Brucella epidydimo-orchitis successfully treated with dual oral drug regimen: A case report with differential diagnoses of malignancy and tuberculosis

Nahas, Renad S.; Alsulami, Abdulsalam; Lashkar, Manar O.; Thabit, Abrar K.

doi:10.1016/j.radcr.2022.07.012

Cited by 4 publications

(8 citation statements)

References 11 publications

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“…Ultrasonography serves as a highly accurate imaging modality for diagnosing testicular and scrotal pathology and plays a crucial role in evaluating testicular vascularity [28]. It can be used to confirm the diagnosis of scrotal infections with testicular causes, such as malignancy, abscesses and testicular torsion, which may present with similar clinical findings [4,19]. Furthermore, ultrasonography can reveal additional findings, including the presence of hydrocele, scrotal wall thickening, fistula formation, calcifications and abscess formation, which may manifest as avascular hypoechoic areas in the epididymis [20].…”

Section: Discussionmentioning

confidence: 99%

“…To date, there is no specific recommended regimen for the treatment of EO, leading to the utilization of the same regimen for uncomplicated brucellosis [19]. Multiple treatment regimens have been proposed for EO, with their selection based on the individual patient's baseline characteristics and clinical data [19,31,34].…”

Section: Discussionmentioning

confidence: 99%

“…A prior investigation conducted in a tertiary care hospital in Riyadh reported EO in 1.6% of patients with brucellosis [18]. Additional studies in Saudi Arabia have documented complications of brucellosis, including testicular abscess [17] and non-caseating granulomatous EO, with a focus on necrosis [19]. Therefore, healthcare practitioners encountering EO cases in endemic areas should be vigilant regarding the potential association with brucellosis [18].…”

Section: Introductionmentioning

confidence: 98%

“…Therefore, healthcare practitioners encountering EO cases in endemic areas should be vigilant regarding the potential association with brucellosis [18]. The differential diagnosis of an inflamed scrotum, a common urological emergency, remains a clinical challenge [2,19,20]. Nevertheless, it is crucial to highlight that delayed investigation and inappropriate management of EO can lead to various complications, including testicular abscess, atrophy, necrotizing orchitis, testicular infarction, atrophy and male infertility [2,18].…”

Section: Introductionmentioning

confidence: 99%

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Clinical characteristics, management, and treatment outcomes of epididymo-orchitis among patients in a referral hospital in Southern Saudi Arabia

2024

JOMH

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Epididymo-orchitis (EO) is a common genitourinary clinical syndrome in men, and delayed investigation and improper management can lead to complications. This study aimed to analyze clinical and laboratory findings and treatment outcomes in EO patients. We conducted a retrospective record-based study at King Abdullah Hospital in southern Saudi Arabia from 2018 to 2022, reviewing data from 63 EO patients who had a median age of 34 years (range: 16-82 years). The results showed that the most common complaints were scrotal pain and swelling (54%), followed by testicular pain (44.4%). Scrotal ultrasonography showed increased vascularity in both testes and epididymis in 49 patients (77.8%), while 14 patients (22.2%) had epididymal involvement alone. Reactive hydrocele was observed in 15 patients (23.8%), abscesses in seven (11.1%), and hypoechoic lesions in three (3.8%). Anti-Brucella antibody titers (≥1:80) were detected in 22 cases, and 14.3% had positive urine cultures. Of the patients, 87.3% responded well to the initial treatment course, while four (6.3%) were cured after a second course of treatment. EO complications occurred in three cases (4.8%), and one patient (1.6%) succumbed to septicemia. Of the 15 patients treated with ceftriaxone and ciprofloxacin, one required orchiectomy due to non-response. Relapse occurred in one of the 10 patients treated with triple therapy (doxycycline, rifampicin and gentamicin). Among the nine patients treated with ceftriaxone and co-trimoxazole, one did not respond, developed a testicular abscess, and underwent incision and drainage. In conclusion, our study highlights that most cases of EO can be effectively resolved with appropriate antibiotic therapy, particularly combinations containing cefuroxime and/or ciprofloxacin. Clinicians in Brucella-endemic regions should consider the possibility of brucellosis as an underlying cause of EO.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Clinical characteristics, management, and treatment outcomes of epididymo-orchitis among patients in a referral hospital in Southern Saudi Arabia

2024

JOMH

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“…In humans, acquiring the disease can occur through various routes, including contact with infected animals, consumption of contaminated animal products, and inhalation of airborne agents ( 6 ). The impact of brucellosis on human health is wide ranging, spanning from the characteristic undulant fever to more debilitating effects such as arthritis, orchitis, hepatitis, and endocarditis ( 7 – 11 ).…”

Section: Introductionmentioning

confidence: 99%

Contrasting roles for IgM and B-cell MHCII expression in Brucella abortus S19 vaccine-mediated efficacy against B. melitensis infection

Abushahba,

Dadelahi,

Ponzilacqua-Silva

et al. 2024

mSphere

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Brucella is a neglected zoonotic pathogen with a worldwide distribution. Our study delves into B-cell effector functions in live vaccine-mediated immunity against brucellosis. Notably, we found antibody production, particularly secretory IgM, confers protection against virulent Brucella melitensis in vaccinated mice, which was associated with complement activation. By contrast, B-cell MHCII expression negatively impacted vaccine efficacy. In addition, B-cell depletion after vaccination, but before the B. melitensis challenge, enhanced protection against infection, suggesting a detrimental B-cell role during the challenge phase. Interestingly, deficiency of T follicular helper cells, which are crucial for aiding germinal center B cells, dampened vaccine efficacy at later stages of challenge independent of antibody production. This study underscores contrasting and phase-dependent roles of B-cell effector functions in vaccine-mediated immunity against Brucella .

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Clinical insights: Brucellosis-induced febrile orchitis - A case report and treatment strategy

Golomb,

Bar,

Brosh-Nissimov

et al. 2024

Urology Case Reports

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Brucella epidydimo-orchitis successfully treated with dual oral drug regimen: A case report with differential diagnoses of malignancy and tuberculosis

Cited by 4 publications

References 11 publications

Clinical characteristics, management, and treatment outcomes of epididymo-orchitis among patients in a referral hospital in Southern Saudi Arabia

Clinical characteristics, management, and treatment outcomes of epididymo-orchitis among patients in a referral hospital in Southern Saudi Arabia

Contrasting roles for IgM and B-cell MHCII expression in Brucella abortus S19 vaccine-mediated efficacy against B. melitensis infection

Clinical insights: Brucellosis-induced febrile orchitis - A case report and treatment strategy

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