Antimicrobial peptides for treatment of patients with herpes virus-associated chronic prostatitis

Introduction. Genital herpes is a chronic sexually transmitted infection characterised by recurrent self-limiting genital ulcers caused by herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2) and can be associated with chronic prostatitis (CP).Objective. To determine the efficacy of cytokines-antimicrobial peptides complex in therapy of patients with herpes virus-associated chronic prostatitis.Materials & methods. The pilot, open, prospective, non-comparative study included 23 patients who were followed up for CP for a mean of 9.7 ± 4.2 years. All were diagnosed with abacterial CP / chronic pelvic pain syndrome (CPPS) with signs of inflammation and detection of HSV DNA in urethral swabs by polymerase chain reaction (PCR). Prescribed therapy: Tab. Valaciclovir 500 mg b.i.d. p.o. for 10 days, Tab. Ketoprofen 100 mg q.d. for 5 days, Supp. Superlymph 10 IU q.d. p.r. q.h.s. for 20 days. The results were evaluated at the end of therapy, 3 and 6 months after its completion.Results. At the end of therapy, the leukocytes count in prostate secretion decreased by almost five times and remained stable throughout the entire follow-up period. The total symptom scale score at the end of therapy decreased from 22.96 ± 6.01 to 6.61 ± 3.71 points (p < 0.05). There was also a change in the perception of pain on a visual analog scale. If, before the start of treatment, 14 patients (60.9%) assessed the pain intensity as “severe” and only two (8.7%) had “weak” pain intensity, then after the end of therapy, none of the patients had severe pain, 21 (91.3%) patients noted "mild" pain and in 2 patients (8.7%) the intensity of pain was regarded as "average". Quality of life improved from baseline 8.23 ± 1.91 points to 2.43 ± 1.41 points immediately after completion of therapy (p < 0.05). Three months after therapy, patients assessed the quality of life as 2.43 ± 1.41 points, and six months later, as 2.81 ± 1.21 points. During the first three months, one patient experienced a HPV-relapse; one more — within the next three months. These patients underwent a second course according to a similar scheme. None of the patients reported significant side effects on any component of the therapeutic complex.Conclusion. In abacterial CP/CPPS, a herpes infection should be identified. Being neurotropic, HSV can cause / exacerbate the pain characteristic of CP/CPPS. In case of persistent pain, HSV infection should be excluded. In the treatment of patients with herpes virus-associated abacterial CP, Supp. Superlymph showed good immediate and long-term results

ДИФФЕРЕНЦИАЛЬНАЯ ДИАГНОСТИКА ТУБЕРКУЛЕЗА ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ

Prostate tuberculosis is difficult to be diagnosed, especially if lesions are limited only by this organ. The article analyses the experience of differential diagnostics of prostate tuberculosis based on the data of examination of 84 patients. 45 of them were diagnosed with prostate tuberculosis, and 39 patients were diagnosed with chronic bacterial prostatitis. Pathognomonic diagnostics criteria of prostate tuberculosis were the following: detection of tuberculous mycobacteria in the prostatic fluid or ejaculate, signs of granulomatous prostatitis with areas of cavernous necrosis in prostate biopsy samples, and prostate cavities visualized by X-ray or ultrasound examinations. Should the above criteria be absent, the disease can be diagnosed based on the combination of indirect signs: symptoms of prostate inflammation with active tuberculosis of the other localization; large prostate calcification, extensive hyperechoic area of the prostate, spermatocystic lesions, leucospermia and hemospermia, failure of the adequate non-specific anti-bacterial therapy.Туберкулез предстательной железы – труднодиагностируемое заболевание, особенно при изолированном ее поражении. В статье проанализирован опыт дифференциальной диагностики туберкулеза простаты на основании данных обследования 84 пациентов. У 45 из них диагностирован туберкулез предстательной железы, у 39 пациентов установлен диагноз хронического бактериального простатита. Патогномоничными диагностическими критериями туберкулеза простаты являлись: выявление микобактерий туберкулеза в секрете простаты или эякуляте; картина гранулематозного простатита с зонами казеозного некроза в биоптатах предстательной железы, а также каверны простаты по данным рентгенологического и/или ультразвукового исследований. В отсутствие этих критериев диагноз может быть установлен на основании сочетания косвенных признаков: симптомы воспаления предстательной железы в сочетании с наличием активного туберкулеза других локализаций; крупные кальцинаты простаты, обширные гиперэхогенные зоны в предстательной железе, поражение семенных пузырьков, лейко- и гематоспермия, неэффективность адекватной неспецифической антибактериальной терапии

Рецидивы урогенитального туберкулеза

The objective of the study: to characterize the cases of tuberculosis relapses with lesion in urogenital organs.Subjects and methods. Out of 140 case histories of patients with urogenital tuberculosis (UGTB; tuberculosis of the urinary and male reproductive system), registered for follow-up by the phthisiourologist, all files of patients with tuberculosis relapses were picked up, totally, there were 13 of them.Results. Men prevailed among cases of relapses (61.5%). Patients at the age of 30-50 years old made 46.1%, and 53.9% were 51 years old and above. In the first episode of tuberculosis, lesions of the genitourinary system were observed in 53.9% of patients, bacterial excretion was found in 38.5%. On the average, the relapse developed in 9.1 years after successful cure of the first episode of tuberculosis: after respiratory tuberculosis – in 5.6 years and after UGTB – in 12.3 years. In 3 (23.1%) patients with relapse, mycobacteriuria was documented, in 1 of them, drug resistance (to streptomycin and isoniazid) was detected. In general, in the relapse of tuberculosis with urogenital lesions, the kidneys were most often (69.2%) affected. The treatment of relapse was effective in 12 out of 13 patients. During chemotherapy of tuberculosis, 3 (23.1%) patients developed toxic and allergic reactions that required treatment interruption or cancellation of the drug.Цель исследования: охарактеризовать случаи рецидива туберкулеза с поражением урогенитальных органов.Материал и методы. Из 140 амбулаторных карт больных урогенитальным туберкулезом (УГТ; туберкулез мочевой и мужской половой системы), находящихся на диспансерном учете у фтизиоуролога, выбраны все карты больных с рецидивом туберкулеза, их оказалось 13. Результаты исследования. Среди больных с рецидивом преобладали мужчины (61,5%). Пациентов в возрасте 30-50 лет было 46,1%, в возрасте 51 года и старше – 53,9%. При первом эпизоде туберкулеза поражение органов мочеполовой системы было у 53,9% пациентов, бактериовыделение установлено у 38,5%. Средний срок рецидива после успешного излечения первого эпизода туберкулеза составил 9,1 года: после туберкулеза органов дыхания ‒ в среднем 5,6 года; после УГТ ‒ в среднем 12,3 года. У 3 (23,1%) больных с рецидивом зафиксирована микобактериурия, у 1 из них выявлена лекарственная устойчивость микобактерий туберкулеза (к стрептомицину и изониазиду). В целом при рецидиве туберкулеза с урогенитальным поражением наиболее часто (69,2%) в процесс вовлекались почки. Курс лечения рецидива был эффективен у 12 из 13 пациентов. У 3 (23,1%) больных во время химиотерапии туберкулеза были токсико-аллергические реакции, требовавшие перерыва в лечении или отмены препаратов

Masks of Chronic Prostatitis: Overactive bladder and Myofascial Syndrome. Case study

Prostatitis is a chronic disease that does not respond well to therapy. It is prone to frequent relapses and does not have a clear and unambiguous clinical picture, which can lead to diagnostic failure. A case of overactive bladder and myofascial syndrome described. The clinical picture was interpreted as «chronic prostatitis» erroneously. Differentiated analysis of the International Prostate Symptom Score (IPSS) and NIH-CPSI (National Institute of Health Chronic Prostatitis Symptom Index) questionnaires, as well as palpation of trigger points made it possible to establish the correct diagnosis. The following drugs were prescribed: Trospium chloride (Spasmex® ) 15 mg twice a day, Baclоfen (Baclophenum) 10 mg daily, Combilipen (B vitamins multicomplex) intramuscularly, Nimesulide (Nimesulide) orally, and locally low-intensity laser therapy. The patient noted a marked improvement after 14 days: the pain intensity decreased from 8 points to 1, urination urgency was not noted, nocturia stopped. The quality of life (QoL) accordingly improved to 1 point on the IPSS scale. The total score for domains III and IV decreased from 11 to 3 according to the NIH-CPSI symptom scale of chronic prostatitis. The pronounced positive dynamics of the patient’s state of health has confirmed the accuracy of the diagnosis and treatment

DIFFERENTIAL DIAGNOSTICS OF PROSTATE TUBERCULOSIS

Prostate tuberculosis is difficult to be diagnosed, especially if lesions are limited only by this organ. The article analyses the experience of differential diagnostics of prostate tuberculosis based on the data of examination of 84 patients. 45 of them were diagnosed with prostate tuberculosis, and 39 patients were diagnosed with chronic bacterial prostatitis. Pathognomonic diagnostics criteria of prostate tuberculosis were the following: detection of tuberculous mycobacteria in the prostatic fluid or ejaculate, signs of granulomatous prostatitis with areas of cavernous necrosis in prostate biopsy samples, and prostate cavities visualized by X-ray or ultrasound examinations. Should the above criteria be absent, the disease can be diagnosed based on the combination of indirect signs: symptoms of prostate inflammation with active tuberculosis of the other localization; large prostate calcification, extensive hyperechoic area of the prostate, spermatocystic lesions, leucospermia and hemospermia, failure of the adequate non-specific anti-bacterial therapy

DIAGNOSTIC ALGORITHM OF PROSTATE TUBERCULOSIS

Всемирная организация здравоохранения (ВОЗ) обозначила туберкулез как глобальную проблему современности, имея в виду преимущественно туберкулез органов дыхания. Экстрато- ракальному туберкулезу должного внимания мировыми организациями не уделяется. Однако, по данным аутопсий, туберкулезное поражение предстательной железы встречается у 70% больных с распространенными формами туберкулеза легких, как правило, прижизненно не диагностированное [2]

АЛГОРИТМ ДИАГНОСТИКИ ТУБЕРКУЛЕЗА ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ

Всемирная организация здравоохранения (ВОЗ) обозначила туберкулез как глобальную проблему современности, имея в виду преимущественно туберкулез органов дыхания. Экстрато- ракальному туберкулезу должного внимания мировыми организациями не уделяется. Однако, по данным аутопсий, туберкулезное поражение предстательной железы встречается у 70% больных с распространенными формами туберкулеза легких, как правило, прижизненно не диагностированное [2].Всемирная организация здравоохранения (ВОЗ) обозначила туберкулез как глобальную проблему современности, имея в виду преимущественно туберкулез органов дыхания. Экстрато- ракальному туберкулезу должного внимания мировыми организациями не уделяется. Однако, по данным аутопсий, туберкулезное поражение предстательной железы встречается у 70% больных с распространенными формами туберкулеза легких, как правило, прижизненно не диагностированное [2]