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Golomb D, Bar I, Brosh-Nissimov T, Leshin-Carmel D, Cooper A, Raz O. Clinical insights: Brucellosis-induced febrile orchitis - A case report and treatment strategy. Urol Case Rep 2024; 55:102764. [PMID: 38911465 PMCID: PMC11190496 DOI: 10.1016/j.eucr.2024.102764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 06/02/2024] [Indexed: 06/25/2024] Open
Abstract
Brucellosis, a systemic infection, can affect various organs, including the genitourinary system, causing epididymo-orchitis in 2%-20 % of cases. This report details a 34-year-old Thai male migrant worker with febrile orchitis. Initial gentamicin treatment failed, but serological tests confirmed brucellosis, likely from raw dairy consumption. The patient was successfully treated with gentamicin, doxycycline, and rifampicin, resulting in complete symptom resolution. Brucella orchitis, though rare, should be considered in patients from endemic areas. Conservative treatment with combined antibiotics is typically effective.
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Affiliation(s)
- Dor Golomb
- Department of Urology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Ido Bar
- Department of Urology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Tal Brosh-Nissimov
- Infectious Diseases Unit, Samson Assuta Ashdod University Hospital, Ashdod, Israel
- Faculty of Health Sciences, Ben Gurion University in the Negev, Beer Sheba, Israel
| | - Daniel Leshin-Carmel
- Infectious Diseases Unit, Samson Assuta Ashdod University Hospital, Ashdod, Israel
- Faculty of Health Sciences, Ben Gurion University in the Negev, Beer Sheba, Israel
| | - Amir Cooper
- Department of Urology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Orit Raz
- Department of Urology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
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2
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Khodadadi J, Dodangeh M, Nasiri M. Brucellar epididymo-orchitis: Symptoms, diagnosis, treatment and follow-up of 50 patients in Iran. IDCases 2023; 32:e01736. [PMID: 36938337 PMCID: PMC10020095 DOI: 10.1016/j.idcr.2023.e01736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/02/2023] [Accepted: 03/05/2023] [Indexed: 03/08/2023] Open
Abstract
Introduction Epididymo-orchitis (EO) is a disease of both the epididymis and ipsilateral testis. Brucellar epididymo-orchitis (BEO) is an uncommon localized infection of the testis and epididymis which occurs in about 2-14 % of all patients with brucellosis as a result of urine Brucella removal or due to blood-borne septic metastasis. Methods Between January 2018 and June 2021, 50 patients with fever, chills, swelling, and pain of the testicle (testicles) were referred to our center. Two approaches were used for the treatment of brucellarepididymo-orchitis among these individuals. Intravenous Gentamicin and Doxycycline were used in seven cases, while Rifampicin was added to this combination for the remaining 43 patients. Intravenous Gentamicin was administered for 7 days and the other drugs were used for 45 days. All patients were followed up for six months by monitoring the symptoms and signs of the disease. Results None of the patients had been diagnosed with brucellosis before referral to our clinic. 43 patients were successfully treated by. Intravenous Gentamicin, Doxycycline and Rifampicin, whereas seven patients were fully treated using. Intravenous Gentamicin and Doxycycline. The two therapeutic groups were hospitalized for 7.56 ± 3.45 (3-23) and 10.14 ± 1.77 (8-13) days, respectively. Treatment failure, drug side effects, and disease complications were not observed in any of the cases over a 6-month follow-up period. Conclusions Physicians should be alert regarding Brucellarepididymo-orchitis (BEO) within the differential diagnosis of nonspecific epididymo-orchitis, especially in regions where the disease is endemic. Delay in diagnosis or inappropriate management of BEO may result in complications.
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Key Words
- 2 ME, 2-mercaptoethanol
- ALK, Anaplastic lymphoma kinase
- ALT, Alanine Aminotransferase
- AST, Aspartate aminotransferase
- BEO, Brucellar epididymo-orchitis
- Brucella
- Brucellar epididymo-orchitis
- Brucellosis
- CBC, Complete blood count
- EO, Epididymo-orchitis
- ESR, erythrocyte sedimentation rate
- Epididymo-orchitis
- Iran
- PMH, Past medical history
- STA, Standard tube agglutination testing
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Affiliation(s)
- Javad Khodadadi
- Department of Infectious Diseases, Faculty of Medicine, Qom University of Medical Sciences, Qom, Islamic Republic of Iran
| | - Milad Dodangeh
- MD-MPH, Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Maryam Nasiri
- Department of Infectious Diseases, School of Medicine, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
- Corresponding author.
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3
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Nahas RS, Alsulami A, Lashkar MO, Thabit AK. Brucella epidydimo-orchitis successfully treated with dual oral drug regimen: A case report with differential diagnoses of malignancy and tuberculosis. Radiol Case Rep 2022; 17:3485-3489. [PMID: 35912293 PMCID: PMC9334919 DOI: 10.1016/j.radcr.2022.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 07/02/2022] [Indexed: 12/01/2022] Open
Abstract
Brucellosis is a zoonotic disease caused by Brucella spp. When complicated, Brucella may affect any organ system, including the genitourinary system in the form of epidydimo-orchitis. Brucella orchitis is the second most common form of complicated brucellosis. The present case is for an adolescent who is otherwise healthy but presented with right testicular pain. Ultrasound imaging showed heterogeneous enlarged right testis with large heterogeneous mass and central necrosis. α-fetoprotein was normal and β-human choriogonadotropin was negative. Malignancy and tuberculosis were excluded based on histopathology and microbiology of the tissue biopsy, respectively. The history of raw dairy consumption and positive serology for B. melitensis and B. abortus established the diagnosis of Brucella epidydimo-orchitis. Treatment was successful with doxycycline and rifampin for four weeks. In pediatrics, it is important to rule out malignancy and make every attempt to avoid orchidectomy by making necessary investigations and involving infectious diseases consultation.
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Affiliation(s)
- Renad S. Nahas
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, 7027 Abdullah Alsulaiman St, Jeddah 22254-2265, Saudi Arabia
| | - Abdulsalam Alsulami
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, 7027 Abdullah Alsulaiman St, Jeddah 22254-2265, Saudi Arabia
| | - Manar O. Lashkar
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, 7027 Abdullah Alsulaiman St, Jeddah 22254-2265, Saudi Arabia
| | - Abrar K. Thabit
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, 7027 Abdullah Alsulaiman St, Jeddah 22254-2265, Saudi Arabia
- Corresponding author.
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4
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Bako D, Tosun H, Ozer A, Köksoy AY, Utangac MM. From testis to brucellosis: A report of two paediatric cases presenting with acute scrotum. J Paediatr Child Health 2022; 58:1100-1103. [PMID: 34590390 DOI: 10.1111/jpc.15772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 09/09/2021] [Accepted: 09/20/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Derya Bako
- Department of Pediatric Radiology, Van Regional Training and Research Hospital, Van, Turkey
| | - Halil Tosun
- Department of Pediatric Urology, Van Regional Training and Research Hospital, Van, Turkey
| | - Arife Ozer
- Department of Pediatric Infectious Diseases, Van Regional Training and Research Hospital, Van, Turkey
| | - Adem Y Köksoy
- Department of Pediatric Nephrology, Van Regional Training and Research Hospital, Van, Turkey
| | - Mehmet M Utangac
- Department of Pediatric Urology, Van Regional Training and Research Hospital, Van, Turkey
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5
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Lan S, Guo Z, He Y, Liu W, Guo H. Brucella prostatic abscess: a retrospective study of eight cases and a literature review. J Int Med Res 2021; 49:3000605211027442. [PMID: 34586877 PMCID: PMC8485306 DOI: 10.1177/03000605211027442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To present the clinical characteristics, diagnostics, and treatments for Brucella prostatic abscess (BPA). METHODS We retrospectively analyzed eight BPA patients according to their vocations, age, clinical manifestations, laboratory test results, magnetic resonance imaging (MRI) findings, and treatments. RESULTS The median age was 59 years. The most common clinical symptom was fever, followed by dysuria, erectile dysfunction, frequent urination, and urodynia. C-reactive protein (CRP) concentrations were significantly elevated in all patients, and in all by one patient, the erythrocyte sedimentation rate (ESR) was high. Prostate enlargement occurred in 87.5% of the patients. Lesions were located in the prostate peripheral (87.5%) and central zones (100%), with homogenous signals on T1-weighted imaging (T1WI) and a hyperintense signal on short tau inversion recovery (STIR). Patients had a small nodule or multiple nodules, with slight hyperintense to hyperintense signals on T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI). Three patients had pelvic effusion, and seminal vesicle (37.5%), epididymis (12.5%), and bladder (12.5%) infections occurred. All patients received rifampicin and doxycycline with levofloxacin; all lesions had resolved at follow-up ultrasonography. CONCLUSION Even in epidemic areas, the incidence of BPA is relatively rare. Our findings may increase the understanding of BPA and reduce misdiagnosis and mistreatment.
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Affiliation(s)
- Siqin Lan
- Xinjiang Medical University Affiliated First Hospital, Medical Imaging Center, Urumqi, P.R. China
| | - Zhaoxing Guo
- Beijing Capital Medical University, Beijing, P.R. China
| | - Yuanlin He
- Xinjiang Medical University Affiliated First Hospital, Medical Imaging Center, Urumqi, P.R. China
| | - Wenya Liu
- Xinjiang Medical University Affiliated First Hospital, Medical Imaging Center, Urumqi, P.R. China
| | - Hui Guo
- Xinjiang Medical University Affiliated First Hospital, Medical Imaging Center, Urumqi, P.R. China
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6
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Yan JF, Zhou HY, Luo SF, Wang X, Yu JD. Rare case of brucellosis misdiagnosed as prostate carcinoma with lumbar vertebra metastasis: A case report. World J Clin Cases 2021; 9:6009-6016. [PMID: 34368321 PMCID: PMC8316935 DOI: 10.12998/wjcc.v9.i21.6009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/06/2021] [Accepted: 05/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Prostatitis caused by Brucella infection is rare and usually lacks typical lower urinary tract symptoms. However, Brucella infection can cause serum prostate-specific antigen levels to become abnormally elevated. When concurrent with lumbar vertebra infection and erosion, brucellosis can easily be misdiagnosed as prostate cancer with bone metastasis.
CASE SUMMARY A 45-year-old man complained of recurrent low back pain and fever for 2 wk. Magnetic resonance imaging of the lumbar vertebrae showed abnormal signs at the rear of the L4–5 vertebral body. Serum prostate-specific antigen level was 17.64 ng/mL, and positron emission tomography/computed tomography suggested the possibility of prostate cancer with liver and lumbar metastases. The patient was transferred to our department for further treatment. He experienced repeated bouts of fever and low back pain during hospitalization. Biopsy results indicated prostatitis. There was no significant increase in white blood cell count or procalcitonin levels. The Mycobacterium tuberculosis smear and antibody detection results were negative. Cefoperazone sulbactam was not effective. Blood culture test results were positive for brucellosis, confirming the diagnosis of brucellosis. After oral anti-infection treatment with doxycycline and rifampicin, the body temperature gradually returned to normal, and lumbago improved. After continuous treatment for 6 mo, the patient recovered.
CONCLUSION In patients with low back pain and fever accompanied by elevated prostate-specific antigen levels and lesions of the prostate and lumbar spine, a detailed medical history and blood and urine cultures should be obtained, and attention should be given to the local epidemic infectious disease situation.
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Affiliation(s)
- Jun-Feng Yan
- Department of Urology, Zhejiang Hospital, Hangzhou 310030, Zhejiang Province, China
| | - Hai-Yong Zhou
- Department of Urology, Zhejiang Hospital, Hangzhou 310030, Zhejiang Province, China
| | - Sheng-Fu Luo
- Department of Urology, Zhejiang Hospital, Hangzhou 310030, Zhejiang Province, China
| | - Xing Wang
- Department of Urology, Zhejiang Hospital, Hangzhou 310030, Zhejiang Province, China
| | - Jian-Di Yu
- Department of Urology, Zhejiang Hospital, Hangzhou 310030, Zhejiang Province, China
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7
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Yu J, Li S, Wang L, Dong Z, Si L, Bao L, Wu L. Pathogenesis of Brucella epididymoorchitis-game of Brucella death. Crit Rev Microbiol 2021; 48:96-120. [PMID: 34214000 DOI: 10.1080/1040841x.2021.1944055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Brucellosis is a worldwide zoonotic disease caused by Brucella 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 Brucella epididymo-orchitis and the composition of testicular and epididymal immune system. Secondly, with regard to the mechanism of Brucella epididymoorchitis, we mainly discussed the process of Brucella invading testis and epididymis in temporal and spatial order, including i) Brucella evades innate immune recognition of testicular PRRs；ii) Brucella overcomes the immune storm triggered by the invasion of testis through bacterial lipoproteins and virulence factors, and changes the secretion mode of cytokines; iii) Brucella 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) Brucella inhibits apoptosis of testicular phagocytes. Finally, we revealed the structure and sequence of testis invaded by Brucella 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, Brucella is like Bruce Lee in the movie Game of Death, winning is survival while losing is death.HIGHLIGHTSWe summarized the clinical features and pathological changes of Brucellaepididymoorchitis.Our research reveals the pathogenesis of Brucella epididymoorchitis, which mainly includes the subversion of testicular immune privilege by Brucella 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 Brucella and provide reference for determining new therapeutic targets for brucellosis in the future.
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Affiliation(s)
- Jiuwang Yu
- Mongolian Medicine School, Inner Mongolia Medical University, Hohhot, China
| | - Sha Li
- Department of Pharmacy, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Lu Wang
- Department of Pharmacy, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Zhiheng Dong
- Department of Pharmacy, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Lengge Si
- Mongolian Medicine School, Inner Mongolia Medical University, Hohhot, China
| | - Lidao Bao
- Department of Pharmacy, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Lan Wu
- Mongolian Medicine School, Inner Mongolia Medical University, Hohhot, China
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8
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Varikkodan I, Naushad VA, Purayil NK, Mathew J, Alrawi FM. Complicated Brucellosis With Multisystem Involvement: Two Case Reports. Cureus 2021; 13:e15950. [PMID: 34336447 PMCID: PMC8312997 DOI: 10.7759/cureus.15950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2021] [Indexed: 12/04/2022] Open
Abstract
Brucellosis is a zoonotic infection caused by facultative intracellular bacteria of the genus Brucella. The ability of the organism to invade both phagocytic and non-phagocytic cells and survive in the intracellular environment makes brucellosis a systemic infection that can affect various organs of the body. Complications of brucellosis occur when the infection involves one or more focal body sites. Early identification of complications of brucellosis and initiation of appropriate treatment is the key to a better outcome. Here we present two cases of complicated brucellosis, both having multiple body site involvement.
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Affiliation(s)
| | - Vamanjore A Naushad
- College of Medicine, Qatar University, Doha, QAT.,Internal Medicine, Weill Cornell, Doha, QAT.,General Internal Medicine, Hamad Medical Corporation, Doha, QAT
| | - Nishan K Purayil
- Internal Medicine, Weill Cornell, Doha, QAT.,General Internal Medicine, Hamad Medical Corporation, Doha, QAT.,College of Medicine, Qatar University, Doha, QAT
| | - Joe Mathew
- General Internal Medicine, Hamad Medical Corporation, Doha, QAT.,Clinical Medicine, College of Medicine, Qatar University, Doha, QAT.,Clinical Medicine, Weill Cornell, Doha, QAT
| | - Farooq M Alrawi
- General Internal Medicine, Hamad Medical Corporation, Doha, QAT
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9
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Bonner M, Sheele JM, Cantillo-Campos S, Elkins JM. A Descriptive Analysis of Men Diagnosed With Epididymitis, Orchitis, or Both in the Emergency Department. Cureus 2021; 13:e15800. [PMID: 34306868 PMCID: PMC8294204 DOI: 10.7759/cureus.15800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Epididymitis and orchitis are illnesses characterized by pain and inflammation of the epididymis and testicle. They represent the most common causes of acute scrotal pain in the outpatient setting. Epididymitis and orchitis have both infectious and noninfectious causes, with most cases being secondary to the invasive pathogens chlamydia, gonorrhea, and Escherichia coli (E.coli). The study's objective was to examine the epidemiology and clinical characteristics of men diagnosed with epididymitis or orchitis in a United States emergency department. Methods We examined a dataset of 75,000 emergency department (ED) patient encounters from a single health system in Northeast Ohio who underwent nucleic acid amplification testing (NAAT) for chlamydia, gonorrhea, or trichomonas, or who received a urinalysis and urine culture. All patients were ≥18 years of age, and all encounters took place between April 18, 2014, and March 7, 2017. The analysis only included men receiving an ED diagnosis of epididymitis, orchitis, or both. We evaluated laboratory and demographic data using univariable and multivariable analyses. Results There were 1.3% (256/19,308) of men in the dataset diagnosed with epididymitis, orchitis, or both. Only 50.1% (130/256) of men diagnosed with epididymitis, orchitis, or both were tested for gonorrhea and chlamydia during their clinical encounter, and among those 13.8% (18/130) were positive. Chlamydia (12.3% [16/130]) was more common than both gonorrhea (3.1% [4/129]) and trichomonas (8.8% [3/34]) among men <35 years of age diagnosed with epididymitis, orchitis, or both. Only 62.1% of men diagnosed with epididymitis, orchitis, or both received a urine culture, of which 20.1% grew bacteria at ≥10,000 CFU/ml. E. coli (N= 20) was the most common bacteria growing in urine culture followed by Streptococcus (N= 3), Klebsiella (N= 2), Pseudomonas (N= 2), and Serratia (N= 2). Men diagnosed with epididymitis, orchitis, or both who had a positive urine culture were more likely to be ≥35 years of age, married, had higher urine white blood cells (WBCs), more urine bacteria, higher urine leukocyte esterase, more likely to have urine nitrite, and were less likely to be empirically treated for gonorrhea and chlamydia (P≤.03 for all). Conclusions In the ED, epididymitis, orchitis, or both are uncommonly diagnosed among patients undergoing genitourinary tract laboratory testing. Sexually transmitted infections (STIs) are common in men <35 years of age diagnosed with epididymitis, orchitis, or both, with chlamydia being most common. E. coli was the most common bacteria growing in urine culture.
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Affiliation(s)
- Mason Bonner
- Emergency Medicine, Mayo Clinic, Jacksonville, USA
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10
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Zhou Y, Xie S, Zheng R, Dai Q, Xu Z, Zuo W, Ding J, Zhang Y. Brucellar reproductive system injury: A retrospective study of 22 cases and review of the literature. J Int Med Res 2021; 48:300060520924548. [PMID: 32552113 PMCID: PMC7303501 DOI: 10.1177/0300060520924548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objective We aimed to describe the clinical characteristics and prognosis of 22
patients with Brucella-induced reproductive system
injury. Methods We assessed 22 patients with reproductive system injury between 2010 and 2018
at The First Affiliated Hospital of Xinjiang Medical University. Results The disease is predominant in men. Male patients had orchitis, erectile
dysfunction, prostatitis, and urethral stricture, while female patients had
vaginitis and cervicitis. Some patients had laboratory abnormalities and
liver injury. Patients received combination therapy of rifampicin and
doxycycline. Doxycycline combined with levofloxacin or moxifloxacin was
administered to patients with rifampicin intolerance. All patients had
received antibiotic therapy for at least 6 weeks. One patient was lost to
follow-up, one patient relapsed because of osteoarthropathy, and one patient
had dysuria resulting from chronic prostatitis. The clinical symptoms
resolved in the other patients, and the overall patient prognosis was
good. Conclusion Clinicians should pay attention to brucellosis-induced reproductive system
damage. The two-drug regimen of rifampicin+doxycycline is recommended for
these patients. Doxycycline combined with levofloxacin or moxifloxacin
should be used in patients with brucellosis-induced reproductive system
damage who have rifampicin intolerance. The treatment course should be at
least 6 weeks.
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Affiliation(s)
- Yan Zhou
- Department of Infection Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Songsong Xie
- The First Hospital of Shihezi University, Shihezi, Xinjiang, China
| | - Rongjiong Zheng
- Department of Infection Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Qinqi Dai
- Department of Infection Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Zheng Xu
- Department of Infection Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Weize Zuo
- The First Hospital of Shihezi University, Shihezi, Xinjiang, China
| | - Jianbing Ding
- Department of Immunology, Basic Medical College, Xinjiang Medical University, Urumqi, China
| | - Yuexin Zhang
- Department of Infection Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.,Department of Immunology, Basic Medical College, Xinjiang Medical University, Urumqi, China
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11
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Edathodu J, Alamri M, Alshangiti KA, Alfagyh NS, Alnaghmush AS, Albaiz F, Alothman B, Khalil H, Edathodu Z, Alrajhi AA. Clinical manifestations and treatment outcomes of human brucellosis at a tertiary care center in Saudi Arabia. Ann Saudi Med 2021; 41:109-114. [PMID: 33818142 PMCID: PMC8020648 DOI: 10.5144/0256-4947.2021.109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/06/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Brucellosis, which has profound public health and economic consequences, is endemic to Saudi Arabia. Brucella is transmitted to humans by direct contact with infected animals or by consumption of unpasteurized dairy products. Manifestations of brucellosis are protean and require a combination of drugs to prevent the emergence of resistance. The WHO recommends the use of doxycycline with rifampicin or an aminoglycoside for brucellosis, but experts in Saudi Arabia prefer to avoid the use of rifampicin and aminoglycosides to lessen the possibility of emergence of drug-resistant tuberculosis. OBJECTIVES Compare rifampicin and doxycycline in the treatment of human brucellosis versus various combinations of doxycycline, with either trimethoprim-sulfamethoxazole (co-trimoxazole), quinolones or aminoglycosides, and describe the clinical manifestations of brucellosis. DESIGN Retrospective medical record review. SETTING Single tertiary care center. PATIENTS AND METHODS Diagnosis of brucellosis was based on positive serology by standard agglutination test (SAT), or isolation by culture of Brucella species from blood, body fluid or tissue. MAIN OUTCOME MEASURES Cure rate with the use of doxycycline in combination with either co-trimoxazole, quinolone or aminoglyco-sides in comparison to doxycycline/rifampicin and the clinical features of brucellosis. SAMPLE SIZE 123. RESULTS In 118 (96%) patients, the median IgG/IgM antibody titers at diagnosis and at 6 and 12 months were 1:1280/1:1280, 1:640/1:640, and 1:320/1:160, respectively. There were no differences in outcome between treatment regimens, as evidenced by a significant decrease in SAT titers and symptom resolution within six months. Five (4%) patients relapsed from non-adherence to treatment, but responded well to a second course of treatment. Blood cultures were positive in 50 patients (41%) patients. Fever, arthralgia and back pain were the most common symptoms. Good serological and clinical responses were achieved in 96% of patients. Relapse in 4% (n=5) was due to self-reported non-adherence. LIMITATIONS Retrospective, relatively small sample size. CONCLUSIONS Doxycycline with co-trimoxazole is as efficacious as doxycycline/rifampicin in non-focal brucellosis and is preferred in countries with a high prevalence of tuberculosis. CONFLICT OF INTEREST None.
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Affiliation(s)
- Jameela Edathodu
- From the Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Maha Alamri
- From the Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Khadijah Ahmed Alshangiti
- From the Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Noura S. Alfagyh
- From the Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ahmed S. Alnaghmush
- From the Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Faisal Albaiz
- From the Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Bader Alothman
- From the Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Hala Khalil
- From the Department of Biostatistics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Zenusha Edathodu
- From the Research Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdulrahman A. Alrajhi
- From the Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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12
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Risk factors for acute human brucellosis in Ijara, north-eastern Kenya. PLoS Negl Trop Dis 2020; 14:e0008108. [PMID: 32236091 PMCID: PMC7153889 DOI: 10.1371/journal.pntd.0008108] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 04/13/2020] [Accepted: 02/01/2020] [Indexed: 11/19/2022] Open
Abstract
Brucellosis is an important zoonotic disease globally, with particularly high burdens in pastoral settings. While the zoonotic transmission routes for Brucella spp. are well known, the relative importance of animal contact, food-handling and consumption practices can vary. Understanding the local epidemiology of human brucellosis is important for directing veterinary and public health interventions, as well as for informing clinical diagnostic decision making. We conducted a cross-sectional study in Ijara District Hospital, north-eastern Kenya. A total of 386 individuals seeking care and reporting symptoms of febrile illness were recruited in 2011. Samples were tested for the presence of Brucella spp. using a real-time PCR (RT-PCR) and results compared to those from the test for brucellosis used at Ijara District Hospital, the febrile Brucella plate agglutination test (FBAT). A questionnaire was administered to all participants and risk factors for brucellosis identified using logistic regression with an information theoretic (IT) approach and least absolute shrinkage and selection (LASSO). Sixty individuals were RT-PCR positive, resulting in a prevalence of probable brucellosis of 15.4% (95% CI 12.0-19.5). The IT and LASSO approaches both identified consuming purchased milk as strongly associated with elevated risk and boiling milk before consumption strongly associated with reduced risk. There was no evidence that livestock keepers were at different risk of brucellosis than non-livestock keepers. The FBAT had poor diagnostic performance when compared to RT-PCR, with an estimated sensitivity of 36.6% (95% CI 24.6-50.1) and specificity of 69.3% (95% CI 64.0-74.3). Brucellosis is an important cause of febrile illness in north-eastern Kenya. Promotion of pasteurisation of milk in the marketing chain and health messages encouraging the boiling of raw milk before consumption could be expected to lead to large reductions in the incidence of brucellosis in Ijara. This study supports the growing evidence that the FBAT performs very poorly in the diagnosis of brucellosis.
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Abstract
Objective: Brucellosis is a multisystemic disease which may affect all organs. Epididymo-orchitis is the most common form of genitourinary involvement. The aim of this study was to present our eight-year experience regarding the management of patients with brucellar epididymo-orchitis (BEO).Materials and method: The medical records of male brucellosis patients treated in two centers, between 2010 and 2018 were analyzed retrospectively. The diagnosis of epididymo-orchitis was made when the patients had scrotal pain, swelling, and enlarged tender testicles and/or epididymis on clinical examination. Brucellosis was diagnosed with a positive standard tube agglutination test or a positive blood culture.Results: Brucellosis was diagnosed in 996 male patients. Of these patients, 25 had a diagnosis of BEO (2.5%). All BEO patients suffered from enlarged painful testicles, however, testicular complaints were the only presentation symptoms in three of them. All patients received medical treatment alone except one patient with testicular abscess who underwent surgical drainage besides medical treatment. All patients recovered completely and no relapses have been detected during six-month follow-up.Conclusion: Patients with epididymo-orchitis should be investigated for brucellosis especially in endemic regions. To our knowledge, BEO patients may present with isolated testicular symptoms that make a diagnostic challenge.
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Affiliation(s)
- Hasan Tahsin Gozdas
- Department of Infectious Diseases and Clinical Microbiology, Abant Izzet Baysal University Faculty of Medicine, Bolu, Turkey
| | - Tayibe Bal
- Department of Infectious Diseases and Clinical Microbiology, Siirt State Hospital, Siirt, Turkey
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Ip CCK, Tumali K, Hoh IM, Arunasalam A. Acute epididymo-orchitis from brucellosis melitensis in Australia. BMJ Case Rep 2019; 12:12/7/e230007. [PMID: 31296622 DOI: 10.1136/bcr-2019-230007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Brucellosis epididymo-orchitis (BEO) is extremely rare in non-endemic areas such as Australia. While epididymo-orchitis is relatively common in adolescent men, when presented with a significant travel history, consideration should be given to rare causes such as this. Here, we present a case of BEO in a young 18-year-old man who recently migrated from Greece, with symptoms of acute scrotal pain, swelling and persistent fever. Brucella melitensis was isolated in the blood culture and confirmed with PCR. We suspect transmission was related to ingestion of unpasteurised goat dairy products. He made a full recovery after 7 days of intravenous gentamicin and 6 weeks of oral doxycycline. BEO should be considered in those who present with acute scrotal pain and fever after a recent history of travel to or from a brucellosis- endemic area.
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Affiliation(s)
| | - Khrisna Tumali
- Department of Urology, Western Health, Footscray, Victoria, Australia
| | - Ivan M Hoh
- Department of Urology, Western Health, Footscray, Victoria, Australia
| | - Arun Arunasalam
- Department of Urology, Western Health, Footscray, Victoria, Australia
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15
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Safwat AS, Hasanain AF, Mahran A, Bakkar S, Abdel-Aal S, Nafee A. Erectile dysfunction among patients with chronic brucellosis. Int J Impot Res 2018; 30:230-236. [PMID: 30154453 DOI: 10.1038/s41443-018-0068-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/11/2018] [Accepted: 08/06/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Only a single study investigated erectile dysfunction (ED) among patients with chronic brucellosis without including a control group. Our study objective was to determine the prevalence of ED among patients with chronic brucellosis compared to normal subjects, and to explore the predictors of ED. MATERIALS AND METHODS We included 93 chronic brucellosis patients and 92 subjects as a control, from June 2013 to August 2017. Chronic brucellosis was diagnosed based on persistent symptoms for ≥1 year with positive immunoglobulin G antibody titer (≥1:160) by standard tube agglutination test; the mean duration was 21 ± 6.2 months. Clinical evaluation (including an Arabic validated version of the five-item International Index of Erectile Function to diagnose ED; score of 5-21 was diagnostic), imaging studies (including scrotal ultrasonography) and laboratory investigations (including estimation of fasting serum level of glucose (after fasting for 8 h), lipids profile (after fasting for 14 h), and serum level of testosterone) were conducted. A fasting serum glucose level of ≥ 7 mmol/L defined diabetes mellitus (DM). Predictors of ED were identified using multivariate analysis (binary logistic regression). RESULTS The mean age of patients was 35.4 ± 13.7 years; 24.7% of them had DM, while low serum level of testosterone was detected among 54.8%. Among the patients, ED was significantly more frequent compared to the control subjects (69.9% vs. 19.6%, p < 0.001). Low serum level of testosterone (OR 4.8, 95% CI 1.7-29.3, p 0.008), and DM (OR 3.5, 95% CI 1.2-34.6, p 0.011) were the predictors of ED among the patients. CONCLUSIONS The prevalence of ED among patients with chronic brucellosis is high. Low serum level of testosterone and DM are associated with ED among such patients.
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Affiliation(s)
- Ahmed S Safwat
- Department of Urology, Assiut University, Assiut, Egypt.
| | - Ahmad F Hasanain
- Department of Tropical Medicine and Gastroenterology, Assiut University, Assiut, Egypt
| | - Ali Mahran
- Department of Dermatology and Andrology (Andrology Unit), Assiut University, Assiut, Egypt
| | - Sally Bakkar
- Department of Biochemisrty, Assiut University, Assiut, Egypt
| | - Sherif Abdel-Aal
- Department of Diagnostic Radiology, Assiut University, Assiut, Egypt
| | - Amany Nafee
- Department of Microbiology and Immunology, Assiut University, Assiut, Egypt
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16
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Cift A, Yucel MO. Comparison of inflammatory markers between brucella and non-brucella epididymo-orchitis. Int Braz J Urol 2018; 44:771-778. [PMID: 29697933 PMCID: PMC6092658 DOI: 10.1590/s1677-5538.ibju.2018.0004.0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 03/26/2018] [Indexed: 11/30/2022] Open
Abstract
Objectives: Brucellosis is a multi-system infectious disease that is associated with inflammation, which causes an increase in acute phase reactants. Hematological inflammatory markers of brucellosis include mean platelet volume (MPV), red cell distribution width (RDW), neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR). In this study, we aimed to evaluate the diagnostic value of hematological inflammatory markers in Brucella epididymo-orchitis (BEO), and to investigate the utility of these markers for differential diagnosis from non-Brucella epididymo-orchitis (non-BEO). Materials and Methods: We retrospectively reviewed the records of 22 BEO and 50 non-BEO patients. Hematological parameters were recorded and compared between the two groups. The main diagnostic criteria for BEO were positive clinical findings (i.e., testicular pain, tenderness and scrotal swelling), a positive Rose Bengal test result, standard tube agglutination (STA) titer ≥ 1/160, and/or a positive blood culture. Results: The most decisive factors in discriminating between BEO and non-BEO were NLR, RDW, and MPV, in decreasing order of their strength. Regardless of other factors, NLR values < 2.3 significantly increased the odds of BEO (OR=8.080, 95% CI: 1.929-33.843, p=0.004). After adjusting for other factors, RDW values >14.45% significantly increased the odds of BEO (OR=7.020, 95% CI: 1.749-28.176, p=0.006). Independent of the other factors, patients with MPV < 7.65 fL had a 6.336 times higher risk for BEO (95% CI: 1.393 - 28.822, p=0.017). Conclusion: Hematological inflammatory markers such as NLR, RDW, and MPV can aid in the differential diagnosis of BEO and non-BEO.
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Affiliation(s)
- Ali Cift
- Department of Urology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Mehmet Ozgur Yucel
- Department of Urology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
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17
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Sacks CA, Kilcoyne A, Wallace ZS, Glomski K. Case 20-2018: A 64-Year-Old Man with Fever, Arthralgias, and Testicular Pain. N Engl J Med 2018; 378:2518-2529. [PMID: 29949483 DOI: 10.1056/nejmcpc1800334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Chana A Sacks
- From the Department of Medicine, Brigham and Women's Hospital (C.A.S.), the Departments of Medicine (C.A.S., Z.S.W.), Radiology (A.K.), and Pathology (K.G.), Massachusetts General Hospital, and the Departments of Medicine (C.A.S., Z.S.W.), Radiology (A.K.), and Pathology (K.G.), Harvard Medical School - all in Boston
| | - Aoife Kilcoyne
- From the Department of Medicine, Brigham and Women's Hospital (C.A.S.), the Departments of Medicine (C.A.S., Z.S.W.), Radiology (A.K.), and Pathology (K.G.), Massachusetts General Hospital, and the Departments of Medicine (C.A.S., Z.S.W.), Radiology (A.K.), and Pathology (K.G.), Harvard Medical School - all in Boston
| | - Zachary S Wallace
- From the Department of Medicine, Brigham and Women's Hospital (C.A.S.), the Departments of Medicine (C.A.S., Z.S.W.), Radiology (A.K.), and Pathology (K.G.), Massachusetts General Hospital, and the Departments of Medicine (C.A.S., Z.S.W.), Radiology (A.K.), and Pathology (K.G.), Harvard Medical School - all in Boston
| | - Krzysztof Glomski
- From the Department of Medicine, Brigham and Women's Hospital (C.A.S.), the Departments of Medicine (C.A.S., Z.S.W.), Radiology (A.K.), and Pathology (K.G.), Massachusetts General Hospital, and the Departments of Medicine (C.A.S., Z.S.W.), Radiology (A.K.), and Pathology (K.G.), Harvard Medical School - all in Boston
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18
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Singh B, Khatkar M, Aulakh R, Gill J, Dhand N. Estimation of the health and economic burden of human brucellosis in India. Prev Vet Med 2018; 154:148-155. [DOI: 10.1016/j.prevetmed.2018.03.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 03/06/2018] [Accepted: 03/28/2018] [Indexed: 11/25/2022]
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Boehm A, Bruyère F. [Dermato-urology: Male genital lesions urologist should know]. Prog Urol 2018; 28:251-281. [PMID: 29428190 DOI: 10.1016/j.purol.2018.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 12/13/2017] [Accepted: 01/02/2018] [Indexed: 10/18/2022]
Abstract
This article aimed to gather male genital dermatoses that may lead to consult a urologist, except pre-neoplastic or neoplastic lesion. METHOD This review is based on a research on Pubmed and EM-consult database, in English and in French, using the following key terms "male genital dermatoses", "male genital lesions", "balanitis", "balanoposthitis", "dermatoses des organes génitaux externes masculines", "lésions des organes génitaux externes de l'homme", "balanoposthites". RESULTS It highlights normal morphological aspects, acute balanoposthitis (nonspecific, infectious, allergic, irritative and traumatic), common skin disease localized to male genital and male genital specific dermatoses. CONCLUSION Any suspicious, fixed, must lead to a skin biopsy.
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Affiliation(s)
- A Boehm
- Service d'urologie, CHRU de Tours, université François-Rabelais, 37000 Tours, France.
| | - F Bruyère
- Service d'urologie, CHRU de Tours, université François-Rabelais, 37000 Tours, France; Université François-Rabelais de Tours, PRES centre Val-de-Loire, 37000 Tours, France
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20
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Shome R, Kalleshamurthy T, Shankaranarayana PB, Giribattanvar P, Chandrashekar N, Mohandoss N, Shome BR, Kumar A, Barbuddhe SB, Rahman H. Prevalence and risk factors of brucellosis among veterinary health care professionals. Pathog Glob Health 2017; 111:234-239. [PMID: 28689480 DOI: 10.1080/20477724.2017.1345366] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The study describes prevalence, clinical symptoms and risk factors for brucellosis in personnel engaged in veterinary health care in Karnataka, India. A total of 1050 sera samples were collected from animal handlers, veterinarians, veterinary students, para-veterinarians and persons engaged in artificial insemination of animals. The sera samples were tested for brucellosis by Rose Bengal plate test (RBPT), serum agglutination test (SAT), IgG and IgM indirect ELISA and PCR. Age, sex, clinical symptoms and risk factors were recorded in structured questionnaire. Of the 1050 samples tested, 6.76, 6.38, 3.90, 2.67 and 2.0% were positive by IgG ELISA, RBPT, SAT, IgM ELISA and PCR, respectively and overall prevalence recorded was 7.04%. The prominent clinical symptoms observed were intermittent fever (71.62%) followed by joint pain and body aches. A high degree of suspicion, awareness and multimodal diagnostic approach is suggested for early diagnosis, treatment and disease follow up.
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Affiliation(s)
- Rajeswari Shome
- a ICAR-National Institute of Veterinary Epidemiology and Disease Informatics , Bengaluru , India
| | - Triveni Kalleshamurthy
- a ICAR-National Institute of Veterinary Epidemiology and Disease Informatics , Bengaluru , India
| | | | - Prashanth Giribattanvar
- a ICAR-National Institute of Veterinary Epidemiology and Disease Informatics , Bengaluru , India
| | - Nagarathna Chandrashekar
- b Department of Neuromicrobiology , National Institute of Mental Health and Neuro Sciences , Bengaluru , India
| | - Nagalingam Mohandoss
- a ICAR-National Institute of Veterinary Epidemiology and Disease Informatics , Bengaluru , India
| | - Bibek Ranjan Shome
- a ICAR-National Institute of Veterinary Epidemiology and Disease Informatics , Bengaluru , India
| | - Ashok Kumar
- c Division of Animal Sciences , Indian Council of Agricultural Research , New Delhi , India
| | | | - Habibur Rahman
- c Division of Animal Sciences , Indian Council of Agricultural Research , New Delhi , India
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Barbier T, Machelart A, Zúñiga-Ripa A, Plovier H, Hougardy C, Lobet E, Willemart K, Muraille E, De Bolle X, Van Schaftingen E, Moriyón I, Letesson JJ. Erythritol Availability in Bovine, Murine and Human Models Highlights a Potential Role for the Host Aldose Reductase during Brucella Infection. Front Microbiol 2017; 8:1088. [PMID: 28659902 PMCID: PMC5468441 DOI: 10.3389/fmicb.2017.01088] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 05/30/2017] [Indexed: 12/15/2022] Open
Abstract
Erythritol is the preferential carbon source for most brucellae, a group of facultative intracellular bacteria that cause a worldwide zoonosis. Since this polyol is abundant in genital organs of ruminants and swine, it is widely accepted that erythritol accounts at least in part for the characteristic genital tropism of brucellae. Nevertheless, proof of erythritol availability and essentiality during Brucella intracellular multiplication has remained elusive. To investigate this relationship, we compared ΔeryH (erythritol-sensitive and thus predicted to be attenuated if erythritol is present), ΔeryA (erythritol-tolerant but showing reduced growth if erythritol is a crucial nutrient) and wild type B. abortus in various infection models. This reporting system indicated that erythritol was available but not required for B. abortus multiplication in bovine trophoblasts. However, mice and humans have been considered to lack erythritol, and we found that it was available but not required for B. abortus multiplication in human and murine trophoblastic and macrophage-like cells, and in mouse spleen and conceptus (fetus, placenta and envelopes). Using this animal model, we found that B. abortus infected cells and tissues contained aldose reductase, an enzyme that can account for the production of erythritol from pentose cycle precursors.
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Affiliation(s)
- Thibault Barbier
- Research Unit in Biology of Microorganisms, Department of Veterinary Medicine, University of NamurNamur, Belgium
| | - Arnaud Machelart
- Research Unit in Biology of Microorganisms, Department of Veterinary Medicine, University of NamurNamur, Belgium
| | - Amaia Zúñiga-Ripa
- Departamento de Microbiología y Parasitología, Instituto de Salud Tropical, Instituto de Investigación Sanitaria de Navarra, Universidad de NavarraPamplona, Spain
| | - Hubert Plovier
- Research Unit in Biology of Microorganisms, Department of Veterinary Medicine, University of NamurNamur, Belgium
| | - Charlotte Hougardy
- Research Unit in Biology of Microorganisms, Department of Veterinary Medicine, University of NamurNamur, Belgium
| | - Elodie Lobet
- Research Unit in Biology of Microorganisms, Department of Veterinary Medicine, University of NamurNamur, Belgium
| | - Kevin Willemart
- Research Unit in Biology of Microorganisms, Department of Veterinary Medicine, University of NamurNamur, Belgium
| | - Eric Muraille
- Laboratoire de Parasitologie, Faculté de Médecine, Université Libre de BruxellesBrussels, Belgium
| | - Xavier De Bolle
- Research Unit in Biology of Microorganisms, Department of Veterinary Medicine, University of NamurNamur, Belgium
| | | | - Ignacio Moriyón
- Departamento de Microbiología y Parasitología, Instituto de Salud Tropical, Instituto de Investigación Sanitaria de Navarra, Universidad de NavarraPamplona, Spain
| | - Jean-Jacques Letesson
- Research Unit in Biology of Microorganisms, Department of Veterinary Medicine, University of NamurNamur, Belgium
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Blanc-Gruyelle AL, Lemaire X, Guaguere A, Sotto A, Senneville E, Lavigne JP. Un cas de brucellose atypique. Med Mal Infect 2017; 47:164-166. [DOI: 10.1016/j.medmal.2016.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 10/05/2016] [Accepted: 10/18/2016] [Indexed: 10/20/2022]
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Bosilkovski M, Kamiloski V, Miskova S, Balalovski D, Kotevska V, Petrovski M. Testicular infection in brucellosis: Report of 34 cases. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2016; 51:82-87. [PMID: 27036087 DOI: 10.1016/j.jmii.2016.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/09/2015] [Accepted: 02/01/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND/PURPOSE To present clinical and laboratory features, treatment options, and outcome in patients with brucellar testicular infection and to compare them with analogous in brucellar patients without testicular involvement. METHODS Thirty four brucellar patients with testicular infection treated in two general hospitals in the Republic of Macedonia, during the period 1998-2009, were retrospectively analyzed. Their clinical and laboratory characteristics were compared with analogous in 364 male brucellar patients without testicular infection, who were treated at the same hospitals during the same time period. RESULTS Brucellar testicular infection was evident in 34 (8.5%) out of 398 male patients with brucellosis. The median age of the patients was 46.5 years. In all patients testicular involvement was presented as an acute form with a median duration of 5 days (range, 2-14 days) prior to diagnosis. Twenty-three of the patients had at least one other simultaneous focal infection. After starting with the treatment testicular infection lasted a median 10 days, range 7-21 days. Brucellar patients with testicular infection when compared with other brucellar patients more frequently manifested fever (97% vs. 61%), concomitant spondylitis (32% vs. 16%), and urinary system involvement (12% vs. 2%). Also, the relapse rate in patients with testicular involvement was significantly higher (24% vs. 9%). CONCLUSION In endemic regions brucellosis should be taken into consideration in any patient with testicular infection. Brucellar testicular involvement is usually characterized with a severe acute clinical presentation and a high percentage of relapses which entails the need of timely recognition and proper treatment duration of at least 60 days.
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Affiliation(s)
- Mile Bosilkovski
- Medical Faculty "Ss Cyril and Methodius University", Skopje, Macedonia.
| | - Viktor Kamiloski
- Medical Faculty "Ss Cyril and Methodius University", Skopje, Macedonia
| | - Silvana Miskova
- Department for Infectious Diseases, Medical Center, Veles, Macedonia
| | - Danco Balalovski
- Department for Infectious Diseases, Medical Center, Bitola, Macedonia
| | - Vesna Kotevska
- Medical Faculty "Ss Cyril and Methodius University", Skopje, Macedonia; Institute for Clinical Microbiology, Skopje, Macedonia
| | - Mile Petrovski
- Medical Faculty "Ss Cyril and Methodius University", Skopje, Macedonia
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24
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Erdem H, Elaldi N, Ak O, Gulsun S, Tekin R, Ulug M, Duygu F, Sunnetcioglu M, Tulek N, Guler S, Cag Y, Kaya S, Turker N, Parlak E, Demirdal T, Ataman Hatipoglu C, Avci A, Bulut C, Avci M, Pekok A, Savasci U, Kaya S, Sozen H, Tasbakan M, Guven T, Bolukcu S, Cesur S, Sahin-Horasan E, Kazak E, Denk A, Gonen I, Karagoz G, Haykir Solay A, Alici O, Kader C, Senturk G, Tosun S, Turan H, Baran A, Ozturk-Engin D, Bozkurt F, Deveci O, Inan A, Kadanali A, Sayar M, Cetin B, Yemisen M, Naz H, Gorenek L, Agalar C. Genitourinary brucellosis: results of a multicentric study. Clin Microbiol Infect 2014; 20:O847-53. [DOI: 10.1111/1469-0691.12680] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 05/12/2014] [Accepted: 05/12/2014] [Indexed: 01/15/2023]
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25
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Savasci U, Zor M, Karakas A, Aydin E, Kocaaslan R, Oren NC, Coskun O, Turhan V, Gul HC, Cicek AF, Aydur E, Eyigun CP. Brucellar epididymo-orchitis: a retrospective multicenter study of 28 cases and review of the literature. Travel Med Infect Dis 2014; 12:667-72. [PMID: 25457303 DOI: 10.1016/j.tmaid.2014.10.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 08/03/2014] [Accepted: 10/01/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To review retrospectively the clinical symptoms, laboratory findings and treatment outcomes of patients with Brucellar epididymo-orchitis. MATERIAL AND METHOD Retrospective data of 28 patients with Brucellar epididymo-orchitis who admitted to four medical centers between 2005 and 2013 were retrospectively reviewed. Positive blood culture, positive Rose Bengal test results or high agglutination titres of ≥ 1/160 with the positive clinical and ultrasonographic findings of orchitis were accepted as the main criteria for Brucellar epididymo-orchitis. RESULTS The mean patient age was 31 ± 16.9 years. Testicular involvement was on the left side in 16 patients and on the right side in 11 patients, one had bilateral disease. Testicular pain and swelling were the most common symptoms and elevation of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and leucocytosis were the most common laboratory findings. Initial treatment was orchidectomy in six patients due to malignancy suspicion. All but three patients were successfully treated with antibiotic combinations of rifampicin, doxycycline and streptomycin. Two of three treatment resistant patients underwent orchidectomy. CONCLUSION Brucellosis is a common cause of epididymo-orchitis in endemic regions. Early diagnosis and treatment is crucial in the management and thus it must be kept in mind in endemic and non-endemic regions.
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Affiliation(s)
- Umit Savasci
- Sarıkamış Military Hospital, Department of Infectious Diseases and Clinical Microbiology, Kars, Turkey
| | - Murat Zor
- Sarıkamış Military Hospital, Department of Urology, Kars, Turkey.
| | - Ahmet Karakas
- Gulhane Military Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Emsal Aydin
- Kafkas Application and Research Hospital of Medicine Faculty, Department of Infectious Diseases and Clinical Microbiology, Kars, Turkey
| | - Ramazan Kocaaslan
- Kafkas Application and Research Hospital of Medicine Faculty, Department of Urology, Kars, Turkey
| | - N Cem Oren
- Sarıkamış Military Hospital, Department of Radiology, Kars, Turkey
| | - Omer Coskun
- Gulhane Military Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Vedat Turhan
- GATA Haydarpasa Training Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - H Cem Gul
- Gulhane Military Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - A Fuat Cicek
- Gulhane Military Hospital, Department of Pathology, Ankara, Turkey
| | - Emin Aydur
- Gulhane Military Hospital, Department of Urology, Ankara, Turkey
| | - Can Polat Eyigun
- Gulhane Military Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
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Epididymoorchitis as the first finding in patients with brucellosis. Adv Urol 2013; 2013:765023. [PMID: 24454352 PMCID: PMC3888676 DOI: 10.1155/2013/765023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 10/15/2013] [Indexed: 11/22/2022] Open
Abstract
Purpose. Acute scrotal pain as the first symptom of brucellosis is rarely observed. We aimed to evaluate the data of male patients with brucellosis and epididymoorchitis as the initial diagnosis. Material and Methods. The data of seven patients presented with testicular pain, hyperemia, swelling, and increased fever were reviewed. Concomitant focal diseases as well as clinical, laboratory, and radiological findings were retrospectively evaluated. Results. The mean age of the patients was 22.28 ± 7.78 (16–35) years. All patients presented with scrotal pain, swelling, and increased sweating. Additional findings included fever, asthenia, arthralgia, dysuria, shiver and rash, weight loss, and vomiting in 6, 5, 4, 4, 3, 2, and 1 patient, respectively. In all of 7 patients, the agglutination tests of Rose-Bengal and Wright were positive. Coombs test was positive only in 3 patients. The patients underwent antibiotic and conservative treatment. No relapse was observed following the treatment. Conclusion. In endemic regions, epididymoorchitis caused by brucellosis should be considered in the differential diagnosis of patients presenting with acute scrotal pain. Clinical and serological findings are sufficient for the diagnosis. Conservative management combined with antibiotic therapy is adequate for managing brucellar epididymoorchitis.
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Ning P, Guo M, Guo K, Xu L, Ren M, Cheng Y, Zhang Y. Identification and effect decomposition of risk factors for Brucella contamination of raw whole milk in china. PLoS One 2013; 8:e68230. [PMID: 23874552 PMCID: PMC3707899 DOI: 10.1371/journal.pone.0068230] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 05/28/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Lack of clear risk factor identification is the main reason for the persistence of brucellosis infection in the Chinese population, and there has been little assessment of the factors contributing to Brucella contamination of raw whole milk. The purpose of this study was to identify risk factors affecting Brucella contamination of raw milk, and to evaluate effective measures for disease reduction in order to determine preventive strategies. METHODS AND FINDINGS A nationwide survey was conducted and samples were obtained from 5211 cows corresponding to 25 sampling locations throughout 15 provinces in China. The prevalence of Brucella in the raw milk samples averaged 1.07% over the 15 Chinese provinces, while the prevalence of positive areas within these regions ranged from 0.23-3.84% among the nine provinces with positive samples. The survey examined factors that supposedly influence Brucella contamination of raw whole milk, such as management style, herd size, abortion rate, hygiene and disease control practices. A binary logistic regression analysis was carried out to determine the association between risk factors for Brucella and contamination of milk samples. Furthermore, a relative effect decomposition study was conducted to determine effective strategies for reducing the risk of Brucella contamination of raw whole milk. Our data indicate that disease prevention and control measures, abortion rate, and animal polyculture are the most important risk factors. Meanwhile, culling after quarantine was identified as an effective protective measure in the current Chinese dairy situation. CONCLUSIONS These results indicate that, although there is a low risk of contamination of milk with Brucella nationwide in China, there are individual regions where contamination is a significant problem. Controlling three factors-culling after quarantine, maintaining a low abortion rate, and avoiding mixing groups of cattle and small ruminants-could effectively reduce the risk of Brucella contamination of raw whole milk.
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Affiliation(s)
- Pengbo Ning
- College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi, PR China
- * E-mail: (PN); (YZ)
| | - Mancai Guo
- College of Science, Northwest A&F University, Yangling, Shaanxi, PR China
| | - Kangkang Guo
- College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi, PR China
| | - Lei Xu
- College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi, PR China
| | - Min Ren
- College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi, PR China
| | - Yuanyuan Cheng
- College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi, PR China
| | - Yanming Zhang
- College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi, PR China
- * E-mail: (PN); (YZ)
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Ron-Román J, Saegerman C, Minda-Aluisa E, Benítez-Ortíz W, Brandt J, Douce R. First report of orchitis in man caused by Brucella abortus biovar 1 in Ecuador. Am J Trop Med Hyg 2012; 87:524-8. [PMID: 22826490 DOI: 10.4269/ajtmh.2012.11-0341] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We present a 44-year-old man from a rural community in northern Ecuador who worked on a cattle farm where he was involved with primary veterinary care, including assistance during births (or calving) and placenta retention and artificial insemination, with minimal precautions. In September of 2009, quite abruptly, he developed asthenia and hypersomnia without any apparent cause or symptoms like fever, chills, or night sweats. On November 14, 2009, he suffered from pain and edema in the right testicle that coincided with pain in the abdomen. Clinical, serological, and bacteriological investigations confirmed the first case of unilateral orchitis in man in Ecuador caused by Brucella abortus biovar 1. Because brucellosis is a neglected disease, special attention should be given to it in the training of medical and veterinary students.
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Affiliation(s)
- Jorge Ron-Román
- International Center for Zoonoses (CIZ), Central University of Ecuador, Quito, Ecuador
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Yemisen M, Karakas E, Karakas O, Ozdemir I. Brucellar testicular abscess: a rare cause of testicular mass. J Infect Chemother 2012; 18:760-3. [DOI: 10.1007/s10156-011-0354-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 11/28/2011] [Indexed: 10/14/2022]
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Tsu JHL, Law DMC, Lo AKL, Chiu Y, Chan SWH, Liu PL. Epididymo-orchitis due to Brucella melitensis: A case report in a nonendemic area and review of the literature. SURGICAL PRACTICE 2011. [DOI: 10.1111/j.1744-1633.2011.00559.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Najafi N, Ghassemian R, Davoody AR, Tayebi A. An unusual complication of a common endemic disease: clinical and laboratory aspects of patients with brucella epididymoorchitis in the north of Iran. BMC Res Notes 2011; 4:286. [PMID: 21834966 PMCID: PMC3170334 DOI: 10.1186/1756-0500-4-286] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 08/11/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Brucella epididymoorchitis(BEO) is a focal complication of human brucellosis and has been reported in 2-20% of patients with brucellosis. Brucellosis is an endemic disease in Iran. The incidence of the disease in this country is 34 per 100 000 per year. METHODS In a retrospective study, we identified 30 cases of Brucella epididymoorchitis in two teaching hospitals in the north of Iran during 1997-2009. FINDINGS Epididymoorchitis occurred in 11.1% of male patients with brucellosis. The average age was 25.5 ± 12.43 years. Pain and scrotal swelling (100%) and fever (96.7%) were the most common symptoms. Different treatment regimens were administered including doxycycline plus rifampin (60%), doxycycline plus rifampin plus aminoglycoside for the first two weeks (36.6%) and doxycycline plus cotrimoxazole(3.4%). Ten percent of the patients did not respond to antibiotic therapy and required surgical drainage or orchiectomy. CONCLUSIONS In brucellosis endemic areas, clinicians who encounter patients with epididymoorchitis should consider the likelihood of brucellosis. A careful history and physical examination and an immediate laboratory evaluation help to make a correct diagnosis. Generally, classical therapy of brucellosis is adequate for the treatment of epididymoorchitis.
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Affiliation(s)
- Narges Najafi
- Department of infectious disease, North Iranian tropical and infectious disease research center, Mazandran university of medical sciences, Iran.
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Kurt M, Kuran S, Tekce YT, Sayilir A, Oztas E, Sasmaz N. Brucella epididymo-orchitis initially mimicking choledocholithiasis. Infection 2011; 39:393-4. [PMID: 21431339 DOI: 10.1007/s15010-011-0099-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Accepted: 02/28/2011] [Indexed: 11/28/2022]
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33
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Ryu SY, Kim HA, Park J, Choe M, Kwon K. BrucellaProstatitis: A First Case Report Diagnosed in Korea. KOREAN JOURNAL OF PATHOLOGY 2011. [DOI: 10.4132/koreanjpathol.2011.45.s1.s66] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Seong Yeol Ryu
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Hyun Ah Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Jiyoung Park
- Department of Pathology, Keimyung University School of Medicine, Daegu, Korea
| | - Misun Choe
- Department of Pathology, Keimyung University School of Medicine, Daegu, Korea
| | - Kunyoung Kwon
- Department of Pathology, Keimyung University School of Medicine, Daegu, Korea
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34
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Celen MK, Ulug M, Ayaz C, Geyik MF, Hosoglu S. Brucellar epididymo-orchitis in southeastern part of Turkey: an 8 year experience. Braz J Infect Dis 2010. [DOI: 10.1016/s1413-8670(10)70021-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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35
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Hasanjani Roushan MR, Baiani M, Javanian M, Kasaeian AA. Brucellar epididymo-orchitis: Review of 53 cases in Babol, northern Iran. ACTA ACUST UNITED AC 2009; 41:440-4. [DOI: 10.1080/00365540902968043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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36
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Testicular nodules in a 16-year-old boy. Pediatr Infect Dis J 2009; 28:168, 171-2. [PMID: 19177033 DOI: 10.1097/inf.0b013e3181880a24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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37
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Palladino MA, Savarese MA, Chapman JL, Dughi MK, Plaska D. ORIGINAL ARTICLE: Localization of Toll-Like Receptors on Epididymal Epithelial Cells and Spermatozoa. Am J Reprod Immunol 2008; 60:541-55. [DOI: 10.1111/j.1600-0897.2008.00654.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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38
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39
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[Brucella prostatic abscess]. Med Mal Infect 2008; 38:235-6. [PMID: 18339502 DOI: 10.1016/j.medmal.2008.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2007] [Revised: 10/03/2007] [Accepted: 01/17/2008] [Indexed: 11/22/2022]
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Tanyel E, Tasdelen-Fisgin N, Sarikaya-Genc H, Doganci L, Tulek N. Brucella epididymo-orchitis relapsing three times despite treatment. Int J Infect Dis 2008; 12:215-7. [PMID: 17681822 DOI: 10.1016/j.ijid.2007.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2006] [Revised: 03/27/2007] [Accepted: 04/09/2007] [Indexed: 10/23/2022] Open
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Ariza J, Bosilkovski M, Cascio A, Colmenero JD, Corbel MJ, Falagas ME, Memish ZA, Roushan MRH, Rubinstein E, Sipsas NV, Solera J, Young EJ, Pappas G. Perspectives for the treatment of brucellosis in the 21st century: the Ioannina recommendations. PLoS Med 2007; 4:e317. [PMID: 18162038 PMCID: PMC2222927 DOI: 10.1371/journal.pmed.0040317] [Citation(s) in RCA: 262] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The authors provide evidence-based guidance on treating human brucellosis, and discuss the future clinical trials that would help address the controversies surrounding treatment.
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42
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Mantur BG, Amarnath SK, Shinde RS. REVIEW OF CLINICAL AND LABORATORY FEATURES OF HUMAN BRUCELLOSIS. Indian J Med Microbiol 2007. [DOI: 10.1016/s0255-0857(21)02105-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cha WH, Choi YS, Kim SW, Ha GY, Kim KH, Seo YJ, Lee KS. Brucella Epididymorchitis: A Rare Cause of Testicular Mass. Korean J Urol 2007. [DOI: 10.4111/kju.2007.48.3.359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Woo Heon Cha
- Department of Urology, College of Medicine, Dongguk University, Gyeongju, Korea
| | - Young Sil Choi
- Division of Zoonoses, Center for Immunology & Pathology, KNIH, Seoul, Korea
| | - Sung Woo Kim
- Department of Diagnostic Radiology, College of Medicine, Dongguk University, Gyeongju, Korea
| | - Gyoung Yim Ha
- Department of Laboratory medicine, College of Medicine, Dongguk University, Gyeongju, Korea
| | - Ki Ho Kim
- Department of Urology, College of Medicine, Dongguk University, Gyeongju, Korea
| | - Young Jin Seo
- Department of Urology, College of Medicine, Dongguk University, Gyeongju, Korea
| | - Kyung Seop Lee
- Department of Urology, College of Medicine, Dongguk University, Gyeongju, Korea
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Colmenero JD, Muñoz-Roca NL, Bermudez P, Plata A, Villalobos A, Reguera JM. Clinical findings, diagnostic approach, and outcome of Brucella melitensis epididymo-orchitis. Diagn Microbiol Infect Dis 2006; 57:367-72. [PMID: 17141451 DOI: 10.1016/j.diagmicrobio.2006.09.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Revised: 09/20/2006] [Accepted: 09/20/2006] [Indexed: 11/26/2022]
Abstract
We have studied 912 patients with brucellosis. Of these, 631 (69.2%) were male and 48 had epididymo-orchitis, giving an incidence of epididymo-orchitis of 7.6%. The duration of symptoms before diagnosis was 52.5 +/- 70 days. All the patients had fever, swelling, and scrotal pain, but only 2 (4.2%) reported urinary symptoms. Seven patients (14.5%) had leukocyte figures above 11 x 10(9)/L, and urine analysis was normal in 69% of the patients. Blood cultures were positive in 65.8% of cases. A total of 33 patients (68.8%) received a combination of doxycycline plus streptomycin and 13 (27.1%) doxycycline plus rifampin. The overall percentage of failure or relapse was 8.8%: 7.1% in the doxycycline plus streptomycin group and 20% in the doxycycline plus rifampin group. None of the patients required surgery. Pending clinical trials to confirm the results, conservative management with a combination of doxycycline for 2 months and streptomycin for 14 to 21 days appears to be adequate and could avoid unnecessary orchiectomy.
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Affiliation(s)
- Juan D Colmenero
- Infectious Diseases Service, Carlos Haya University Hospital, 29010 Malaga, Spain.
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45
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Queipo-Ortuño MI, Colmenero JD, Muñoz N, Baeza G, Clavijo E, Morata P. Rapid Diagnosis of Brucella Epididymo-Orchitis by Real-Time Polymerase Chain Reaction Assay in Urine Samples. J Urol 2006; 176:2290-3. [PMID: 17070314 DOI: 10.1016/j.juro.2006.07.052] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2005] [Indexed: 11/24/2022]
Abstract
PURPOSE We studied the diagnostic yield of a real-time polymerase chain reaction assay in urine samples for the rapid diagnosis of brucella epididymo-orchitis compared to that of conventional microbiological techniques. MATERIALS AND METHODS We used an SYBR Green I LightCycler based real-time polymerase chain reaction to retrospectively study 10 urine samples from patients with Brucella epididymo-orchitis. The assay amplifies a 223 bp sequence of a gene that codes for the synthesis of an immunogenetic membrane protein specific for Brucella genus (BCSP31). After amplifying this 223 bp sequence we performed melting curve analysis to verify the specificity of polymerase chain reaction products. RESULTS Brucella melitensis was isolated from blood cultures in 9 cases (90%). Wright's seroagglutination was negative or inconclusive in 30% of cases. Brucella was isolated from urine in only 1 case, whereas real-time polymerase chain reaction assay in urine was positive in 9 (90%). Also, results were available in 4 hours, whereas mean time to availability of the final blood culture results was 5.8 days (range 4.5 to 7). CONCLUSIONS SYBR Green I LightCycler based real-time polymerase chain reaction assay in urine samples is highly sensitive and specific, and easy to perform. It could provide the clinician with results in less than 5 hours. The technique could be a practical and useful tool for the rapid diagnosis of genitourinary complications of human brucellosis.
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Andriopoulos P, Tsironi M, Deftereos S, Aessopos A, Assimakopoulos G. Acute brucellosis: presentation, diagnosis, and treatment of 144 cases. Int J Infect Dis 2006; 11:52-7. [PMID: 16651018 DOI: 10.1016/j.ijid.2005.10.011] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2005] [Revised: 08/21/2005] [Accepted: 10/12/2005] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Brucellosis, whether in an endemic region or not, remains a diagnostic puzzle due to occasional misleading unusual presentations and non-specific symptoms. Presented herein is our 14-year experience with acute brucellosis at Sparta General Hospital, Lakonia, Greece. METHODS A case series of 144 patients admitted to the internal medicine, pediatrics, and urology departments, through evaluation of history, occupational data, serological tests, cultures of blood and other body fluids, and imaging studies. Patients were treated with a 21-day course of intramuscular streptomycin and a prolonged two-month course of doxycycline with a six-month follow-up. RESULTS Infected patients had a relevant occupational history in fewer than 20% of cases. Clinical manifestations included non-specific symptoms (fever, malaise, sweats, arthralgias, lower back pain, headache), findings such as splenomegaly (51%), osteoarticular involvement (42%), cervical lymphadenitis (31%), hepatomegaly (25%), genitourinary involvement (13% of men), cholecystitis (2%), breast abscess (0.7%), and acute abdomen (0.7%). Ninety-five percent of the patients had a serological titer > or =1/160 with culture-proven brucellosis. Overall, 82% of blood cultures and 100% of other body fluid cultures (synovial, bile) were positive. Ninety-seven percent of the patients were cured. Relapse in the follow-up period was observed in four patients who had not complied with treatment. CONCLUSIONS Brucellosis is an infection with multiple presentations, and whether in an endemic region or not, a thorough history of exposure and clinical suspicion are required since thresholds in serological evaluation may lead to misdiagnosis and withholding of adequate treatment.
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Yetkin MA, Erdinc FS, Bulut C, Tulek N. Epididymoorchitis due to brucellosis in central Anatolia, Turkey. Urol Int 2005; 75:235-8. [PMID: 16215312 DOI: 10.1159/000087801] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2004] [Accepted: 05/19/2005] [Indexed: 11/19/2022]
Abstract
Brucellosis may involve many organs and tissues. Epididymoorchitis is a focal genitourinary complication of human brucellosis. In this study, we describe our experience with the diagnosis, treatment, and final outcomes of 17 patients with epididymoorchitis out of 186 male patients with brucellosis between March 1999 and December 2003. The rate of epididymoorchitisdue to brucellosiswas 9.1%. All subjects complained about swollen, painful testicles. The duration of their complaint varied between 1 week and 2 months. Both testis and epididymis were involved in 15 patients and 2 had bilateral involvement. The patients were treated with medical treatment and a complete resolution was achieved in all of them. Patients with Brucella infection occasionally manifest genitourinary complications. Clinicians, especially those serving in endemic areas or serving patients coming from endemic areas, should consider the likelihood of brucellosis as a cause of epididymoorchitis.
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Affiliation(s)
- Meltem Arzu Yetkin
- Department of Infectious Diseases and Clinical Microbiology, Health Ministry Ankara Training and Research Hospital, Ankara, Turkey.
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48
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Akinci E, Bodur H, Cevik MA, Erbay A, Eren SS, Ziraman I, Balaban N, Atan A, Ergül G. A complication of brucellosis: epididymoorchitis. Int J Infect Dis 2005; 10:171-7. [PMID: 16360332 DOI: 10.1016/j.ijid.2005.02.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2004] [Revised: 01/28/2005] [Accepted: 02/24/2005] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Epididymoorchitis is the most frequent genitourinary complication of brucellosis. METHODS This prospective study was conducted between February 2001 and January 2004, prospectively. Male patients diagnosed with brucellosis were included in this study and evaluated for testicular involvement. RESULTS Epididymoorchitis was detected in 17 out of 134 (12.7%) male patients with brucellosis. Mean age of the patients was 36.9+/-7.1 years. Twelve patients (70.6%) had acute, four patients (23.5%) had subacute, and one patient (5.9%) had chronic brucellosis. The most common symptoms were scrotal pain (94%) and swelling (82%). Eleven patients had unilateral epididymoorchitis, four had unilateral orchitis and two had unilateral epididymitis. A testicular abscess was detected in one patient. Sperm analysis was performed on 14 patients. Five patients had aspermia and eight had oligospermia. Combined antibiotic therapy was started and continued for 6-8 weeks. Orchiectomy was required for two patients and granulomatous orchitis was detected in the resected specimens. Relapse occurred in only one patient. Three patients had permanent oligospermia and one patient had permanent aspermia after the antibiotic therapy. Younger age, high C-reactive protein level and blood culture positivity were statistically significant differences between the patients with and without epididymoorchitis. CONCLUSIONS Brucellosis should be considered in the diagnosis of scrotal diseases in endemic areas. A conservative approach is usually adequate for managing brucellar epididymoorchitis. However, infertility problems may develop in these patients. Well-designed further investigations are needed to explain the relationship between brucellar epididymoorchitis and infertility in man.
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Affiliation(s)
- Esragül Akinci
- Department of Infectious Diseases and Clinical Microbiology, Ankara Numune Education and Research Hospital, Ankara, Turkey.
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Affiliation(s)
- Georgios Pappas
- Brucellosis Unit, University Hospital of Ioannina, Ioannina, Greece.
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50
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Troy SB, Rickman LS, Davis CE. Brucellosis in San Diego: epidemiology and species-related differences in acute clinical presentations. Medicine (Baltimore) 2005; 84:174-187. [PMID: 15879907 DOI: 10.1097/01.md.0000165659.20988.25] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Although aggressive public health measures have greatly reduced the number of brucellosis cases in the United States, there is a resurgence of interest in this worldwide zoonosis because of its potential as a bioweapon and its 8-fold higher incidence in California, Texas, and the other borderlands between the United States and Mexico compared with the national rate. Accordingly, we reviewed the clinical records of 28 patients diagnosed at a university hospital in San Diego, CA, between 1979 and 2002 to look for new epidemiologic trends and to test the hypothesis that there are species-specific differences in clinical presentations. In contrast to the latest California-wide study completed in 1992, Brucella abortus infections were more common (73%) than Brucella melitensis after 1992, and women were more commonly infected (77% compared with 39%) than men. Major risk factors remained Hispanic ethnicity, travel to Mexico, and ingestion of nonpasteurized dairy products. Analysis of diagnostic procedures suggested that the traditional practice of prolonged incubation of blood cultures increased their sensitivity for Brucella, even in automated radiometric systems. Direct comparison of the clinical manifestations of infections with B. abortus and B. melitensis strongly supported differences in acute presentations. B. melitensis presented more acutely as fevers of unknown origin with statistically significant higher rates of abdominal tenderness, hepatomegaly, splenomegaly, thrombocytopenia, pancytopenia, and hepatic dysfunction. These results suggest that the epidemiology of brucellosis in California may be evolving, and they show, to our knowledge for the first time in a single series, that species-specific differences in presentations may account for some of the protean manifestations of brucellosis. Familiarity with manifestations of brucellosis and the optimal laboratory techniques for its diagnosis could help physicians protect the public against this reemerging, under-recognized zoonosis.
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Affiliation(s)
- Stephanie B Troy
- From Departments of Pathology (CED) and Medicine (SBT, LSR, CED), School of Medicine, University of California, San Diego and UCSD Medical Center, San Diego, CA
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