Prostatic Abscess Due To Histoplasma Capsulatum in the Acquired Immunodeficiency Syndrome

Abstract

We report a case of prostate abscess due to Histoplasma capsulatum in a patient with the acquired immunodeficiency syndrome. The diagnosis and management are discussed, and the literature is reviewed.

The urologist and the patient infected with human immunodeficiency virus or with acquired immunodeficiency syndrome

“…Prostatic abscesses in patients with AIDS are becoming more common [15,32]; these may be caused by the usual uropathogens or opportunistic fungal and mycobacterial infections [25,33,34]. Patients present with symptoms akin to acute prostatitis and a¯uctuant mass may be palpated.…”

Minimal Invasive Therapy of Prostatic Abscess by Transrectal Ultrasound-Guided Perineal Drainage

“…Also adjuvant antibiotic therapy should be given [3]. Spontaneous transurethral or transrectal drainage with resolution of symptoms has been reported, but delay in treatment has also resulted in and unresponsive urinary tract infection to appropriate treatment are suspicious for prostatic abscess [3,6], Pre disposing factors for prostatic abscess include diabetes, indwelling catheters, instrumentation of the lower urinary tract, bladder outlet obstruction, chronic prostatitis, im munosuppressive therapy or AIDS [1,7,8]. Kadmon et al [ 1 ] report on 2 patients with prostatic abscess who were on maintenance hemodialysis and conclude that chronic renal failure should be added to the list of the predispos ing factors.…”

“…Prostatic abscess is a rare, but severe disease with a mortality rate between 3 and 16% [1][2][3], Since the devel opment of effective antibiotics its frequency is decreasing [1,2], It can be an aggressive lesion within the pelvis and may rupture into the urethra, rectum, perivesical space, perineum or ischiorectal fossa and may cause sepsis [4], Therefore, early detection and adequate treatment is nec essary [5], However, prostatic abscess is a difficult clinical diagnosis due to the lack of pathognomonic symptoms and physical findings [3,5], In the past it was not uncom mon in patients with gonorrhea and urethral stricture [ 1,2], Currently Escherichia coli followed by Staphylococci are the most common bacteria found in prostatic ab scesses [1,6], There are also reports on prostatic abscess owing to anaerobic bacteria, fungal infections such as Histoplasma capsulatum or Candida glabrata or tropicans [2,3,[6][7][8][9]. Recently, prostatic abscesses were described in patients with AIDS [7,8], The pathogenesis involves two mechanisms [1,6].…”

“…Recently, prostatic abscesses were described in patients with AIDS [7,8], The pathogenesis involves two mechanisms [1,6]. The first mechanism occurs in older patients with bladder outlet obstruction where the pros fig.…”

The management of chronic prostatitis in men with HIV

“…Cytomegalovirus is found within the epithelial layer of the genitourinary tract, leading to relapsing prostatitis in many immunocompromised HIV-infected patients [11,13]. In addition to bacteria and viruses, prostatitis in HIV-infected patients, particularly those who are immunocompromised with low T-cell counts below 200 cells/�L, also can be caused by fungal organisms such as Candida albicans, Aspergillus fumigatus [14], Cryptococcus neoformans [15], and Histoplasma capsulatum [16]. The prostate appears to harbor the organism even after the apparent successful therapy for the primary fungal infection, allowing for eventual relapse [11].…”