Cardiac Tamponade Caused by Cutibacterium acnes: An Updated and Comprehensive Review of the Literature

Abstract

Bacterial pericarditis is a critical diagnosis caused by a wide range of organisms including Streptococcus pneumoniae and other anaerobic organisms like Cutibacterium acnes which has been gaining more importance as a causative organism. Cutibacterium species are Gram-positive microaerophilic rods that constitute part of the normal flora of skin and mucosal membranes. The incidence of pericarditis caused by this organism is underreported as it is often dismissed as a skin flora contaminant. However, if left untreated, Cutibacterium acnes can cause pericarditis with serious complications. In this paper, we present a comprehensive review of the literature regarding pericarditis caused by Cutibacterium acnes along with a case presentation from our institution. In our institution, a 20-year-old man with history of atrial septal defect presented with chest pain radiating to the back along with symptoms of upper respiratory tract infection including headaches and myalgia. Electrocardiogram was remarkable for diffuse low-voltage waves. Echocardiography revealed a large pericardial effusion with tamponade features. Pericardiocentesis drained 1.2 L of milky fluid. Pericardial fluid analysis grew Cutibacterium acnes after being cultured for 8 days. The patient received 3 weeks of IV penicillin followed by 3 weeks of oral amoxicillin along with nonsteroidal anti-inflammatory agents and colchicine with no recurrence. Pericarditis caused by Cutibacterium acnes requires a high clinical suspicion since isolation of this organism can be dismissed as a skin flora contaminant. Literature review reveals that this infection may be underdiagnosed and underreported. Prompt diagnosis may lead to timely initiation of antibiotics which can help prevent devastating complications like constrictive pericarditis. Prospective studies are needed to evaluate the true incidence and prevalence of this disease.

Microbiome Analysis Reveals the Attenuation Effect of Lactobacillus From Yaks on Diarrhea via Modulation of Gut Microbiota

“…(2020) reported that Pantoea was closely related to bacteremia in humans. Cutibacterium was considered as skin flora contaminant, which can result in pericarditis with serious complications ( Fakhri et al., 2020 ). Moreover, Cutibacterium was also closely related to multiple postoperative complications, including persistent postoperative pain, chronic inflammation, and endoprosthesis involving bacterial biofilms because it ubiquitously colonizes the skin and resides in various other locations in the human body ( Patel et al., 2009 ; Achermann et al., 2013 ; Hudek et al., 2021 ).…”

Pleural and Pericardial Infection Due to Cutibacterium acnes in a Splenectomized Patient: A Case Report of an Underreported Systemic Infection

“…In an earlier review of the literature between 1889 and 1975, Klacsmann et al found Streptococcus pneumoniae as the prevalent bacterial cause of infectious pericarditis prior to 1943 and Staphylococcus aureus as the most prevalent after 1943 [4]. However, according to recent data, Cutibacterium acnes, formerly, Propionibacterium acnes, appears to play an important role as a causative agent of pericarditis [1,3,[5][6][7][8]. In a retrospective study done at Mayo Clinic, the three frequently identified causes of bacterial pericarditis were C. acnes, Staphylococci spp, and Streptococci spp, with C. acnes being the most prevalent.…”

“…Infectious pericarditis presents a diagnostic challenge in an immunocompromised patient due to poor inflammatory response. In this scenario, fever, pleuritic chest pain, and frictional rub may be missing [ 1 , 2 ]. The most common cause of infectious pericarditis is viral.…”

“…The most common cause of infectious pericarditis is viral. However, bacterial pericarditis does occur with severe complications such as constrictive pericarditis, pericardial effusion, cardiac tamponade, left ventricular pseudoaneurysm, and aortic mycotic aneurysm [ 1 , 3 ]. Expected sources include contiguous spread from surrounding structures, direct inoculation from trauma involving the pericardium, cardiothoracic surgery, and hematogenous spread [ 1 ].…”

“…However, bacterial pericarditis does occur with severe complications such as constrictive pericarditis, pericardial effusion, cardiac tamponade, left ventricular pseudoaneurysm, and aortic mycotic aneurysm [ 1 , 3 ]. Expected sources include contiguous spread from surrounding structures, direct inoculation from trauma involving the pericardium, cardiothoracic surgery, and hematogenous spread [ 1 ]. We report a rare case of pericarditis with concomitant pleural space infection due to Cutibacterium acnes ( C. acnes ) in a 54-year-old female with a previous history of splenectomy due to Hodgkin’s lymphoma.…”