Differential Diagnosis for Acute Prostatitis with G-ve Rods

• Single most likely diagnosis:
  • Neisseria gonorrhoeae: This bacterium is a common cause of sexually transmitted infections, which can lead to acute prostatitis. It is a G-ve diplococcus, not a rod, but it can cause the described symptoms and is known to grow on agar with specific supplements.
• Other Likely diagnoses:
  • Escherichia coli (E. coli): A common cause of urinary tract infections, including prostatitis. E. coli is a G-ve rod that grows well on agar.
  • Klebsiella pneumoniae: Another G-ve rod that can cause urinary tract infections and prostatitis, especially in individuals with certain risk factors.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • None of the options provided (A. Chlamydia, B. Legionella, C. Mycoplasma) exactly match the description of G-ve rods that grow on agar yeast, but it's crucial to consider:
    • Chlamydia trachomatis: Although it's an obligate intracellular pathogen and not typically described as a G-ve rod, it's a significant cause of sexually transmitted infections and can lead to prostatitis. Specialized media or cell culture are required for its growth.
• Rare diagnoses:
  • Legionella: While Legionella is a G-ve rod, it is more commonly associated with respiratory infections (Legionnaires' disease) and would be an unusual cause of prostatitis. It requires specific media for growth, such as buffered charcoal yeast extract (BCYE) agar.
  • Mycoplasma: Mycoplasma genitalium can cause urethritis and, less commonly, prostatitis. However, it does not fit the description of G-ve rods as it lacks a cell wall and requires specialized media for growth.

Justification: The question's details about G-ve rods growing on agar yeast do not perfectly align with the typical characteristics of the organisms listed in the options (A, B, C). However, in the context of acute prostatitis and the provided options, considering common pathogens and their growth requirements is essential. The most likely cause based on common pathogens for prostatitis would typically include bacteria like Neisseria gonorrhoeae, E. coli, and others, but the specific details given point towards considering less common or atypical presentations.