van Leeuwen Wouter J, Kappetein A Pieter, Bogers Ad J J C
Int J Cardiol. 2007 Apr 25;117(2):e79-81. doi: 10.1016/j.ijcard.2006.11.166. Epub 2007 Feb 22.
Propionibacterium acnes, a common human skin organism [Perry A.L., Lambert P.A., Under the microscope Propionibacterium acnes, Lett App Microbiol 2006; 42:185-186], mostly considered a contaminant, has rarely been associated with cases of infectious endocarditis [Vanagt W.Y., Daenen W.J., Delhaas T., Propionibacterium acnes endocarditis on an annuloplasty ring in an adolescent boy, Heart 2004; 90:56]. We report on a 48-year old man with a history of mitral valve replacement who acutely developed dyspnoea, tachypnoea and forward failure. Transesophageal echocardiography showed a dehiscence of the St. Jude mechanical mitral prosthesis necessitating urgent surgery. The prosthesis was replaced by another St. Jude mechanical valve. Blood cultures were initially negative but after a prolonged incubation period the tissue cultures became positive for Propionibacterium acnes. In cases of valvular dehiscence without macroscopic signs of endocarditis, communication between clinicians and the laboratory is important in order to incubate blood and tissue samples for a longer period of time to be able to detect exceptional causes of endocarditis.
痤疮丙酸杆菌是一种常见的人体皮肤微生物[佩里·A.L.，兰伯特·P.A.，《显微镜下的痤疮丙酸杆菌》，《应用微生物学快报》2006年；42:185 - 186]，大多被视为污染物，很少与感染性心内膜炎病例相关[范阿赫特·W.Y.，戴嫩·W.J.，德尔哈斯·T.，《青少年男孩人工瓣环上的痤疮丙酸杆菌性心内膜炎》，《心脏》2004年；90:56]。我们报告一例48岁男性，有二尖瓣置换病史，急性出现呼吸困难、呼吸急促和心力衰竭。经食管超声心动图显示圣犹达机械二尖瓣假体裂开，需要紧急手术。该假体被另一个圣犹达机械瓣膜替换。血培养最初为阴性，但经过长时间培养后，组织培养结果显示痤疮丙酸杆菌呈阳性。在没有心内膜炎宏观体征的瓣膜裂开病例中，临床医生与实验室之间的沟通很重要，以便对血液和组织样本进行更长时间的培养，从而能够检测出心内膜炎的特殊病因。
