Journal cover Journal topic
Journal of Bone and Joint Infection An open-access journal of the European Bone and Joint Infection Society and the MusculoSkeletal Infection Society
Journal topic
Volume 5, issue 4
J. Bone Joint Infect., 5, 205–211, 2020
https://doi.org/10.7150/jbji.46187
© Author(s) 2020. This work is distributed under
the Creative Commons Attribution 4.0 License.
J. Bone Joint Infect., 5, 205–211, 2020
https://doi.org/10.7150/jbji.46187
© Author(s) 2020. This work is distributed under
the Creative Commons Attribution 4.0 License.

Original full-length article 23 Jun 2020

Original full-length article | 23 Jun 2020

Plasma Cell Infiltration on Histopathological Samples of Chronic Bone and Joint Infections due to Cutibacterium acnes: A series of 21 Cases

Alexis Trecourt1, Marie Brevet1,2, Anne Champagnac1, Anne Conrad2,3,4,5, Jérôme Josse2,4,5, Céline Dupieux-Chabert2,4,5,6, Florent Valour2,3,4,5, and Tristan Ferry2,3,4,5 Alexis Trecourt et al.
  • 1Hospices Civils de Lyon, Institut de pathologie multisites des Hospices Civils de Lyon, Site Est et plateforme de pathologie moléculaire, Bron, France.
  • 2Université Claude Bernard Lyon 1, Lyon, France.
  • 3Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Service de Maladies Infectieuses et Tropicales, Lyon, France.
  • 4Centre de Référence des Infections Ostéo- Articulaires Complexes de Lyon, Lyon, France.
  • 5Centre International de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France.
  • 6Hospices Civils de Lyon, Hôpital Croix-Rousse, Institut des Agents Infectieux, Laboratoire de Bactériologie, Lyon, France.

Keywords: Cutibacterium acnes, Bone and joint infection, Plasma cells, Plasma cells infiltration, CRIOAc Lyon's criterion

Abstract. Introduction: Histopathological definition of bone and joint infection (BJI) is based on Mirra's criterion (≥ 5 polymorphonuclears (PMNs) per field in 5 high power fields (HPFs)). However, this definition does not seem appropriate for chronic BJIs caused by slow-growing germs such as Cutibacterium acnes (C. acnes). The aim of this study was to confirm that Mirra's criterion is not adequate for diagnosis of BJIs due to C. acnes. The second objective was to determine if plasma cell infiltration could be useful for the diagnosis of chronic BJIs due to C. acnes.

Methods: We retrospectively selected 25 consecutive patients from 2009 to 2013 with chronic BJIs due to C. acnes. Histological analysis was performed on the 21 cases with at least two C. acnes positive cultures. In addition of Mirra's criterion, the number of plasma cells (≥5 plasma cells/5 HPFs, defined as “CRIOAc Lyon's criterion”) was implemented in the histopathological analysis. Patients were defined as infected, if at least one of the two criteria were present.

Results: According to Mirra's and CRIOAc Lyon's criteria, positive histopathology was observed in 12 (57.1%) and 15 (71.4%) cases respectively. Considering the 9 cases with negative Mirra's criterion, high plasma cell infiltration (≥5 plasma cells per field/5 HPFs) was observed in 5 cases (55.6%), and low plasma cells infiltration (2-5 plasma cells per field/5 HPFs) was observed in 4 other cases (44.4%).

Conclusions: Adding CRIOAc Lyon's criterion to Mirra's criterion might restore some histopathological diagnosis of chronic BJIs due to C. acnes when a chronic BJI is clinically suspected.

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