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BMJ Case Reports Feb 2019Testicular tuberculosis (TB) is rare, and, because of this, the lack of pathognomonic clinical features and its tendency to mimic other commoner conditions, the...
Testicular tuberculosis (TB) is rare, and, because of this, the lack of pathognomonic clinical features and its tendency to mimic other commoner conditions, the diagnosis is frequently delayed or may be missed. In this case, the initial clinical presentation was typical for bacterial epididymo-orchitis in a 38-year-old man. When the patient failed to improve with standard treatment including broadening of antibiotics, the diagnosis was re-considered because some unusual signs suggested testicular malignancy or lymphoma. Further, history-taking and subsequent cross-sectional imaging with CT/MRI identified co-existent pulmonary nodularity, thoracic and abdominal lymphadenopathy and bony changes that, together, raised the suspicion of TB. was confirmed on DNA-based testing of the hydrocele fluid, although standard acid-fast bacilli culture was negative. This case prompted a review of the literature to explore the optimal steps in the investigation and diagnosis of this rare disease.
Topics: Abdominal Cavity; Adult; Antitubercular Agents; Diagnosis, Differential; Epididymitis; Humans; Lymphadenopathy; Magnetic Resonance Imaging; Male; Mycobacterium tuberculosis; Orchitis; Pain; Testicular Diseases; Testicular Hydrocele; Testis; Tomography, X-Ray Computed; Treatment Outcome; Tuberculosis, Urogenital
PubMed: 30787023
DOI: 10.1136/bcr-2018-226697 -
Critical Reviews in Microbiology Feb 2022Brucellosis is a worldwide zoonotic disease caused by spp. Human infection often results from direct contact with tissues from infected animals or by consumption of... (Review)
Review
Brucellosis is a worldwide zoonotic disease caused by spp. Human infection often results from direct contact with tissues from infected animals or by consumption of undercooked meat and unpasteurised dairy products, causing serious economic losses and public health problems. The male genitourinary system is a common involved system in patients with brucellosis. Among them, unilateral orchitis and epididymitis are the most common. Although the clinical and imaging aspect of orchi-epididymitis caused by brucellosis have been widely described, the cellular and molecular mechanisms involved in the damage and the immune response in testis and epididymis have not been fully elucidated. In this review, we first summarised the clinical characteristics of epididymo-orchitis and the composition of testicular and epididymal immune system. Secondly, with regard to the mechanism of epididymoorchitis, we mainly discussed the process of invading testis and epididymis in temporal and spatial order, including i) evades innate immune recognition of testicular PRRs;ii) overcomes the immune storm triggered by the invasion of testis through bacterial lipoproteins and virulence factors, and changes the secretion mode of cytokines; iii) breaks through the blood-testis barrier with the help of macrophages, and inflammatory cytokines promote the oxidative stress of Sertoli cells, damaging the integrity of BTB; iv) inhibits apoptosis of testicular phagocytes. Finally, we revealed the structure and sequence of testis invaded by at the tissue level. This review will enable us to better understand the pathogenesis of orchi-epididymitis caused by brucellosis and shed light on the development of new treatment strategies for the treatment of brucellosis and the prevention of transition to chronic form. Facing the testicle with immunity privilege, is like Bruce Lee in the movie , winning is survival while losing is death.HIGHLIGHTSWe summarized the clinical features and pathological changes of epididymoorchitis.Our research reveals the pathogenesis of epididymoorchitis, which mainly includes the subversion of testicular immune privilege by and a series of destructive reactions derived from it.As a basic framework and valuable resource, this study can promote the exploration of the pathogenesis of and provide reference for determining new therapeutic targets for brucellosis in the future.
Topics: Animals; Brucella; Brucellosis; Epididymitis; Humans; Male; Orchitis; Zoonoses
PubMed: 34214000
DOI: 10.1080/1040841X.2021.1944055 -
Journal of the College of Physicians... Apr 2020To find parameters for differential diagnosis between Brucella epididymo-orchitis (BEO) and non-brucella epididymo-orchitis (NBEO) cases with comparison of BEO and...
OBJECTIVE
To find parameters for differential diagnosis between Brucella epididymo-orchitis (BEO) and non-brucella epididymo-orchitis (NBEO) cases with comparison of BEO and NBEO in terms of inflammatory markers, full urinalysis (FU) for pyuria, and abscess formation (AF).
STUDY DESIGN
Descriptive study.
PLACE AND DURATION OF STUDY
Agri State Hospital Urology and Infectious Disease Clinics, between January 2014 and November 2017.
METHODOLOGY
Data of the patients, who were diagnosed with epididymo-orchitis, were divided in BEO and NBEO groups on the basic of serum agglutination test. Parameters including age, white blood cell neutrophil, lymphocyte, monocyte, platelet, mean platelet volume, C-reactive protein (CRP), neutrophil/lymphocyte ratio, monocyte/lymphocyte ratio, platelet / lymphocyte ratio, and FU. The values were statistically compared.
RESULTS
One hundred and thirty-eight (138) patients were found eligible for the study. Twenty-three (23) of these patients (16.66%) had BEO, and 115 (83.33%) had NBEO. BEO vs. NBEO cases were significantly different regarding mean age (26.17 ±8.15 vs. 48.53 ±21.78 years, p=0.0001) and frequency of pyuria (3,13.04%) vs. 89 (77.39%, p=0.001). However CRP values i.e. 6.07 ±6.59 vs. 6.07 ±5.85 mg/dl (p=0.999) was not significantly different.
CONCLUSION
BEO cases are often younger and do not have pyuria or abscess formation. High frequency of pyuria was found in NBEO cases. CRP levels cannot be used in the differential diagnosis between BEO and NBEO cases. Key Words: Abscess formation, Brucella epididymo-orchitis, C-reactive protein, Orchiectomy, Pyuria.
Topics: Brucella; Brucellosis; Epididymitis; Humans; Male; Orchitis; Retrospective Studies
PubMed: 32513361
DOI: 10.29271/jcpsp.2020.04.403 -
Frontiers in Immunology 2020Infection and inflammation of the male reproductive tract are relevant causes of infertility. Inflammatory damage occurs in the special immunosuppressive... (Review)
Review
Infection and inflammation of the male reproductive tract are relevant causes of infertility. Inflammatory damage occurs in the special immunosuppressive microenvironment of the testis, a hallmark termed testicular immune privilege, which allows tolerance to neo-antigens from developing germ cells appearing at puberty, long after the establishment of systemic immune tolerance. Experimental autoimmune orchitis (EAO) is a well-established rodent model of chronic testicular inflammation and organ specific autoimmunity that offers a valuable tool to investigate the pathological and molecular mechanisms leading to the breakdown of the testicular immune privilege. The disease is characterized by the infiltration of the interstitium by immune cells (mainly macrophages, dendritic cells, and T cells), formation of autoantibodies against testicular antigens, production of pro-inflammatory mediators such as NO, MCP1, TNFα, IL6, or activins and dysregulation of steroidogenesis with reduced levels of serum testosterone. EAO leads to sloughing of germ cells, atrophic seminiferous tubules and fibrotic remodeling, parameters all found similarly to changes in human biopsies from infertile patients with inflammatory infiltrates. Interestingly, testosterone supplementation during the course of EAO leads to expansion of the regulatory T cell population and inhibition of disease development. Knowledge of EAO pathogenesis aims to contribute to a better understanding of human testicular autoimmune disease as an essential prerequisite for improved diagnosis and treatment.
Topics: Animals; Autoimmune Diseases; Humans; Male; Orchitis
PubMed: 33101310
DOI: 10.3389/fimmu.2020.583135 -
EMBO Molecular Medicine Feb 2024Inflammation in the testes induced by infection and autoimmunity contributes significantly to male infertility, a public health issue. Current therapies using...
Inflammation in the testes induced by infection and autoimmunity contributes significantly to male infertility, a public health issue. Current therapies using antibiotics and broad-spectrum anti-inflammatory drugs are ineffective against non-bacterial orchitis and induce side effects. This highlights the need to explore the pathogenesis of orchitis and develop alternative therapeutic strategies. In this study, we demonstrated that Gasdermin D (GSDMD) was activated in the testes during uropathogenic Escherichia coli (UPEC)-induced acute orchitis, and that GSDMD in macrophages induced inflammation and affected spermatogenesis during acute and chronic orchitis. In testicular macrophages, GSDMD promoted inflammation and antigen presentation, thereby enhancing the T-cell response after orchitis. Furthermore, the pharmacological inhibition of GSDMD alleviated the symptoms of UPEC-induced acute orchitis. Collectively, these findings provide the first demonstration of GSDMD's role in driving orchitis and suggest that GSDMD may be a potential therapeutic target for treating orchitis.
Topics: Male; Humans; Orchitis; Gasdermins; Antigen Presentation; Inflammation; Macrophages; Pyroptosis
PubMed: 38177538
DOI: 10.1038/s44321-023-00016-8 -
Reproductive Toxicology (Elmsford, N.Y.) Jan 2023Busulfan is an alkylating agent commonly used in cancer chemotherapy. It is also an ideal agent for preparing transplant recipients of spermatogonial stem cells because... (Review)
Review
Busulfan is an alkylating agent commonly used in cancer chemotherapy. It is also an ideal agent for preparing transplant recipients of spermatogonial stem cells because of its high efficiency in destroying endogenous germ cells in the testis. However, its toxicity mechanism remains unclear, affecting its clinical use and applications. Based on reports of busulfan causing orchitis and a previous study by our team, this article summarizes the relationship between busulfan and orchitis, cytokines, the blood-testis barrier, and the cytoskeleton, unravels the regulatory pathways and mechanism behind busulfan-induced orchitis, and reveals the molecular mechanism underlying impaired spermatogenic function in orchitis, providing new ideas for the clinical application of busulfan while reducing its testicular toxicity.
Topics: Male; Humans; Busulfan; Spermatogonia; Orchitis; Testis; Infertility, Male
PubMed: 36372306
DOI: 10.1016/j.reprotox.2022.11.002 -
AJR. American Journal of Roentgenology Jun 2021
Topics: Abdomen; Epididymitis; Humans; Male; Orchitis; Pelvis
PubMed: 33852338
DOI: 10.2214/AJR.21.25537 -
Andrologia Feb 2021COVID-19 pandemic leads to health challenges globally, and its diverse aspects need to be uncovered. Multi-organ injuries have been reported by describing potential... (Review)
Review
COVID-19 pandemic leads to health challenges globally, and its diverse aspects need to be uncovered. Multi-organ injuries have been reported by describing potential SARS-CoV-2 entrance routes: ACE2 and TMPRSS2. Since these cell surface receptors' expression has been disclosed within the male reproductive system, its susceptibility to being infected by SARS-CoV-2 has been summarised through this literature review. Expression of ACE2 and TMPRSS2 at RNA or protein level has been reported across various investigations indicates that the male genitalia potentially is vulnerable to SARS-CoV-2 infection. Presence of SARS-CoV-2 within semen samples and following direct viral damage, secondary inflammatory response causing orchitis or testicular discomfort and finally the amount of viral load leading testicular damage and immune response activation are among probable underlying mechanisms. Therefore, genital examination and laboratory tests should be considered to address the male reproductive tract complications and fertility issues.
Topics: Angiotensin-Converting Enzyme 2; COVID-19; Genitalia, Male; Humans; Infertility, Male; Male; Orchitis; RNA, Messenger; SARS-CoV-2; Semen; Serine Endopeptidases; Spike Glycoprotein, Coronavirus; Testis
PubMed: 33236375
DOI: 10.1111/and.13914 -
Der Urologe. Ausg. A Jul 2016Infections in the urogenital tract are accepted causes of male infertility. Epidemiologic data indicate 6-10 % of all males undergoing andrological work-up for... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Infections in the urogenital tract are accepted causes of male infertility. Epidemiologic data indicate 6-10 % of all males undergoing andrological work-up for infertility having an infectious etiology.
TOPICS
This review gives a comprehensive overview on the most important urogenital tract infections (prostatitis, epididymitis, orchitis, male accessory gland infection-MAGI) and the impact on fertility. In males suffering infertility, evidence is also presented regarding an infectious etiology.
Topics: Causality; Comorbidity; Genital Diseases, Male; Humans; Incidence; Infertility, Male; Male; Risk Factors; Urinary Tract Infections
PubMed: 27335094
DOI: 10.1007/s00120-016-0151-0 -
Proceedings of the National Academy of... Nov 2021Inflammation in the epididymis and testis contributes significantly to male infertility. Alternative therapeutic avenues treating epididymitis and orchitis are expected...
Inflammation in the epididymis and testis contributes significantly to male infertility. Alternative therapeutic avenues treating epididymitis and orchitis are expected since current therapies using antibiotics have limitations associated to side effects and are commonly ineffective for inflammation due to nonbacterial causes. Here, we demonstrated that type 1 parathyroid hormone receptor (PTH1R) and its endogenous agonists, parathyroid hormone (PTH) and PTH-related protein (PTHrP), were mainly expressed in the Leydig cells of testis as well as epididymal epithelial cells. Screening the secretin family G protein-coupled receptor identified that PTH1R in the epididymis and testis was down-regulated in mumps virus (MuV)- or lipopolysaccharide (LPS)-induced inflammation. Remarkably, activation of PTH1R by abaloparatide (ABL), a Food and Drug Administration-approved treatment for postmenopausal osteoporosis, alleviated MuV- or LPS-induced inflammatory responses in both testis and epididymis and significantly improved sperm functions in both mouse model and human samples. The anti-inflammatory effects of ABL were shown to be regulated mainly through the Gq and β-arrestin-1 pathway downstream of PTH1R as supported by the application of ABL in and mouse models. Taken together, our results identified an important immunoregulatory role for PTH1R signaling in the epididymis and testis. Targeting to PTH1R might have a therapeutic effect for the treatment of epididymitis and orchitis or other inflammatory disease in the male reproductive system.
Topics: Animals; Epididymitis; GTP-Binding Protein alpha Subunits, Gq-G11; Infertility, Male; Lipopolysaccharides; Male; Mice, Inbred C57BL; Mumps virus; Orchitis; Receptor, Parathyroid Hormone, Type 1; beta-Arrestin 1; Mice
PubMed: 34740971
DOI: 10.1073/pnas.2107363118