Clinical and therapeutic insights into brucellar epididymo-orchitis: a retrospective analysis in a brucellosis endemic area.

Background: Brucellosis is an endemic, occupational and travellers' zoonotic disease. Involvement of testis and epididymis can occur in acute and chronic forms of systemic brucellosis. If the diagnosis and treatment is delayed, young men may suffer with complications resulting in permanent damage to reproductive system and infertility. This study gives an insight into clinical and therapeutic approaches used in brucellar endemic area and also highlight clues that can help in early detection of Brucellar epididymo-orchitis.

Methods: This is retrospective, hospital record-based study. After ethical approval and record de-identification, data from Urology clinic of King Abdullah hospital, Bisha was collected for 2 years. All cases presenting with swelling or pain in scrotal region with suggestive radiological features of epididymo-orchitis and brucellar antibody titre ≥1:160 were included in our study.

Results: Brucella contributed to 18 (30.51%) of epididymo-orchitis cases during study period. Young men were affected with mean age ± standard deviation (SD) 36.78 ± 7.93. History of animal contact and ingestion of unpasteurized dairy products was positive in all cases. Most common presenting symptoms were scrotal pain (18, 100%), swelling (10, 55.56%) and fever (8, 44.44%) with an average duration of 20 days. Leukocytosis with lymphocytic predominance was observed. All patients were treated medically with no complications and unremarkable follow up.

Conclusions: Brucellar epididymo-orchitis must be considered by physicians in patients with prolong duration of illness, systemic symptoms and relative lymphocytosis. Strict follow up for compliance to therapy, relapse and complication is needed.