Which clinical history findings are characteristic of Cutibacterium (Propionibacterium) infection following neurosurgery?

Updated: Dec 03, 2019
  • Author: Sajeev Handa, MBBCh, BAO, LRCSI, LRCPI; Chief Editor: John L Brusch, MD, FACP  more...
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Answer

C acnes has been known to infect internal or external shunts, including Ommaya reservoirs. [11]

In a retrospective analysis of shunt infections by Conen et al in adults aged 12 years or older, out of 78 episodes, C acnes was isolated in 9% of cases, ranking third. The most common organisms were coagulase-negative staphylococci, followed by Staphylococcus aureus. [12]

C acnes shunt infections characteristically present with a paucity of symptoms. When present, they are related to obstruction and/or shunt malfunction, with signs of raised intracranial pressure (ie, headache, nausea, vomiting, lethargy, and/or mental status changes). Fever and meningeal symptoms may or may not be present. Ventriculoperitoneal shunt infections may manifest as peritonitis; ventriculoatrial shunt infections may manifest as fever and bacteremia, with the potential to progress to endocarditis. C acnes infection of a distal external shunt typically manifests as a soft-tissue infection.

In rare cases, Cutibacterium species have been implicated as a cause of brain abscess [13] and subdural empyema. A case report describes a patient who developed C acnes cerebral abscess as a consequence of severe chronic sinus disease. [14]


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