Successful use of a phage endolysin for treatment of chronic pelvic pain syndrome/chronic bacterial prostatitis

Chronic prostatitis (CP) is a common inflammatory condition of the prostate that is estimated to effect 2%–10% of the world’s male population. It can manifest as perineal, suprapubic, or lower back pain and urinary symptoms occurring with either recurrent bacterial infection [chronic bacterial prostatitis (CBP)] or in the absence of evidence of bacterial infection [chronic pelvic pain syndrome (CPPS)]. Here, in the case of a 39 years-old CBP patient, we report the first successful use of a bacteriophage-derived muralytic enzyme (endolysin) to treat and resolve the disease. Bacteriological analysis of the patient’s prostatic secretion and semen samples revealed a chronic Enterococcus faecalis prostate infection, supporting a diagnosis of CBP. The patient’s E. faecalis strain was resistant to several antibiotics and developed resistance to others during the course of treatment. Previous treatment with multiple courses of antibiotics, bacteriophages, probiotics, and immunologic stimulation had failed to achieve long term eradication of the infection or lasting mitigation of the symptoms. A cloned endolysin gene, encoded by E. faecalis bacteriophage ϕEf11, was expressed, and the resulting gene product was purified to electrophoretic homogeneity. A seven-day course of treatment with the endolysin resulted in the elimination of the E. faecalis infection to below culturally detectable levels, and the abatement of symptoms to near normal levels. Furthermore, during the endolysin treatment, the patient experienced no untoward reactions. The present report demonstrates the effectiveness of an endolysin as a novel modality in managing a recalcitrant infection that could not be controlled by conventional antibiotic therapy

Mycotic aneurysm as a hidden cause of treatment failure of pyelonephritis caused by Salmonella enterica, serovar Enteritidis

Invasive non-typhoidal Salmonella (NTS) infections are rare in developed countries but their incidence is increasing. One of the most severe complications of extraintestinal NTS infection is mycotic aneurysm. Its natural course is usually fatal and its treatment demands complex interdisciplinary management. We present a case of severe NTS sepsis complicated by mycotic aneurysm of the abdominal aorta and left internal iliac artery and obstructive pyelonephritis. Obstruction of the left ureter was caused by pressure from the left internal iliac artery aneurysm and surrounding edema. The patient presented with clinical symptoms of sepsis and pyelonephritis. Despite abdominal ultrasound and native computed tomography, the mycotic aneurysm eluded initial examination. It remained undiagnosed until the patient presented with recurrent symptoms after stopping 17 days of antimicrobial treatment and was finally revealed by magnetic resonance imaging and contrast computed tomography. The patient was successfully treated by ligation of the left internal iliac artery, partial extirpation of the aneurysm and prolonged parenteral antimicrobial treatment. This case raises concerns that mycotic aneurysm might be present in cases of obstructive pyelonephritis caused by NTS and its early recognition is vital for appropriate management

Streptococcal Toxic Shock Syndrome: Diagnostic and Therapeutic Approaches Incorporating Point-of-Care Antigen Testing—Case Series

Background: Streptococcal toxic shock syndrome (STSS) is a serious and potentially fatal complication of invasive Streptococcus pyogenes (Group A Streptococcus, GAS) infection, often stemming from severe soft tissue infections. While uncommon, tonsillitis can also lead to STSS, with lethality rates reported as high as 70%. Methods: We present three cases of patients diagnosed with tonsillitis who developed STSS. Point-of-care testing for GAS antigens was utilized to facilitate rapid diagnosis. Results: In all three cases, the characteristic clinical presentations, including scarlatiniform rash, strawberry tongue, and signs of shock with multi-organ dysfunction, were observed. Microbiological evidence confirmed ongoing GAS infections, and point-of-care testing for GAS antigens assisted in the diagnosis of tonsillitis in conjunction with STSS, enabling timely treatment interventions. Conclusions: Rapid diagnosis is crucial for the optimal management of STSS. The point-of-care testing for GAS may be useful for diagnosing STSS associated with tonsillitis

Neurosyphilis Presenting as Syndrome of Limbic Encephalitis Mimicking Herpes Simplex Virus Neuro-Infection Diagnosed Using CXCL13 Point-of-Care Assay—Case Report

The syndrome of limbic encephalitis is a severe clinical condition with heterogenous aetiopathogenesis. A common pathogen causing the infectious syndrome of limbic encephalitis is herpes simplex virus (HSV), but rare cases caused by Treponema pallidum have also been reported. We present the case of a 46-year-old man who presented with sudden onset of headaches, nausea, vomiting, and short-term loss of consciousness with clonic convulsions and subsequent disorientation and aphasia. Examination of the cerebrospinal fluid (CSF) revealed lymphocytic pleocytosis and magnetic resonance of the brain revealed bilateral temporal lesions. Clinical, radiologic, and biochemical examinations of CSF suggested encephalitis caused by HSV. However, the positivity of CXCL-13 chemokine in the CSF by a rapid point-of-care assay suggested active spirochetal infection and led to further serologic investigation. The definitive diagnosis of neuro-syphilis was concluded by positive intrathecal synthesis of immunoglobulins against Treponema pallidum. Penicillin therapy led to a rapid improvement, and the patient was discharged home after three weeks. Due to memory problems and irritability, after eighteen months, he came for a follow-up neurological and psychological examination. The psychological examination revealed a significant deficit in executive functions and behavioural changes. Neurosyphilis should be considered in the differential diagnosis of limbic encephalitis with lymphocytic pleocytosis in cerebrospinal fluid, and CXCL-13 may help to achieve diagnosis

Prevalence and Risk Factors of Headache Associated with COVID-19

Background: Headache is a prevalent and disabling non-respiratory symptom of COVID-19, posing a persistent challenge in post-COVID syndrome. This study aimed to determine the prevalence, phenotypes, risk factors and biomarkers associated with COVID-related headaches. Methods: A retrospective analysis of 634 hospitalized COVID-19 patients was conducted, with 295 participants being followed up 12–15 months post-discharge via telephone call. Initial laboratory workups, including complete blood count and various biochemical parameters, were compared between headache and non-headache groups. Results: One-third of hospitalized patients experienced headaches, predominantly younger individuals (p < 0.001) and women (p = 0.002). Non-dominant headaches were characterized as dull (56.9%) and holocranial (26.5%), while dominant headaches were unilateral (31.3%) with photophobia (34.3%) and nausea (56.3%). Persistent headaches were unilateral (40%) and pulsating (38%) with phonophobia (74%). Decreased CD4 T cells independently predicted COVID-associated headaches, with elevated IL-6 levels noted in the dominant-headache group (p = 0.040). Remarkably, 50% of patients reported persistent headaches 12–15 months post-infection. Dexamethasone administration significantly reduced the likelihood of long-COVID headaches (52% vs. 73%, p = 0.029). Conclusions: Headache was present in one-third of patients with heterogenous phenotypes: tension headache in the non-dominant group, and migraine in the dominant and persistent headache groups. Persistent headache remains a challenge, with dexamethasone showing potential in reducing its incidence, emphasizing the need for tailored approaches in managing long-COVID headaches