Propionibacterium acnes vertebral osteomyelitis: seek and ye shall find?
The pathogenic potential of Propionibacterium acnes in implant-associated spine infections is increasingly recognized. However, the clinical findings and outcomes associated with this pathogen in nonimplant-associated spine infections are unknown. We retrospectively reviewed nine male patients who met our strict case definition for P. acnes vertebral osteomyelitis to determine whether the laboratory, radiographic, and histopathology found in these infections differs from that typically associated with vertebral osteomyelitis. We also determined clinical outcomes as they related to medical and surgical treatments rendered. Radiographic results, laboratory results, and histopathology results of patients with P. acnes vertebral osteomyelitis were often not those classically described for this disease. Two of the nine patients' imaging examinations did not suggest infection. Five of six patients had normal erythrocyte sedimentation rates at diagnosis. Three of six patients' histopathology did not show evidence of infection. Two patients whose treatment included spinal surgery with implant placement developed relapse of their infection. The remaining seven patients had rapid improvement with antimicrobial therapy. Patients with P. acnes vertebral osteomyelitis may present with atypical findings. Clinicians should be aware of the pathogenic potential of this organism, particularly following invasive spine procedures.
Kowalski
Todd J
TJ
Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
Berbari
Elie F
EF
Huddleston
Paul M
PM
Steckelberg
James M
JM
Osmon
Douglas R
DR
D000328:Adult; D000368:Aged; D001799:Blood Sedimentation; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis* / Q000382:microbiology*; D011425:Propionibacterium acnes; D013122:Spinal Diseases / Q000175:diagnosis* / Q000382:microbiology*