Enterococcus Infections: Arthritis, Neuropathy, and More

Enterococcus arthritis neuropathy

Hello Dr.
Liao: I have seen many doctors without improvement in my condition, so I am here to seek your advice regarding my medical history: Last August, I was diagnosed with prostatitis and took broad-spectrum antibiotics, specifically tetracycline, for one month with no effect.
It later developed into chronic inflammation.
I underwent two complete sexually transmitted infection screenings (no infections), three PCR tests for Chlamydia (no infections), three PCR tests for Mycoplasma (no infections), and five semen cultures.
Out of the five semen cultures, Enterococcus was isolated three times.
I have HLA-B27, and since June of this year, I have been experiencing multiple joint pains.
I took Celecoxib for three months, and since early September, I have started to experience numbness in my limbs and sharp chest pain.
I would like to ask: 1.
Can a long-term Enterococcus infection lead to arthritis, limb numbness, and sharp chest pain? 2.
The doctor mentioned that the accuracy of PCR testing is 95%, but I had just stopped antibiotics two days prior.
Would the accuracy be high if I tested three times?

Xiao Zhang, 30~39 year old female. Ask Date: 2017/09/18

Dr. Liao Zhongxin reply Internal Medicine

Dear readers,
Recently, there have been reports of an increase in cases of vancomycin-resistant enterococci (VRE) infections in hospitals in Hong Kong.
Once infected, treatment can be very challenging, with a mortality rate as high as 30%.
This outbreak has quickly garnered public attention.
Some internet users searched online and found no information on vancomycin-resistant enterococci but did find information on vancomycin-resistant enterococci.
Additionally, some users discovered that the probiotics we consume, such as lactic acid bacteria, contain these types of intestinal bacteria, raising concerns about the possibility of getting sick from consuming probiotics.
Are enterococci and streptococci the same thing?
I.
Enterococci are part of the normal gut flora
Enterococci are part of the normal flora in the intestines of humans and animals and were initially isolated from human feces.
Because these bacteria often appear in short chains, resembling streptococci, they were classified under the Streptococcus genus.
Thus, they were referred to as fecal streptococci.
Later, it was discovered that these fecal streptococci are actually quite different from streptococci.
In 1984, they were separated from the Streptococcus genus, forming a new genus called Enterococcus, and fecal streptococci were renamed Enterococcus faecalis.
However, some doctors still refer to them as streptococci.
Enterococci are one of the normal flora in the digestive tract of humans and animals.
Healthy human feces contain a large number of enterococci, with 10^6 to 10^8 enterococci per gram of feces.
Enterococci are not only found in the intestines but also in the human mouth, gallbladder, and female vagina and uterus.
Enterococci can ferment carbohydrates, produce lactic acid, break down proteins, aid in digestion, and participate in nutrient metabolism.
They can also produce certain antimicrobial proteins or peptides that inhibit the growth of harmful bacteria, prevent pathogenic microorganisms from contacting intestinal mucosal cells, and protect the gastrointestinal mucosa.
Indeed, the yogurt we consume contains Enterococcus faecalis.
II.
Enterococci can cause disease if they are in the wrong place
While enterococci are part of the normal flora in the intestines, if they end up in the wrong place, they can become our enemies and cause illness.
In hospitals, certain invasive medical procedures (such as punctures and surgeries) may inadvertently introduce these normal flora to areas where they do not belong (such as the urinary tract, bloodstream, endocardium, abdominal cavity, and biliary tract), leading to infections in these areas, which can result in severe sepsis.
Sometimes, it may also occur because a patient's immune function is compromised, allowing enterococci to invade areas where they should not be (such as the bloodstream and wounds), leading to sepsis or wound infections.
Therefore, enterococci are also referred to as opportunistic pathogens.
Since these infections mostly occur in hospitalized patients, who are already ill, the treatment becomes very challenging.
III.
Why do enterococci develop antibiotic resistance?
Enterococci can coexist with humans in the intestines due to their strong ability to adapt to their surrounding environment.
Enterococci were originally not resistant to antibiotics, but in today's world, patients may use gentamicin one day, erythromycin the next, and vancomycin the following day.
Over time, the weaker bacteria are killed off, while the more resistant enterococci gradually adapt to this antibiotic-laden environment, developing antibiotic resistance.
This antibiotic-resistant enterococcus not only can withstand antibiotic attacks but may also transmit this ability to other nearby bacteria, leading to the spread of antibiotic resistance.
Infections caused by antibiotic-resistant enterococci are more difficult to treat.
After widespread antibiotic resistance among enterococci, vancomycin is often regarded as the last effective drug for treating enterococcal infections.
However, with the clinical use of vancomycin, some enterococci have also developed resistance to it.
Once enterococci become resistant to vancomycin, it indicates that they have developed resistance to multiple antibiotics, turning them into superbugs, making treatment for infected patients extremely challenging, with a mortality rate exceeding 30%.
IV.
Misuse of antibiotics turns friends into foes
Due to the weakened immune systems of hospitalized patients and the higher likelihood of invasive medical procedures, the use of antibiotics is more frequent, leading to the prevalence of vancomycin-resistant enterococci infections primarily in hospitals, which results in nosocomial infections.
Therefore, the general public need not worry excessively.
However, the spread of vancomycin-resistant enterococci serves as a warning: we must not misuse antibiotics.
Nowadays, people often have a habit of seeking intravenous therapy or taking antimicrobial medications at the slightest discomfort.
Enterococci and many other bacteria coexist with humans; they can be both our friends and potential foes.
Thank you!

Reply Date: 2017/09/18

More Info

Enterococcus infections, particularly those caused by Enterococcus faecalis and Enterococcus faecium, can lead to a variety of health issues, including urinary tract infections, endocarditis, and, in some cases, complications that may affect the joints and nervous system. Your situation, involving chronic prostatitis and subsequent joint pain and neurological symptoms, raises several important considerations.

1. Enterococcus and Arthritis: Chronic infections can indeed lead to reactive arthritis, a condition where joint inflammation occurs in response to an infection elsewhere in the body. While Enterococcus is not the most common pathogen associated with reactive arthritis, it is possible that the persistent infection could contribute to joint pain and inflammation. The HLA-B27 antigen you mentioned is associated with several autoimmune conditions, including ankylosing spondylitis and reactive arthritis. Therefore, it is plausible that your joint symptoms could be linked to your underlying infection or an autoimmune response triggered by it.

2. Neuropathy and Cardiac Symptoms: The symptoms of limb numbness and heart pain you described could be multifactorial. Neuropathy can arise from various causes, including infections, autoimmune conditions, or even side effects from medications. The heart pain, or angina-like symptoms, could be related to anxiety, musculoskeletal issues, or potentially a more serious condition that warrants further investigation. It is crucial to discuss these symptoms with your healthcare provider, as they may require a comprehensive evaluation, including cardiac assessments.

3. PCR Testing Accuracy: PCR (Polymerase Chain Reaction) testing is a highly sensitive and specific method for detecting bacterial DNA, including Enterococcus. The accuracy of PCR tests can be influenced by several factors, including the timing of the test in relation to antibiotic treatment. If you recently completed a course of antibiotics, it may affect the test results, potentially leading to false negatives. Generally, waiting a period after antibiotic treatment before retesting can improve the accuracy of the results. If you are considering additional testing, it may be beneficial to consult with your physician about the optimal timing for these tests.

4. Management and Treatment: Given the complexity of your symptoms and the chronic nature of your infection, a multidisciplinary approach may be beneficial. This could involve urologists, rheumatologists, and infectious disease specialists. Treatment may include a longer course of targeted antibiotics for the Enterococcus infection, as well as management strategies for your joint pain and neurological symptoms. Non-steroidal anti-inflammatory drugs (NSAIDs) may help alleviate joint pain, while physical therapy could assist with mobility and strength.

5. Lifestyle and Monitoring: In terms of lifestyle modifications, maintaining a healthy diet, staying hydrated, and managing stress can support your overall health. Regular follow-ups with your healthcare provider are essential to monitor your symptoms and adjust treatment as necessary. If your symptoms persist or worsen, further diagnostic imaging or laboratory tests may be warranted to rule out other underlying conditions.

In summary, while Enterococcus infections can lead to a variety of complications, including arthritis and neurological symptoms, a thorough evaluation and tailored treatment plan are essential for managing your health. It is crucial to maintain open communication with your healthcare providers to ensure that all aspects of your condition are addressed effectively.

Similar Q&A

Understanding Reactive Arthritis: The Link Between Enterococcus and Joint Pain

Dear Dr. Gao, Thank you very much for your response. It seems that the cause of my condition is becoming clearer! About a year ago, I had bacterial prostatitis, which has not been completely resolved to this day. I have undergone multiple tests for sexually transmitted infection...

Dr. Gao Jiankai reply Internal Medicine
Hello Mr. Zhang, thank you for your question. Here are my responses: 1. Among the intestinal bacteria that can easily trigger Reiter's syndrome, enterococci are not included. However, I remain cautious about whether enterococci can induce Reiter's syndrome, as there are...

Understanding Septic Arthritis: Causes, Symptoms, and Care Tips

Hello, doctor. I would like to ask a question. My father recently injured his knee in a car accident. He had some swelling initially, but after a few days, the injury seemed to heal, so we didn't pay much attention to it. However, starting yesterday, the swelling returned an...

Dr. Zheng Shuxing reply Internal Medicine
Hello, Ms. Chou. Septic arthritis is an infection of the joint cavity caused by pathogens. Typically, after a physician suspects septic arthritis, a joint aspiration procedure is performed. The synovial fluid obtained is then tested and cultured for 2-3 days to confirm the diagno...

Frequent Bacterial Infections: Is It a Sign of Immune System Issues?

Hello, doctor. In mid-May of this year, I had an acne wound infection that spread inflammation to half of my face within a week. After taking antibiotics for three weeks, I recovered. Shortly after, at the end of May, I experienced an unexplained fever for three days, followed by...

Dr. Gao Jiankai reply Internal Medicine
Hello, thank you for your inquiry. The frequent infections during this period are indeed unusual. It is recommended to consult with an immunologist or a hematologist. The Changhua Hospital of the Ministry of Health and Welfare has an Allergy, Immunology, and Rheumatology Departme...

Spinal Issues Caused by Bacterial Infections: Understanding Treatment Options

Hello Doctor, My father recently developed a systemic bacterial infection (Klebsiella pneumoniae) due to diabetes, and the doctor diagnosed it as sepsis. He has been in the intensive care unit for over ten days and has since been transferred to a general ward. He has been receiv...

Dr. Shi Guozheng reply Orthopedics
Surgical intervention for spinal bacterial infections is one method that may be effective, but its success largely depends on the ability to achieve complete debridement. Postoperatively, antibiotic therapy is also necessary. As for neurological deficits, recovery is not guarante...