Clinico-Bacteriological Study Of Acne Vulgaris Patients Attending Dermatology Out Patient Department, With Special Reference To Anaerobes- A One Year Cross Sectional Study

Abstract

Acne vulgaris is a chronic inflammatory disorder affecting the skin of 70-90% young adults especially during puberty. Although Propionibacterium acnes (P.acnes) is known to predominate over other bacteria, the spectrum of others has been infrequently studied. OBJECTIVES: 1. To isolate and identify the aerobic and anaerobic bacteria associated with acne vulgaris patients and correlate them with clinical findings. 2. To carry out the antibiotic sensitivity of the aerobic and anaerobic bacteria involved in acne vulgaris patients. MATERIALS AND METHODS: After Ethical Committee approval, the study was conducted from January 2017 to December 2017 at Department of Microbiology, Jawaharlal Nehru Medical College (in collaboration with Department of Dermatology), KLE Society’s Dr.Prabhakar Kore Hospital and Medical Research Centre, Belagavi, Karnataka. Eighty-five samples, from patients of all age groups suffering from acne vulgaris, were obtained after informed consent under strict asepsis using a comedone-extractor. The sample was transferred to thioglycollate medium and transported to the Microbiology Laboratory. It was subjected to Gram’s stain and was put up on blood agar, propionibacterium agar and chocolate agar for aerobic and anaerobic cultures. RESULTS: Overall, the majority of patients belonged to grade one acne vulgaris and the highest prevalence was seen between 15-25 years of age (71.8%). Women were marginally more affected than men (51.8%). Gram’s stain predominantly showed gram positive cocci. Sixty seven of eighty five samples yielded growth. Out of 67 culture positives, 32 (47.8%) grew a single type of bacteria and 35(52.2%) showed mixed growth. Among 32 pure isolates, 21 (65.6%) cultured positive for P.acnes while 10 (31.3%) were S.epidermidis and only 1 (3.1%) showed positive for S.aureus. Out of 35 mixed isolates, there were 24 (68.6%) samples with concurrent growth of P.acnes and S. epidermidis while 11 (31.4%) were P.acnes and S.aureus. Overall, 56 P.acnes(83.6%), 34S.epidermidis(50.7%) and 12 S.aureus (17.9%) were isolated. Among all P. acnes growths, over 66% had mild lesions (grade 1). Likewise, most of the concomitant growths (P. acnes with S. epidermidis and S. aureus) were also grade1 lesions. Aerobic bacterial isolates were found to be mainly resistant to Clindamycin and Erythromycin whereas Gentamicin and Doxycycline were found to act well against them. Among the anaerobes, 50% of the isolates were resistant to Clindamycin. CONCLUSION: Although P.acnes was the dominant organism isolated from acne lesions, however, co-existence with Staphylococcal species also appears prevalent. The emergence of a resistance pattern amongst anaerobes, as reported by many studies, is also reflected in this study. Knowing the susceptibility pattern of these pathogenic bacteria will help in effective treatment thereby, preventing complications.