Endemic brucellar epididymo-orchitis: a 10-year experience

Abstract

B. melitensis-induced epididymo-orchitis is a recognized clinical problem in endemic regions, requiring early detection and appropriate medication. Clinicians encountering epididymo-orchitis should consider the likelihood of brucellosis and initiate anti-Brucella medication upon clinical diagnosis and not only after serologic confirmation.

Brucella melitensis: a rarely suspected cause of infections of genitalia and the lower urinary tract

“…The demographic profile of the patients in this study was similar to those of groups of patients with BEO described elsewhere [15][16][17][18][19][20], however, the generally low median age of patients presenting BEO needs to be investigated. Although the impact of Brucella infection on the sexual functioning of our patients was not investigated, the relationship between brucellar epididymoorchitis and infertility reported in the study of Akinci et al [4] indicates that it should also be examined.…”

“…Since they were not hospitalized and therefore not promptly investigated, they might have been misdiagnosed as non-specific epididymo-orchitis. Both clinical and radiological characteristics of BEO have been previously reported [14,15]. Seasonal pattern, gradual onset, long duration, typical undulatory fever, absence of serious leukocytosis and lower urinary tract symptoms, and relatively minimal local signs of florid inflammation poses a clinical suspicion of BEO, while heterogenicity, focal echogenicity differences and hydrocele with granularity and/or septation on scrotal ultrasound raise the possibility of BEO rather than non-specific epididymo-orchitis.…”

“…Seasonal pattern, gradual onset, long duration, typical undulatory fever, absence of serious leukocytosis and lower urinary tract symptoms, and relatively minimal local signs of florid inflammation poses a clinical suspicion of BEO, while heterogenicity, focal echogenicity differences and hydrocele with granularity and/or septation on scrotal ultrasound raise the possibility of BEO rather than non-specific epididymo-orchitis. Only a few BEO series have been reported in sufficient detail to allow analysis and therefore to establish distinct diagnostic criteria [15][16][17][18][19][20]. Moreover, the above-mentioned characteristics are not always present in patients with BEO and therefore differential diagnosis between BEO and non-specific epididymo-orchitis is often difficult.…”

Brucellosis in Immunocompromised Hosts

“…It occurs predominantly in young individuals and it presents with testicular swelling or mass, abscess formation, testicular atrophy and pain which may be absent [179][180][181][182]. The typical features of Brucella-related EO include: presence of an occupational risk factor, seasonal incidence, gradual onset, long duration of clinical manifestations, typical undulant fever, absence of severe leukocytosis, absence of lower urinary tract symptoms, relatively minimal signs of florid inflammation, unilateral involvement in most cases and relapses which are rarely encountered [178,183,184]. Mild to moderate leukocytosis is usually present and CRP is usually elevated [178].…”

“…However, early detection and appropriate therapy of Brucella-related EO are essential and brucellosis should be considered as a possible cause of EO and testicular swellings [184]. Also, Brucella-related EO should be included in the differential diagnosis of testicular tumors in patients living in areas that are endemic for the disease [178][179][180][181][182][183] In patients with EO caused by brucellosis, conservative management in the form of combination of antibiotics is usually adequate [178,183,184].…”