Enterococcus – Diagnostics and Treatment

Post Reply
Message
Author
Stoyanov
Администратор
Posts: 43
Joined: 24 Mar 2018, 16:21

Enterococcus – Diagnostics and Treatment

#1 Post by Stoyanov » 07 May 2018, 23:01

Enterococcus is a small oval-shaped bacterium that forms part of the normal microflora of the human intestine (previously similar microorganisms were classified as Group D streptococci).

Types of Enterococci. Causes of Contamination

Enterococci include more than 17 species, some of them can cause infectious diseases of the genitourinary system, endocarditis, etc. The most common are Enterococcus Fecalis (Enterococcus faecalis) and Enterococcus faecium. Although normally enterococcus inhabits the intestine, Enterococcus faecalis is present in the anterior part of the urethra in almost 25% of healthy men. This is why enterococcus is considered opportunistic pathogenic (transient) microflora of the urogenital organs. In turn, Enterococcus faecium is responsible for the majority of vancomycin-resistant enterococcus infections. Resistance of the bacteria to antibiotics is a serious problem for modern medicine.

Enterococci have both their own antibiotic resistance determined by a unique structure, and acquired resistance. This contributes significantly to the development of hospital acquired infections and constrains physicians in dealing with the treatment of enterococcus.

Enterococcus in men (more often called Enterococcus faecalis) can affect the organs of the urogenital tract, especially in those undergoing appropriate instrumental examination and/or taking antibiotics:
• prostatitis;
• balanoposthitis;
• urethritis;
• epididymitis/orchiepididymitis;
• cystitis, etc.

Routes of Infection:
• sexual intercourse (especially, alternating genital-genital and anal-genital);
• improper hygiene;
• transmission from mother to newborn;
• rarely, upon organ transplantation.

When entering the urogenital organs, the enterococci can stay there from a few hours to weeks, eventually destroyed by body defenses. This condition is called temporary carriage or transit. In this case, the carrier can contaminate the sexual partner with the pathogen. Transient enterococcus can be diagnosed by high-precision techniques (for example, PCR).

Also, small count of enterococci can permanently be present in the urogenital organs (persistent carriage). Their growth is hampered by the same defenses and normal microflora. With a decrease in the count of normal microorganisms and/or in failure of the defenses, enterococci begin replicating rapidly, thus inducing the inflammatory process. Persistent carriage is typically asymptomatic, with the exception of the period of exacerbation; enterococcus can be detected by PCR, and the culture-based method. In this case, there is also the possibility of infection of the partner.

When the body stops restraining the development of enterococci, clinical signs of the disease appear. Below are the factors predisposing to the development of enterococcal infection:
• severe diseases;
• gonococcal and/or chlamydial infections in history;
• failure of genital defenses (such defenses include a neutral/slightly alkaline environment in the urethra, antimicrobial factor of the prostate, mechanical, and local immunological defenses)
• chronic prostatitis (this disease is suggested to have effect because of the decrease in zinc content and, as a result, disruption of the antimicrobial factor of the prostate, which is zinc-peptide complex);
• extended antibiotic therapy;
• abuse of local anesthetics, leading to burns of the urethra;
• catheterization of the urinary tract or other instrumental examination that can cause trauma to the mucous membranes;
• old age, etc.

Symptoms of Enterococcal Infection

There are no specific signs of injury to the urogenital system with enterococci. With the development of the pathological process, patients make complaints typical of a specific type of disease (depending on the location of the inflammation).

Urethritis is accompanied by:
• frequent, painful urination;
• urethral discharge;
• redness, irritation, discomfort in the urethra.

Below are the symptoms characteristic of prostatitis:
• painful condition and discomfort in the perineum, pain in the testicles, urethra, burning after sexual intercourse/urination;
• micturition disorder (frequent urination, feeling of incomplete emptying, low/intermittent flow);
• orgastic and ejaculation issues (pain, indistinct orgasm, premature ejaculation or prolonged sexual intercourse);
• mucopurulent discharge, if combined with chronic urethritis.

The patients suffering balanitis/balanoposthitis patients complain of pain and redness in the balanus, erythema (erosion, ulcers, cracks), plaque, swelling, discharge.

Orchiepididymitis is a combination of inflammation of the testicle (orchitis) and epididymis (epididymitis). In the acute form, dull, expressed pain in the scrotum, enlargement/tightening of one or both testicles, hyperemia of the scrotum skin, enlargement/compaction of the epididymis with sharp soreness can be observed. Painful sensations in the scrotum will diminish upon raising the organ. Chronic disease is characterized by indistinct symptoms, sometimes there are traces of blood in the sperm.

Methods of Diagnostics

Diagnosis of enterococcus in the organs of the male urogenital tract implies the following procedures:
• examination by a specialist;
• general urine and blood tests;
• polymerase chain reaction (detects a microorganism even in asymptomatic carriage);
• inoculation (also known as a bacteriological culture technique) to define sensitivity to antibiotics;
• other in vitro techniques, such as IFA, ELISA, smear microscopy, etc., as well as instrumental (Ultrasound, urethroscopy, MRI, CT) studies to exclude other causes of the disease (non-enterococcal genital infections, tumors, etc.).

Samples of urine, sperm, secretion of the prostate, urethral discharge are studied in vitro.

In the presence of negative manifestations from the urogenital tract it is important to understand that enterococcus is not often the cause of such problems. If the tests did not show the presence of other pathogens, it may be necessary to re-diagnose (sometimes even in another laboratory). Only after all other possible pathogens (trichomonads, gonococcus, chlamydia, etc.) are excluded, an individual therapeutic course for the elimination of enterococci may be prescribed.

Methods of Treatment of Enterococcus

If enterococcus is detected by chance during routine examination, treatment is recommended only if there are characteristic complaints, and/or if operative interventions on the organs of the urogenital tract are planned (under some circumstances, the doctor can recommend adequate therapy in planning pregnancies). This is due to the fact that such a microorganism can be normally found in absolutely healthy men.

Enterococci titres count 1*10 to the sixth power is considered diagnostically significant (without clinical manifestations). In this case, asymptomatic bacteriuria (detection of enterococcus in the urine) may require only the supervision of the doctor and, if necessary, periodical survey, viz. repeated inoculation. Routine laboratory detection of enterococcus is not recommended for boys not having symptoms of a urinary tract infection.

If enterococcus is suspected as the only cause of the urogenital issues in a man (urethritis, pyelonephritis, prostatitis, cystitis, etc.), adequate antibiotic therapy is necessary. Given the increased resistance of such microorganisms to antibacterial drugs, it is highly desirable to determine their sensitivity before starting treatment (unfortunately, this is a time-consuming procedure, and it is not always possible to postpone the initiation of treatment).

In most cases, the cause of inflammatory infectious diseases of the urogenital system in men is Enterococcus faecalis. This type of enterococcus has the following characteristics:
• sensitivity to Rifaximin, Levofloxacin, Nifuratel, in some cases, to Doxycycline;
• moderate sensitivity to Ciprofloxacin;
• insignificant sensitivity (for most strains) to Tetracycline;
• poor sensitivity to Lincomycin.

Penicillins, some cephalosporins, early fluoroquinolones are inactive or only subactive against Enterococcus faecalis.

As a general rule, one medicine is sufficient for the treatment; if it fails, another one or a combination of several drugs can be prescribed. After the course of therapy is completed, repeated diagnostics for enterococcus shall be carried out. The sexual partner should be treated if recommended by a physician (often when pregnancies are planned). If a mixed infection is detected, preparations that are effective against each pathogen are selected.

The course of antibiotic therapy is usually enough for complete recovery. Nevertheless, in a number of cases, the doctor can additionally prescribe the following procedures:
• physiotherapy procedures;
• a series of massage (often applied to for inflammatory pathologies of the prostate gland);
• enzyme preparations;
• vitamins;
• immunomodulating agents;
• homeopathic treatment;
• traditional medicine (baths with teas of medicinal herbs, drinking cranberry juice, etc.);
• local treatment (so-called instillations of solutions of various medicinal substances, for example, antiseptics, into the urethra).

Neglecting medical recommendations, abuse of self-medication and folk remedies might not only postpone the recovery, but even significantly worsen the patient's condition. For example, abuse of antiseptic solutions in the urethra often leads to a mucosal burn, which may induce the development of a bacterial infection.

Complications

Without adequate therapy for enterococcal infection, the following complications are possible:
• spread of the inflammatory process to other organs and tissues;
• turning into a chronic form;
• deterioration of sperm quality and, therefore, male infertility;
• violation of erectile function, etc.

Preventive Treatment

Prevention of enterococcal infection implies the following procedures:
• safe sex (barrier methods, permanent partner);
• timely detection and elimination/correction of chronic diseases;
• competent treatment of the sexual infections identified (especially gonococcal, trichomonas);
• healthy lifestyle (normalization of the work and rest schedule, high-grade healthy nutrition, moderate physical activity, minimization of stressful situations, etc.), and so on.

Post Reply