A case of acute epididymo-orchitis due to Pseudomonas aeruginosa presenting as ARDS in an immunocompetent host

Severe epididymal orchitis and total testicular infarction induced by Pseudomonas aeruginosa infection, and assessment of testicular endocrine function: A case report

Epididymal orchitis is a common urological condition for which medical management is the primary treatment strategy. Although Pseudomonas aeruginosa is a common cause of nosocomial urinary tract infections, it rarely causes acute epididymal orchitis in adolescence and is difficult to treat. Furthermore, it may progress to potentially fatal complications such as global testicular infarction and late atrophy. Urinary tract infection(s) can harm the gonads and is a well-known cause of male infertility. This case study involved a 13-year-old boy with acute epididymal orchitis caused by P. aeruginosa infection, which led to testicular infarction. Testicular volume, and anti-sperm antibody, reproductive hormone, and serum inhibin B levels were monitored for six months, which revealed that left testicular volume was 1/20 of that of the right. Anti-sperm antibodies were negative, oestradiol level was elevated, but serum inhibin B level declined. This case report emphasises the importance of early treatment by implementing the use of antibiotic(s) to maximise the opportunity for testicular rescue. Testicular function on the healthy side must be monitored when testicular necrosis is detected.

Presence of Toxoplasma gondii tissue cysts in human semen: Toxoplasmosis as a potential sexually transmissible infection

OBJECTIVES

Toxoplasma gondii is a widely prevalent protozoan parasite in human populations. This parasite is thought to be primarily transmitted through undercooked meat and contamination by cat feces. Here, we seek to determine if Toxoplasma gondii cysts can be found within human semen.

METHODS

We used a mixture of histological and immunofluorescence stains to visualize Toxoplasma gondii cysts in thin smears of human semen. Further, we probed for presence of bradyzoite-specific mRNA transcription using in-situ hybridization.

RESULTS

We visualized Toxoplasma gondii cysts in ejaculates of immune-competent and latently infected human volunteers. We confirmed the encystment by probing transcription of a bradyzoite-specific gene in these structures. These observations extend previous observations of the parasite in semen of several non-human host species, including rats, dogs, and sheep.

CONCLUSIONS

Toxoplasma gondii infection is a clinically significant infection, in view of its high prevalence, its purported role in neuropsychiatric disorders such as schizophrenia, as well as in the more serious form of congenital toxoplasmosis. Our demonstration of intact Toxoplasma gondii cysts in the ejaculate supports the possibility of sexual transmission of the parasite and provides an impetus for further investigations.

Epididymo-Orchitis Caused by POM-1 Metallo-β-Lactamase-Producing Pseudomonas otitidis in an Immunocompetent Patient: Case Report and Molecular Characterization

Pseudomonas otitidis is a rare and unique species among the Pseudomonas genus that has not been previously reported as a cause of male genitourinary tract infection. In this report, we describe a case of a 20-year-old immunocompetent male who presented with recurrent epididymo-orchitis, which was initially misidentified as Vibrio vulnificus and treated successfully. The causative agent could not be identified appropriately using the available routine methods, but a final identification was established using 16S rRNA targeted sequencing followed by whole-genome sequencing.

Epididymo-orchitis caused by enteric organisms in men > 35 years old: beyond fluoroquinolones

Epididymo-orchitis is a common urological condition in men of all ages, causing a unilateral or bilateral swelling of the epididymis and/or testis. It is frequently caused by sexually transmitted infections, Chlamydia trachomatis and Neisseria gonorrheae, as well as common enteric organisms implicated in urinary tract infections. Men over 35 years old may develop epididymo-orchitis associated with enteric organisms, often associated with functional bladder outlet problems such as benign prostatic hyperplasia or urethral stricture disease. Fluoroquinolones, especially ciprofloxacin, have long been the mainstay of treatment for these infections; however, rising resistance to ciprofloxacin in E. coli isolates in Europe and the USA means that there is an unprecedented necessity for alternative antimicrobials with adequate penetration into genital tissues (epididymis and testes) to allow appropriate and comprehensive treatment of epididymo-orchitis in this group of patients.

Virulence Attributes and Host Response Assays for Determining Pathogenic Potential of Pseudomonas Strains Used in Biotechnology

Pseudomonas species are opportunistically pathogenic to humans, yet closely related species are used in biotechnology applications. In order to screen for the pathogenic potential of strains considered for biotechnology applications, several Pseudomonas strains (P.aeruginosa (Pa), P.fluorescens (Pf), P.putida (Pp), P.stutzeri (Ps)) were compared using functional virulence and toxicity assays. Most Pa strains and Ps grew at temperatures between 28°C and 42°C. However, Pf and Pp strains were the most antibiotic resistant, with ciprofloxacin and colistin being the most effective of those tested. No strain was haemolytic on sheep blood agar. Almost all Pa, but not other test strains, produced a pyocyanin-like chromophore, and caused cytotoxicity towards cultured human HT29 cells. Murine endotracheal exposures indicated that the laboratory reference strain, PAO1, was most persistent in the lungs. Only Pa strains induced pro-inflammatory and inflammatory responses, as measured by elevated cytokines and pulmonary Gr-1 -positive cells. Serum amyloid A was elevated at ≥ 48 h post-exposure by only some Pa strains. No relationship was observed between strains and levels of peripheral leukocytes. The species designation or isolation source may not accurately reflect pathogenic potential, since the clinical strain Pa10752 was relatively nonvirulent, but the industrial strain Pa31480 showed comparable virulence to PAO1. Functional assays involving microbial growth, cytotoxicity and murine immunological responses may be most useful for identifying problematic Pseudomonas strains being considered for biotechnology applications.