Clinical findings, diagnostic approach, and outcome of Brucella melitensis epididymo-orchitis

Diagn Microbiol Infect Dis. 2007 Apr;57(4):367-72. doi: 10.1016/j.diagmicrobio.2006.09.008. Epub 2006 Dec 1.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anti-Bacterial Agents / therapeutic use*
  • Brucella melitensis* / isolation & purification
  • Brucella melitensis* / pathogenicity
  • Brucellosis* / diagnosis
  • Brucellosis* / drug therapy
  • Brucellosis* / microbiology
  • Brucellosis* / pathology
  • Doxycycline / therapeutic use
  • Drug Therapy, Combination
  • Epididymitis* / diagnosis
  • Epididymitis* / drug therapy
  • Epididymitis* / microbiology
  • Epididymitis* / pathology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Orchitis* / diagnosis
  • Orchitis* / drug therapy
  • Orchitis* / microbiology
  • Orchitis* / pathology
  • Streptomycin / therapeutic use
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents
  • Doxycycline
  • Streptomycin