(245) Epididymo-Orchitis as the First Presentation of Brucellosis in an Endemic Area

Abstract

Brucellosis, which is also called Mediterranean or Malta fever, is an endemic enzootic disease and can involve various organ systems. It is commonly endemic in the Mediterranean countries and the Middle East. Epididymo-orchitis is a focal form of human brucellosis. Brucella species cause granulomatous orchitis usually presenting as an acute or chronic unilateral swelling of the testis. Patients rarely present to the clinicians with acute scrotum due to Brucellosis Epididymo-Orchitis (BEO) as an initial finding. Our aim is to estimate the prevalence of the BEO among the cases diagnosed with Epididymoorchitis in our hospital over the last four years. Retrospective study from 2015–2018 involving all cases diagnosed with Epididymoorchitis in our hospital. A total of 92 cases of Epididymoorchitis were diagnosed during this period. These cases presented to ER complaining of severe unilateral scrotal pain, swelling, fever and sweating. Local examination showed swollen enlarged testis and epididymis with marked tenderness. Brucella serologic test for both B abortus and B melitensis were requested routinely for all cases of epididymo-orchitis. Scrotal Doppler ultrasonographic examination was requested at initial diagnosis and after 2 weeks to exclude abscess formation. Out of 92 cases, 8 were diagnosed to have brucellosis (8.7%). The median age of patients was 32 years (range, 18–41 years). All patients had positive history of consuming unpasteurized dairy products, which is a risk factor for brucellosis. The diagnosis of brucellosis was made via positive serological testing results (Brucella abortus and melitensis). One case showed testicular abscess formation. All cases were given combination of tetracyclin and rifampicin for 6–12 weeks. Two cases required prolonged hospital stay due to testicular abscess formation in one and development of Brucellosis spondylitis in the other. Gentamycin was added for one week in such cases. In endemic regions for brucellosis, we have to consider it in the workup of all cases of epididiymo-orchitis. The diagnosis is easy by positive serology tests. Positive cases need special antibiotic combination protocol for longer time and close monitoring for development of local complications or other systemic brucellosis manifestations No.