Uncommon Infection of an Epidermoid Cyst in the Face with <em>Peptoniphilus harei</em> - A Systematic Review of the Literature Regarding Treatment Strategy

Special Article – Oral and Maxillofacial Surgery

Austin J Surg. 2018; 5(9): 1155.

Uncommon Infection of an Epidermoid Cyst in the Face with Peptoniphilus harei - A Systematic Review of the Literature Regarding Treatment Strategy

Abazi S, Harnik B, Wiesli MG, Leiggener CS and Augello M*

Department of Oral and Maxillofacial Surgery, Kantonsspital Aarau, Switzerland

*Corresponding author: Augello M, Department of Oral and Maxillofacial Surgery, Kantonsspital Aarau, Switzerland

Received: November 08, 2018; Accepted: December 13, 2018; Published: December 20, 2018

Abstract

Purpose: Infections with Peptoniphilus harei are rare and no consens about treatment exists. Based on a case report, we report on our approach and make a review of the literature. To our knowledge, we are the first to be confronted with an infected epidermoid cyst in the facial area due to Peptoniphilus harei in its pure form.

Material and Methods: A smear test for microbiological examination and for culture determination was taken intraoperative. Peptoniphilus harei could be detected by using the matrix-assisted laser desorption ionization time-off light mass spectrometry (MOLDI-TOF) method. A literature research showed only few documentations of an infection with this microorganism.

Results: The post-operative course was uneventful. No antibiotics were needed. The microbiological examination detected Peptoniphilus harei as the only microorganism.

Conclusion: The clinical impact of Peptinophilus harei is not clearly clarified due to poor data. Resistance cannot currently be considered as a problem. In our case report compared to the other case reports, no antibiotic therapy was initiated. For the detection of the causative microorganism, a microbiological sample is recommended.

Keywords: Peptoniphilus harei; Peptostreptococcus harei; Epidermoidcyst

Introduction

Peptostreptococcus harei was first isolated from antral lavage, from the peritoneal cavity and from a suppurative sacral ulcer. Furthermore also from abscesses of the neck area [1]. The bacterium Peptostreptococcus was reclassified in 2001 to the genus Peptoniphilus, which also includes Peptoniphilus harei [2]. Peptoniphilus harei are non-spore-forming, gram-positive, obligate Anaerobic cocci. Peotinophilus harei has been found mainly in polymicrobial infections [3,4]. Only in a few cases, Peptinophilus harei has been isolated as the only pathogen without the involvement of other bacteria out of an infection [5-8].

In this case, report we document the first case of an infected epidermoid cyst of the face caused by Peptinophilus harei. To our knowledge, we are the first to be confronted with an infected epidermoid cyst in the facial area due to Peptoniphilus harei in its pure form.

Case Report

A 57-year-old man introduced himself to our department. He reported that 3 weeks before a pustula on the right he manipulated cheek. After that the patient observed a slowly rising swelling on the right cheek. In the course, it came to swelling with redness and painfull palpation of the soft tissues. Finally, with abscess formation in the right cheek the patient presented himself to our clinic. The patient was in good general condition with no history of any other diseases and no history of drugs administration. In addition, the social and sexual anamnes is showed no abnormalities. The patient was afebrile and presented no ague. Because of the clear clinical findings and good general condition without further diseases, we renounced a radiological and an examination of inflammation parameters. There was no indication to take blood cultures. On the day of the presentation the abscess incision with drainage was performed. A smear test for microbiological examination and for culture determination was taken intraoperatively. After 48 hours of cultivation, gram-positive cocci were found. The detection of Peptoniphilus harei was achieved using the matrix-assisted laser desorption ionization time-off light mass spectrometry (MOLDI-TOF) method. The result showed Peptoniphilus harei as the only microorganism. After another 24 hours, an antibiogram profile was made. The microorganism was sensitive to all the antibiotics we tested: penicillin, amoxicillin-clavulanic acid, ampicillin, clarithromycin, clindamycin and metronidazole. We did not initiate antibiotic therapy. With regular irrigation, there was a clear clinical improvement (Figure 1). During the therapy, the drainage could be removed. One week after abscess incision surgical excision of the tumorous tissue could be fulfilled (Figure 2). The histological examination revealed an epidermoid cyst without evidence of malignancy. The further course was uneventful. We could conclude the treatment two weeks after abscess incision.