May Chlamydia trachomatis be an aetiological agent of chronic prostatic infection?

Chlamydia trachomatis infection is the most common sexually transmitted bacterial disease. The objective of this study was to establish the presence/absence of C. trachomatis in 98 patients with chronic complaints about the prostate and to evaluate the role of this bacterium in the inflammation of the gland. We performed culture and microscopical examination of pre‐massage/post‐massage urine and expressed prostatic secretions (EPS). In all cases, culture on McCoy cells and polymerase chain reaction (PCR) of the EPS was performed. Based on laboratory findings in 53 cases (54.08%), Escherichia coli, Klebsiella, Enterobacter, Proteus, Pseudomonas and Staphylococcus were isolated and accepted as causative agents of chronic bacterial prostatitis. Forty‐five patients were categorised as patients with chronic pelvic pain syndrome. The results from the PCR and the cell culture for detection of C. trachomatis were as follows – two positive probes detected at the same time by applying PCR and cultivation and 1 positive only by PCR but not by cultivation on the cell line. Based on these results, it is concluded that C. trachomatis is not so frequently detected in our patients. C. trachomatis may be accepted as one of the aetiological agents of chronic prostatitis and testing for this infection is highly recommended when presumption for chronic prostatitis is apparent.     

Chlamydia trachomatis Infection Is Related to Poor Semen Quality in Young Prostatitis Patients

Background

The impact of chronic prostatitis resulting from Chlamydia trachomatis infection on male fertility is controversial.

Objective

To investigate the correlation between C. trachomatis infection and semen quality in young male patients affected by chronic prostatitis resulting from C. trachomatis infection and to evaluate the correlation between anti–C. trachomatis immunoglobulin (Ig) A against heat shock protein 60 (HSP60), heat shock protein 70 (HSP70), and semen parameters.

Design, setting, and participants

All patients with clinical and instrumental diagnosis of chronic prostatitis underwent microbiological cultures for common bacteria, DNA extraction, mucosal and serum antibody evaluation for C. trachomatis, and semen parameter analysis. Western blot analysis of mucosal anti–C. trachomatis IgA was performed.

Interventions

Subjects were split into two groups: Group A consisted of patients with chronic prostatitis resulting from common bacteria (uropathogens), and group B consisted of patients with chronic prostatitis resulting from C. trachomatis infection.

Measurements

The relationship between C. trachomatis infection and semen parameters as well as the correlation among IgA levels, IgA characterisation, and semen analysis were determined.

Results and limitations

We enrolled 1161 patients (mean age: 36.5 yr). Of these, 707 patients were placed in group A, and 454 were placed in group B. Significant statistical differences were reported between groups in terms of sperm concentration (p < 0.001), percentage of motile sperm (p < 0.001), and normal morphologic forms (p < 0.001). Strong correlations between mucosal anti–C. trachomatis IgA and sperm concentration (p < 0.001) and normal morphologic forms (p < 0.001) were reported. Correlations among positivity to HSP60, HSP70, and sperm concentration (p < 0.003) and normal morphologic forms (p < 0.001) were also reported.

Conclusions

This study demonstrated the role of chronic prostatitis resulting from C. trachomatis in male fertility decrease, highlighting probable immunomediated damage to germinal cells because of C. trachomatis infections.     

Chlamydia trachomatis antigen can be detected in the urine sample of men with non-gonococcal urethritis

Summary We tested the first portion of voided urine (FVU) and urethral swab from 80 patients with nongonococcal urethritis (NGU) using a novel enzymeamplified immunoassay (IDEIA) for the detection of Chlamydia trachomatis antigen. Urine specimens were positive in all patients with positive urethral swabs (positive coincidence ratio, 100%) and in 6 of 54 patients with negative swabs (negative coincidence ratio, 88.9%). Our data suggest that FVU is suitable for the detection of Chlamydia trachomatis antigen using the IDEIA test in patients with NGU.     

The evaluation and treatment of acute epididymitis in a large university based population: are CDC guidelines being followed?

Purpose  To review the evaluation and treatment of epididymitis in a contemporary population and evaluate adherence to Centers for Disease Control (CDC) guidelines. Materials and methods  From 1999 to 2005, 870 patients from a single institution were diagnosed with epididymitis. Information regarding patient demographics, diagnostic evaluation, and treatment was reviewed. Adherence to CDC guidelines for the treatment of acute epididymitis was evaluated. Results  A total of 455 men between 3 and 88 years met inclusion requirements for acute epididymitis. Seven percent of pediatric patients (<18 years) and 29.5% of adult patients (≥18 years) undergoing urine culture demonstrated bacterial growth. Twelve percent of adult patients with urethral swab PCR performed for Chlamydia trachomatis had positive results. A bacterial etiology for epididymitis was documented in 6.6% of pediatric patients and 28% of adult patients who were tested by urine culture and/or urethral swab for C. trachomatis. Less than 35% of adult men underwent the appropriate CDC work-up. Fifty percent of patients, 18–35 years and 85% of patients, >35 years were prescribed an effective treatment according to CDC guidelines. Patients were less likely to be admitted to the hospital (100 vs. 2.3%) and more likely to be treated with antibiotics than in previously published series (97 vs. 75%). Conclusions  CDC guidelines for the evaluation and treatment of acute epididymitis were followed in less than 35% of patients seen in a university based health care system. Despite a paucity of documented urinary infection, 97% of adult men are treated empirically with antibiotics often not in accordance with CDC guidelines.     

Relationship between Chlamydia trachomatis and Mycoplasma genitalium infection and pregnancy rate and outcome in Iranian infertile couples

The study was performed to investigate the prevalence of Chlamydia trachomatis and Mycoplasma genitalium in a population of infertile couples from Iran and how this relates to tubal factor infertility, pregnancy rate and outcome of pregnancy. Blood, semen and first‐void urine samples were obtained from 250 infertile couples and 250 fertile women as a control. Infertile couples were followed up after 24 months to determine diagnosis, referral for assisted conception, any pregnancy and pregnancy outcome. Data were analysed with regard to the results of (i) serological analysis for specific antibodies to C. trachomatis in serum; (ii) the presence of C. trachomatis and M. genitaliumDNA in first‐void urine; and (iii) in a semen sample of the male partner. Prevalence of C. trachomatis in our study population was comparable to other studies using similar methods and test specimens. No evidence of M. genitalium infection was found. Detection of C. trachomatis in one partner rarely correlated with infection in the other. The risk of tubal factor infertility and the probability of pregnancy and pregnancy outcome were unrelated to the results of serological tests for C. trachomatis antibodies or the presence of C. trachomatisDNA in first‐void urine of both partners and in a semen sample provided by the male.     

Effects of Chlamydia trachomatis infection on sperm chromatin condensation and DNA integrity

The present study was performed to investigate the relation of Chlamydia trachomatis infection to sperm chromatin/DNA integrity in a population of infertile men (male partner of infertile couples) from Iran. Blood, semen and first‐void urine samples were obtained from 250 infertile men. Data were analysed with regard to the results of (i) serological analysis for specific antibodies to C. trachomatis in serum; (ii) the presence of C. trachomatis and DNA in first‐void urine; and (iii) in the semen sample of the male partner, in addition to sperm analysis, four different tests (aniline blue, chromomycin A3, acridine orange and TUNEL) were used to detect sperm chromatin and DNA abnormalities. The main conclusions of the results were: (i) no evidence of C. trachomatis infection in semen samples was found; (ii) sperm DNA fragmentation and chromatin studies were not correlated with C. trachomatis diagnosis; (iii) the percentage of DNA fragmentation is positively correlated with the percentage of immotile sperm but negatively with semen volume, normal morphology; and (iv) in sperm chromatin evaluations, only the percentage of chromatin protamination was related to male age.     

Acute and chronic bacterial prostatitis due to E. coli

Summary Inoculation of Escherichia coli (serotype O:6) into the bladder of male and female Mastomys (Praomys) natalensis produced severe prostatitis. In this rodent both male and female animals possess a well developed prostatic gland. The histologic and microbiologic course of the prostatic infection resembled strongly the human disease. Acute bacterial prostatitis was followed by the development of chronic bacterial or nonbacterial prostatitis. The infection persisted in some animals for up to six months. Prostatitis was observed histologically in all animals sacrificed six months postinfection. Animals responded to the infection with a rise of anti-lipopolysaccharide antibodies. No major morphologic differences were detected in the histologic pattern of the inflammatory process between animals with positive and negative bacterial cultures and between male and female animals.     

Association of asymptomatic Chlamydia trachomatis infection with male infertility and the effect of antibiotic therapy in improvement of semen quality in infected infertile men

The role of asymptomatic infections caused by Chlamydia trachomatis in male infertility and the efficacy of antibiotics in the treatment of this condition are not yet definitely determined. A total of 165 infertile males having abnormal semen parameters (study group) as well as 165 healthy fertile men (control group) were included. Semen samples were taken from all participants and after analysing for semen parameters, undergone real‐time PCR, and reactive oxygen species (ROS) as well as total antioxidant capacity (TAC) assays. Infected individuals of study group were treated with antibiotic. One month after the treatment completion, second semen samples were taken and undergone all the tests mentioned. The frequency of C. trachomatis was significantly higher in the infertile men compared with the fertile ones (4.2% vs 0.6%). Most of the semen parameters were improved and reached their normal range, the level of TAC elevated and ROS level as well as ROS/TAC ratio reduced after antibiotic treatment. Moreover, wives of three infected infertile men (42.9%) became pregnant 4 months after the treatment completion. Our data suggest that asymptomatic infection caused by C. trachomatis is correlated with male infertility and antibiotic therapy can improve the semen quality and fairly treat the male infertility.     

Mutations in 23S rRNA and ribosomal protein L4 account for resistance in Chlamydia trachomatis strains selected in vitro by macrolide passage

Thirteen strains of Chlamydia trachomatis were exposed to subinhibitory concentrations of erythromycin (0.5 μg ml^?1), azithromycin (0.5 μg ml^?1) and josamycin (0.04 μg ml^?1) to select macrolide‐resistant mutants with serial passages. The C. trachomatis mutants presented with low‐level resistance to erythromycin, azithromycin and josamycin for which a 16‐fold increase, a 16‐fold increase and an 8‐fold increase respectively in the minimal inhibitory concentration (MICs) for the mutant strains compared with the MIC for the susceptible strains were found. The results of chemosensitivity showed that josamycin had the highest susceptibility rate compared with erythromycin and azithromycin in the treatment of C. trachomatis. The ribosomal protein L4 and 23S rRNA genes of the susceptible and resistant strains of C. trachomatis were partially sequenced. A double mutation was found in ribosomal protein L4 of the mutants, leading to Pro109(CCG)→Leu(CTG), and Pro151(CCG)→Ala(GCC) (Escherichia coli numbering) in the corresponding protein, but these mutations were also found in parent strains. An investigation into the sequences of 23S rRNAs in the mutants revealed point mutations of A2057G, A2059G and T2611C (E. coli numbering). These results suggest that point mutations located in 23S rRNA were associated with macrolide resistance in C. trachomatis.     

Molecular detection of Chlamydia trachomatis and semen quality of sexual partners of infertile women

Chlamydia trachomatis is considered as the bacterium that is more sexually transmitted as cause of male urethritis, epididymitis, orchitis and infertility. A total of 116 semen samples of men whose couples are infertile women were analysed. The quality of the semen was measured by standard procedures recommended by WHO while C. trachomatis was detected by the PCR assay. Thirty‐seven semen samples were positive for C. trachomatis (31.9%). Regarding semen analysis, no different values were observed between positive and negative samples to C. trachomatis. However, the presence of leucocytes and erythrocytes suggests an inflammatory process; however, these were high in negative samples to C. trachomatis. Furthermore, an association between low seminal volume at 1, 5 ml and the positivity to C. trachomatis was observed (OR=2, 1; CI₉₅% 1,16‐3,07). The total semen volume is a contribution by the various accessory glands (this reflects the secretory activity of the glands); a low semen volume could be due to an obstruction of the ejaculatory duct or infection of accessory glands by C. trachomatis. More studies are necessary to identify the causes of a reduced semen volume.     

IsolatedCandida arthritis of both knee joints: Case report and review of the literature

Candida infection is an increasing problem in immunocompromised patients. Isolated arthritis without candidemia, which is provoked by direct inoculation ofCandida species intraarticularly, is more uncommon than complicated arthritis following systemic candidiasis. This report describes a 77-year-old man, with various compromising risk factors who developed infectious arthritis in both knees simultaneously, due toCandida glabrata, following intraarticular administration of steroids for 2 years. A favorable outcome was achieved 6 months after radical debridement together with a short period of treatment with amphotericin B. We undertook a literature review of 49 previously reported cases of isolated monarthritis due toCandida species without generalized candidiasis to discuss the pathomechanism, spectrum of pathogen species, clinical characteristics, and treatment. Early diagnosis is the best way to assure a favorable outcome; therefore, we should recognize the possibility of fungal infection when dealing with a patient who has predisposing risk-factors for immunosuppression, particularly repeated intraarticular injection of steroids. In treating aged individuals and those with involvement of both knees, showing an advanced stage with bony destruction, complete debridement, combined with local or systemic administration of antifungal agents, seems preferable to primary arthrodesis.     

Incidence of Chlamydia trachomatis infection in patients with reactive arthritis

Objectives

The aim of the study was to evaluate the incidence of Chlamydia trachomatis in patients with reactive arthritis (ReA) within the area of the Podlaskie province (north eastern Poland).

Material and methods

The study concerned 323 patients including 132 women and 191 men diagnosed with ReA. The material for C. trachomatis was collected from the urethra in men and the cervical canal in women. Also, every patient was tested for the presence of anti-C. trachomatis IgG class antibodies, while 121 individuals were additionally tested for IgA class antibodies. In the direct studies, the direct immunofluorescence (DIF) method or polymerase chain reaction (PCR) was used. The immunoenzymatic method was used to detect anti-C. trachomatis antibodies. The control group in the case of direct studies comprised 125 individuals, while in the case of serology research it included 127 (IgG) and 109 (IgA) persons.

Results

Chlamydia trachomatis infection in the urethral and cervical smears was found in 42 patients (13.0%) including 20 women (15.2%) and 22 men (11.5%). In the control group chlamydia was detected in 3 patients (2.4%) including 4% of women and 2% of men. IgA class antibodies were present in 10/121 (8.3%) patients, similarly in women and in men (8.2% and 8.3% respectively). In the control group the specific IgA class antibodies were found in 3/85 patients (3.5%). Anti-C. trachomatis IgG antibodies were found in 70/323 patients (21.7%), similarly in men and women.

Conclusions

1. Chlamydia trachomatis is a common bacterial factor observed in the genitourinary system of patients with ReA. The outcomes of studies within the Podlaskie province indicate less frequent presence of chlamydial infection compared with Dolnośląskie province.
2. No correlations between detecting the presence of C. trachomatis in the urogenital tract and the presence of specific antibodies in the serum of ReA patients were observed.
3. Concurrent direct studies of the urogenital tract and a serological blood test increase the chance of detecting C. trachomatis infection.

     

Role of glycemic elements of <Emphasis Type="Italic">Cynodon dactylon</Emphasis> and <Emphasis Type="Italic">Musa paradisiaca</Emphasis> in diabetes management

The study defined the scientific evaluation of glycemic elements of extracts of Cynodon dactylon and Musa paradisiaca. A dose of 500 mg/kg body weight (bw) of C. dactylon produced maximum falls of 23.2% and 22.8% in blood glucose levels of normoglycemic rats during studies of fasting blood glucose and glucose tolerance, respectively, whereas the same dose of M. paradisiaca produced a rise of 34.9% and 18.4%. In diabetic rats during glucose tolerance tests, a fall of 27.8% and a rise of 17.5% were observed with the same dose of C. dactylon and M. paradisiaca, respectively. Laser-induced breakdown spectroscopy used for detection of glycemic elements present in both the extracts indicated that C. dactylon was rich in magnesium (Mg), whereas M. paradisiaca was rich in potassium (K) and sodium (Na), comparatively, suggesting thereby the defined roles of these elements in diabetes management.     

À propos d’un syndrome de Lemierre secondaire à une parotidite

Lemierre's syndrome is a classical presentation of human necrobacillosis. It is characterized by a primary infection in the face including a septic thrombophlebitis of the internal jugular vein and disseminated metastatic abcesses. Fusobacterium necrophorum is the main pathogen found in that syndrome. The diagnosis is based on clinical features, then on the microbiology with positive anaerobic blood cultures as key role and finally on the computed tomography. Most of the time a well-chosen antibiotic treatment against anaerobic pathogens and Gram negative bacilli is efficient but surgery can be useful. We report a case of a 73 years old man, which seems to be unique because it is the first case reported of a Lemierre's syndrome characterized by a parotitis infected by F. necrophorum.     

Semen inflammatory markers and Chlamydia trachomatis infection in male partners of infertile couples

Previous studies have given conflicting results about the effect of generally infection and Chlamydia trachomatis on seminal ILs and semen parameters. The aim of this study was to investigate the relationship between semen quality and the level of seminal interleukins (ILs) in infertile couples with C. trachomatis. Blood, first void urine (FVU) and semen were obtained from 250 infertile men who had failed to conceive after 12 months of trying. Serological analysis for specific IgA, IgM and IgG antibodies to C. trachomatis in serum, the presence of C. trachomatis in FVU and semen sample and semen analysis were carried out. The main results are as follows: (i) elevated IL‐6 and IL‐8 are observed in C. trachomatis‐positive men, but this is not significant and it varies by diagnostic method; and (ii) IL‐6 and IL‐8 levels were correlated with each other and the concentration of leucocytes, but IL‐8 was correlated with semen volume and patient's age. This study showed that men with such an infection in FVU samples (PCR positive) had only lower semen volume compared with men without infection.     

Acute vesiculitis and its prostatic complications caused by E. Coli in the rat

Summary Injection of solutions of E. coli leads to vesiculitis which regresses spontaneously, and to interstitial prostatitis. Castration preceding experimental injection of a bacterial solution modifies the progression of the vesiculitis which then becomes chronic. Infection does not seem to diffuse via the lympathic system, even after castration.     

Candida albicans osteomyelitis of the spine: progressive clinical and radiological features and surgical management in three cases

Candida albicans vertebral osteomyelitis is rare. Three cases are presented. Without antifungal treatment, they developed spinal collapse and neurological deterioration within 3–6 months from the onset of symptoms. There was a delay of 4.5 and 7.5 months between the onset of symptoms and surgery. All patients were managed with surgical debridement and reconstruction and 12-week fluconazole treatment. The neurological deficits resolved completely. The infection has not recurred clinically or radiologically at 5–6 years follow-up. Although rare, Candida should be suspected as a causative pathogen in cases of spinal osteomyelitis. Without treatment the disease is progressive. As soon as osteomyelitis is suspected, investigations with MRI and percutaneous biopsy should be performed followed by medical therapy. This may prevent the need for surgery. However, if vertebral collapse and spinal cord compression occurs, surgical debridement, fusion and stabilisation combined with antifungal medications can successfully eradicate the infection and resolve the neurological deficits.     

Effectiveness of Bombesin and Saccharomyces boulardii Against the Translocation of Candida albicans in the Digestive Tract in Immunosuppressed Rats

Purpose We investigated the effects of bombesin on disseminated candidiasis, and compared the effectiveness of bombesin with Saccharomyces boulardii against Candida albicans translocation from the gastrointestinal tract in immunosuppressed rats.Methods Sixty rats were divided into five groups of 12. Group 1 was given only a laboratory pellet diet and water during the experiments; the other four groups were orally inoculated with C. albicans; and groups 3, 4, and 5 were also given prednisolone intraperitoneally. The treatment groups consisted of group 4, given S. boulardii orally, and group 5, given bombesin subcutaneously. The rats were killed after 10 days, and the large bowel, liver, spleen, and kidneys were removed for microbiological and histopathological examination. Blood samples were taken to measure tumor necrosis factor-α (TNF-α) and interleukin-1 β (IL-1β) levels, and the results were compared.Results The number of translocated C. albicans colonies from the gastrointestinal tract and the serum TNF-α and IL-β levels were significantly lower in groups 4 and 5 than in group 3 (P < 0.05). Histological analysis revealed that the bombesin-treated group (group 5) had significantly less mucosal ulceration and submucosal inflammation in the large bowel, less inflammation and necrosis in the liver, and less inflammation of the Bowman capsules in the kidney than the S. boulardii-treated group (group 4) (P < 0.05).Conclusions These findings show that both S. boulardii and bombesin inhibit the translocation of C. albicans from the gastrointestinal tract, although mucosal ulceration, submucosal inflammation in the large bowel, and dissemination in the liver and kidneys were significantly less severe in the bombesin-treated immunosuppressed rats.     

Pseudomembranous colitis: how useful is endoscopy?

Summary Clostridium difficile colitis may be diagnosed either by endoscopy or by laboratory tests. To determine the role of endoscopy, we reviewed 59 cases of confirmed C. difficile colitis. In all patients, the etiology was confirmed by stool tests. Twenty-nine underwent lower gastrointestinal endoscopy. In 16 (55%) there was endoscopic confirmation of pseudomembranes while 4 (14%) had only nonspecific colitis. There was no apparent difference in the rate of detection of pseudomembranes between rigid sigmoidoscopy (57%), flexible sigmoidoscopy (50%), and colonoscopy (50%). Vancomycin and metronidazole were equally effective therapy but treatment with vancomycin cost more than 250 times that for metronidazole. There were no patients in whom the diagnosis was made by endoscopy alone. Endoscopy was costly and insensitive, while noninvasive stool tests were cheap and accurate. We conclude that endoscopy should be relegated to a secondary role in the workup of antibiotic-associated diarrhea.     

Successful management of Brucella mellitensis endocarditis with combined medical and surgical approach

Objectives: Brucella endocarditis is an underdiagnosed complication of human brucellosis, associated with high morbidity and mortality. We report the successful management of a number of cases of Brucella mellitensis endocarditis. Patients and methods: Seven consecutive cases of Brucella mellitensis endocarditis were treated over the last 20 years, based on high suspicion of the disease at first place. The early suspicion of Brucella endocarditis relied on medical history and a standard tube agglutination titer ≥1:320. Blood and/or cardiac tissue cultures were positive in all patients, but available late following surgery. All patients were successfully treated with a combination of aggressive medical and early surgical therapy. All affected valves were replaced within 1 week from admission (five aortic and three mitrals). Medical treatment included co-trimoxazole, tetracyclines and streptomycin, before surgery, followed by co-trimoxazole and tetracyclines for a median of 12 months (range: 3–15 months) after surgery until the titers returned to a level ≤1:160. Results: There were neither operative deaths nor recurrence of infection. One patient died two years after the operation due to massive cerebrovascular accident. Ten-year survival was 85.7±13.2%. Conclusion: Although Brucella mellitensis endocarditis is a rare entity, its optimum management should be a combination of aggressive medical treatment and early surgical intervention, based on high degree of suspicion in areas with high incidence of the disease.