Eur J Ophthalmol 2001;11:383–385.
 
13. Kunishima S, Inoue C, Kamiya T, Ozawa K. Presence of Propionibacterium acnes in blood components. Transfusion 2001;41:1126–1129.
 
14. Bourdeaut F, Quartier P, Alkaer G, et al. Propionibacterium acnes chest infections in patients with chronic granulomatous disease: case reports. CID 2002;34:853–854.
 
15. Ichiyasu H, Suga M, Iyonaga K, Ando M. Role of monocyte chemoattractant protein-1 inPropionibacterium acnes-induced pulmonary granulomatosis. Microsc Res Tech 2001;53:288–297.
 
16. Yamada T, Eishi Y, Ikeda S, et al. In situ localization of Propionibacterium acnes DNA in lymph nodes from sarcoidosis patients by signal amplification with catalysed reporter deposition. J Pathol2002;198:541–547.
 
17. Engelkirk PG, Duben-Engelkirk J. Anaerobes of clinical importance, in Mahon CR, Manuselis G (eds): Textbook of Diagnostic Microbiology. Philadelphia, WB Saunders, 2000, pp 565–622.