Background: Brucellosis is a zoonotic disease which has the ability to afflict a number of organs and tissues. Brucellosis epididymoorchitis (BEO), a complication of human brucellosis, can emanate in complications. In brucellosis non-endemic areas, some clinicians may be unfamiliar with the disease entity which may lead to delay in the diagnosis.
Aim: To review the literature on BEO, in order to document its presentation, diagnosis, management and outcome following treatment as well as update the literature related to the disease.
Methods: Various internet data bases were usedto obtain literature on BEO.
Results / Literature Review: BEO (epididymitis plus or minus orchitis) is a complication of an infection caused by brucella species which can be transmitted via contact through the respiratory tract, skin, or conjunctiva, and through the gastrointestinal tract pursuant to ingestion of unpasteurized milk/milk products or raw infected meat. BEO does in endemic areas affect 2% to 20% of patients who have been afflicted by brucellosis but the disease can also be encountered sporadically globally in non-endemic areas. BEO could at times be bilateral. The manifestation of BEO is non-specific and it could be mistaken for non-specific epididymo-orchitis or epididymitis or testicular tumour or abscess. Ultrasound scan and MRI scan findings are not specific to BEO. Diagnosis of BEO may be established by (a) history of contact, (b) cultures from blood/epididymal aspirations, (c) various types of laboratory studies including: (I) Culture, (II) PCR, and (III) serology. Laboratory test criteria for the diagnosis of Brucellosis is divided into (I) those for presumptive diagnosis and (II) those for confirmatory diagnosis: BEO can be effectively treated by means of combination chemotherapy for about six weeks but at times orchidectomy or drainage of testicular collection may be necessitated for persistence of symptoms or suspicion of a tumour / testicular abscess. Relapses of brucellosis can occur hence careful follow-up of patients is required.
Conclusions: BEO can occur anywhere globally. A high index of suspicion is thus required from clinicians in order to establish early diagnosis of the disease. Most cases of BEO can be effectively treated with combination chemotherapy for about 6 weeks. Clinicians should be aware that brucellosis epididymo-orchitis, brucellosis epididymitis and epididymo-orchitis exist and this condition could be unilateral or bilateral, though more commonly encountered in brucellosis endemic areas because of global travel the disease entity may be encountered sporadically globally.
Mr Anthony Kodzo-Grey Venyo MB ChB FRCS(Ed) FRCSI FGCS Urol. LLM
Department of Urology, North Manchester General Hospital, Manchester, United Kingdom.
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