Epididymo-orchitis and epididymitis: a review of causes and management of unusual forms

Hagley, M T

doi:10.1258/095646203765371240

Cited by 18 publications

(14 citation statements)

References 28 publications

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“…1 Epididymitis represents a serious clinical condition and is characterized by inflammation and obstruction of sperm movement, resulting from the retrograde extension of microorganisms from the vas deferens. 4,5 If left untreated, the infection could lead to the formation of epididymal and testicular abscesses. 3 The incidence of epididymitis is approximately 600 000 cases per year in the United States, with the highest prevalence observed in young men aged 19-35 years.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 The infection can be the result of sexually transmitted pathogens such as Chlamydia, Neisseria gonorrohoea or of common pathogenic bacteria such as Escherichia coli. 4,6 A number of pattern recognition receptors, including Toll-like receptors (TLR) and nucleotide-binding oligomerization domain (NOD), play a pivotal role in mediating the innate host response to various infectious microorganisms. For example, cell surface TLR4 recognizes lipopolysaccharide (LPS), whereas intracellular Nod2 (CARD15) recognizes peptidoglycan-derived muramyl dipeptide (MDP), a component of Gram-positive and Gram-negative bacterial cell walls.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of epididymitis is approximately 600 000 cases per year in the United States, with the highest prevalence observed in young men aged 19–35 years 6,7 . The infection can be the result of sexually transmitted pathogens such as Chlamydia , Neisseria gonorrohoea or of common pathogenic bacteria such as Escherichia coli 4,6 …”

Section: Introductionmentioning

confidence: 99%

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Regulation and functional impact of lipopolysaccharide induced Nod2 gene expression in the murine epididymal epithelial cell line PC1

et al. 2008

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Summary Epididymitis represents a serious threat to male fertility and usually develops following secondary bacterial infection of the epididymis such as urinary tract infections or sexually transmitted diseases. Surprisingly, very little is known about the innate host response triggered by bacterial infection in the male reproductive tract. In this study we investigated the regulation and function of Nod2 in epididymal epithelial cells following lipopolysaccharide (LPS) stimulation. The immortalized epididymal epithelial cell line PC1 (proximal caput 1) constitutively expressed Toll‐like receptor 4, MD‐2, CD‐14 but not Nod2 messenger RNA. Lipopolysaccharide (LPS; 0·5 μg/ml) rapidly induced IκB phosphorylation and degradation, RelA nuclear translocation and phosphorylation, which correlated with enhanced transcriptional activity (four‐fold) in PC1 cells. The LPS and lipid A rapidly (1 hr) induced Nod2 messenger RNA accumulation in a dose‐dependent manner. RelA and RNApolII recruitment to the Nod2 gene promoter was enhanced in LPS‐stimulated cells. Molecular blockade of nuclear factor‐κB signalling with adenovirus 5 (Ad5) IκBAA or adenovirus 5 double‐negative (Ad5dn) IKKβ prevented LPS‐induced Nod2 gene expression. Functionally, Nod2 upregulation enhanced muramyl dipeptide (MDP) ‐induced tumour necrosis factor messenger RNA accumulation in PC1 cells. We conclude that epididymal epithelial cells mount an innate response following LPS exposure which leads to upregulation of Nod2 and enhanced responsiveness to the microbial product MDP. The rapid Nod2 upregulation in epididymal epithelial cells is probably part of a complex innate host response aimed at protecting the male reproductive tract from the deleterious impact of bacteria.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Regulation and functional impact of lipopolysaccharide induced Nod2 gene expression in the murine epididymal epithelial cell line PC1

et al. 2008

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“…Systemic fungal diseases can involve the epididymis or testis, including blastomycosis, histoplasmosis and coccidioidomycosis. Mycobacterium tuberculosis may also involve these sites [166]. Table X-3 summarizes the approaches to specimen management for cases of epididymitis and orchitis.…”

Section: Polymicrobial Infections Also Consider Submitting Prosthesismentioning

confidence: 99%

A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2013 Recommendations by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM)a

Baron

Miller

Weinstein

et al. 2013

Clinical Infectious Diseases

475

339

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The critical role of the microbiology laboratory in infectious disease diagnosis calls for a close, positive working relationship between the physician and the microbiologists who provide enormous value to the health care team. This document, developed by both laboratory and clinical experts, provides information on which tests are valuable and in which contexts, and on tests that add little or no value for diagnostic decisions. Sections are divided into anatomic systems, including Bloodstream Infections and Infections of the Cardiovascular System, Central Nervous System Infections, Ocular Infections, Soft Tissue Infections of the Head and Neck, Upper Respiratory Infections, Lower Respiratory Tract infections, Infections of the Gastrointestinal Tract, Intraabdominal Infections, Bone and Joint Infections, Urinary Tract Infections, Genital Infections, and Skin and Soft Tissue Infections; or into etiologic agent groups, including Tickborne Infections, Viral Syndromes, and Blood and Tissue Parasite Infections. Each section contains introductory concepts, a summary of key points, and detailed tables that list suspected agents; the most reliable tests to order; the samples (and volumes) to collect in order of preference; specimen transport devices, procedures, times, and temperatures; and detailed notes on specific issues regarding the test methods, such as when tests are likely to require a specialized laboratory or have prolonged turnaround times. There is redundancy among the tables and sections, as many agents and assay choices overlap. The document is intended to serve as a reference to guide physicians in choosing tests that will aid them to diagnose infectious diseases in their patients.

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“…Less commonly, systemic bacterial infections (eg, Mycobacterium tuberculosis, Haemophilus influenzae type B, Salmonella , and Brucella ) or nonbacterial infections (eg, Cytomegalovirus and Filariasis) may be responsible, particularly in children or immunocompromised individuals. Noninfectious causes of epididymitis include various medical procedures, the arrhythmia drug amiodarone, trauma, physical stress, vasectomy, urinary reflux, neoplasia, postinfectious and systemic inflammation, vasculitis, and autoimmunity (Hagley, 2003; Haidl et al, 2008; Trojian et al, 2009).…”

Section: The Effect Of Infection and Inflammation On The Testis And Ementioning

confidence: 99%

Immunophysiology and Pathology of Inflammation in the Testis and Epididymis

Hedger

2011

Journal of Andrology

178

155

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The ability of spermatogenic cells to evade the host immune system and the ability of systemic inflammation to inhibit male reproductive function represent two of the most intriguing conundrums of male reproduction. Clearly, an understanding of the underlying immunology of the male reproductive tract is crucial to resolving these superficially incompatible observations. One important consideration must be the very different immunological environments of the testis, where sperm develop, and the epididymis, where sperm mature and are stored. Compared with the elaborate blood-testis barrier, the tight junctions of the epididymis are much less effective. Unlike the seminiferous epithelium, immune cells are commonly observed within the epithelium, and can even be found within the lumen, of the epididymis. Crucially, there is little evidence for extended allograft survival (immune privilege) in the epididymis, as it exists in the testis, and the epididymis is much more susceptible to loss of immune tolerance. Moreover, the incidence of epididymitis is considerably greater than that of orchitis in humans, and susceptibility to sperm antibody formation after damage to the epididymis or vas deferens increases with increasing distance of the damage from the testis. Although we still know relatively little about testicular immunity, we know less about the interactions between the epididymis and the immune system. Given that the epididymis appears to be more susceptible to inflammation and immune reactions than the testis, and thereby represents the weaker link in protecting developing sperm from the immune system, it is probably time this imbalance in knowledge was addressed.

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Epididymo-orchitis and epididymitis: a review of causes and management of unusual forms

Cited by 18 publications

References 28 publications

Regulation and functional impact of lipopolysaccharide induced Nod2 gene expression in the murine epididymal epithelial cell line PC1

Regulation and functional impact of lipopolysaccharide induced Nod2 gene expression in the murine epididymal epithelial cell line PC1

A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2013 Recommendations by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM)a

Immunophysiology and Pathology of Inflammation in the Testis and Epididymis

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