Pseudopropionibacterium propionicum as a Cause of Empyema; A Diagnosis with Next-Generation Sequencing

Author:

Babar Sumbal1,Liu Emily2,Kaur Savreet2,Hussain Juzar3,Danaher Patrick J.45ORCID,Anstead Gregory M.45ORCID

Affiliation:

1. Division of Infectious Diseases, Department of Medicine, Carilion Clinic, 2001 Crystal Spring Ave, Suite 301, Roanoke, VA 24014, USA

2. Long School of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA

3. Internal Medicine Residency Program, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA

4. Division of Infectious Diseases, Department of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA

5. Division of Infectious Diseases, Medical Service, South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX 78229, USA

Abstract

Pseudopropionibacterium propionicum (P.p.) is an anaerobic, Gram-positive, branching beaded rod that is a component of the human microbiome. An infection of the thoracic cavity with P.p. can mimic tuberculosis (TB), nocardiosis, and malignancy. We present a case of a 77-year-old male who presented with dyspnea and a productive cough who was initially misdiagnosed with TB based on positive acid-fast staining of a pleural biopsy specimen and an elevated adenosine deaminase level of the pleural fluid. He was then diagnosed with nocardiosis based on the Gram stain of his pleural fluid that showed a Gram-positive beaded and branching rod. The pleural fluid specimen was culture-negative, but the diagnosis of thoracic P.p. infection was determined with next-generation sequencing (NGS). The patient was initially treated with imipenem and minocycline, then ceftriaxone and minocycline, and later changed to minocycline only. This report shows the utility of NGS in making a microbiological diagnosis when other techniques either failed to provide a result (culture) or gave misleading information (histopathologic exam, pleural fluid adenosine deaminase determination, and organism morphology on Gram stain).

Funder

MicroGenDX

Publisher

MDPI AG

Reference36 articles.

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2. Actinomycosis: Etiology, clinical features, diagnosis, treatment, and management;Valour;Infect. Drug Resist.,2014

3. Lacrimal canaliculitis due to Arachnia (Actinomyces) propionica;Seal;Br. J. Ophthalmol.,1981

4. Propionibacterium propionicum and infections of the lacrimal apparatus;Brazier;Clin. Infect. Dis.,1993

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