Clinical findings, diagnostic approach, and outcome of Brucella melitensis epididymo-orchitis.
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.
Colmenero
Juan D
JD
Infectious Diseases Service, Carlos Haya University Hospital, 29010 Malaga, Spain. jdcolmenero@telefonica.net
Muñoz-Roca
Nuria L
NL
Bermudez
Pilar
P
Plata
Antonio
A
Villalobos
Aurora
A
Reguera
Jose M
JM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017347:Brucella melitensis / Q000302:isolation & purification / Q000472:pathogenicity; D002006:Brucellosis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D004318:Doxycycline / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004823:Epididymitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009920:Orchitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D013307:Streptomycin / Q000627:therapeutic use; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D004318:Doxycycline; D013307:Streptomycin