Download PDF
J Neurol Surg A Cent Eur Neurosurg 2024; 85(06): 622-624
DOI: 10.1055/a-2156-5520
Case Report

Propionibacterium acnes: A Difficult-to-Diagnose Ventriculoperitoneal Shunt Infection. Case Report

Dzmitry Kuzmin 
1   Department of Neurosurgery, General Hospital Bamberg, Bamberg, Germany
,
Guenther C. Feigl
1   Department of Neurosurgery, General Hospital Bamberg, Bamberg, Germany
2   Department of Neurosurgery, University Hospital Tuebingen, Tuebingen, Germany
3   Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas
› Author Affiliations Funding None.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Background Ventriculoperitoneal (VP) shunt infections are a fairly common complication in both the early and late postoperative periods. Sometimes diagnosis is difficult despite the fact that infection is often accompanied by clinical symptoms. Furthermore, pathogenic bacteria can be detected in the cerebrospinal fluid.

Method We describe a case of chronic VP shunt infection in a 24-year-old female patient who was operated on for posterior fossa pilocytic astrocytoma and needed a VP shunt. The infection revealed itself 5 years after shunt implantation with nonspecific symptoms, and it took approximately 2 years to make a correct diagnosis. Meanwhile, the patient's condition became critical. The infection was caused by Propionibacterium acnes, which is capable of forming biofilms on implants, and which is difficult to identify due to the peculiarity of its cultivation.

Result When the bacterium was identified, the shunt was replaced and antimicrobial therapy was performed, after which the patient's condition improved dramatically and she got back to her normal life.

Conclusions This case shows how difficult the diagnosis of VP shunt infection can be and what clinical significance it can have for the patient.

Keywords

Propionibacterium acnes - ventriculoperitoneal shunt infection

Submission Statement

This manuscript is original and has not been submitted elsewhere in part or in whole.


Consent

Written informed consent was obtained from the patient for publication of this case report.




Publication History

Received: 15 June 2023

Accepted: 14 August 2023

Accepted Manuscript online:
18 August 2023

Article published online:
17 October 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Stone JJ, Walker CT, Jacobson M, Phillips V, Silberstein HJ. Revision rate of pediatric ventriculoperitoneal shunts after 15 years. J Neurosurg Pediatr 2013; 11 (01) 15-19
    CrossrefPubMedSearch in Google Scholar
  • 2 Kontny U, Höfling B, Gutjahr P, Voth D, Schwarz M, Schmitt HJ. CSF shunt infections in children. Infection 1993; 21 (02) 89-92
    CrossrefPubMedSearch in Google Scholar
  • 3 Enger PØ, Svendsen F, Wester K. CSF shunt infections in children: experiences from a population-based study. Acta Neurochir (Wien) 2003; 145 (04) 243-248 , discussion 248
    CrossrefPubMedSearch in Google Scholar
  • 4 Forward KR, Fewer HD, Stiver HG. Cerebrospinal fluid shunt infections. A review of 35 infections in 32 patients. J Neurosurg 1983; 59 (03) 389-394
    CrossrefPubMedSearch in Google Scholar
  • 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 2008; 47 (01) 73-82
    CrossrefPubMedSearch in Google Scholar
  • 6 Simpkins CJ. Ventriculoperitoneal shunt infections in patients with hydrocephalus. Pediatr Nurs 2005; 31 (06) 457-462
    PubMedSearch in Google Scholar
  • 7 Jakab E, Zbinden R, Gubler J, Ruef C, von Graevenitz A, Krause M. Severe infections caused by Propionibacterium acnes: an underestimated pathogen in late postoperative infections. Yale J Biol Med 1996; 69 (06) 477-482
    PubMedSearch in Google Scholar
  • 8 Bayston R, Ashraf W, Barker-Davies R. et al. Biofilm formation by Propionibacterium acnes on biomaterials in vitro and in vivo: impact on diagnosis and treatment. J Biomed Mater Res A 2007; 81 (03) 705-709
    CrossrefPubMedSearch in Google Scholar
  • 9 Bayston R, Vera L, Ashraf W. Activity of an antimicrobial hydrocephalus shunt catheter against Propionibacterium acnes . Antimicrob Agents Chemother 2010; 54 (12) 5082-5085
    CrossrefPubMedSearch in Google Scholar
  • 10 Sardana K, Gupta T, Garg VK, Ghunawat S. Antibiotic resistance to Propionobacterium acnes: worldwide scenario, diagnosis and management. Expert Rev Anti Infect Ther 2015; 13 (07) 883-896
    CrossrefPubMedSearch in Google Scholar
  • 11 Achermann Y, Goldstein EJC, Coenye T, Shirtliff ME. Propionibacterium acnes: from commensal to opportunistic biofilm-associated implant pathogen. Clin Microbiol Rev 2014; 27 (03) 419-440
    CrossrefPubMedSearch in Google Scholar
  • 12 Webster GF. Is it reasonable for a dermatologist to treat acne?. Arch Dermatol 1996; 132 (07) 819-820
    CrossrefPubMedSearch in Google Scholar
  • 13 Christensen GJM, Brüggemann H. Bacterial skin commensals and their role as host guardians. Benef Microbes 2014; 5 (02) 201-215
    CrossrefPubMedSearch in Google Scholar
  • 14 Westergren H, Westergren V, Forsum U. Propionebacterium acnes in cultures from ventriculo-peritoneal shunts: infection or contamination?. Acta Neurochir (Wien) 1997; 139 (01) 33-36
    CrossrefPubMedSearch in Google Scholar
  • 15 Santiago MR, Amuh D, Adal K. et al. Propionibacterium acnes CNS shunt infections in adults: a 6-year retrospective review. Clin Infect Dis 1997;25(02):
    PubMed
  • 16 Thompson TP, Albright AL. Propionibacterium [correction of Proprionibacterium] acnes infections of cerebrospinal fluid shunts. Childs Nerv Syst 1998; 14 (08) 378-380
    CrossrefPubMedSearch in Google Scholar
  • 17 Portillo ME, Corvec S, Borens O, Trampuz A. Propionibacterium acnes: an underestimated pathogen in implant-associated infections. BioMed Res Int 2013; 2013: 804391
    CrossrefPubMedSearch in Google Scholar
  • 18 van Voorst Vader PC, Michel MF. Occurrence of Propionobacterium acnes in blood and CSF of neurosurgical patients. Ned Tijdschr Geneeskd 1981;125(05):
    PubMed
  • 19 Ramos JM, Esteban J, Soriano F. Isolation of Propionibacterium acnes from central nervous system infections. Anaerobe 1995; 1 (01) 17-20
    CrossrefPubMedSearch in Google Scholar