Comment on “Emphysematous Infections of the Prostate and Scrotum in an Older Adult in a Nursing Home”

Abstract

We would like to thank Dr. Cheung and Dr. Tsang1 for sharing their interesting case report, “Emphysematous Infections of the Prostate and Scrotum in an Older Adult in a Nursing Home,” in which they reported a rare case of emphysematous infection (EI) of the prostate and scrotum occurring in an older adult in a nursing home. This is the first reported case in the English literature of EI of the prostate and the scrotum with abscess formation. The patient had multiple morbid conditions and was chronically bedridden. He was admitted to a nursing home for long-term care. As mentioned in the case report, the individual was referred to the emergency department of Far Eastern Memorial Hospital, where, upon physical examination, he was found to have an enlarged scrotum with some skin discoloration (Figure 1). We think that the healthcare workers at the nursing home were responsible for the delayed referral to the hospital, because they should have been alert to such clinical manifestation during diaper changes for this individual. We agree that older residents in nursing homes are at risk of infection because of physiological changes, aging, underlying chronic diseases, poor institutional environment, impaired cognition of most older adults in terms of addressing their basic hygienic needs, difficulties in diagnosis of some infections with subtle presentations, presence of comorbid conditions obscuring the symptoms of infection, and lack of on-site diagnostic facilities.2, 3 The diagnosis of emphysematous prostatic and scrotal abscesses is based on clinical history, physical examination, and imaging modalities. The authors should present the educational image (Figure 1) of such clinical signs. Computed tomography of the pelvis is the medical imaging of choice for confirming its diagnosis.4 To reduce the morbidity and mortality of EI of the prostate and scrotum, early detection in the nursing home, aggressive surgical and medical management using appropriate broad-spectrum antibiotics, and good blood glucose control are mandatory. We agree that EI of the genitourinary tract is a life-threatening condition requiring aggressive surgical management and antibiotic therapy and is usually related to diabetes mellitus.5 The reporting authors should emphasize using appropriate broad-spectrum antibiotics. We think that this condition is related to lower urinary tract infection (UTI), especially in elderly adults with comorbidities. Surgical drainage of emphysematous prostatic abscesses can be done using a transrectal, transperineal, or transurethral approach.6 In individuals with diabetes mellitus, the gas formed is usually carbon dioxide, which results from a high concentration of sugar that bacteria ferment in the urine or tissues.7 Like emphysematous cystitis and emphysematous pyelonephritis, EI of the prostate and scrotum is a rare complication of UTI that can easily progress to a life-threatening condition and cause a prolonged hospital stay. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Concept and design: Min-Po Ho. Acquisition of participant and data: Kaung-Chau Tsai, Min-Po Ho. Analysis and interpretation of data: Kaung-Chau Tsai, Min-Po Ho. Preparation of manuscript: Min-Po Ho. Critical review and approval: Kaung-Chau Tsai, Min-Po Ho. Sponsor's Role: None.