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Rubor, Dolor, Calor, Tumor

More than Zits

Mark Crislip, MD, Infectious Diseases, 05:57PM Sep 28, 2009

Not the comic strip, although with a 16 yo at home, I find that particular comic strip especially funny of late.

55 yo male with back surgery and has a month of slowly increasing pain, but no fever, chills, sweats or other inflammatory sighs or symptoms.  MRI shows discitis and a fluid collection.

CBC is normal, CRAP (C Re Active Protein) is elevated.  Rain is wet.  Fire is hot.

Post op wound infection.  Thanks to the SCIP protocols, I do not get to see many of these. So off to the ER.  Thin pus is found, gram stain negative and at three days cultures are negative.

What's it gonna be?

Heavy growth of an anaerobic gram positive rod that is usually resistant to metronidazole grows at day five. Yes, you guessed it. P. acnes.

Despite its Stridex inducing name, P. acnes is not just for acne anymore.  It grows in the base of hair follicles, esp greasy hair follicles, so it is more common in men and more common in craniotomy infections.  I am becoming increasingly resistant to cranial infections.

Thing about P. acnes is that if you hold the cultures longer (up to two weeks) you will find it in prosthetic joint infections and catheter infections.  Most of the time we don't look.  And this organisms really seems to not incite much of an immune response and can fester for years.  My record is a craniotomy infection that manifested 8 years after the tumor was removed, and that duration is not unusual.

Look for P. acnes, it is probably there more than you suspect, especially if the cultures are negative in the first two days.

Treatment?  I tend to use Clindamycin.  Squeezing in front of a mirror doesn't work as well.

===

J Infect. 2008 Apr;56(4):257-60. Epub 2008 Mar 12. Related Articles, Links Click here to read

Propionibacterium acnes is a common colonizer of intravascular catheters.

Propionibacterium spp. are common flora of human skin. Nevertheless, currently recommended culture procedures do not include anaerobic processing with the result that this organism may go undetected on a colonized catheter. To determine the rate of catheter colonization by Propionibacterium spp., a sample of 1000 vascular catheters was processed by the roll-plate technique and, after conventional aerobic processing, all primary culture plates were reincubated in an anaerobic atmosphere. Propionibacterium acnes was detected in significant counts in the vascular catheters of 39 patients. This represents 14.7% (95% CI, 12.5-16.9) of all positive catheters. Propionibacterium is the second most frequent genus-colonizing catheter tips after Staphylococcus spp. Methodological shortcomings impair the detection and proper adscription of P. acnes as a potential cause of catheter-related infections.

PMID: 18336916

Clin Infect Dis. 2008 Jun 15;46(12):1884-6. Related Articles, Links Click here to read

Propionibacterium acnes postoperative shoulder arthritis: an emerging clinical entity.

The purpose of this study, which involved 276 patients, was to report the importance of Propionibacterium acnes in shoulder infections. The proportion of patients with shoulder infection who had infection due to P. acnes was significantly greater than the proportion of patients with lower limb infection who had infection due to P. acnes (9 of 16 patients vs. 1 of 233 patients; P < .001). This bacterium requires a prolonged incubation period and should not be considered to be a contaminant.

PMID: 18462110

About This Blog

For the Benefit of Mr Kite, there will be ID tonight. Infectious Diseases! Antibiotics! Viruses and Bacteria and Fungi! Oh my! Exclamation marks!!!!!! No trampolines, nor will any band be playing at 10 to 6. And Henry the Horse died of the Strangles. Sorry. That's the problem with infections.

The endless excitement that is the daily practice of Infectious Diseases in a Portland teaching hospital! The need for meta data!

Every day I make infectious disease rounds in the hospital and see at least one cool case or learn something new. 25 years and I still do not know everything. Why be selfish and keep all of that wonder and knowledge to myself? This blog will be a mostly qod account of days events, a cool ID case, a referenced pearl, and a minimum of 1 horrible, yet ultimately feeble, attempt at humor. I write these at night or in spare moments. There is always someone who will quibble about spelling, punctuation or grammer. My response is live with it. It's a blog, not Mandel.

Read and listen to more of me at my multimedia empire linked below.
Because The World Needs More Mark Crislip (tm).

Disclosure: Mark A. Crislip, MD, has disclosed the following relevant financial relationships:
Received income in an amount equal to or greater than $250 from: Pusware LLC
Have a 5% or greater equity interest in: Pusware LLC (owner)

  • Mark Crislip

    Mark Crislip, MD, has been practicing in infectious diseases in Portland, Oregon, since 1990. He is nobody from nowhere, but he has an enormous ego that leads him to think someone might care about what he has to say about infectious diseases. And so he blogs and podcasts and writes on the most endlessly fascinating specialty in all of medicine.

    Mark A. Crislip, MD, has disclosed the following relevant financial relationships: Owner, Pusware LLC. He as not talked to a drug rep in over 25 years and does not even eat the pizza provided at conferences. But he is for sale for the right price. Please. Someone. Buy me.

The content of this blog does not necessarily reflect the viewpoints of Medscape.
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