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European Journal of Case Reports in... 2024Epididymitis is a common cause of scrotal pain in adults, with coliform bacteria being the most common isolated organisms in patients older than 35.
BACKGROUND
Epididymitis is a common cause of scrotal pain in adults, with coliform bacteria being the most common isolated organisms in patients older than 35.
CASE PRESENTATION
A 51-year-old healthy patient presented with scrotal pain and swelling, and was found to have epididymo-orchitis and bacteraemia caused by , which has not previously been reported as a cause of epididymo-orchitis and bacteraemia in immunocompetent patients.
DISCUSSION
Diagnostic studies can help confirm the diagnosis and detect the causative pathogen. In all suspected cases, a urinalysis, urine culture and a urine or urethral swab for nucleic acid amplification tests (NAATs) for and should be performed. Colour Doppler ultrasonography often shows an enlarged thickened epididymis with increased Doppler wave pulsation in epididymitis. are pleomorphic gram-negative rods that commonly colonise the human respiratory tract and are associated with a number of clinical conditions. has been reported as a cause of epididymo-orchitis in prepubertal boys, and in few cases were associated with positive blood cultures. In adults, has been isolated before from urine samples or urethral swabs in patients with epididymitis or epididymo-orchitis.
CONCLUSION
This case highlights the possibility of causing epididymo-orchitis and bacteraemia in immunocompetent patients. Healthcare providers should consider in the differential diagnosis of epididymitis and epididymo-orchitis in both immunocompetent and immunocompromised patients.
LEARNING POINTS
can cause epididymo-orchitis and bacteraemia in immunocompetent patients. This has not been previously reported. should be considered in the differential diagnosis of epididymitis and epididymo-orchitis in both immunocompromised and immunocompetent patients.Healthcare providers should be aware of the increasing incidence of epididymitis and epididymo-orchitis caused by non-coliform bacteria in patients older than 35 years, especially in immunocompromised patients.
PubMed: 38223271
DOI: 10.12890/2023_004205 -
Medecine Tropicale Et Sante... Mar 2024Brucellosis in marine mammals (cetacean and pinnipeds) has emerged in a very significant way during the last two decades. Currently and are the two recognized species... (Review)
Review
INTRODUCTION
Brucellosis in marine mammals (cetacean and pinnipeds) has emerged in a very significant way during the last two decades. Currently and are the two recognized species in marine mammals, but available information is still limited. Several genotypes have been identified, and studies on the relationship between sequence type (ST) and organ pathogenicity or tropism have indicated differences in pathogenesis between sequences in cetaceans. The zoonotic potential of this disease is based on the identification of the main sources of introduction and spread of spp. in the marine environment as well as on the factors of exposure of marine mammals and humans to the bacteria.
BIBLIOGRAPHIC REVIEW
This article is a bibliographical review on marine mammal brucellosis, including the features, sources and transmission modes of each species, as well as their potential pathogenicity in animals and humans.
CONCLUSION
Different genotypes of marine spp have been isolated from marine mammal species but without any evidence of pathology induced by these bacteria. Associated lesions are variable and include subcutaneous abscesses, meningo-encephalomyelitis, pneumonia, myocarditis, osteoarthritis, orchitis, endometritis, placentitis and abortion. The isolation of marine spp from marine mammal respiratory parasites associated to lung injury has raised the intriguing possibility that they may serve as a vector for the transmission of this bacterium.The severity of marine spp remains unknown due to the lack of an estimate of the prevalence of this disease in marine mammals. The number of suspected human cases is still very limited. However, by analogy with other germs of the genus responsible for abortion in ruminants and for a febrile and painful state in human beings, prevention measures are essential. The significant increase in the number of strandings coupled with a high seroprevalence in certain species of marine mammals must be considered for people in direct or indirect contact with these animals. Ongoing epidemiological monitoring combined with extensive post-mortem examinations (necropsy, bacteriology and sequencing) of all species of stranded marine mammals would deepen knowledge on the zoonotic potential of marine species.
Topics: Animals; Brucellosis; Humans; Brucella; Cetacea; Caniformia; Zoonoses
PubMed: 38846127
DOI: 10.48327/mtsi.v4i1.2024.489 -
American Journal of Transplantation :... Dec 2023In 2022, the largest global outbreak of mpox to date emerged. In the immunocompetent host, mpox generally presents as a self-limiting illness. However,... (Review)
Review
In 2022, the largest global outbreak of mpox to date emerged. In the immunocompetent host, mpox generally presents as a self-limiting illness. However, immunosuppression, such as that seen with advanced HIV, has been associated with significant morbidity and mortality related to mpox infection. To evaluate the impact of immunosuppression related to solid organ transplantation on clinical features and outcomes of mpox we established a multicenter case registry. Eleven cases from 7 participating centers in the USA were submitted. All cases occurred in males. The majority were kidney transplant recipients (91%, n = 10). Median duration of symptoms at presentation was 6 days (range, 3-14 days). Rates of hospitalization were high (73%, n = 8) with a median length of stay of 4.5 days (range, 1-10 days). Mpox in solid organ transplant recipients was associated with a high burden of skin lesions and systemic symptoms. Fever, fatigue, pharyngitis, and proctitis were commonly reported. Other clinical features included headache, myalgia, epididymo-orchitis, urinary retention, hematemesis, pneumonitis, and circulatory shock. All patients received treatment with tecovirimat. There was 1 mpox-related death in the cohort. Infection was reported to have resolved at 30-day follow-up in all other cases.
Topics: Male; Humans; Mpox (monkeypox); Organ Transplantation; Hospitalization; Immunosuppression Therapy; Fever; Transplant Recipients; Multicenter Studies as Topic
PubMed: 37516243
DOI: 10.1016/j.ajt.2023.07.016 -
Journal of Clinical Ultrasound : JCU Apr 2024The aim of this study was to investigate the relationship between left-sided varicocele and epididymitis or epididymo-orchitis.
OBJECTIVE
The aim of this study was to investigate the relationship between left-sided varicocele and epididymitis or epididymo-orchitis.
MATERIALS AND METHODS
The study included 72 patients with left side epididymitis (EP) or epididymo-orchitis (EPO) (Group 1) and a control group of 72 patients without EP or EPO (Group 2). Those with right EP-EPO were excluded due to possible other underlying retroperitoneal pathologies causing varicocele. Groups were evaluated for presence of left side varicocele, varicocele grade and pampiniform plexus vein diameter.
RESULTS
The average age was 38 ± 8.4 years (range, 18-50 years) in Group 1, and 36 ± 9.1 years (range, 16-47 years) in Group 2. Varicocele was significantly more common in patients with EP or EPO (p < .001). The rate of varicocele was 66.7% (48/72) in Group 1, and 22.3% (16/72) in Group 2. The median grade of varicocele was 2 in Group 1, and 0 in Group 2. Pampiniform plexus vein diameters were found to be significantly larger in patients with EP or EPO compare to patients without EP and EPO. The median vein diameter was 3.3 mm with the 25th and 75th percentiles at 2.7 and 3.8 mm, and was 1.9 mm with the 25th and 75th percentiles at 1.7 and 2.3 mm, respectively (p < .001).
CONCLUSIONS
Left-sided varicocele was significantly more common in patients with EP or EPO and it is an important cause for the development of EP/EPO because of chronic venous stasis.
PubMed: 38651691
DOI: 10.1002/jcu.23694 -
Urology Mar 2024
Topics: Male; Humans; Orchitis; Anti-Bacterial Agents; Epididymitis
PubMed: 38110125
DOI: 10.1016/j.urology.2023.12.004 -
Infectious Diseases & Clinical... Dec 2023Brucellosis is one of the most prevalent zoonoses worldwide and is endemic in Türkiye. It is a multisystemic infection that can affect various organ systems....
OBJECTIVE
Brucellosis is one of the most prevalent zoonoses worldwide and is endemic in Türkiye. It is a multisystemic infection that can affect various organ systems. Epididymo-orchitis is the most common form of genitourinary involvement. This study aimed to evaluate the incidence, clinical characteristics, laboratory values, and treatment outcomes of brucellar epididymo-orchitis (BEO) in the East Anatolian region, where brucellosis is hyperendemic.
MATERIALS AND METHODS
This study was conducted between January 1, 2018, and April 30, 2019. All male patients diagnosed with brucellosis at the infectious disease clinic were evaluated for epididymo-orchitis according to clinical findings (testicular pain, swelling, erythema). In addition, to identify BEO patients, all epididymo-orchitis cases admitted to the urology outpatient clinic according to the study protocol were referred to the infectious diseases clinic for infection. Patients were enrolled prospectively, and data were analyzed retrospectively.
RESULTS
infection was diagnosed in 326 patients during the study period, of whom 208 (63.8%) were male. Brucellar epididymo-orchitis was diagnosed in 18 patients at the end of sixteen months. The incidence of epididymo-orchitis in patients with infection was 8.7%. The mean age of the patients was 36.9±11.5 years. The majority of patients had occupational animal contact (83.3%) and consumption of fresh cheese made from raw milk (55.5%). Acute brucellosis was diagnosed in 17 (94.4%) patients; all patients presented with scrotal pain and swelling. Unilateral epididymo-orchitis was observed in 16 (88.8%) patients. Most patients (88.3%) applied to outpatient clinics other than infectious diseases, especially the urology clinic (77.7%).Double or triple combined treatments with aminoglycoside/doxycycline/rifampicin were given to the patients. Hydrocelectomy was performed in three patients, orchiectomy in one patient, and relapse was seen in one patient.
CONCLUSION
infection should be considered in patients presenting with epididymo-orchitis in endemic regions. Awareness of brucellosis by urologists will ensure that the disease is diagnosed without complications.
PubMed: 38633857
DOI: 10.36519/idcm.2023.253 -
Cureus Apr 2024Even though infected vasitis is rarely reported in the literature, there are other diagnoses that share the same clinical signs, including testicular torsion,...
Even though infected vasitis is rarely reported in the literature, there are other diagnoses that share the same clinical signs, including testicular torsion, epididymo-orchitis, epididymitis, trauma, and incarcerated hernia. A 27-year-old man was brought to the emergency department by his brother with right inguinal and testicular pain for one day. The history was not significant with fever, lower urinary tract symptoms, urethral discharge, change in bowel habits, previous history of inguinal swelling, or surgical intervention. On presentation, the patient was vitally stable, and right infra-inguinal and inguinal vas deferens were tender and swollen; however, both testes and epididymis were normal, and no urethral discharge. Vasitis, or inflammation of the vas deferens, is an uncommon illness that Chan PT and Schlegel classified as either asymptomatic vasitis nodosa or severely painful infectious vasitis. Acute infective vasitis is a really uncommon illness, with only a few occurrences documented in the literature. However, the retrograde transmission of urinary pathogens such as and is thought to cause acute vasitis. Because of its rarity and ambiguous imaging findings, diagnosing vasitis can be difficult. Epididymitis, orchitis, and testicular torsion can all be ruled out with ultrasound and duplex Doppler screening. Inguinal hernia is difficult to distinguish from vasitis with ultrasound; hence, CT and MRI are more commonly used to confirm the diagnosis. Since this is the first occurrence in our city that we are aware of, it was reported. A few cases from Saudi Arabia have also been documented, and by doing so, we may raise clinicians' awareness of this disease and ensure that they can treat patients without making an incorrect diagnosis.
PubMed: 38784330
DOI: 10.7759/cureus.58785 -
Urology Case Reports Sep 2023Contemporary chemotherapy regimens have led to improved survival and decreased incidence of testicular relapse for pediatric patients with acute lymphoblastic leukemia...
Contemporary chemotherapy regimens have led to improved survival and decreased incidence of testicular relapse for pediatric patients with acute lymphoblastic leukemia (ALL). Local therapies to the testes, such as radiotherapy and orchiectomy, are often not necessary given that high-dose chemotherapy agents can overcome the relative blood-testis barrier. However, urologists should be aware of clinical scenarios involving ALL which still warrant testicular biopsy to guide management. Here, we present a case of a 12-year-old boy with high-risk pre-B cell ALL presenting with a testicular relapse and a clinical presentation overlapping with non-infectious epididymo-orchitis.
PubMed: 37416750
DOI: 10.1016/j.eucr.2023.102449 -
Radiologie (Heidelberg, Germany) Jan 2024Ultrasound, the imaging method of choice to evaluate abnormalities of the testes and the scrotum, provides accurate anatomic details and allows the assessment of... (Review)
Review
BACKGROUND
Ultrasound, the imaging method of choice to evaluate abnormalities of the testes and the scrotum, provides accurate anatomic details and allows the assessment of perfusion using color Doppler and power Doppler. Ultrasound represents a rapid and reliable procedure which in most cases leads to a conclusive diagnosis.
DIFFERENTIAL DIAGNOSIS
The three most common conditions in the clinical picture of acute scrotum are testicular torsion, torsion of the testicular appendages and inflammatory changes of the testis and the epididymis (epididymo-orchitis). Especially in the case of testicular torsion, rapid diagnosis is essential since time is an important factor to initiate organ-preserving therapy.
EQUIPMENT TECHNOLOGY
High-frequency linear array transducer (at least 10 MHz), which allows detection of slow flow rates, is recommended.
Topics: Child; Male; Humans; Adolescent; Testis; Spermatic Cord Torsion; Acute Disease; Ultrasonography; Ultrasonography, Doppler, Color
PubMed: 37853238
DOI: 10.1007/s00117-023-01220-w -
Biology Apr 2024Experimental autoimmune orchitis (EAO) is a well-established rodent model of organ-specific autoimmunity associated with infertility in which the testis...
Experimental autoimmune orchitis (EAO) is a well-established rodent model of organ-specific autoimmunity associated with infertility in which the testis immunohistopathology has been extensively studied. In contrast, analysis of testis biopsies from infertile patients associated with inflammation has been more limited. In this work, testicular biopsies from patients with idiopathic non-obstructive azoospermia diagnosed with hypospermatogenesis (HypoSp) [mild: = 9, and severe: = 11], with obstructive azoospermia and complete Sp (spermatogenesis) (control group, C, = 9), and from Sertoli cell-only syndrome (SCOS, = 9) were analyzed for the presence of immune cells, spermatogonia and Sertoli cell (SCs) alterations, and reproductive hormones levels. These parameters were compared with those obtained in rats with EAO. The presence of increased CD45+ cells in the seminiferous tubules (STs) wall and lumen in severe HypoSp is associated with increased numbers of apoptotic meiotic germ cells and decreased populations of undifferentiated and differentiated spermatogonia. The SCs showed an immature profile with the highest expression of AMH in patients with SCOS and severe HypoSp. In SCOS patients, the amount of SCs/ST and Ki67+ SCs/ST increased and correlated with high serum FSH levels and CD45+ cells. In the severe phase of EAO, immune cell infiltration and apoptosis of meiotic germ cells increased and the number of undifferentiated and differentiated spermatogonia was lowest, as previously reported. Here, we found that orchitis leads to reduced sperm number, viability, and motility. SCs were mature (AMH-) but increased in number, with Ki67+ observed in severely damaged STs and associated with the highest levels of FSH and inflammatory cells. Our findings demonstrate that in a scenario where a chronic inflammatory process is underway, FSH levels, immune cell infiltration, and immature phenotypes of SCs are associated with severe changes in spermatogenesis, leading to azoospermia. Furthermore, AMH and Ki67 expression in SCs is a distinctive marker of severe alterations of STs in human orchitis.
PubMed: 38666890
DOI: 10.3390/biology13040278