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A case of testicular infarction from the complications of Klebsiella oxytoca induced acute epididymitis
J Infect Chemother xxx (2015) 1e3
Contents lists available at ScienceDirect
Journal of Infection and Chemotherapy journal homepage: http://www.elsevier.com/locate/jic
Case report
A case of testicular infarction from the complications of Klebsiella oxytoca induced acute epididymitis Wonae Lee a, Heeyoon Park b, Gilho Lee b, * a b
Department of Pathology, Dankook University College of Medicine, Cheonan, Republic of Korea Department of Urology, Dankook University College of Medicine, Cheonan, Republic of Korea
a r t i c l e i n f o
a b s t r a c t
Article history: Received 19 August 2015 Received in revised form 22 September 2015 Accepted 29 September 2015 Available online xxx
Herein, we reported a case of testicular infarction in a patient with Klebsiella oxytoca induced acute epididymitis. Acute left epididymitis progressed into testicular infarction requiring orchiectomy in spite of antibiotics treatment. Ordinary urine cultures did not reveal any specific organism, suggesting viable but noncultureable state. We amplified a bacterial 16S ribosomal subunit gene from the urine and orchiectomized samples, and we found K. oxytoca infections from both of them. © 2015, Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Keywords: Klebsiella oxytoca Epididymitis Infarction 16s rRNA
1. Introduction
2. Case report
Testicular infarction due to infectious epididymitis is a rare phenomenon [1,2]. Infarction occurs when testicular arterial blood flow is compressed due to either inflammation or edema of the epididymis or spermatic cord [1]. Urine culture is absolutely necessary to identify the organisms causal to the infection. Although the causal organisms in urine are easily revealed in most cases, some cases have been reported as culture-negative epididymitis [1]. This patient did not exhibit pyuria or host specific pathogens in ordinarily urine culture, but progressed into testicular infarction despite the continuous use of antibiotics therapy. The method of bacterial 16S ribosomal subunit gene sequencing in uncharacterized or viable nonculturable bacteria has been widely used in recent decades to demonstrate the etiologic pathogens [3]. Herein, we reported a case of testicular infarction in the patient with acute epididymitis due to Klebsiella oxytoca that could be confirmed through the 16S ribosomal subunit gene sequencing method from the orchiectomized epididymis and patient's urine.
A healthy 37-year-old man visited the emergency room because of recently developed fever and severely painful left scrotal swelling. The patient denied the histories of drugs use, prior sexually transmitted diseases, diabetes mellitus, and hypertension. On admission, his vital signs revealed blood pressure of 143/90 mmHg, heart rate of 87/min, respiratory rate of 18/min, and body temperature of 38 C. Genital examination revealed a swollen left testicle with severe tenderness, and the epididymis and scrotal sulcus was not easily delineated. His complete blood count (CBC) showed white blood cell (WBC) 13,450/mL, hemoglobin 14.7 g/dL, and platelet 235,000/mL. Chemical profiles showed creatinine 0.78 mg/dL, glucose 102 mg/dL, and C-reactive protein (CRP) 0.12 mg/dL. A midstream specimen of urine revealed nitrite (e), WBC in urine stick (e), WBC [1e4/high power field (HPF)], and red blood cell (RBC) (<1/HPF). We could not identify any specific pathogen from urine cultures and one blood culture. In addition, we could not find urinary Trichomonas vaginalis, Mycoplasma hominis, Ureaplasma urealyticum, Chlamydia trachomatis, Mycoplasma genitalium, and Neisseria gonorrhoeae with the Seeplex STD Detection Kit (Seegene, Seoul, Korea). Scrotal ultrasound confirmed swollen left epididymis, and increased testicular vascularity suggestive of severe epididymtis (Fig. 1A). One day later, CRP was increased to 20.16 mg/dL. With the typical symptoms, signs, and the scrotal ultrasound findings of acute epididymitis, we started treatment
* Corresponding author. Department of Urology, Dankook University College of Medicine, San 29, Anseo-dong, Dongnam-gu, Cheonan, Chungnam 330-714, Republic of Korea. Tel.: þ82 41 550 3963; fax: þ82 41 551 6630. E-mail address: [email protected] (G. Lee).
http://dx.doi.org/10.1016/j.jiac.2015.09.011 1341-321X/© 2015, Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Lee W, et al., A case of testicular infarction from the complications of Klebsiella oxytoca induced acute epididymitis, J Infect Chemother (2015), http://dx.doi.org/10.1016/j.jiac.2015.09.011
2
W. Lee et al. / J Infect Chemother xxx (2015) 1e3
Fig. 1. Color Doppler sonography findings at two epididymitis episodes. A. Color Doppler sonography of left scrotum at first admission revealed left epididymal swollen and increased vascularity. However, the testicle revealed well preserved vascularity. B. Thirteen days later, the Doppler sonography revealed a small sized, irregular-shaped and heterogeneous left testis with absent blood flow.
using 2.0 g of cefbuperazone per day for 11 days. The symptoms and signs were improved, and laboratory findings also improved; WBC in CBC 9430/mL, CRP 0.81 mg/dL, and RBC < 1 HPF and WBC < 1 HPF in urinalysis. He was discharged from the hospital with oral fluoroquinolone medication, tosofloxacin with the dosage of 450 mg per day. The patient returned two days later complaining of recurring symptoms and signs of acute epididymitis. His CBC showed WBC 12,810/mL and CRP 1.13 mg/dL. A midstream specimen of urine revealed nitrite (e), WBC in urine stick (e), WBC (1e4/HPF), and RBC (<1/HPF). Similar to the previous visit, urine culture revealed no bacterial growth. We stored a 15-mL midstream urine sample in a 70 C freezer for further pathogens identification. Scrotal ultrasound revealed left testicular size reduction, irregular-shaped heterogeneous echogenicity, and poor testicular blood flow, suggesting the testicular infarction (Fig. 1B). Under the impression of testicular infarction due to infectious epididymitis, we explored the scrotum through a left inguinal incision. We could not easily separate the epididymis from the testis due to severe scrotal cavity adhesion. Definitively, there was no evidence of testicular torsion. We removed the testis. We also aseptically harvested the small pieces from the inflammatory epididymis and stored them in a 70 C freezer for further pathogens identification. The orchiectomy specimen was a necrotic testis exhibiting yellowish white color. The tunica albuginea and tunica vaginalis were markedly thicker with fibrous adherence to the epididymis and spermatic cord (Fig. 2A).
Microscopically, the testis was completely necrotized. Abundant neutrophils with abscess formation infiltrated the seminiferous tubules and interstitium. The epididymis was not necrotic but showed an infiltrate of chronic inflammatory cells (Fig. 2B). Pathologic diagnosis was testicular infarction, believed to be secondary to acute epididymitis. After the surgery, his general conditions and laboratory findings were improved and he was discharged from this hospital without complications. Four weeks after his discharge, we re-evaluated his clinical conditions and examined laboratory tests from the patient. He was healthy, and the values from his CBC, CRP, and urine samples were within normal ranges. The stored 15-mL midstream urine sample was thawed at room temperature and centrifuged at 3000 rpm for 4 min. After washing once with a phosphate-buffered saline solution, we extracted DNA from the urine sample by using Wizard genomic DNA purification kit (Promega, WI, U.S.A.). We also extracted genomic DNAs from the stored epididymis tissues. Polymerase chain reactions (PCR) were performed from both genomic DNAs, using consensus primers for the bacterial 16S ribosomal subunit gene [3]. The amplified products were sent to the Solgent (Daejon, Korea) and we read the DNA sequence with the Sanger's sequencing method. Because we could find one identical Klebsiella specific DNA sequence from both samples (Fig. 3), we differentiated the K. oxytoca with the presence of peh X gene from the Klebsiella pneumoniae with the rpo B gene by pathogens specific PCR primers. Finally, we found the presence of peh X gene of K. oxytoca in both samples (Fig. 4).
Fig. 2. Macroscopically, the sectioned surface of the testis is yellowish and white in color, friable and totally necrotic. The capsule of the testis is markedly thicker with fibrous adherence (A). Microscopically, seminiferous tubules and interstitium are entirely effaced by intense acute inflammation (Hematoxylin-eosin stain, original magnification 200) (B).
Please cite this article in press as: Lee W, et al., A case of testicular infarction from the complications of Klebsiella oxytoca induced acute epididymitis, J Infect Chemother (2015), http://dx.doi.org/10.1016/j.jiac.2015.09.011
W. Lee et al. / J Infect Chemother xxx (2015) 1e3
3
Fig. 3. Analysis of the 16S rRNA gene sequences. The electropherograms reveal variations in the 16S rRNA genes sequence from Klebsiella oxytoca strain MTJW-7 (GenBank accession no KM516015.1), Klebsiella sp. Y1 (HQ616650.1), E. coli (J01859.1), and P. aeruginosa (M34133.1), and our case. The box represents the dissimilar DNA sequences among five different isolates. The arrow indicates the 451th nucleotide site of gene accession no. J01859.1.
3. Discussion Acute scrotum must be immediately evaluated and treated appropriately using either medical or surgical measures [4,5]. If testicular torsion is present, the twisted testicle must be immediately relieved to prevent testicular ischemia and orchiopexy for the prevention of recurrence, while acute epididymitis can usually be managed with antibiotics and analgesics. Unfortunately, some epididymitis leads to more serious complications, including orchitis and global testicular infarction. Retrograde ascending infection is the common route of the epididymal infection. Therefore, urine analysis and urine culture should be obtained to identify the causal organisms, and to prescribe appropriated antibiotics depending on the culture results. Sometime, however, microbiological characterization is not possible in ordinary urinary culture system [1,5]. Empirical antibiotics approaches to the culture-negative epididymitis patient may worsen the symptoms and can incur the loss of organ function. We proved the presence of K. oxytoca in ochiectomized sample and urine by using a bacterial 16S rRNA gene sequencing method (Fig. 3). The 16S rRNA gene is commonly used for bacterial classification as it is highly conserved among different bacterial species. The primer 8F and 1492R were currently used to amplify 1484 base pairs through the bacterial domains IeIV [3]. As the DNA sequences from both samples were completely matched, the
epididymitis was most likely from K. oxytoca in urine. We compared our DNA sequences with the references in GenBank by using the BLAST program. We found four similar references; K. oxytoca strain MTJW-7 (GenBank accession no KM516015.1), Klebsiella sp. Y1 (HQ616650.1), Escherichia coli (J01859.1), and Pseudomonas aeruginosa (M34133.1). Because of the genetic similarity between K. oxytoca and K. pneumoniae, we differentiated the two pathogens with pathogens specific DNA primers; the rpo B gene for K. pneumoniae and the peh X gene for K. oxytoca. Finally, we found a band of 343 base pairs that was specific to K. oxytoca infection [6]. K. oxytoca is an important opportunistic pathogen that causes septicemia, pneumonia and urinary tract infections in hospitalized patients, including neonates [7]. It can produce the extended spectrum beta-lactase and possesses the characteristics for fluoroquinolone resistance. Furthermore, the bacterial antibiotics resistance is an important risk factor for the progression of epididymitis [1,2]. While we did not evaluate the genetic mechanisms for antibiotics resistance in this pathogen, K. oxytoca in this case may acquire the ability of drugs resistance. Herein, we reported a unique case of testicular infarction in a patient with K. oxytoca induced acute epididymitis.
Conflict of interest No author has any financial interest or conflict of interest to describe.
References
Fig. 4. The results of polymerase chain reaction by using Klebsiella oxytoca specific and Klebsiella pneumoniae specific primers. We used DNA templates from the urine sample and epididymitis tissue sample. Lanes 1e4 show the results of unique gene of Klebsiella oxytoca (peh X) and lanes 5e8 show the results of amplification of unique gene of Klebsiella pneumoniae (rpo B). Lanes 1 and 5 reveal the results from the urine specimens; lanes 2 and 6 reveal the results from the epididymitis tissues; lanes 3 and 7 present the results of 10 times dilution from the stored DNA sample from the epididymitis tissue in lanes 2 and 6; lanes 4 and 8 present the results of 40 times dilution from the stored DNA sample from the epididymitis tissue in lanes 2 and 6. M represents 100 bp DNA marker.
[1] Sue SR, Pelucio M, Gibbs M. Testicular infarction in a patient with epididymitis. Acad Emerg Med 1998;5:1128e30. [2] Farber NJ, Slater RC, Maranchie JK. Multidrug resistant epididymitis progressing to testicular infarct and orchiectomy. Case Rep Urol 2013;2013. 645787. [3] Hiraishi A. Direct automated sequencing of 16S rDNA amplified by polymerase chain reaction from bacterial cultures without DNA purification. Lett Appl Microbiol 1992;15:210e3. [4] Srinath H. Acute scrotal pain. Aust Fam Physician 2013;42:790e2. [5] Redshaw JD, Tran TL, Wallis MC, deVries CR. Epididymitis: a 21-year retrospective review of presentations to an outpatient urology clinic. J Urol 2014;192:1203e7. [6] Chander Y, Ramakrishnan MA, Jindal N, Hanson K, Goyal SM. Differentiation of Klebsiella penumoniae and K. oxytoca by multiplex polymerase chain reaction. Intern J Appl Res Vet Med 2011;9:138e42. [7] Kim BN, Ryu J, Kim YS, Woo JH. Retrospective analysis of clinical and microbiological aspects of Klebsiella oxytoca bacteremia over a 10-year period. Eur J Clin Microbiol Infect Dis 2002;21:419e26.
Please cite this article in press as: Lee W, et al., A case of testicular infarction from the complications of Klebsiella oxytoca induced acute epididymitis, J Infect Chemother (2015), http://dx.doi.org/10.1016/j.jiac.2015.09.011
Contents lists available at ScienceDirect
Journal of Infection and Chemotherapy journal homepage: http://www.elsevier.com/locate/jic
Case report
A case of testicular infarction from the complications of Klebsiella oxytoca induced acute epididymitis Wonae Lee a, Heeyoon Park b, Gilho Lee b, * a b
Department of Pathology, Dankook University College of Medicine, Cheonan, Republic of Korea Department of Urology, Dankook University College of Medicine, Cheonan, Republic of Korea
a r t i c l e i n f o
a b s t r a c t
Article history: Received 19 August 2015 Received in revised form 22 September 2015 Accepted 29 September 2015 Available online xxx
Herein, we reported a case of testicular infarction in a patient with Klebsiella oxytoca induced acute epididymitis. Acute left epididymitis progressed into testicular infarction requiring orchiectomy in spite of antibiotics treatment. Ordinary urine cultures did not reveal any specific organism, suggesting viable but noncultureable state. We amplified a bacterial 16S ribosomal subunit gene from the urine and orchiectomized samples, and we found K. oxytoca infections from both of them. © 2015, Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Keywords: Klebsiella oxytoca Epididymitis Infarction 16s rRNA
1. Introduction
2. Case report
Testicular infarction due to infectious epididymitis is a rare phenomenon [1,2]. Infarction occurs when testicular arterial blood flow is compressed due to either inflammation or edema of the epididymis or spermatic cord [1]. Urine culture is absolutely necessary to identify the organisms causal to the infection. Although the causal organisms in urine are easily revealed in most cases, some cases have been reported as culture-negative epididymitis [1]. This patient did not exhibit pyuria or host specific pathogens in ordinarily urine culture, but progressed into testicular infarction despite the continuous use of antibiotics therapy. The method of bacterial 16S ribosomal subunit gene sequencing in uncharacterized or viable nonculturable bacteria has been widely used in recent decades to demonstrate the etiologic pathogens [3]. Herein, we reported a case of testicular infarction in the patient with acute epididymitis due to Klebsiella oxytoca that could be confirmed through the 16S ribosomal subunit gene sequencing method from the orchiectomized epididymis and patient's urine.
A healthy 37-year-old man visited the emergency room because of recently developed fever and severely painful left scrotal swelling. The patient denied the histories of drugs use, prior sexually transmitted diseases, diabetes mellitus, and hypertension. On admission, his vital signs revealed blood pressure of 143/90 mmHg, heart rate of 87/min, respiratory rate of 18/min, and body temperature of 38 C. Genital examination revealed a swollen left testicle with severe tenderness, and the epididymis and scrotal sulcus was not easily delineated. His complete blood count (CBC) showed white blood cell (WBC) 13,450/mL, hemoglobin 14.7 g/dL, and platelet 235,000/mL. Chemical profiles showed creatinine 0.78 mg/dL, glucose 102 mg/dL, and C-reactive protein (CRP) 0.12 mg/dL. A midstream specimen of urine revealed nitrite (e), WBC in urine stick (e), WBC [1e4/high power field (HPF)], and red blood cell (RBC) (<1/HPF). We could not identify any specific pathogen from urine cultures and one blood culture. In addition, we could not find urinary Trichomonas vaginalis, Mycoplasma hominis, Ureaplasma urealyticum, Chlamydia trachomatis, Mycoplasma genitalium, and Neisseria gonorrhoeae with the Seeplex STD Detection Kit (Seegene, Seoul, Korea). Scrotal ultrasound confirmed swollen left epididymis, and increased testicular vascularity suggestive of severe epididymtis (Fig. 1A). One day later, CRP was increased to 20.16 mg/dL. With the typical symptoms, signs, and the scrotal ultrasound findings of acute epididymitis, we started treatment
* Corresponding author. Department of Urology, Dankook University College of Medicine, San 29, Anseo-dong, Dongnam-gu, Cheonan, Chungnam 330-714, Republic of Korea. Tel.: þ82 41 550 3963; fax: þ82 41 551 6630. E-mail address: [email protected] (G. Lee).
http://dx.doi.org/10.1016/j.jiac.2015.09.011 1341-321X/© 2015, Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Lee W, et al., A case of testicular infarction from the complications of Klebsiella oxytoca induced acute epididymitis, J Infect Chemother (2015), http://dx.doi.org/10.1016/j.jiac.2015.09.011
2
W. Lee et al. / J Infect Chemother xxx (2015) 1e3
Fig. 1. Color Doppler sonography findings at two epididymitis episodes. A. Color Doppler sonography of left scrotum at first admission revealed left epididymal swollen and increased vascularity. However, the testicle revealed well preserved vascularity. B. Thirteen days later, the Doppler sonography revealed a small sized, irregular-shaped and heterogeneous left testis with absent blood flow.
using 2.0 g of cefbuperazone per day for 11 days. The symptoms and signs were improved, and laboratory findings also improved; WBC in CBC 9430/mL, CRP 0.81 mg/dL, and RBC < 1 HPF and WBC < 1 HPF in urinalysis. He was discharged from the hospital with oral fluoroquinolone medication, tosofloxacin with the dosage of 450 mg per day. The patient returned two days later complaining of recurring symptoms and signs of acute epididymitis. His CBC showed WBC 12,810/mL and CRP 1.13 mg/dL. A midstream specimen of urine revealed nitrite (e), WBC in urine stick (e), WBC (1e4/HPF), and RBC (<1/HPF). Similar to the previous visit, urine culture revealed no bacterial growth. We stored a 15-mL midstream urine sample in a 70 C freezer for further pathogens identification. Scrotal ultrasound revealed left testicular size reduction, irregular-shaped heterogeneous echogenicity, and poor testicular blood flow, suggesting the testicular infarction (Fig. 1B). Under the impression of testicular infarction due to infectious epididymitis, we explored the scrotum through a left inguinal incision. We could not easily separate the epididymis from the testis due to severe scrotal cavity adhesion. Definitively, there was no evidence of testicular torsion. We removed the testis. We also aseptically harvested the small pieces from the inflammatory epididymis and stored them in a 70 C freezer for further pathogens identification. The orchiectomy specimen was a necrotic testis exhibiting yellowish white color. The tunica albuginea and tunica vaginalis were markedly thicker with fibrous adherence to the epididymis and spermatic cord (Fig. 2A).
Microscopically, the testis was completely necrotized. Abundant neutrophils with abscess formation infiltrated the seminiferous tubules and interstitium. The epididymis was not necrotic but showed an infiltrate of chronic inflammatory cells (Fig. 2B). Pathologic diagnosis was testicular infarction, believed to be secondary to acute epididymitis. After the surgery, his general conditions and laboratory findings were improved and he was discharged from this hospital without complications. Four weeks after his discharge, we re-evaluated his clinical conditions and examined laboratory tests from the patient. He was healthy, and the values from his CBC, CRP, and urine samples were within normal ranges. The stored 15-mL midstream urine sample was thawed at room temperature and centrifuged at 3000 rpm for 4 min. After washing once with a phosphate-buffered saline solution, we extracted DNA from the urine sample by using Wizard genomic DNA purification kit (Promega, WI, U.S.A.). We also extracted genomic DNAs from the stored epididymis tissues. Polymerase chain reactions (PCR) were performed from both genomic DNAs, using consensus primers for the bacterial 16S ribosomal subunit gene [3]. The amplified products were sent to the Solgent (Daejon, Korea) and we read the DNA sequence with the Sanger's sequencing method. Because we could find one identical Klebsiella specific DNA sequence from both samples (Fig. 3), we differentiated the K. oxytoca with the presence of peh X gene from the Klebsiella pneumoniae with the rpo B gene by pathogens specific PCR primers. Finally, we found the presence of peh X gene of K. oxytoca in both samples (Fig. 4).
Fig. 2. Macroscopically, the sectioned surface of the testis is yellowish and white in color, friable and totally necrotic. The capsule of the testis is markedly thicker with fibrous adherence (A). Microscopically, seminiferous tubules and interstitium are entirely effaced by intense acute inflammation (Hematoxylin-eosin stain, original magnification 200) (B).
Please cite this article in press as: Lee W, et al., A case of testicular infarction from the complications of Klebsiella oxytoca induced acute epididymitis, J Infect Chemother (2015), http://dx.doi.org/10.1016/j.jiac.2015.09.011
W. Lee et al. / J Infect Chemother xxx (2015) 1e3
3
Fig. 3. Analysis of the 16S rRNA gene sequences. The electropherograms reveal variations in the 16S rRNA genes sequence from Klebsiella oxytoca strain MTJW-7 (GenBank accession no KM516015.1), Klebsiella sp. Y1 (HQ616650.1), E. coli (J01859.1), and P. aeruginosa (M34133.1), and our case. The box represents the dissimilar DNA sequences among five different isolates. The arrow indicates the 451th nucleotide site of gene accession no. J01859.1.
3. Discussion Acute scrotum must be immediately evaluated and treated appropriately using either medical or surgical measures [4,5]. If testicular torsion is present, the twisted testicle must be immediately relieved to prevent testicular ischemia and orchiopexy for the prevention of recurrence, while acute epididymitis can usually be managed with antibiotics and analgesics. Unfortunately, some epididymitis leads to more serious complications, including orchitis and global testicular infarction. Retrograde ascending infection is the common route of the epididymal infection. Therefore, urine analysis and urine culture should be obtained to identify the causal organisms, and to prescribe appropriated antibiotics depending on the culture results. Sometime, however, microbiological characterization is not possible in ordinary urinary culture system [1,5]. Empirical antibiotics approaches to the culture-negative epididymitis patient may worsen the symptoms and can incur the loss of organ function. We proved the presence of K. oxytoca in ochiectomized sample and urine by using a bacterial 16S rRNA gene sequencing method (Fig. 3). The 16S rRNA gene is commonly used for bacterial classification as it is highly conserved among different bacterial species. The primer 8F and 1492R were currently used to amplify 1484 base pairs through the bacterial domains IeIV [3]. As the DNA sequences from both samples were completely matched, the
epididymitis was most likely from K. oxytoca in urine. We compared our DNA sequences with the references in GenBank by using the BLAST program. We found four similar references; K. oxytoca strain MTJW-7 (GenBank accession no KM516015.1), Klebsiella sp. Y1 (HQ616650.1), Escherichia coli (J01859.1), and Pseudomonas aeruginosa (M34133.1). Because of the genetic similarity between K. oxytoca and K. pneumoniae, we differentiated the two pathogens with pathogens specific DNA primers; the rpo B gene for K. pneumoniae and the peh X gene for K. oxytoca. Finally, we found a band of 343 base pairs that was specific to K. oxytoca infection [6]. K. oxytoca is an important opportunistic pathogen that causes septicemia, pneumonia and urinary tract infections in hospitalized patients, including neonates [7]. It can produce the extended spectrum beta-lactase and possesses the characteristics for fluoroquinolone resistance. Furthermore, the bacterial antibiotics resistance is an important risk factor for the progression of epididymitis [1,2]. While we did not evaluate the genetic mechanisms for antibiotics resistance in this pathogen, K. oxytoca in this case may acquire the ability of drugs resistance. Herein, we reported a unique case of testicular infarction in a patient with K. oxytoca induced acute epididymitis.
Conflict of interest No author has any financial interest or conflict of interest to describe.
References
Fig. 4. The results of polymerase chain reaction by using Klebsiella oxytoca specific and Klebsiella pneumoniae specific primers. We used DNA templates from the urine sample and epididymitis tissue sample. Lanes 1e4 show the results of unique gene of Klebsiella oxytoca (peh X) and lanes 5e8 show the results of amplification of unique gene of Klebsiella pneumoniae (rpo B). Lanes 1 and 5 reveal the results from the urine specimens; lanes 2 and 6 reveal the results from the epididymitis tissues; lanes 3 and 7 present the results of 10 times dilution from the stored DNA sample from the epididymitis tissue in lanes 2 and 6; lanes 4 and 8 present the results of 40 times dilution from the stored DNA sample from the epididymitis tissue in lanes 2 and 6. M represents 100 bp DNA marker.
[1] Sue SR, Pelucio M, Gibbs M. Testicular infarction in a patient with epididymitis. Acad Emerg Med 1998;5:1128e30. [2] Farber NJ, Slater RC, Maranchie JK. Multidrug resistant epididymitis progressing to testicular infarct and orchiectomy. Case Rep Urol 2013;2013. 645787. [3] Hiraishi A. Direct automated sequencing of 16S rDNA amplified by polymerase chain reaction from bacterial cultures without DNA purification. Lett Appl Microbiol 1992;15:210e3. [4] Srinath H. Acute scrotal pain. Aust Fam Physician 2013;42:790e2. [5] Redshaw JD, Tran TL, Wallis MC, deVries CR. Epididymitis: a 21-year retrospective review of presentations to an outpatient urology clinic. J Urol 2014;192:1203e7. [6] Chander Y, Ramakrishnan MA, Jindal N, Hanson K, Goyal SM. Differentiation of Klebsiella penumoniae and K. oxytoca by multiplex polymerase chain reaction. Intern J Appl Res Vet Med 2011;9:138e42. [7] Kim BN, Ryu J, Kim YS, Woo JH. Retrospective analysis of clinical and microbiological aspects of Klebsiella oxytoca bacteremia over a 10-year period. Eur J Clin Microbiol Infect Dis 2002;21:419e26.
Please cite this article in press as: Lee W, et al., A case of testicular infarction from the complications of Klebsiella oxytoca induced acute epididymitis, J Infect Chemother (2015), http://dx.doi.org/10.1016/j.jiac.2015.09.011