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Prostatitis Foundation

Third International Chronic Prostatitis Network

RAPD and antifungal sensitivity testing studies in fungal prostatitis

J. Dimitrakov,
Justus-Liebig University, Urology Clinic, Giessen, Germany and
Higher Medical Institute, Departments of Urology and Pathology, Plovdiv, Bulgaria
To understand the dynamics of an infectious organism, decipher the complex relationship between commen-salism and infection, identify the origin of infection, or monitor the emergence of drug-resistant strains, a physician must have a way of assessing genetic relat-edness of isolates within a species. Since DNA finger-printing of infectious fungi has become an indispensa-ble tool in contemporary medical mycology, we decided to assess its utility in CPPS patients.
Material & Interest
Expanding on our previous experience with fungal infections in prostatitis patients, we performed RAPD and antifungal sensitivity testing in one hundred male patients (median age 21, range 18-45) with fungal prostatitis diagnosed on the basis of the presence of pathogenic fungi in EPS and/or PPMU and absence of fungi in the urethral swab, FVU and midstream urine. Elevated levels of IL-1, TNF-alpha and IL-6 were used as an additional diagnostic marker. Antifungal sensitivity testing was performed using commercial fungal identification and sensitivity tests (Fungisone, Auxacolor, Pasteur-Merieux Diagnostics, Paris, France). Skin biopsy samples (2 patients) and gastric, ileal and colon samples (20 patients), obtained during fiberoptic esophagogastroscopy and colonoscopy, respectively, were also analyzed.
The most frequently isolated strain showing a charac-teristic RAPD pattern was Candida dubliniensis (13%). The RAPD pattern was consistent with the presence of more than one strain of Candida in 12 patients (12%) with a difference between the urethral and prostatic isolates. The same strain–Candida dubliniensis– was identified in both the EPS, ejaculate and skin biopsy of the patients who provided skin biopsy sam-ples. Both gastric samples, 7 of the ileal and 12 of the colon samples yielded a Candida strain with the same RAPD pattern as the one isolated from the prostate-specific secretions providing a putative connection between the gastro-intestinal and genital mucosae. The same cytokine pattern was also observed in the mucosal expression of cytokine genes–elevated levels of IL-6, TNF-alpha and IL-1. Surprisingly, almost 50 % of the isolates were susceptible to quinolones (Ciprofloxacin) and these, when given together with antifungals, resulted in a greater success rate (75 % resolution of symptoms vs. 60 % on antifungals alone).
RAPD is an indispensable tool in the diagnosis of fungal infections of the prostate. The results from our studies show a common inflammatory pattern of cytokine expression in both gut and genital mucosae supporting the importance of the common mucosal immune system. The fact that C. dubliniensis was the most frequent isolate and the reported ability of this species to follow prolonged inappropriate anti-fungal therapy necessitate detailed fungal studies in prostatitis patients before initiating antifungal therapy. The importance of quinolones in treating fungal prostatic infections deserves further studies. We recommend the implementation of gene chips for monitoring the expression of genes conferring antifungal sensitivity or resistance.
Supported by a grant from the Prostatitis Foundation of America
© 2002 The Prostatitis Foundation
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