IJBAF, January, 2013, 1(1): 1-8 ISSN: 2320 – 0774 INCIDENCE OF BACTERIAL AND ABACTERIAL PROSTATITIS AMONG THE PROSTATITIS PATIENTS IN THI-QAR PROVINCE SOUTH OF IRAQ ISSA AWATIF H1, AL-SAADI MOHAMMED AK2 AND ATIYALL SAAD A3 1: Department of Biology, College of Sciences, Basra University 2: Department of Microbiology, College of Medicine, Babylon University 3: Department of Microbiology, College of Medicine, ThiQar University Corresponding Author: E Mail: [email protected] ABSTRACT The prostatitis is a worldwide problem affects man at all ages , the incidence of the types of prostatitis is remain unclear due to the defects in the methods that differentiate between bacterial and abacterial prostatitis especially culture. Objective of current study was to determine the incidence of different types of the prostatitis by using culture and PCR based technique using universal bacterial primer. Post massage urine specimens were collected from 60 patients with prostatitis and 20 apparently healthy men, the bacterial infections were diagnosed by culture method and amplification by using B27f-U1492r universal bacterial primer. Bacterial prostatitis was diagnosed in 11(18.33%) patients by using culture, while, 23(38.33%) patients gave a positive bacterial signals in PCR with high significant differences (p< 0.001). The remaining patients 37(61.67%) was suffering from abacterial prostatitis. Therefore, according to the results above abacterial prostatitis were high prevalent among the patients. But, bacterial prostatitis has high proportion which is larger than those of international survey which recorded in some studies.PCR technique has a high specificity and sensitivity in detection of bacteria in prostatic specimens than culture technique. Keywords: Bacterial and Abacterial Prostatitis, Thi-Qar and Iraq INTRODUCTION Prostatitis is an inflammation of prostate inflammatory gland inflammatory prostatitis [1, 2, 3]. classified into four categories The bacterial infectious caused by bacteria, acute bacterial chronic and second asymptomatic including: acute bacterial prostatitis, chronic prostatitis, first and categories are prostatitis/chronic pelvic pain syndrome prostatitis (ABP) is a serious bacterial which is may be inflammatory or non- infection of the prostate. Chronic bacterial 1 Issa Awatif H et al Research Article prostatitis (CBP) is a rare conditions (<5 %) from prostatitis with age ranged from ( 24- usually developed as recurrent urinary tract 78 ) years and (20) apparently healthy male infections originated from recurrent prostate as controls in Al-Hussein Teaching Hospital infections [4, 5, 6]. CP/CPPS represent the in Thi-Qar province through the period from most prevalent form of prostatitis that February 2011 to July 2011. affects men in all ages, data reveals that 210% of adult men suffer from CP and 15% Culture The two urine specimens were inoculated on of men affected at some point of their lives culture media and incubated aerobically at [7, 8], the causes of CP/CPPS are remain 37°C for 24h.The bacterial isolation and unclear. But, it may be associated with identification was performed according to psychological factors and dysfunction in the diagnostic procedures recommended by immune, endocrine [17, 18] by using the colon morphology and systems and autoimmune responses to biochemical tests in API 20E system prostatic (Biomerux-France). neurological antigens and represents important causes for CP/CPPS [9, 10, 11]. The loss of symptoms is the most important feature of Cat. IV of prostatitis (Asymptomatic inflammatory prostatitis), inflammation can be detected in semen, EPS, urine and Culture technique can be detects only < 10 % of bacterial pathogens that causes But, by using molecular techniques such as PCR this percent is rise greatly to reach to 77% as mentioned by some researchers [14, 15, 16] by using universal and specific The DNA was extracted from urine samples according to the manufacturer’s instructions of genomic supplemented prostate tissue [12, 13]. prostatitis. Direct PCR-Based Bacterial Detection DNA Extraction bacterial DNA primers. This study aimed to determine the incidence of the types of prostatitis by culture and molecular-based methods. MATERIALS AND METHODS Samples DNA by purification the Kit manufacturing company (Sacase-Italy). PCR Reaction Assays The extracted DNA were used for PCR amplification of 16S rRNA genes using the bacteria universal primers B27F AGAGTTTGATCCTGGCTCAG-3) (5and U1492R (5-GGTTACCTTGTTACGACTT3) [19]. Bacterial 16S rRNA gene sequences were amplified with prepared master mix (premix-Bioneer-Korea), the final mixture contain 5µl premix , 3 µl upstream primer , 3 µl downstream primer , 5 µl target DNA The post massage urine samples (VB3) were and 4 µl nuclease free water. The collected from (60) male patients suffering amplification was performed depending on 2 IJBAF, January, 2013, 1(1) Issa Awatif H et al Research Article the following program : 1 cycle of 96°C for While PCR revealed that 23out of 60 3 min, 56°C for 25 s and 72°C for 15 s and specimens (38.33%) from the prostatitis 27 cycles of 96°C for 30 s , 56°C for 25 s , patients have a positive bacterial signals and 72°C for 15 s , followed by 72°C for 10 after amplification by PCR and agarose-gel min. The PCR products were detected by electrophoresis agarose gel electrophoresis. bacterial prostatitis cases as shown in Table RESULTS 1, the results B27-U1492 primer were All specimens 20 (100%) of control were produced 1500 bp PCR products (Figure 1). give a negative results in culture and PCR Abacterial prostatitis was shown in the methods for bacterial detection. Positive others patients 37 (61.67%) out of 60 culture results were shown in 11 (18.33%) prostatitis patients with high significant of patients including (10) isolates of E. coli differences (p<0.001) as revealed in Table and (1) isolate of Enterobacteraerogenes. 2. that representing the Table 1: The Incidence of Bacterial Infections Among the Patients With Prostatitis According to Culture PCR Methods Result Methods Positive Negative Total No. % No. % No. % Culture 11 18.33 49 81.77 60 100 PCR 23 38.33 37 61.67 60 100 Table 2: The Incidence of Bacterial and Abacterial Prostatitis Depending on PCR Techniques Types of Cases Prostatitis Bacterial No. 23 % 38.3333 Abacterial No. 37 % 61.6667 Total No. 60 % 100 Figure 1: Agarose Gel Electrophoresis of PCR of B27-U1492 Universal 16S rRNA Primer Which Showed a Product of (1500 bp). L: Ladder 1,2, 3, 4,5,6,7: no. of DNA Samples Were Extracted From Post Massage Urine Samples Obtained From Urine of Prostatitis Patients , lane 5,6,7 was Gave a Positive Bacterial Signals to the Used Primer 3 IJBAF, January, 2013, 1(1) Issa Awatif H et al Research Article DISCUSSION CP/CPPS such as C. trachomatis and genital Universal PCR primers used as a tool for the mycoplasmas , these finding lead to rapid detection of bacteria in normally developed sterile clinical samples and it can be using in bacteria in development of CP/CPPS even differentiating viral though the inflammatory nature of this infections. This would confirm the necessity syndrome . Therefore, this finding should be for antibiotic treatment and would influence taken in consideration in any attempts to patient management. Many researchers have development of an a new classification used the 16S rRNA gene as target fornon- system to differentiate between the types of culture detection and it has been the most the prostatitis. widely PCR technique is the most sensitive and bacterial used targetfor from universal PCR hypothesis about the role of amplification of DNAs from a broad range specific of organisms [14, 20]. The B27-U1492 give bacterial infections including prostatitis due (1500 bp) products and it represents the to itsability to detects very small number of most common used universal primer pair bacteria in the specimens than others which devised by [21]. methods [25]. Also, PCR is not affected by The results of current study revealed that the the presence of some inhibitors in urine and incidence of bacterial pathogens was high the inhibition effects of seminal plasma among the patients suffering from prostatitis which may suppress the growth of bacteria which compatible to the results of many in culture methods, PCR has ability to researches [4, 14, 15, 22, 23] that shown detects high bacterial prostatitis chlamydia and mycoplasmas [15, 26, 16, 27, depending on PCR technique. This result 28, 29]. Also, many patients received reflects antibiotics randomly at any time that may incidence the of role of bacteria in the methods in unculturable the culture determination bacteria results. such of as developments of the prostatitis either by affect Therefore, direct effects via their toxins and other molecular method may help in elimination virulence factors or indirectly by their the dependence on cultivation methods ability to induce an immune response and especially by PCR to detect universal and inflammation within the prostate tissues specific 16SrRNA bacterial primers [30]. which lead cell damage and histological The results of current study was compatible changes. Moreover , some researchers [14 , to some researches [31, 32, 33] which 24] found the bacterial pathogens in the mentioned that the E. coli is the most specimens obtained from the patients with common cause of bacterial prostatitis 4 IJBAF, January, 2013, 1(1) Issa Awatif H et al Research Article because it accompanied with (> 82 %) of [3] Nickel JC, Nyberg LM and bacterial prostatitis . While the rate of Hennenfent M, Research guidelines isolation of bacteria by culture technique for chronic prostatitis: consensus (18.33%) was slightly higher than those that report revealed by several studies [14, 34] which Institutes of Health, Int. Prostatitis found that the rate of isolation of bacteria Collaborative Network. 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