A Case of Brain Abscess Caused by Propionibacterium acnes 13 Months after Neurosurgery and Confirmed by 16S rRNA Gene Sequencing
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Propionibacterium acnes is a gram-positive anaerobic bacillus and a normal inhabitant of the skin. Although it is often considered a contaminant of blood cultures, it can occasionally cause serious infections, including postoperative central nervous system infections. Here, we report the case of a 70-yr-old man who developed a large cerebral abscess caused by P. acnes 13 months after neurosurgery. Immediate gram staining of the pus from his brain revealed the presence of gram-positive coccobacilli. However, colony growth was observed only after 5 days of culture. Therefore, we performed 16S rRNA gene sequencing of the pus specimen. The isolate was identified as P. acnes. The colonies developed 9 days after the initial culture. The API Rapid ID 32A test (bioMérieux, France) was performed using a colony, but an unacceptable profile was obtained. Then, the pus was transferred into the enrichment broths of the BACTEC FX (Becton Dickinson, USA) and BacT/Alert 3D (bioMérieux, Organon Teknika, USA) systems, but only the BACTEC FX system could detect growth after 5 days. We performed 16S rRNA gene sequencing and API Rapid 32A profiling with a colony recovered from Brucella agar, which was inoculated with the microbial growth in the enrichment broth from the BACTEC FX system. The organism was identified as P. acnes by both methods. This case suggests that 16S rRNA gene sequencing may be a useful alternative for identifying slowly growing P. acnes from specimens that do not show growth after 5 days of culture.
Abstract
Propionibacterium acnes is a gram-positive anaerobic bacillus and a normal inhabitant of the skin. Although it is often considered a contaminant of blood cultures, it can occasionally cause serious infections, including postoperative central nervous system infections. Here, we report the case of a 70-yr-old man who developed a large cerebral abscess caused by P. acnes 13 months after neurosurgery. Immediate gram staining of the pus from his brain revealed the presence of gram-positive coccobacilli. However, colony growth was observed only after 5 days of culture. Therefore, we performed 16S rRNA gene sequencing of the pus specimen. The isolate was identified as P. acnes. The colonies developed 9 days after the initial culture. The API Rapid ID 32A test (bioMérieux, France) was performed using a colony, but an unacceptable profile was obtained. Then, the pus was transferred into the enrichment broths of the BACTEC FX (Becton Dickinson, USA) and BacT/Alert 3D (bioMérieux, Organon Teknika, USA) systems, but only the BACTEC FX system could detect growth after 5 days. We performed 16S rRNA gene sequencing and API Rapid 32A profiling with a colony recovered from Brucella agar, which was inoculated with the microbial growth in the enrichment broth from the BACTEC FX system. The organism was identified as P. acnes by both methods. This case suggests that 16S rRNA gene sequencing may be a useful alternative for identifying slowly growing P. acnes from specimens that do not show growth after 5 days of culture.
참고문헌 (18)
- Brook I, "Infections caused by Propionibacterium species", Rev Infect Dis, 13, pp.819~822 (1991)
- Ramos JM, "Isolation of Propionibacterium acnes from central nervous system infections", Anaerobe, 1, pp.17~20 (1995)
- Conen A, "Characteristics and treatment outcome of cerebrospinal fluid shunt-associated infections in adults: a retrospective analysis over an 11-year period", Clin Infect Dis, 47, pp.73~82 (2008)
- 김종훈, "Superimposed Propionibacterium Acnes Subdural Empyema in a Patient with Chronic Subdural Hematoma", 대한신경외과학회지, 45(1), pp.53~56 (2009), 대한신경외과학회
- Clinical and Laboratory Standards Institute, "Interpretive criteria for identification of bacteria and fungi by DNA target sequencing: approved guideline. MM18-A" (2008), Clinical and Laboratory Standards Institute
- Kranick SM, "Propionibacterium acnes brain abscess appearing 10 years after neurosurgery", Arch Neurol, 66, pp.793~795 (2009)
- McClelland S 3rd, "Postoperative central nervous system infection: incidence and associated factors in 2111 neurosurgical procedures", Clin Infect Dis, 45, pp.55~59 (2007)
- Nisbet M, "Propionibacterium acnes: an under-appreciated cause of post-neurosurgical infection", J Antimicrob Chemother, 60, pp.1097~1103 (2007)
- Barazi SA, "Delayed postoperative intracerebral abscess caused by Proprionibacterium acnes: case report and review of the literature", Br J Neurosurg, 17, pp.336~339 (2003)
- Kabongo Muamba ML, "Exoenzymes of Propionibacterium acnes", Can J Microbiol, 28, pp.758~761 (1982)
- Looney WJ, "Evaluation of the ATB 32 A system for identification of anaerobic bacteria isolated from clinical specimens", J Clin Microbiol, 28, pp.1519~1524 (1990)
- 박상혁, "Clinical Relevance of Time-to-positivity in BACTEC9240 Blood Culture System", Annals of Laboratory Medicine, 30(3), pp.276~283 (2010), 대한진단검사의학회
- Reisner BS, "Times to detection of bacteria and yea-sts in BACTEC 9240 blood culture bottles", J Clin Microbiol, 37, pp.2024~2026 (1999)
- Hardy DJ, "Time to detection of positive BacT", Alert blood cultures and lack of need for routine subculture of 5- to 7-day negative cultures, 1992, pp.30, 2743~2745
- Mirrett S, "Validation of performance of plastic versus glass bottles for culturing anaerobes from blood in BacT", ALERT SN medium, 2005, pp.43, 6150~6151
- Le Page L, "Molecular diagnosis of a vascular prosthesis infection, due to Propionibacterium acnes, by amplification and sequencing of 16S rDNA", Clin Microbiol Infect, 9, pp.1125~1127 (2003)
- Breitkopf C, "Impact of a molecular approach to improve the microbiological diagnosis of infective heart valve endocarditis", Circulation, 111, pp.1415~1421 (2005)
- Justesen US, "16S rRNA gene sequencing in routine identification of anaerobic bacteria isolated from blood cultures", J Clin Microbiol, 48, pp.946~948 (2010)