AUCTORES
Research Article
*Corresponding Author: Anthony Kodzo-Grey Venyo, North Manchester General Hospital, Department of Urology, Delaunays Road, Manchester, M8 5RB. United Kingdom.
Citation: Anthony Kodzo-Grey Venyo, (2023), Candida Prostatitis: A Review and Update, J. Endocrinology and Disorders. 7(3):
DOI: 10.31579/2640-1045/137
Copyright: © 2023, Anthony Kodzo-Grey Venyo. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 27 May 2023 | Accepted: 12 June 2023 | Published: 19 June 2023
Keywords: candida prostatitis; candidal prostatitis; candida prostatic abscess; candidal prostatic abscess; lower urinary tract symptoms; serum prostate specific antigen; inflammation of prostate; biopsy of prostate
Candidiasis is a terminology that is used for a fungal infection that is caused by a yeast which is a fungus that called candida species. Some species of candida can cause infection in human beings and the commonest candida species that can infect human beings is candida Albicans. Candida normally lives upon the skin as well as inside the human body, such as the mouth, the throat, the gut, and the vagina, without causing problems. Candida can cause infections if it grows out of control or if it enters deep into the body. For example, it could cause infections in the bloodstream or internal organs like the kidney, the heart, or the brain. Candida infection can be localized to one body organ or it could be a disseminated candida infection affecting various organs. Candida infection does tend to afflict immune-supressed individuals more often in comparison with immune competent individuals. Candida prostatitis an uncommon condition which clinicians should have a high index of suspicion for because it does manifest with non-specific symptoms that tend to be associated with more common conditions of the prostate and the urinary tract. Candida infection of the prostate gland may be an isolated de novo infection or it may be associated disseminated candida infection, or it may also be associated with prostate cancer or various immune-suppression conditions. Candida infection of the prostate gland could manifest as an acute infection/inflammation of the prostate gland or a chronic inflammation of the prostate gland or it could manifest as prostatic abscess. Some of the potential manifestations of candida prostatitis and or prostatic abscess include: (a) incidental finding upon biopsy of the prostate gland or following trans-urethral resection of prostate gland or prostatectomy. ( b) patient may manifest with lower urinary tract symptoms, (c) a patient may manifest with urinary retention that may be acute or chronic, (d) a patient may manifest with raised levels of serum prostate specific antigen (PSA), € at times when digital rectal examination is undertaken on a patient who has Candida prostatitis, the prostate gland may feel benign and in the case of a candida prostatic abscess rectal examination may demonstrate bogginess in the area of the prostate with soft fluctuant feeling. (f) Eosinophil count in some cases of Candida prostatitis would tend to be normal but in some cases of candida infection of the prostate gland, there could be Eosinophilia but this would not be diagnostic of Candida infection, (g) a history of having had coital contact with an individual who has been treated for candida infection or a history of past treatment of the individual should alert all clinicians to exclude the possibility of candida prostatitis. (h) on rare occasions urine culture or culture of expressed prostatic secretions would yield a growth of Candida. Diagnosis of Candida infection or abscess of the prostate gland may be confirmed by positive culture of Candida in prostate biopsy specimen or resected or excised prostate specimen. Treatment of Candida Prostatitis / prostatic abscess does tend to entail: (a) Treatment with appropriate antifungal medicament, plus (b) Complete radiology image-guided aspiration / drainage of any abscess seen plus / minus or endoscopic deroofing trans-urethral resection of the prostate to ensure the abscess drains out completely. Because recurrence of Candida prostatitis or prostatic abscess or Candida infection elsewhere can occur, it is important for patients to have regular follow-up assessments to ensure recurrence disease does not develop and if it develops, it is diagnosed quickly in order to initiate prompt treatment. It is also important to assess all coital contacts of the patient to ascertain if they have Candida infection to enable prompt treatment of their infection. If an individual who has candida prostatitis or prostatic abscess is also found to have contemporaneous adenocarcinoma of the prostate, the carcinoma of the prostate gland should be treated appropriately based upon the Gleason Grade and the Stage of the carcinoma, the performance status and age of the individual patient based upon the national and international guidelines pertaining to prostate cancer as a separate multi-disciplinary team discussion of the patient management.
Prostatitis is a common clinical entity that tends to be seen by many General Practitioners and Urologists. Prostatitis is said to be an umbrella terminology which is utilized for various medical clinical conditions which incorporate bacterial as well as non-bacterial origin illness within the pelvis region [1]. It has been pointed out that in contrast to the plain meaning of the word prostatitis which does appear to mean inflammation of the prostate gland, the diagnosis or the commonly used terminology of prostatitis may not always include evidence of inflammation within the prostate gland [1]. Prostatitis may be classified at times into acute prostatitis, chronic prostatitis, asymptomatic inflammatory prostatitis and chronic pelvic pain syndrome [1]. others may classify prostatitis into various forms including, acute prostatitis, acute on chronic prostatitis, chronic prostatitis, bacterial prostatitis and non-bacterial prostatitis. acute prostatitis, acute on chronic or chronic prostatitis. Some types of prostatitis may be associated with acute prostatic abscesses or chronic prostate abscesses. Prostatitis may manifest with lower urinary tract symptoms (LUTS) which tends to be attributable to acute and chronic bacterial infections (NIH Category I/II) or as asymptomatic inflammatory prostatitis (NIH Category IV). [2] Patients who have chronic prostatitis/chronic pelvic pain syndrome, (CP/CPPS, NIH Category III) may manifest with a wide range of symptoms resulting from varied aetiology; nevertheless, prostatitis is on rare occasions caused by fungal infections [2].
It has been iterated that within the United States of America (USA), prostatitis is diagnosed in 8% of all male Urologist visits and 1% of all primary care physician visits for male genitourinary symptoms [3].
With regard to classification of prostatitis, it has been iterated that the terminology prostatitis does refer to inflammation of the tissue of the prostate gland [2]. It has been pointed out that prostatitis may occur as an appropriate physiological response to an infection, or it may occur in the absence of infection [3].
It has been pointed out that inn 1999, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) had devised a new classification system as illustrated in table 1. [4,5].
Table 1:
Category 1: Acute bacterial prostatitis, the old name was acute bacterial prostatitis and the new name acute bacterial prostatitis, this is associated with pain, this is associated with presence of bacteria, this is associated with white blood cells; this is associated with bacterial infection of the prostate gland, which requires medical treatment, this is associated with bacteria.
Category 2: Chronic bacterial prostatitis, the old name was chronic bacterial prostatitis, this may or may not be associated with pain, this is associated with white blood cells, this is a relatively rare condition that usually presents as intermittent urinary infections.
Category IIIa: Inflammatory Chronic Pelvic Pain syndrome. [Inflammatory CPPS], the old name was non-bacterial prostatitis, this is associated with pain, no bacteria are found in the prostate, white blood cells are found in the prostate, Category IIIa and III b account for 90% to 95% of prostatitis diagnoses, Category IIIa and Category III b were formerly known as chronic nonbacterial prostatitis.
Category IIIb: Non-inflammatory Chronic Pelvic Pain Syndrome. [Non-Inflammatory CPPS], old name proctodynia, this is associated with pain, no bacteria are found in the prostate, no white blood cells are found in the prostate, Category IIIa and III b account for 90% to 95% of prostatitis diagnoses, Category IIIa and Category III b were formerly known as chronic nonbacterial prostatitis [5].
Category IV: Asymptomatic inflammatory prostatitis, there was no name associated with this category, this is not associated with any pain, no bacteria are found in the prostate, white blood cells are found in the prostate gland, no history of genitourinary pain complaints are made but leucocytosis is noted, usually during evaluation of other conditions. Between 6% and 19% of the men have pus cells within their semen, but no symptoms are manifested [6-8].
It has been documented that in 1968, Meares and Stamey had determined a classification technique based upon the culturing of bacteria. [2-9] This classification is no longer used.
It has been pointed out that the conditions in prostatitis are distinguished by the different manifestation of pain, white blood cells (WBCs) within the urine, duration of symptoms and bacteria cultured from the urine. To help express prostatic secretions that may contain WBCs and bacteria, prostate massage is sometimes used [10].
Occasional case reports had been published on prostatitis which has been caused by Candida. In view of the fact that prostatitis that caused by Candida is not common, it would be envisaged that many clinicians globally may not have encountered or treated a case of Candida prostatitis before and they may not be familiar with the manifesting features, diagnosis and management of candidiasis of the prostate gland before. The ensuing article on Candida prostatitis is divided into three parts: (A) Overview of Prostatitis in general, (B) Overview of Candida, and (C) Miscellaneous Narrations and Discussions from Some Case Reports, Case Series, and Studies Related to Candidiasis and Candida Abscess of the Prostate Gland.
Internet data search bases were searched including: Google; Google Scholar; Yahoo and PUBMED. The search words that were used included: Candida Prostatitis; Candidal Prostatitis; Candida prostatic abscess: Candidal Prostatic Abscess. Seventy-seven (77) references were identified which were used to write the article which has been divided mainly
into three (3) parts including: (A) Overview of Prostatitis in general, (B) Overview of Candida, and (C) Miscellaneous Narrations and Discussions from Some Case Reports, Case Series, and Studies Related to Candidiasis and Candida Abscess of the Prostate Gland.
[A] Definition / general statements
The ensuing general statements and definitions related to prostatitis had been made [11].
Essential features
Terminology
Epidemiology
Some of the salient relevant points related to the epidemiology of the prostate gland which had been made include [11].
Sites
Pathophysiology
The pathophysiology of prostatitis has been summated as follows [11].
Aetiology
The aetiology of prostatitis has been summed-up as follows [11].
It is worth noting that other causes of acute and chronic prostatic abscess exist apart from the aforementioned bacterial organisms)
Clinical features [11]
Diagnosis [11]
Laboratory tests [11]
Radiology description [11]
In addition to the above. It is worth pointing out that ultrasound scan can be useful with regard to the assessment of cases of prostatitis and prostate abscess. The value of computed tomography (CT) scan and sonography in the diagnosis and follow-up of abscesses of the prostate was studied in six patients with this disease. Five men had undergone CT scan alone, one had CT scan and ultrasound scan, and one had sonography only. The CT scan findings included an enlarged gland with non-enhancing fluid-density collections which sometimes were multiseptated or had enhancing rims. The sonographic findings were similar, showing a hypoechoic mass with thick walls. Follow-up examinations after antibiotic therapy (one CT, one sonogram) showed improvement or resolution. In the patients who had been studied, CT and sonography were useful methods to detect and follow the course of prostatic abscess. [27].
Prognostic factors [11]
Treatment [11]
Microscopic (histologic) description [11]
Positive stains [11]
Differential diagnoses
Some of the documented differential diagnose include the ensuing: [11]
[B] Overview of Candida infections pertaining to the skin
Definition / general
The ensuing statements had been made [30].
Terminology
Some other terminologies that tend to be used by various people and groups for cutaneous candidiasis include the following [30].
Epidemiology
Some of the general summating statements that had been made pertaining to cutaneous candidiasis include the following [30].
Clinical features [30]
Diagnosis
Some relevant iterations that had been made regarding the diagnosis of candida infection included the following: [30]
With regard to candida of the prostate pathology examination of specimens of the prostate gland of biopsy specimen would demonstrate features of candida and inflammation within the prostate as well as culture from aspirates or biopsy of the prostate would grow candida
Treatment
Cytology description
Positive stains
With regard to the staining features of Candida, it has been iterated that Candida specimens do stain for the following: [30].
Differential diagnoses
Some of the differential diagnoses of Candida infections of various parts of the body had been iterated to include the following: [30].
[C] Miscellaneous Narrations and Discussions related to Some Case Reports, Case Series and Studies related to Candida Prostatitis
Septimus et al. [31] reported a 57-year-old gentleman who had a history of hypertension who was in his usual state of health until January of 2004. At that time, he had undergone an ultrasound-guided transrectal biopsy of his prostate gland in view of his elevated serum prostate specific antigen (PSA). He was placed on fluoroquinolone prophylaxis for the procedure. His biopsy was negative for malignant cells. One week later, he had experienced urinary retention and was catheterized with 400 mL of residual urine. He was then placed on tamsulosin and had done well. In April of 2004, while on a business trip, the patient had started to experience dysuria and had commenced taking levofloxacin. He continued to have symptoms and had reported back to his urologist. He had urinalysis while on antibiotics that showed 20 to 30 white cells and 20 to 30 red blood cells per high power field, but the urine cultures were negative. He was asked to continue taking his antibiotics. One week later, he again had urinary retention and underwent urethral catheterization with 450 mL residual urine. His tamsulosin was increased and levofloxacin was continued. He had a second urine culture, without urinalysis, 3 days later, which was again sterile. His symptoms never completely resolved. At no time did the patient experience systemic symptoms, such as fevers or chills. After 1 month of taking antibiotics, his dysuria had progressed to perineal discomfort and burning after micturition. At that time, he was seen once again by a urologist. He had urinalysis again which showed 20 to 30 white blood cells and 20 to 30 red blood cells per high power field, and rectal examination which revealed a slightly boggy prostate with mild tenderness. His urine culture, prostate secretion cultures, and ejaculate cultures all grew Candida albicans at that time. He had ultrasound scan of his prostate which revealed no abscess. The patient was diagnosed at that time as having Candida prostatitis. He was commenced on fluconazole 400 mg daily for 6 weeks, with total resolution of his symptoms after the first week of treatment. He was at the time of the report of his case symptom-free over a year later, and his follow-up urinalysis after treatment returned to normal.
Golz et al [32]. reported the third case of a culturally and histologically proven candidosis of the prostate gland in the world literature available to them. They reported that autopsy of a 59-year-old man who had metastasizing bronchial carcinoma as predisposing primary disease had revealed a local candidosis of the prostate gland in the left lobe of the prostate, without evidence of a Candida sepsis.
Mahlknecht et al [40]. reported a case of an asymptomatic prostatitis due to Candida Albicans that caused a sepsis. They stated that up to June 2005, in literature only 3 cases of Candida infections of the prostate gland without general illness had been described and that in their case the transurethral electro-resection of prostate was the adequate treatment.
Kurnatowska et al [41]. reported three cases of prostatitis caused by the invasion of Trichomonas. vaginalis and Candida. albicans which had been found in different biological materials. After per rectum examination perineum biopsy of prostate gland had been undertaken in all patients; within histopathological preparations of the biopsy specimens there were features found that pointed at the inflammation reaction of that gland within which the fungi were detected. Also, the same microorganisms were proved in sexual partners of those patients but multifocal invasion of Candida albicans, including genital and urinary organs, mouth and alimentary tract, also in members of their family were documented.
Li et al. [42]. stated the following:
Li et al. [42]. reported a 72-year-old man who was admitted to their department because of dysuria for a period of 5 months, and acute urine retention for 6 days preceding his admission. He had ultrasound scan of his prostate gland which showed an enlarged prostate gland that measured 5.71 cm × 5.52 cm × 5.38 cm, without sign of an abscess, and trans-urethral Foley catheter was inserted and kept in place in the emergence department. The patient had a history of type 2 diabetes mellitus for over 10 years. He underwent digital rectal examination which revealed a mild, enlarged prostate gland, with no local tenderness. On the day he was admitted, his body temperature was 37.8°C. His laboratory tests results revealed a white blood cell count of 8.6 × 109/L with 73.1% neutrophils, hemoglobin 144 g/L, alanine aminotransferase (ALT) 11 IU/L, aspartate aminotransferase (AST) 12 IU/L, blood urea nitrogen (BUN) 4.59 mmol/L, fasting glucose 15.09 mmol/L, prostate specific antigen (PSA) 16.023 ng/ml. Urinalysis showed white blood cells 31 /μL, red blood cells 449/μL, presence of glucose (4+). They adjusted the oral hypoglycemic agents (OHA) and monitored his blood glucose. On day 3, the patient developed chills and his body temperature was 39°C. His laboratory test results showed a white blood cell count of 14.1 × 109/L with 82.7% neutrophils, C-reactive protein (CRP) 190.2 mg/L. His blood sample was taken for culture immediately. Empiric antimicrobial treatment with intravenous cefoperazone/sulbactam (1:1) 2.0 g was given every 8 hours. On day 4, Candida tropicalis was isolated from the culture of his catheter specimen of urine. Fluconazole injection 200 mg every 12 hours was added to his treatment. But the state of his high fever seemed not to have any improvement. On day 8, he had computed tomography (CT) scan of his pelvis, and this revealed swelling of his prostate gland with air and fluid accumulation that measured 4.5 cm × 3.5 cm, which was suggestive of EPA (Fig. (Fig.1).1). On day 9, he underwent trans-rectal ultrasound guided prostate abscess aspiration. Only 5 ml reddish purulent fluid was extracted, saline solution wash did not help to extract more purulent fluid. His blood culture taken before and pus culture both were negative. His body temperature seemed to be improving following the aspiration, but he still got low-grade fever. On day 14, CT scan of his pelvis was undertaken, and gas formation was even bigger which had measured 75mm × 59 mm in the prostate gland (Fig. (Fig.2).2). His laboratory blood tests showed a white blood cell count of 25.9 × 109/L with 88.3% neutrophils, CRP > 270 mg/L. So transurethral unroofing of the prostatic abscess was undertaken immediately. A supra-pubic cystostomy was undertaken during the surgery for urinary diversion. There was not so much purulent fluid within the cavity of the abscess, but lots of necrotic tissue around the abscess cavity. Cefoperazone/sulbactam and fluconazole were administered continuously following the surgery. On day 20, he did not have any fever, and pelvic CT scan was rechecked which had shown a great improvement in the size of the abscess cavity within the prostate gland (Fig. (Fig.3).3). He was discharged home on day 22. Parenteral antibiotics of fluconazole were kept for 14 days after discharge. He had Pelvic CT scan 1 month after his discharge which showed complete resolution of the EPA (Fig. (Fig.4).4). The cystostomy tube was removed 4 weeks subsequently.
Figure 1: Reproduced from [42] Under Creative Commons Agreement License
Pelvic CT revealed a collection of gas and purulent exudates in the prostate gland (arrow) on day 8 of admission (before aspiration).
Figure 2: Reproduced from [42] Under Creative Commons Agreement License
Pelvic CT revealed a progress of gas and purulent exudates collection in the prostate gland (arrow) on day 14 of admission (after aspiration).
Pelvic CT revealed an improvement of EPA in the prostate gland (arrow) on day 20 of admission (after TUR).
Figure 4: Reproduced from [42] Under Creative Commons Agreement License
Pelvic CT showed almost complete resolution of the EPA 1 month after discharge.
Li et al. [42]. made the ensuing summating discussions:
Table 2: Reproduced from [42] Under Creative Commons Agreement License
Cases of emphysematous prostate abscess, including 16 reported patients and the present case.
Li et al. [42] made the ensuing conclusions:
Singh et al. [2]. stated the following:
Singh et al. [2]. reported a case of an elderly diabetic patient who had undergone per-urethral prostatic resection (TURP) for benign prostatic hyperplasia (BPH) and who returned with complaints of LUTS and perineal discomfort one month later. After repeat surgery, the TURP chips upon histopathology examination showed features of prostate hyperplasia and prostatitis with numerous hyphae and yeast forms of Candida which was admixed with acute and chronic inflammatory exudate. After confirmation by special stains and positive urine culture, a final diagnosis of prostatic candidiasis was made.
Wise and Shteynshlyuger made the ensuing summating iterations [55].
Epstein et al. [56]. stated that fungal prostatitis is exceedingly rare with mostly case reports. Epstein et al. [56]. searched the electronic medical records at three medical centres were for cases of fungal prostatitis due to endemic mycoses and Cryptococcus over the preceding 10 years. Epstein et al. [56]. summarized the results as follows:
Epstein et al. [56]. concluded that fungal prostatitis due to endemic mycoses and Cryptococcus is uncommon and associated with favourable outcomes but generally involves prolonged therapy.
Mayayo et al. [57]. made the following summating statements:
Demirci et al. [58]. stated the following:
Demirci et al. [58]. reported a 51 years old man who had lower urinary tract symptoms for 20 years. He was admitted to their clinic due to frequent urination, perineal and suprapubic pain, weak urine stream, and white particles in urine. The patient's IPSS was 20; the pain score was 15, his urinary symptom score was 8, his life quality index score was 9 according to the NIH-CPSI. He did not have any history of comorbidity and operation. He had digital rectal examination which revealed features of a benign prostate gland and during the examination pelvic floor spasm was detected. The results of his serum biochemical analysis included: urea 21.4 mg/dl, creatinine 1 mg/dl, and tPSA 1.12 ng/ml. His urine analysis, revealed 7 erythrocytes and 2 leukocytes, and nitrite was negative. Urine cultures taken before and after his prostate massage were sterile. On urinary tract ultrasound, his upper urinary tract and urinary bladder appeared normal, and his prostate volume was 33 cc. In uroflowmetry analysis, his Qmax was 14 ml/s, volume 539 cc, and his average urine flow rate was 8 ml/s. The patient underwent cystoscopy. The anterior urethra was normal, and the prostate was mildly hyperplastic; there was cloudy urine with dense white particles within his urinary bladder; and there was no mass in the bladder. Cytology examination of the urine specimen revealed uniform bladder epithelial cells. Spore-bearing structures on the ground were seen in smear slides. They were considered as Candida glabrata (see figure 5). The patient began treatment with fluconazole 400 mg/day and doxazosin 4 mg/day. At the end of the first month, white particles in urine were found to be significantly decreased, the patient's IPSS score was 12; the pain score was 6, his urinary symptom score was 2 and his life quality index score was 3 according to NIH-CPSI, and the symptoms were regressed in an obvious manner. In his urine analysis, 48 erythrocytes and 9 leukocytes were detected. His urine culture was negative. In uroflowmetry analysis, his Qmax was 16 ml/s, voided volume of urine was 370 cc, and his average urine flow rate was 12 ml/second, and the doxazosin was stopped. At the end of the second month, white particles in his urine had disappeared completely. Fluconazole 400 mg/day was administered for a total of 8 weeks and then was discontinued. The patient was followed-up for 6 months and no recurrence was observed.
Figure 5: Microscopic findings of urine cytology. Reproduced from: [58] under Creative Commons Attribution License.
Demirci et al. [58]. made the following summating discussions:
Demirci et al. made the following conclusions [58].
Mahlknecht et al [40]. reported a case of a case of asymptomatic prostatitis due to Candida Albicans which had caused a sepsis. They stated that up to the time of the report of their case in 2005 June in literature only 3 cases of Candida infections of the prostate gland without general illness had been reported. In their reported case the transurethral electro-resection of prostate was the adequate treatment.
Indudhara et al [35]. stated that fungal prostatitis is an uncommon entity. Indudhara et al [35]. reported a case of isolated candidal prostatitis in an elderly patient who had manifested with acute urinary retention and who was clinically diagnosed as having benign hypertrophy of the prostate. Histology of his resected prostate gland demonstrated invasive prostatic involvement by Candida albicans. There was no evidence of systemic involvement by Candida.
Elert et al [33]. in 2000 reported a case of isolated Candidal prostatitis and the details of the case report can be seen in the original article.
Goltz et al [63]. stated that the third case of a culturally and histologically proven candidosis of the prostate in the world literature available to them had been reported by them. They reported that autopsy of a 59-year-old man with metastasizing bronchial carcinoma as predisposing primary disease had revealed a local candidosis of the prostate in the left lobe of the prostate, without evidence of a Candida sepsis.
Gupta et al. [64]. made the ensuing introductory iterations:
Gupta et al [64]. reported a 73-year-old man who was sent to their hospital from an extended care facility, with lethargy, chills, perineal pain, and tenesmus, which had progressively worsened over 2 days. He had denied having fevers, dysuria, abdominal pain, nausea, vomiting, diarrhoea, cough, weight loss, and night sweats. His medical history included end-stage renal disease requiring peritoneal dialysis, insulin-dependent diabetes mellitus, hypertension, coronary artery disease, hypothyroidism, benign prostatic hypertrophy, and peripheral vascular disease requiring multiple revascularization surgeries. Ten months preceding his admission, he had undergone extensive perineal resection and partial colectomy for Fournier gangrene. For 6 months prior to his admission, the patient had been given systemic antibiotics for recurrent urinary tract infections with Escherichia coli and Candida glabrata. Until 2 months before his admission, he had received urinary bladder irrigations with amphotericin B and neomycin/polymyxin B. During his admission, the patient's vital signs were stable, with temperature of 98.6°F, blood pressure of 140/80 mm Hg, pulse rate of 78 beats/min, and blood oxygen saturation of 97% on breathing air. His cardiopulmonary examination was unremarkable, and his abdomen was noted to be soft, non-tender, and distended with peritoneal dialysate. No groin lesions or skin rashes were found during his examination. He had digital rectal examination which revealed an extremely tender enlarged prostate gland. The results of his laboratory tests were notable for leukocytosis (18.6 cells per µL/mm3 with 89% granulocytes), hypokalaemia (2.9 mEq/L), and hyperglycaemia (269 mg/dL). His serum creatinine level was elevated (5.5 mg/dL) as expected with his renal insufficiency. His serum electrolytes were repleted. His urine cultures grew Escherichia. coli and multidrug-resistant Proteus mirabilis, which were treated with intravenous ertapenem. He had Computed tomographic (CT) scan of abdomen and pelvis with oral and intravenous contrast which had revealed a multi-loculated prostatic collection, that measured 6.0 cm × 4.5 cm in dimensions. Peritoneal dialysate and dialysis catheter were visualized; no other significant abnormalities were demonstrated. Percutaneous radiologically guided catheterization of prostate was undertaken, and purulent fluid was obtained. Cultures of this fluid resulted in abundant growth of Candida. glabrata. Given his previous hospitalizations and nosocomial acquisition of C. glabrata urinary infection in the past, the authors had predicted probable resistance to azole antifungals and, therefore, deferred using these for his treatment. Later, this was confirmed when the isolate had demonstrated minimal inhibitory concentrations (MICs) ≥256 µg/mL for fluconazole and ≥2 µg/mL for voriconazole. A long course of amphotericin B was relatively contraindicated in this patient to preserve his residual renal function and to avoid potential hyperkalaemia [66]. In view of concern of maintaining residual renal function, the authors recommended micafungin in addition to catheter-drainage to treat the prostatic abscess. The C. glabrata isolate was found to be susceptible to echinocandins, with an MIC of 0.06 µg/mL for caspofungin, which is therapeutically equivalent to micafungin [67]. In order to determine tissue penetration of micafungin into the prostate, the authors measured levels of the drug in serum as well as abscess fluid. Micafungin level in serum was 1.28 µg/mL, and in abscess fluid, it was 0.43 µg/mL, well above the MIC for the isolate. The patient received micafungin 100 mg/d intravenously for 37 days. The patient was determined not to be a candidate for prostatectomy because of his underlying comorbidities. Many attempts at radiologically guided catheter-drainage failed because of multiple loculations in the abscess. Eventually, transurethral unroofing of the abscess was undertaken with decortication of loculations, which had resulted in optimal drainage of abscess fluid via the urethra. Computed tomographic (CT) scan was undertaken 45 days after his admission which had shown complete resolution of the prostatic abscess.
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As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.