eMedicine Specialties > Infectious Diseases > Bacterial Infections

Propionibacterium Infections: Differential Diagnoses & Workup

Author: Sajeev Handa, MB, BCh, BAO, LRCSI, LRCPI, Director, Division of Hospital Medicine, Department of Medicine, Rhode Island Hospital
Contributor Information and Disclosures

Updated: Mar 30, 2009

Differential Diagnoses

Actinomycosis
Behcet Disease
Cryptococcosis

Other Problems to Be Considered

Acne vulgaris: Comedones are not unique to acne. Senile comedones are common, particularly in the periorbital area of elderly persons. In addition, radiation therapy may result in comedones.

Acnelike lesions may develop in individuals with Behçet disease and in immunocompromised hosts.

Disseminated cryptococcosis may present as an acneiform eruption.

Other diseases associated with sebaceous cysts include atheromas, keratin cysts, and pilar cysts.

Workup

Laboratory Studies

  • Although many laboratory studies have been performed in acne vulgaris, the findings have not generally been significant. Androgen studies may be appropriate in select cases.
  • Other infections: In some high-risk patients, Propionibacterium species are capable of causing significant infections, and efforts should be made to obtain specimens free of contamination by the normal flora of the mucous membranes and skin, where they reside. In addition, strict anaerobic technique should be followed to ensure isolation in suspected cases of Propionibacterium infection.
  • CNS shunt infections require evaluation of cerebrospinal fluid (CSF) and blood cultures, particularly in cases of suspected ventriculoatrial shunt infections, in which case the yield may be higher.
  • In cases of P acnes infectious keratitis, cultures were positive for P acnes using thioglycolate broth. None became positive before 7 days of growth, and the recommendation is to monitor the culture for at least 10 days to ensure isolation of this fastidious organism.10
  • In chronic pseudophakic-related endophthalmitis, culture of a vitreous biopsy sample may be positive for P acnes. If the artificial lens is removed, Gram stain and electron microscopy of the capsule may demonstrate gram-positive rods.
  • In transfusion-transmitted bacterial infection, blood should be collected from the opposite arm; aside from appropriate hematologic tests, this blood should be sent for culture. Following reporting, the blood-product bag should be sent to the microbiology laboratory for Gram stain and culture.

Imaging Studies

  • In cardiovascular device–related infections, P acnes can be difficult to recover in cultures of clinical specimens unless anaerobic cultures are obtained and held for extended periods. CT scanning, ultrasonography, and MRI are useful in demonstrating fluid collection around a device, which can suggest infection. Percutaneous aspirate of the fluid with ultrasound or CT guidance may confirm device infection. Transesophageal echocardiography is required to visualize a vegetation in prosthetic valve endocarditis.11
  • In CNS shunt infections, neuroimaging studies may be used to look for evidence of ventriculitis or CSF obstruction. CT scanning or ultrasonography may be helpful in evaluating loculations at the distal end of a ventriculoperitoneal shunt.

More on Propionibacterium Infections

Overview: Propionibacterium Infections
Differential Diagnoses & Workup: Propionibacterium Infections
Treatment & Medication: Propionibacterium Infections
Follow-up: Propionibacterium Infections
Multimedia: Propionibacterium Infections
References
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References

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

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

  3. Delyle LG, Vittecoq O, Bourdel A, et al. Chronic destructive oligoarthritis associated with Propionibacterium acnes in a female patient with acne vulgaris: septic-reactive arthritis?. Arthritis Rheum. Dec 2000;43(12):2843-7. [Medline].

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

  5. 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. Jul 1 2008;47(1):73-82. [Medline].

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

  7. Chaudhry R, Dhawan B, Pandey A, et al. Propionibacterium granulosum: a rare cause of endocarditis. J Infect. Nov 2000;41(3):284. [Medline].

  8. 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. Mar 2001;33(3):530-6. [Medline].

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

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

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

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

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

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

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

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

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

  18. Webster G. Combination azelaic acid therapy for acne vulgaris. J Am Acad Dermatol. Aug 2000;43(2 Pt 3):S47-50. [Medline].

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Further Reading

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Keywords

Propionibacterium infection, Propionibacterium acnes, P acnes, Propionibacterium granulosum, P granulosum, Propionibacterium avidum, P avidum, Propionibacterium propionicus, P propionicus pustular acne, acne vulgaris, cystic acne, nodular acne, acneiform drug eruptions, Propionibacterium acne, inflammatory acne, Propionibacterium acne vulgaris

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Contributor Information and Disclosures

Author

Sajeev Handa, MB, BCh, BAO, LRCSI, LRCPI, Director, Division of Hospital Medicine, Department of Medicine, Rhode Island Hospital
Sajeev Handa, MB, BCh, BAO, LRCSI, LRCPI is a member of the following medical societies: Infectious Diseases Society of America and Society of Hospital Medicine
Disclosure: Nothing to disclose.

Medical Editor

Douglas A Drevets, MD, Assistant Professor, Department of Medicine, Section of Infectious Disease, Oklahoma University Health Sciences Center
Douglas A Drevets, MD is a member of the following medical societies: American Association of Immunologists, American Society for Microbiology, Central Society for Clinical Research, and Christian Medical & Dental Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Aaron Glatt, MD, Professor of Clinical Medicine, New York Medical College; President and CEO, Former Chief Medical Officer, Departments of Medicine and Infectious Diseases, New Island Hospital
Aaron Glatt, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physician Executives, 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, and Society for Healthcare Epidemiology of America
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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