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J Med Microbiol 55 (2006), 981-987; DOI: 10.1099/jmm.0.46613-0
© 2006 Society for General Microbiology
ISSN 1473-5644

Review

Endocarditis caused by Propionibacterium species: a report of three cases and a review of clinical features and diagnostic difficulties

James J. Clayton1, Wazir Baig2, Gregory W. Reynolds2 and Jonathan A. T. Sandoe1

Department of Microbiology1 and Department of Cardiology2 , Leeds Teaching Hospitals NHS Trust, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, UK

Correspondence
Jonathan A. T. Sandoe
jonathan.sandoe{at}leedsth.nhs.uk


Propionibacterium species are members of the normal flora of skin and the mouth but their pathogenic potential is often overlooked. Three fatal cases of endocarditis caused by Propionibacterium species over an 8-year period are reported, and a review is presented of a further 33 cases from the world literature. In most cases, infection was protracted, with minimal signs in the early stages. Fourteen cases (42.4 %) involved native valves, 16 (48.5 %) involved prosthetic valves and three (9.1 %) were associated with other intracardiac prosthetic material. Intracardiac abscesses were commonly encountered, with Propionibacterium endocarditis occurring in 28.6 % of native valve infections and 52.9 % of prosthetic valve infections. A very high proportion of all of the cases (70.6 %) required surgical intervention. Several factors appeared to delay institution of appropriate therapy and may have contributed to abscess formation, including an indolent clinical course, negative or delayed culture results, and the tendency to consider this organism as a blood-culture contaminant. The authors recommend careful clinical evaluation before disregarding a blood-culture isolate of Propionibacterium spp. as a skin contaminant, and consideration of this bacterium as a potential cause of apparently culture-negative endocarditis.






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