How to diagnose and treat fungal infections in chronic prostatitis

Abstract

Epidemiologic changes that include immune-compromised patients and drug-resistant fungi have caused an increase in nosocomial infections by Candida albicans and non-albicans Candida species. Other fungi, aspergilla and Cryptococcus (environmental contaminants), are opportunistic invaders of the immune-compromised (transplant, HIV) patients. The environmental fungi Coccidioides immitis (dry arid areas), Histoplasma capsulatum (Avian-infested areas), and Blastomyces dermatitidis (aquatic areas) can cause infections in immune-competent and immune-deficient patients. Each fungus can cause changes in the prostate that mimic bacterial infection, benign prostatic hypertrophy, or neoplasm. Diagnosis can be established by urine cultures or needle biopsy of the prostate. Prostate surgery for carcinoma or benign enlargement may detect latent fungal infection. Different fungal species can have divergent clinical manifestations and require different treatment. In some cases, asymptomatic localized fungal prostatitis can be cured by removal of the infected gland. Symptomatic and disseminated infection may require prostatectomy and systemic antifungal therapy.

Benign Conditions That Mimic Prostate Carcinoma: MR Imaging Features with Histopathologic Correlation

“…It is characterized by well-formed granulomas with epithelioid cell and multinucleated giant cell infiltration with or without central necrosis (caseation) (Fig 7). Other rare infectious agents are Treponema pallidum , viruses (herpes zoster), and fungi ( Cryptococcus , Candida , Aspergillus ) (Fig E6 [online]) (43,44). …”

Rare Dysuria: Prostatic Abscess due to Disseminated Coccidioidomycosis

“…These drugs have in limited studies shown to reach levels in prostatic secretions equal to or nearly equal to serum levels 5 . Amphotericin B is recommended for rapidly progressing disease 7 . In the limited number of reported cases, both amphotericin and azole-treated patients have been shown to be able to make successful recoveries, though the period of treatment required to drop their antibody titers to within normal limits has varied from days to more than a year 5, 9…”

“…Infection with C. immitis results in symptomatic pulmonary disease in fewer than half of those infected, and dissemination beyond the lungs occurs in less than 1% of patients 4, 5, 6, 7. At increased risk for disseminated infection are the immunosuppressed, pregnant women, diabetics, and non-Caucasians 4 .…”

“…A review of the literature reveals fewer than 40 case of male non-renal genitourinary tract involvement described since 1943, and fewer than fifteen cases of prostatic involvement 4, 5, 7. However, a retrospective review of 3676 prostatic pathology reports (biopsies and surgical pathology) from two Arizona hospitals (an area of endemic C. immitis ) found that 44 cases of granulomatous Coccidioides of the prostate gland were identified (an incidence of 1.2%), suggesting that the undiagnosed rate may be higher in endemic areas 8 …”

“…Coccidioides does not stain on Gram stain 7 . As urine culture may reflect involvement of another structure in the urinary tract, definitive diagnosis of prostate involvement can be made only with biopsy and pathology showing double walled coccidioidal spherules 9 .…”