Infective endocarditis: acne to zoonoses on the valve, an A to Z perspective

Abstract

Cutibacterium acnes (C. acnes), previously known as Propionibacterium acnes, is a rare cause of infective endocarditis (IE). We provide a review of the literature and describe two recent cases from a single centre to provide insight into the various clinical presentations, progression and management of patients with this infection. The primary objective of our review is to highlight the difficulty in the initial assessment of these patients with an aim to improve the time and accuracy of diagnosis and expedite subsequent treatment. There are currently no guidelines in the literature specific to the management of IE caused by C. acnes. Our secondary objectives are to disseminate information about the indolent course of the disease and add to the growing body of evidence around this rare, yet complex, cause of IE.

Keywords: cardiovascular diseases; endocarditis; heart diseases; heart valve disease.

Figure 1.. Transoesophageal echocardiography (TOE) showing vegetation measuring over 3.3 cm² in the aortic valve with large aortic root abscess

Figure 2.. Computed tomography (CT) imaging and 3D reconstruction of focal outpouchings in keeping with aortic root abscesses

Figure 3.. Transthoracic echocardiography (TTE) showing severe aortic regurgitation

Figure 4.. Excised bioprosthetic aortic valve replacement

Figure 5.. Cutibacterium species anaerobic, Gram-positive bacilli