Brucellosis of Testis and Epididymis: An Update of the Literature

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.

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