Brucellar epididymo‐orchitis in Saudi Arabia: a retrospective study of 26 cases and review of the literature

Abstract

Objective To review the clinical and laboratory features and response to treatment of patients with acute brucellar epididymo‐orchitis reporting to a tertiary care hospital in Riyadh, and to compare these with other cases reported previously. Patients and methods In this retrospective study, records of all 26 adult patients with brucellosis, who presented with epididymitis or epididymo‐orchitis at a tertiary hospital in Riyadh from 1983 to 2000, were reviewed. Positive blood culture or high agglutination titres of 1 : 320 and positive clinical manifestations of brucellosis were the main criteria for diagnosing brucellosis. Among these cases, epididymitis or epididymo‐orchitis was diagnosed on the basis of a typical history of gradual onset of scrotal pain and findings of enlarged tender testes and/or epididymis. Results Epididymo‐orchitis occurred in 1.6% of all patients with brucellosis. Most (58%) were 25–44 years old; ≈ 77% of the patients presented with acute symptoms of < 2 weeks' duration. All patients complained of swollen painful testicles. Other presenting symptoms included undulant fever (96%), chills (54%) and arthralgia (23%). Four patients had dysuria and one haematuria. Ten patients gave a positive history of ingestion of raw milk and milk products; one patient had laboratory‐acquired brucellosis. Six patients had unilateral epididymo‐orchitis (two with features of florid presentation); the remaining 20 had only orchitis (bilateral in two, right in 10 and left in eight). Leucocytosis was present in six patients; 25 had initial agglutination titres of > 1 : 320 and the remaining patient had a positive blood culture. All patients received combined therapy with streptomycin for the first 2 weeks (or oral rifampicin for 6 weeks) with doxycycline or tetracycline for 6 weeks. All showed improvement, fever subsided in 2–5 days and the scrotal enlargement and tenderness regressed. Only one patient had a relapse within one year. Conclusion In brucellosis‐endemic areas, clinicians encountering epididymo‐orchitis should consider the likelihood of brucellosis. A careful history, a meticulous physical examination and a rapid laboratory evaluation help in diagnosis. Clinical and serological data are sufficient for diagnosis. Leucocytosis is not an atypical feature of brucellar epididymo‐orchitis and so cannot be used for differentiating it from the nonspecific variety. Conservative management with combination antibiotic therapy is adequate for managing brucellar epididymo‐orchitis.

Clinical Manifestations and Laboratory Findings of Brucellosis at Boo-Ali-Siena Hospital of Ghazvin Province of Iran

“…This finding was comparable with previous studies, which reported the incidence of epididymo-orchitis from 1.6% to 17% (17,18). Inappropriate diagnosis and treatment of epididymo-orchitis may cause significant complications, such as testicular abscess formation, infarction, atrophy, and superlative necrosis (19,20).…”

Two cases of brucellosis epididymo-orchitis

“…Though it is an occupational risk especially for workers of animal husbandry, the whole population may be under risk in countries with poor food hygiene and sanitation. Main routes of transmission from animals to humans include direct contact with infected animals or its abort material, and by ingestion of unpasteurized or raw dairy products [1,2,4].…”

“…BEO, acute or chronic, usually appears as a unilateral testicular swelling. Its differential diagnosis may be troublesome with regard of other scrotal pathologies [4,6]. Brucella orchitis mimics testicular malignancy or tuberculosis [4].…”

“…Its differential diagnosis may be troublesome with regard of other scrotal pathologies [4,6]. Brucella orchitis mimics testicular malignancy or tuberculosis [4]. Because of the uneasy differential, cases diagnosed only after radical orchiectomy were reported in the literature [6].…”

“…Non-specific lab findings include increased CRP and ESR; AST and ALT abnormalities, and sometimes anemia, leukopenia, leukocytosis and thrombocytopenia may occur [4]. Memish and Venkatesh reported that 23% of BEO cases had leukocyte count of upper than 10.000/mm3, 31% had ESR of upper than 40 mm/hour.…”