Haemophilus Influenzae Epididymo-Orchitis and Bacteraemia in an Immunocompetent Patient

Background

Epididymitis is a common cause of scrotal pain in adults, with coliform bacteria being the most common isolated organisms in patients older than 35.

Case presentation

A 51-year-old healthy patient presented with scrotal pain and swelling, and was found to have epididymo-orchitis and bacteraemia caused by Haemophilus influenzae, which has not previously been reported as a cause of epididymo-orchitis and bacteraemia in immunocompetent patients.

Discussion

Diagnostic studies can help confirm the diagnosis and detect the causative pathogen. In all suspected cases, a urinalysis, urine culture and a urine or urethral swab for nucleic acid amplification tests (NAATs) for Neisseria gonorrhoeae and Chlamydia trachomatis should be performed. Colour Doppler ultrasonography often shows an enlarged thickened epididymis with increased Doppler wave pulsation in epididymitis. H. influenzae are pleomorphic gram-negative rods that commonly colonise the human respiratory tract and are associated with a number of clinical conditions. H. influenzae has been reported as a cause of epididymo-orchitis in prepubertal boys, and in few cases were associated with positive blood cultures. In adults, H. influenzae has been isolated before from urine samples or urethral swabs in patients with epididymitis or epididymo-orchitis.

Conclusion

This case highlights the possibility of H. influenzae causing epididymo-orchitis and bacteraemia in immunocompetent patients. Healthcare providers should consider H. influenzae in the differential diagnosis of epididymitis and epididymo-orchitis in both immunocompetent and immunocompromised patients.

LEARNING POINTS

H. influenzae can cause epididymo-orchitis and bacteraemia in immunocompetent patients. This has not been previously reported.H. influenzae should be considered in the differential diagnosis of epididymitis and epididymo-orchitis in both immunocompromised and immunocompetent patients.Healthcare providers should be aware of the increasing incidence of epididymitis and epididymo-orchitis caused by non-coliform bacteria in patients older than 35 years, especially in immunocompromised patients.

A Rare Case of COVID-19 Presenting as Acalculous Cholecystitis

At its onset, coronavirus disease 2019 (COVID-19) commonly presents with generalized myalgia and upper respiratory symptoms. COVID-19 presenting as acalculous cholecystitis has been rarely described in the literature. The following case presents a patient whose first presentation of COVID-19 was acalculous cholecystitis without respiratory symptoms, critical illness, or severe COVID-19 infection.

Abstract P675: Cardiovascular and Cerebrovascular Events in Status Migrainosus and Migraine With Aura- A National Estimate

Objective: Primary aim of this study is to compare the prevalence of vascular events [VEs - acute ischemic stroke (AIS), transient ischemic attack (TIA), acute myocardial infarction (AMI) and angina] among patients with status migrainosus and intractable migraine (SM), migraine with aura (MWA), migraine without aura (MWOA) and non-migraineurs. Secondary aim of this study is to evaluate the linkage of VEs and associated disability with different migraine subtypes.

Methods: A cross-sectional study was performed using National Inpatient Sample [2016-2017] for adult hospitalizations. We extracted a cohort of secondary diagnoses of specific migraine subtypes amongst which primary diagnoses of VEs were identified using ICD 10 code. Weighted analysis using chi-square and multivariable survey logistic regression was performed to identify prevalence of VEs and evaluate relationship and disability (using APRDRG Risk Severity Score) between VEs and migraine subtypes.

Results: Out of total 58,259,589 US hospitalizations, 0.1%, 0.08% and 0.03% had SM, MWA and MWOA, respectively. Prevalence of AIS (5.5 vs 0.96 vs 1.96 vs 1.71%) and TIA (3.99 vs 1.07 vs 0.49 vs 0.38%) was higher amongst MWA in comparison with SM, MWOA and non-migraineurs, respectively. (p<.0001) Prevalence of AMI was lower amongst migraineurs (SM:0.40 vs MWA:0.86 vs MWOA:0.86 vs non-migraineurs:2.15%) but prevalence of angina was higher amongst MWOA (0.01 vs 0.07 vs 0.21 vs 0.06%). (p<.0001) MWA and MWOA were associated with higher odds of AIS [MWA - aOR 3.7; 95%CI 3.4-4.1; MWOA - 1.7 (1.3-2.1)] and TIA [MWA - 11.8 (10.5-13.1); MWOA - 4.0 (2.9-5.6)] compared to non-migraineurs. Angina was associated with MWOA [3.0 (1.4-6.8)]. AIS hospitalization with SM had 52% [1.52 (1.2-1.9)] higher odds of extreme/severe disability compared to MWA. TIA patients with SM had higher odds of disability compared to MWA [3.0 (2.1-4.3)] and non-migraineurs [1.9 (1.4-2.6)]. Angina with MWOA had a significant disability [1.5 (1.04-2.2)] compared to non-migraineurs.

Conclusion: SM and MWA had a significant role not only to predict AIS, TIA and angina but also increase disability. Early identification and management of these migraine subtypes may prevent VEs and mitigate disability associated with them.