Clinical and therapeutic insights into brucellar epididymo-orchitis: a retrospective analysis in a brucellosis endemic area

Perspectivas clínicas y terapéuticas sobre la orquiepididimitis brucelar: un análisis retrospectivo en una zona endémica de brucellosis

Background: Brucellosis is an endemic, occupational and travellers' zoonotic disease. Involvement of testis and epididymis can occur in acute and chronic forms of systemic brucellosis. If the diagnosis and treatment is delayed, young men may suffer with complications resulting in permanent damage to reproductive system and infertility. This study gives an insight into clinical and therapeutic approaches used in brucellar endemic area and also highlight clues that can help in early detection of Brucellar epididymo-orchitis. Methods: This is retrospective, hospital record-based study. After ethical approval and record de-identification, data from Urology clinic of King Abdullah hospital, Bisha was collected for 2 years. All cases presenting with swelling or pain in scrotal region with suggestive radiological features of epididymo-orchitis and brucellar antibody titre ≥1:160 were included in our study. Results: Brucella contributed to 18 (30.51%) of epididymo-orchitis cases during study period. Young men were affected with mean age ± standard deviation (SD) 36.78 ± 7.93. History of animal contact and ingestion of unpasteurized dairy products was positive in all cases. Most common presenting symptoms were scrotal pain (18, 100%), swelling (10, 55.56%) and fever (8, 44.44%) with an average duration of 20 days. Leukocytosis with lymphocytic predominance was observed. All patients were treated medically with no complications and unremarkable follow up. Conclusions: Brucellar epididymo-orchitis must be considered by physicians in patients with prolong duration of illness, systemic symptoms and relative lymphocytosis. Strict follow up for compliance to therapy, relapse and complication is needed.

Antecedentes: La brucelosis es una enfermedad zoonótica endémica, ocupacional y de viajeros. La afectación de los testículos y el epidídimo puede ocurrir en formas agudas y crónicas de brucelosis sistémica. Si el diagnóstico y el tratamiento se retrasan, los hombres jóvenes pueden sufrir complicaciones que resultan en daño permanente al sistema reproductivo e infertilidad. Este estudio brinda una perspectiva de los enfoques clínicos y terapéuticos utilizados en el área endémica de brucelosis y también destaca pistas que pueden ayudar en la detección temprana de la epididimoorquitis brucelar. Métodos: Este es un estudio retrospectivo basado en registros hospitalarios. Después de la aprobación ética y la desidentificación de los registros, se recopilaron datos de la clínica de urología del hospital King Abdullah, Bisha durante 2 años. Todos los casos que presentaban hinchazón o dolor en la región escrotal con características radiológicas sugestivas de epididimoorquitis y título de anticuerpos brucelares ≥1:160 se incluyeron en nuestro estudio. Resultados: Brucella contribuyó a 18 (30.51%) de los casos de epididimoorquitis durante el período de estudio. Se afectaron hombres jóvenes con una edad media de ± desviación estándar (DE) 36.78 ± 7.93. La historia de contacto con animales e ingestión de productos lácteos no pasteurizados fue positiva en todos los casos. Los síntomas de presentación más comunes fueron dolor escrotal (18, 100%), hinchazón (10, 55.56%) y fiebre (8, 44.44%) con una duración media de 20 días. Se observó leucocitosis con predominio linfocítico. Todos los pacientes fueron tratados médicamente sin complicaciones y seguimiento sin novedades. Conclusiones: La epididimoorquitis brucelar debe ser considerada por los médicos en pacientes con duración prolongada de la enfermedad, síntomas sistémicos y linfocitosis relativa. Es necesario un seguimiento estricto para el cumplimiento de la terapia, recaídas y complicaciones.

Scrotal pain; Brucellosis; Epididymo-orchitis; Occupational disease; Zoonosis

Palabras Clave

Dolor escrotal; Brucelosis; Orquiepididimitis; Enfermedad profesional; Zoonosis

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