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Bapir R, Abdalqadir AM, Aghaways E, Bayz HH, Abdullah HO, Ahmed SF, Abdalla BA, Hama JI, Muhammed BO, Hamahussein KF, Faraj FM, Kakamad FH. Brucella epididymo-orchitis: A single-center experience with a review of the literature. Arch Ital Urol Androl 2023; 95:11978. [PMID: 38193225 DOI: 10.4081/aiua.2023.11978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 10/23/2023] [Indexed: 01/10/2024] Open
Abstract
Brucella epididymo-orchitis (BEO) is a rare complication of brucellosis. Despite the high incidence of brucellosis in developing countries, few case series on BEO are available. This study focuses on the clinical presentations, diagnosis, and treatment of BEO with a review of the literature. This study included consecutive BEO patients diagnosed and treated at Smart Health Tower between 2021 and 2023. The required data were retrospectively collected from patients' profiles. The BEO diagnosis was established through scrotal Doppler ultrasound in cases with a positive Rose Bengal test and positive IgG and IgM results for brucellosis, in addition to scrotal pain and swelling. This study included 11 cases whose ages ranged from 22 to 55 years. Most of the cases presented with testicular pain (72.7%), followed by fever (63.6%) and arthralgia (63.6%). The right side (54.5%) was slightly more affected than the left side (45.5%). The major abnormal laboratory finding was an elevated C-reactive protein (82%). The treatment was conservative, in which a combination of gentamicin, doxycycline, and rifampicin was administered to the patients for about 6-8 weeks. One case underwent an orchiectomy due to the abscess formation. All the patients responded well to the treatment, with no recurrence. In the Middle East, brucellosis remains a concerning infectious disease. Early diagnosis, aimed at preventing abscess formation and other complications, takes first priority to avoid invasive interventions.
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Affiliation(s)
- Rawa Bapir
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan; Department of Urology, Sulaimani Surgical Teaching Hospital, Sulaimani; Kscien Organization, Hamdi Street, Azadi Mall, Sulaimani, Kurdistan.
| | | | - Esmaeel Aghaways
- College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaimani, Kurdistan.
| | | | - Hiwa O Abdullah
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan; Kscien Organization, Hamdi Street, Azadi Mall, Sulaimani, Kurdistan.
| | - Shaho F Ahmed
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan.
| | - Berun A Abdalla
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan; Kscien Organization, Hamdi Street, Azadi Mall, Sulaimani, Kurdistan.
| | | | | | - Karokh Fadhil Hamahussein
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan; Kurdistan Center for Gastroenterology and Hepatology, Sulaimani, Kurdistan.
| | | | - Fahmi Hussein Kakamad
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan; Kscien Organization, Hamdi Street, Azadi Mall, Sulaimani, Kurdistan; College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaimani, Kurdistan.
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Öztürk-Çerik H, Özbek LM, Altıntaş-Öner B, Bozkurt İ. Brucellar Epididymo-Orchitis in a Brucellosis Hyperendemic Region in Türkiye. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2023; 5:367-375. [PMID: 38633857 PMCID: PMC10986701 DOI: 10.36519/idcm.2023.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/26/2023] [Indexed: 04/19/2024]
Abstract
Objective Brucellosis is one of the most prevalent zoonoses worldwide and is endemic in Türkiye. It is a multisystemic infection that can affect various organ systems. Epididymo-orchitis is the most common form of genitourinary involvement. This study aimed to evaluate the incidence, clinical characteristics, laboratory values, and treatment outcomes of brucellar epididymo-orchitis (BEO) in the East Anatolian region, where brucellosis is hyperendemic. Materials and Methods This study was conducted between January 1, 2018, and April 30, 2019. All male patients diagnosed with brucellosis at the infectious disease clinic were evaluated for epididymo-orchitis according to clinical findings (testicular pain, swelling, erythema). In addition, to identify BEO patients, all epididymo-orchitis cases admitted to the urology outpatient clinic according to the study protocol were referred to the infectious diseases clinic for Brucella infection. Patients were enrolled prospectively, and data were analyzed retrospectively. Results Brucella infection was diagnosed in 326 patients during the study period, of whom 208 (63.8%) were male. Brucellar epididymo-orchitis was diagnosed in 18 patients at the end of sixteen months. The incidence of epididymo-orchitis in patients with Brucella infection was 8.7%. The mean age of the patients was 36.9±11.5 years. The majority of patients had occupational animal contact (83.3%) and consumption of fresh cheese made from raw milk (55.5%). Acute brucellosis was diagnosed in 17 (94.4%) patients; all patients presented with scrotal pain and swelling. Unilateral epididymo-orchitis was observed in 16 (88.8%) patients. Most patients (88.3%) applied to outpatient clinics other than infectious diseases, especially the urology clinic (77.7%).Double or triple combined treatments with aminoglycoside/doxycycline/rifampicin were given to the patients. Hydrocelectomy was performed in three patients, orchiectomy in one patient, and relapse was seen in one patient. Conclusion Brucella infection should be considered in patients presenting with epididymo-orchitis in endemic regions. Awareness of brucellosis by urologists will ensure that the disease is diagnosed without complications.
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Affiliation(s)
- Hatun Öztürk-Çerik
- Department of Infectious Diseases and Clinical Microbiology, Ordu University School of Medicine, Ordu, Türkiye
| | | | - Betül Altıntaş-Öner
- Department of Infectious Diseases and Clinical Microbiology, Osmangazi University School of Medicine, Eskişehir, Türkiye
| | - İlkay Bozkurt
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayıs University School of Medicine, Samsun, Türkiye
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Bapir R, Ahmed SF, Tahir SH, Salih AM, Kakamad FH, Ahmed GS, Ali RK, Ahmed SM, Sidiq SH. Brucella orchitis presenting as a testicular mass mimicking a testicular tumor: a rare case report. AFRICAN JOURNAL OF UROLOGY 2023. [DOI: 10.1186/s12301-023-00334-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Introduction
Brucella epididymo-orchitis is a complication that occurs in 5.7% of patients with brucellosis and can rarely mimic a testicular tumor. We here report a case of a 25-year-old man with a testicular brucellosis that presented as a testicular mass that responded to conservative treatment using antibiotic therapy.
Case report
A 25-year-old patient presented with left testicular pain, abdominal pain, easy fatiguability, and feeling unwell. Physical examinations were normal. A testicular tumor was suggested by a scrotal color Doppler US scan and testicular MRI. However, tumor markers were all within the normal range. A serum Brucella agglutination test (Rose Bengal test) was done, and it was positive. The patient received anti-brucella antibiotics. An ultrasound scan 3 months later revealed complete recovery after completing antibiotic treatments.
Discussion
Brucella orchitis can be determined based on the triad of serology, ultrasonography, and the presence of the common symptoms like fever, testicular pain, redness, and enlargement. The early diagnosis of this phenomenon is crucial due to the morbidity and complications that may be encountered. Moreover, it has several differential diagnoses, such as testicular tumor, epididymitis, trauma, torsion of the testis, and hematocele. Failure to obtain an adequate diagnosis, particularly if a testicular tumor is suspected, may result in unnecessary intervention like orchiectomy.
Conclusion
Brucella orchitis is a complication of brucella infection that may mimic a testicular tumor. Several techniques of diagnosis are required for an accurate assessment.
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Hensel ME, Stranahan LW, Edwards JF, Arenas-Gamboa AM. Intratracheal inoculation results in Brucella-associated reproductive disease in male mouse and guinea pig models of infection. Front Microbiol 2022; 13:1029199. [DOI: 10.3389/fmicb.2022.1029199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
Brucella species are considered a significant cause of reproductive pathology in male and female animals. Importantly, Brucella melitensis can induce reproductive disease in humans. Reproductive pathogenesis and evaluation of newly developed countermeasures against brucellosis studies have traditionally utilized female animal models. However, any potential, new intervention for use in humans would need to be evaluated in both sexes. Therefore, animal models for male reproductive brucellosis are desperately needed to understand disease progression. Accordingly, we evaluated guinea pigs and mice using B. melitensis 16 M in an intratracheal model of inoculation at different stages of infection (peracute, acute, and chronic) with an emphasis on determining the effect to the male reproductive organs. Aerosol inoculation resulted in colonization of the reproductive organs (testicle, epididymis, prostate) in both species. Infection peaked during the peracute (1-week post-infection [p.i.]) and acute (2-weeks p.i.) stages of infection in the mouse in spleen, epididymis, prostate, and testicle, but colonization was poorly associated with inflammation. In the guinea pig, peak infection was during the acute stage (4-weeks p.i.) and resulted in inflammation that disrupted spermatogenesis chronically. To determine if vaccine efficacy could be evaluated using these models, males were vaccinated using subcutaneous injection with vaccine candidate 16 MΔvjbR at 109 CFU/100 μl followed by intratracheal challenge with 16 M at 107. Interestingly, vaccination efficacy varied between species and reproductive organs demonstrating the value of evaluating vaccine candidates in multiple models and sexes. Vaccination resulted in a significant reduction in colonization in the mouse, but this could not be correlated with a decrease in inflammation. Due to the ability to evaluate for both colonization and inflammation, guinea pigs seemed the better model not only for assessing host-pathogen interactions but also for future vaccine development efforts.
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Nahas RS, Alsulami A, Lashkar MO, Thabit AK. Brucella epidydimo-orchitis successfully treated with dual oral drug regimen: A case report with differential diagnoses of malignancy and tuberculosis. Radiol Case Rep 2022; 17:3485-3489. [PMID: 35912293 PMCID: PMC9334919 DOI: 10.1016/j.radcr.2022.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 07/02/2022] [Indexed: 12/01/2022] Open
Abstract
Brucellosis is a zoonotic disease caused by Brucella spp. When complicated, Brucella may affect any organ system, including the genitourinary system in the form of epidydimo-orchitis. Brucella orchitis is the second most common form of complicated brucellosis. The present case is for an adolescent who is otherwise healthy but presented with right testicular pain. Ultrasound imaging showed heterogeneous enlarged right testis with large heterogeneous mass and central necrosis. α-fetoprotein was normal and β-human choriogonadotropin was negative. Malignancy and tuberculosis were excluded based on histopathology and microbiology of the tissue biopsy, respectively. The history of raw dairy consumption and positive serology for B. melitensis and B. abortus established the diagnosis of Brucella epidydimo-orchitis. Treatment was successful with doxycycline and rifampin for four weeks. In pediatrics, it is important to rule out malignancy and make every attempt to avoid orchidectomy by making necessary investigations and involving infectious diseases consultation.
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Affiliation(s)
- Renad S. Nahas
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, 7027 Abdullah Alsulaiman St, Jeddah 22254-2265, Saudi Arabia
| | - Abdulsalam Alsulami
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, 7027 Abdullah Alsulaiman St, Jeddah 22254-2265, Saudi Arabia
| | - Manar O. Lashkar
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, 7027 Abdullah Alsulaiman St, Jeddah 22254-2265, Saudi Arabia
| | - Abrar K. Thabit
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, 7027 Abdullah Alsulaiman St, Jeddah 22254-2265, Saudi Arabia
- Corresponding author.
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Yu J, Li S, Wang L, Dong Z, Si L, Bao L, Wu L. Pathogenesis of Brucella epididymoorchitis-game of Brucella death. Crit Rev Microbiol 2021; 48:96-120. [PMID: 34214000 DOI: 10.1080/1040841x.2021.1944055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Brucellosis is a worldwide zoonotic disease caused by Brucella spp. Human infection often results from direct contact with tissues from infected animals or by consumption of undercooked meat and unpasteurised dairy products, causing serious economic losses and public health problems. The male genitourinary system is a common involved system in patients with brucellosis. Among them, unilateral orchitis and epididymitis are the most common. Although the clinical and imaging aspect of orchi-epididymitis caused by brucellosis have been widely described, the cellular and molecular mechanisms involved in the damage and the immune response in testis and epididymis have not been fully elucidated. In this review, we first summarised the clinical characteristics of Brucella epididymo-orchitis and the composition of testicular and epididymal immune system. Secondly, with regard to the mechanism of Brucella epididymoorchitis, we mainly discussed the process of Brucella invading testis and epididymis in temporal and spatial order, including i) Brucella evades innate immune recognition of testicular PRRs;ii) Brucella overcomes the immune storm triggered by the invasion of testis through bacterial lipoproteins and virulence factors, and changes the secretion mode of cytokines; iii) Brucella breaks through the blood-testis barrier with the help of macrophages, and inflammatory cytokines promote the oxidative stress of Sertoli cells, damaging the integrity of BTB; iv) Brucella inhibits apoptosis of testicular phagocytes. Finally, we revealed the structure and sequence of testis invaded by Brucella at the tissue level. This review will enable us to better understand the pathogenesis of orchi-epididymitis caused by brucellosis and shed light on the development of new treatment strategies for the treatment of brucellosis and the prevention of transition to chronic form. Facing the testicle with immunity privilege, Brucella is like Bruce Lee in the movie Game of Death, winning is survival while losing is death.HIGHLIGHTSWe summarized the clinical features and pathological changes of Brucellaepididymoorchitis.Our research reveals the pathogenesis of Brucella epididymoorchitis, which mainly includes the subversion of testicular immune privilege by Brucella and a series of destructive reactions derived from it.As a basic framework and valuable resource, this study can promote the exploration of the pathogenesis of Brucella and provide reference for determining new therapeutic targets for brucellosis in the future.
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Affiliation(s)
- Jiuwang Yu
- Mongolian Medicine School, Inner Mongolia Medical University, Hohhot, China
| | - Sha Li
- Department of Pharmacy, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Lu Wang
- Department of Pharmacy, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Zhiheng Dong
- Department of Pharmacy, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Lengge Si
- Mongolian Medicine School, Inner Mongolia Medical University, Hohhot, China
| | - Lidao Bao
- Department of Pharmacy, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Lan Wu
- Mongolian Medicine School, Inner Mongolia Medical University, Hohhot, China
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Claeys E, Schockaert O. A funny case of Funiculitis. Acta Clin Belg 2021; 76:232-235. [PMID: 31760888 DOI: 10.1080/17843286.2019.1696029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Funiculitis, an inflammation of the spermatic cord, usually results from infection of adjacent structures like the epididymis, testis or the urethra. It is most frequently caused by a bacterial infection, but has a broad (non-infectious) differential diagnosis.Methods: This case illustrates an unusual cause of funiculitis. A 72-year old man presented with sequential right- and left side funiculitis. He was non-responsive to antibiotics and developed constitutional symptoms. A non-infectious inflammatory etiology was suspected and further diagnostic procedures were performed.Results: PET findings suggested medium and large vessel vasculitis. CT angiography and histopathological analysis of the spermatic cord lacked the typical characteristics of Polyarteritis Nodosa (PAN) or medium size vasculitis. In light of a probable medium vessel vasculitis the patient was treated with corticosteroids, with a favorable response.Conclusion: Vasculitis should be considered in the differential diagnosis of a funiculitis that does not respond to antibiotic therapy. PET CT is an important tool for the diagnosis of vasculitis in patients with an atypical presentation and inconclusive diagnostic testing.
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Affiliation(s)
- E. Claeys
- Resident Internal Medicine, University Hospital Leuven, Leuven, Belgium
| | - O. Schockaert
- Department of Nephrology, AZ Groeninge, Kortrijk, Belgium
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8
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Whole-Genome Sequence of a Strain of Brucella melitensis Isolated from a Patient with Swelling of the Right Testicle in Inner Mongolia, China. Microbiol Resour Announc 2021; 10:10/20/e00110-21. [PMID: 34016671 PMCID: PMC8188337 DOI: 10.1128/mra.00110-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This report describes the isolation, sequencing, and annotation of Ws20160810, which was isolated from a blood sample from a brucellosis patient suffering from swelling of the right testicle in the Inner Mongolia Autonomous Region, China. The genome size was 3,244,234 bp with a 57.23% GC content, 3,294 coding DNA sequences (CDSs), 55 tRNAs, 5 rRNAs (5S [n = 2], 16S [n = 1], and 23S [n = 2]), and 3 small RNAs (sRNAs). This report describes the isolation, sequencing, and annotation of Ws20160810, which was isolated from a blood sample from a brucellosis patient suffering from swelling of the right testicle in the Inner Mongolia Autonomous Region, China. The genome size was 3,244,234 bp with a 57.23% GC content, 3,294 coding DNA sequences (CDSs), 55 tRNAs, 5 rRNAs (5S [n = 2], 16S [n = 1], and 23S [n = 2]), and 3 small RNAs (sRNAs).
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Chirwa M, Davies O, Castelino S, Mpenge M, Nyatsanza F, Sethi G, Shabbir M, Rayment M. United Kingdom British association for sexual health and HIV national guideline for the management of epididymo-orchitis, 2020. Int J STD AIDS 2021; 32:884-895. [PMID: 34009058 DOI: 10.1177/09564624211003761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The British Association for Sexual Health and HIV (BASHH) UK guideline for the management of epididymo-orchitis has been updated in 2020. It offers advice on diagnostic tests, treatment and health promotion principles in the effective management of epididymo-orchitis. Empirical treatment should be started in patients with objective swelling and tenderness on testicular examination. First-line empirical treatment for sexually acquired epididymo-orchitis has changed to ceftriaxone 1g intramuscularly and doxycycline. Higher dose of ceftriaxone in line with the BASHH 2018 gonorrhoea guideline ensures effective treatment of strains with reduced susceptibility. Ofloxacin or doxycycline is recommended in patients with epididymo-orchitis probably due to non-gonococcal organisms (e.g. negative microscopy for gram-negative intracellular diplococci or no risk factors for gonorrhoea identified). Where Mycoplasma genitalium is tested and identified, treatment should include an appropriate antibiotic (e.g. moxifloxacin). If enteric pathogens are a likely cause (e.g. older patient, not sexually active, recent instrumentation, men who practice insertive anal intercourse, men with known abnormalities of the urinary tract or a positive urine dipstick for leucocytes and nitrites), ofloxacin and levofloxacin are recommended. A clinical care pathway has been produced to simplify the management of epididymo-orchitis. A patient information leaflet has been developed.
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Affiliation(s)
- Mimie Chirwa
- Genitourinary Medicine, 9762Bedfordshire Hospitals NHS Foundation Trust, Luton, UK
| | - Olubanke Davies
- Genitourinary Medicine, Epsom & St Helier University Hospitals NHS Trust, London, UK
| | - Sheena Castelino
- Genitourinary Medicine, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Mbiye Mpenge
- Consultant Microbiologist, Weston Area Health NHS Trust, Weston-super-Mare, Somerset, UK
| | - Farai Nyatsanza
- Genitourinary Medicine, Cambridge Community Services NHS Trust, Cambridgeshire, UK
| | - Gulshan Sethi
- Genitourinary Medicine, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Majid Shabbir
- Urologist, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Michael Rayment
- Genitourinary Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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Abstract
Objective: Brucellosis is a multisystemic disease which may affect all organs. Epididymo-orchitis is the most common form of genitourinary involvement. The aim of this study was to present our eight-year experience regarding the management of patients with brucellar epididymo-orchitis (BEO).Materials and method: The medical records of male brucellosis patients treated in two centers, between 2010 and 2018 were analyzed retrospectively. The diagnosis of epididymo-orchitis was made when the patients had scrotal pain, swelling, and enlarged tender testicles and/or epididymis on clinical examination. Brucellosis was diagnosed with a positive standard tube agglutination test or a positive blood culture.Results: Brucellosis was diagnosed in 996 male patients. Of these patients, 25 had a diagnosis of BEO (2.5%). All BEO patients suffered from enlarged painful testicles, however, testicular complaints were the only presentation symptoms in three of them. All patients received medical treatment alone except one patient with testicular abscess who underwent surgical drainage besides medical treatment. All patients recovered completely and no relapses have been detected during six-month follow-up.Conclusion: Patients with epididymo-orchitis should be investigated for brucellosis especially in endemic regions. To our knowledge, BEO patients may present with isolated testicular symptoms that make a diagnostic challenge.
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Affiliation(s)
- Hasan Tahsin Gozdas
- Department of Infectious Diseases and Clinical Microbiology, Abant Izzet Baysal University Faculty of Medicine, Bolu, Turkey
| | - Tayibe Bal
- Department of Infectious Diseases and Clinical Microbiology, Siirt State Hospital, Siirt, Turkey
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Ip CCK, Tumali K, Hoh IM, Arunasalam A. Acute epididymo-orchitis from brucellosis melitensis in Australia. BMJ Case Rep 2019; 12:12/7/e230007. [PMID: 31296622 DOI: 10.1136/bcr-2019-230007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Brucellosis epididymo-orchitis (BEO) is extremely rare in non-endemic areas such as Australia. While epididymo-orchitis is relatively common in adolescent men, when presented with a significant travel history, consideration should be given to rare causes such as this. Here, we present a case of BEO in a young 18-year-old man who recently migrated from Greece, with symptoms of acute scrotal pain, swelling and persistent fever. Brucella melitensis was isolated in the blood culture and confirmed with PCR. We suspect transmission was related to ingestion of unpasteurised goat dairy products. He made a full recovery after 7 days of intravenous gentamicin and 6 weeks of oral doxycycline. BEO should be considered in those who present with acute scrotal pain and fever after a recent history of travel to or from a brucellosis- endemic area.
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Affiliation(s)
| | - Khrisna Tumali
- Department of Urology, Western Health, Footscray, Victoria, Australia
| | - Ivan M Hoh
- Department of Urology, Western Health, Footscray, Victoria, Australia
| | - Arun Arunasalam
- Department of Urology, Western Health, Footscray, Victoria, Australia
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Vallianou NG, Melaki K, Constantinou F, Gennimata V, Kokkinakis E. Testicular abscesses due to Brucella melitensis. New Microbes New Infect 2018; 26:1-2. [PMID: 30245825 PMCID: PMC6141671 DOI: 10.1016/j.nmni.2018.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 08/04/2018] [Accepted: 08/08/2018] [Indexed: 12/30/2022] Open
Abstract
Brucella may cause testicular masses, which may be confused with a testicular tumour. We present the case of a man with fever and oedema in the scrotum. Ultrasound and colour Doppler ultrasound with a 6 to 15 MHz high-frequency linear-array transducer was performed, revealing bilateral scrotal wall oedema, heterogeneous echo texture and slightly increased vascularization of the right testis, with hypoechoic lesions characterized by hypervascular margins and no flow within them. These findings were compatible with testicular abscesses. Three blood cultures grew Brucella melitensis, so the patient received treatment with doxycycline and rifampin for 8 weeks, which resulted in disappearance of the testicular abscesses.
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Affiliation(s)
| | - K Melaki
- Evangelismos General Hospital, Athens, Greece
| | | | - V Gennimata
- Evangelismos General Hospital, Athens, Greece
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Sacks CA, Kilcoyne A, Wallace ZS, Glomski K. Case 20-2018: A 64-Year-Old Man with Fever, Arthralgias, and Testicular Pain. N Engl J Med 2018; 378:2518-2529. [PMID: 29949483 DOI: 10.1056/nejmcpc1800334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Chana A Sacks
- From the Department of Medicine, Brigham and Women's Hospital (C.A.S.), the Departments of Medicine (C.A.S., Z.S.W.), Radiology (A.K.), and Pathology (K.G.), Massachusetts General Hospital, and the Departments of Medicine (C.A.S., Z.S.W.), Radiology (A.K.), and Pathology (K.G.), Harvard Medical School - all in Boston
| | - Aoife Kilcoyne
- From the Department of Medicine, Brigham and Women's Hospital (C.A.S.), the Departments of Medicine (C.A.S., Z.S.W.), Radiology (A.K.), and Pathology (K.G.), Massachusetts General Hospital, and the Departments of Medicine (C.A.S., Z.S.W.), Radiology (A.K.), and Pathology (K.G.), Harvard Medical School - all in Boston
| | - Zachary S Wallace
- From the Department of Medicine, Brigham and Women's Hospital (C.A.S.), the Departments of Medicine (C.A.S., Z.S.W.), Radiology (A.K.), and Pathology (K.G.), Massachusetts General Hospital, and the Departments of Medicine (C.A.S., Z.S.W.), Radiology (A.K.), and Pathology (K.G.), Harvard Medical School - all in Boston
| | - Krzysztof Glomski
- From the Department of Medicine, Brigham and Women's Hospital (C.A.S.), the Departments of Medicine (C.A.S., Z.S.W.), Radiology (A.K.), and Pathology (K.G.), Massachusetts General Hospital, and the Departments of Medicine (C.A.S., Z.S.W.), Radiology (A.K.), and Pathology (K.G.), Harvard Medical School - all in Boston
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Olsen SC, Boggiatto P, White DM, McNunn T. Biosafety Concerns Related toBrucellaand Its Potential Use as a Bioweapon. APPLIED BIOSAFETY 2018. [DOI: 10.1177/1535676018771983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Street EJ, Justice ED, Kopa Z, Portman MD, Ross JD, Skerlev M, Wilson JD, Patel R. The 2016 European guideline on the management of epididymo-orchitis. Int J STD AIDS 2017. [PMID: 28632112 DOI: 10.1177/0956462417699356] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Epididymo-orchitis is a commonly encountered condition with a reported incidence of 2.45 cases per 1000 men in the United Kingdom. This 2016 International Union against Sexually Transmitted Infections guideline provides up-to-date advice on the management of this condition. It describes the aetiology, clinical features and potential complications, as well as presenting diagnostic considerations and clear recommendations for management and follow-up. Early diagnosis and management are essential, as serious complications can include abscess formation, testicular infarction and infertility. Recent epidemiological evidence suggests that selection of fluoroquinolone antibiotics with anti-Chlamydial activity is more appropriate in the management of sexually active men in the over 35 years age group.
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Affiliation(s)
- Emma J Street
- 1 Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | | | - Zsolt Kopa
- 3 Semmelweis University, Budapest, Hungary
| | - Mags D Portman
- 4 Central and North West London NHS Foundation Trust, London, UK
| | - Jonathan D Ross
- 5 University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mihael Skerlev
- 6 Department of Dermatology and Venereology, Zagreb University School of Medicine, Zagreb, Croatia
| | | | - Rajul Patel
- 8 Solent NHS Trust, University of Southampton, Southampton, UK
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16
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Bosilkovski M, Kamiloski V, Miskova S, Balalovski D, Kotevska V, Petrovski M. Testicular infection in brucellosis: Report of 34 cases. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2016; 51:82-87. [PMID: 27036087 DOI: 10.1016/j.jmii.2016.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/09/2015] [Accepted: 02/01/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND/PURPOSE To present clinical and laboratory features, treatment options, and outcome in patients with brucellar testicular infection and to compare them with analogous in brucellar patients without testicular involvement. METHODS Thirty four brucellar patients with testicular infection treated in two general hospitals in the Republic of Macedonia, during the period 1998-2009, were retrospectively analyzed. Their clinical and laboratory characteristics were compared with analogous in 364 male brucellar patients without testicular infection, who were treated at the same hospitals during the same time period. RESULTS Brucellar testicular infection was evident in 34 (8.5%) out of 398 male patients with brucellosis. The median age of the patients was 46.5 years. In all patients testicular involvement was presented as an acute form with a median duration of 5 days (range, 2-14 days) prior to diagnosis. Twenty-three of the patients had at least one other simultaneous focal infection. After starting with the treatment testicular infection lasted a median 10 days, range 7-21 days. Brucellar patients with testicular infection when compared with other brucellar patients more frequently manifested fever (97% vs. 61%), concomitant spondylitis (32% vs. 16%), and urinary system involvement (12% vs. 2%). Also, the relapse rate in patients with testicular involvement was significantly higher (24% vs. 9%). CONCLUSION In endemic regions brucellosis should be taken into consideration in any patient with testicular infection. Brucellar testicular involvement is usually characterized with a severe acute clinical presentation and a high percentage of relapses which entails the need of timely recognition and proper treatment duration of at least 60 days.
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Affiliation(s)
- Mile Bosilkovski
- Medical Faculty "Ss Cyril and Methodius University", Skopje, Macedonia.
| | - Viktor Kamiloski
- Medical Faculty "Ss Cyril and Methodius University", Skopje, Macedonia
| | - Silvana Miskova
- Department for Infectious Diseases, Medical Center, Veles, Macedonia
| | - Danco Balalovski
- Department for Infectious Diseases, Medical Center, Bitola, Macedonia
| | - Vesna Kotevska
- Medical Faculty "Ss Cyril and Methodius University", Skopje, Macedonia; Institute for Clinical Microbiology, Skopje, Macedonia
| | - Mile Petrovski
- Medical Faculty "Ss Cyril and Methodius University", Skopje, Macedonia
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