Propionibacterium acnes infection

Category: Illness or disabilities

Type

Involuntary

Introduction and description

Propionibacterium acnes is a relatively slow-growing, typically aerotolerant anaerobic, Gram-positive bacterium.  Originally identified as Bacillus acnes, it was later named Propionibacterium acnes for its ability to generate propionic acid.

Propionibacterium acnes is another bacteria that has bacteriophages. “Surprisingly, we found that, unlike other well-studied bacteriophages, P. acnes phages are highly homogeneous and show a striking lack of genetic diversity, …..  those bacteria that are able to support phages ..appear to be able to do so via chromosomally encoded immunity elements within the host genome”.  [PMID: 23015740]

Role and location

The genome of the bacterium has been sequenced and a study has shown several genes can generate enzymes for degrading skin and proteins , as such it appears that this bacteria performs an essential role in clearing dead cells and detritus.  The role appears to be a general one wherever it is found, a sort of natural hoover.

One of its other key roles is that wherever it is found it acts as an immunomodulator able to provoke the immune system into fighting numerous pathogenic microorganisms, as well as providing better control of infection by reducing bacterial counts.   Propionibacterium acnes is found in humans in a number of places where it has clearly demonstrated these very specific activities:

• The skin [including the external ear canal] - This bacterium is largely commensal – that is it is found as part of the skin flora present on most healthy adult humans' skin.  It lives primarily on, among other things, fatty acids in sebum secreted by sebaceous glands in the follicles.  If the sebum becomes excessive, the bacteria can extrude the excess sebum as well as the bacterial ‘by-products’ of its attempts to remove this excess.  These extrusions can attract mites.  [see the acne description for more details].  The aim should be to try to reduce the excess sebum
• Oral cavity -   Propionibacterium acnes exhibits immunopotentiating activity in the mouth.  It is one of a host of bacteria in the oral cavity which form part of the flora of the mouth.   Note that the use of mouthwash with antibacterial activity will serve to destroy both ‘friendly’ flora and any unfriendly bacteria. doi.org/10.1016/0003-9969(77)90087-5
• The conjunctiva – The conjunctiva actually has a very complex indigenous flora that includes P. Acnes.  It has recently been found, for example, that this flora can be very badly affected by the long-term use of prostaglandin analogs during the long-term, continuous administration of eye drops, such as in glaucoma treatment. There is a much higher incidence of MRSE in the flora, and the helpful protective  Propionibacterium acnes drops to only (33%).  PMID:  28796877
• Gastrointestinal tract -  There appears to be some disagreement on the extent of range of the bacteria with some sources linking it to just the large intestine and others citing the entire gastrointestinal tract.  Propionibacterium acnes is  Anaerobic meaning "living, active, occurring, or existing in the absence of free oxygen", as such it is able to perform its role in the intestine by being part of the permanent intestinal flora.  Given its role as an immunomodulator, it is an absolutely essential part of the flora and any disruption is liable to cause severe intestinal dysbiosis

P. acnes was found to be an endophyte of plants. Notably, grapevine appears to host an endophytic population of P. acnes that is closely related to the human-associated strains. The two lines diverged roughly 7,000 years ago, at about the same time when grapevine agriculture may have been established.  This is further evidence for the possibility that the bacteria has an entirely benign role.   This P. acnes subtype was dubbed Zappae in honour of the musician Frank Zappa, to highlight its ‘unexpected and unconventional habitat’ [sic].

Cause or not?

There appears to be the generally held view that when the bacteria finds its way into other parts of the body than those for which it has been identified, it becomes ‘an opportunistic pathogen’, causing a range of general, postoperative and device-related infections.

But is this true?

This bacteria performs an essential role in clearing dead cells and detritus.  Furthermore, its other key role is that wherever it is found it acts as an immunomodulator able to provoke the immune system into fighting numerous pathogenic microorganisms.  Is it possible that it is actually fighting organisms, often far smaller than itself, that have simply not been detected by the microscope or normal tests because no one was looking for them?

It has been found on devices such as joint prostheses, shunts and prosthetic heart valves.  But if we look at this in another way, it is simply acting as it should - as an immunomodulator able to provoke the immune system into fighting.  All these are, after all not ‘of the body’ and P.Acnes is simply doing its job.

And the presence of phages.  These can be an indicator that the bacteria has found it necessary to defend itself, in an attempt to continue to do the job for which it was designed.

Thus a great question mark hangs over the actual role P. Acnes does play in infection.  Whilst many researchers appear to believe it is pathogenic when ‘let loose’ in the body, we believe the opposite is true. There is the real possibility that it plays no part other than as a defender of the body it is in.  The following lists the places and diseases with which it has been ‘associated’, but we emphasise that this association does not prove it to be a causative agent and many of the following research papers have said so:

• Prostate cancer - P. acnes has been associated with chronic prostatitis leading to prostate cancer [PMID: 15879794],
• Eye diseases – It has been found in corneal ulcers, and is commonly found in patients with chronic endophthalmitis following cataract surgery
• Chronic recurrent multifocal osteomyelitis (CRMO) - PMID: 17631745
• Sarcoidosis - PMID:  12434425 and PMID:  19070256
• Sciatica- PMID:  11438138
• Endocarditis - Rarely, it has been found associated with heart valves infected with endocarditis
• Infections of joints – it has been found in the joints of those infected with septic arthritis.
• Skull infections - It has been found in ventriculostomy insertion sites, and areas subcutaneous to suture sites in patients who have undergone craniotomy.  
• Blood - It is common in blood and cerebrospinal fluid cultures.
• Herniated discs - it has been found in herniated discs.
• Implants – It has been found associated with various types of implant-associated infections, including breast implants, neurosurgical shunts, cardiovascular devices, ocular implants, internal fracture fixation devices, spinal hardware, and prosthetic joints.  PMID: 24308006

The point is essential because many researchers have already assumed it is a pathogen and make every attempt to remove it with antibiotics or other mechanisms.  If it is an entirely benign and helpful pathogen then the medical profession are removing an essential part of a person’s immune system.

The illness may then actually be from the antibiotics administered or the immunosuppressants, both of which would serve to remove the bacteria or disrupt the immune system and thus affect its working.

Another culprit that may also be an over-looked cause of skin diseases may be Skin creams and lotions, make-up and moisturisers – which may, in simplistic terms, smother and kill the bacteria and thus stop it performing its essential role.

P. acnes bacteria can live deep within follicles and pores, and are also found on the surface of healthy skin. In these follicles, P. acnes bacteria consume excess sebum, cellular debris and metabolic by-products from the surrounding skin tissue, cleaning the skin and using the debris as their primary sources of energy and nutrients.   

All the fatty substances and greases in these products are simply food to the bacteria and more to clear up.  Furthermore if the sebaceous glands become blocked as well, P. acnes bacteria will grow and multiply.  P. acnes bacteria secrete many proteins, including several digestive enzymes. These enzymes are involved in the digestion of all this fatty stuff.   But whilst they are doing their work, they can also destabilize the layers of cells that form the walls of the follicle. The cellular damage, metabolic by-products and bacterial debris produced by the rapid growth of P acnes in follicles can trigger inflammation.  The skin can often looked bruised.

The damage caused by P. acnes and the associated inflammation make the affected tissue more susceptible to colonization by opportunistic bacteria, such as Staphylococcus aureus. Research shows healthy pores are only colonized by P. acnes, while unhealthy ones universally include the non pore-resident Staphylococcus epidermidis, amongst other bacterial contaminants.

Treatment

The real possibility exists that P. Acnes should not be ‘treated’.   Research is urgently needed on this point to clarify the action that needs to be taken, as if the bacteria is benign and essential, doctors are acting against the patients’ interests.  Since the bacteria is a fundamental part of the intestinal flora, treatment with antibiotics could cause severe intestinal dysbiosis.  It may be that some strains are essential and others not – as long ago as 1976 it was established, for example, that P. acnes C-7, “ showed potent biological activities…. and was found the most effective in tumour protection, adjuvant action in immune response and phagocytic activity “.

• Antibiotics - At the moment antibiotics commonly used to treat apparent infection include erythromycin, clindamycin, doxycycline, minocycline,  quinolones, cephalosporins, pleuromutilins, penicillins, and sulfonamides.  Antibiotic-resistance has been acquired to the macrolides (e.g., erythromycin and azithromycin), lincosamides (e.g., clindamycin) and tetracyclines (e.g., doxycycline and minocycline).
•  Antimicrobial chemicals found in over-the-counter antibacterial products – may be used, again possibly not wisely given its possible essential role, these include  benzoyl peroxide, triclosan, chloroxylenol (PCMX), and chlorhexidine gluconate.
• Several essential oils - such as rosemary, tea tree oil, clove oil, and citrus oils contain antibacterial chemicals.  Again they may be doing more harm than good.

The bacterium is killed by ultraviolet light. P. acnes is especially sensitive to light in the 405–420 nanometer (near the ultraviolet) range.  This may explain why some people with skin problems are made a great deal worse by going out in strong direct sunlight.

References and further reading

• Cohen RJ, Shannon BA, McNeal JE, Shannon T, Garrett KL. Propionibacterium acnes associated with inflammation in radical prostatectomy specimens: a possible link to cancer evolution? Journal of Urology. 2005;173(6):1969–1974.
• Colina M, Lo Monaco A, Khodeir M, Trotta F. Propionibacterium acnes and SAPHO syndrome: a case report and literature review. Clinical and Experimental Rheumatology. 2007;25(3):457–460.
• Yamada T, Eishi Y, Ikeda S, et al. In situ localization of Propionibacterium acnes DNA in lymph nodes from sarcoidosis patients by signal amplification with catalysed reporter deposition. Journal of Pathology. 2002;198(4):541–547.
• Ichikawa H, Kataoka M, Hiramatsu J, et al. Quantitative analysis of propionibacterial DNA in bronchoalveolar lavage cells from patients with sarcoidosis. Sarcoidosis Vasculitis and Diffuse Lung Diseases. 2008;25(1):15–20
• Stirling A, Worthington T, Rafiq M, Lambert PA, Elliott TSJ. Association between sciatica and Propionibacterium acnes . Lancet. 2001;357(9273):2024–2025
• Biomed Res Int. 2013; 2013: 804391.   Published online 2013 Nov 6. doi:  10.1155/2013/804391  PMCID: PMC3838805 ;PMID: 24308006; Propionibacterium acnes: An Underestimated Pathogen in Implant-Associated Infections - María Eugenia Portillo, 1 Stéphane Corvec, 2 , 3 Olivier Borens, 4 and Andrej Trampuz 5 ,*
• Dali, P.; Giugliano, E. R.; Vellozzi, E. M.; Smith, M. A. (2001). "Susceptibilities of Propionibacterium acnes Ophthalmic Isolates to Moxifloxacin". Antimicrobial Agents and Chemotherapy. 45 (10): 2969–70. doi:10.1128/AAC.45.10.2969-2970.2001. PMC 90767. PMID 11583007.
• Japan. J. Microbiol. Vol. 20 (1), 17-25, 1976 Anaerobic Coryneforms Isolated from Human Bone Marrow and Skin Chemical, Biochemical and Serological Studies and Some of Their Biological Activities - Yushi SAINO, Junji EDA, Takao NAGOYA, Yoko YOSHIMURA, Masahito YAMAGUCHI, and Fujio KOBAYASHITokyo Research Laboratories, Kowa Co., Ltd., Higashi-Murayama