RESUMO
Although histoplasmosis is generally a self-limited disease, disseminated infection can occur in patients lacking effective cell-mediated immunity, reaching virtually every organ, even the genitourinary tract in rare cases. We report a case of epididymo-orchitis in an immunocompetent 38-year-old bricklayer from the rural area of Villeta, Cundinamarca, Colombia. The patient presented with testicular pain and macroscopic scrotal changes requiring a left orchiectomy, with microbiological isolation and molecular confirmation of Histoplasma capsulatum.
Assuntos
Epididimite/microbiologia , Histoplasmose/complicações , Orquite/microbiologia , Adulto , Antifúngicos/uso terapêutico , Epididimite/diagnóstico , Epididimite/tratamento farmacológico , Histoplasmose/diagnóstico , Histoplasmose/tratamento farmacológico , Humanos , Itraconazol/uso terapêutico , Masculino , Orquite/diagnóstico , Orquite/tratamento farmacológicoRESUMO
We present a 44-year-old man from a rural community in northern Ecuador who worked on a cattle farm where he was involved with primary veterinary care, including assistance during births (or calving) and placenta retention and artificial insemination, with minimal precautions. In September of 2009, quite abruptly, he developed asthenia and hypersomnia without any apparent cause or symptoms like fever, chills, or night sweats. On November 14, 2009, he suffered from pain and edema in the right testicle that coincided with pain in the abdomen. Clinical, serological, and bacteriological investigations confirmed the first case of unilateral orchitis in man in Ecuador caused by Brucella abortus biovar 1. Because brucellosis is a neglected disease, special attention should be given to it in the training of medical and veterinary students.
Assuntos
Brucella abortus/isolamento & purificação , Brucella abortus/patogenicidade , Orquite/microbiologia , Abdome/microbiologia , Abdome/fisiopatologia , Adulto , Animais , Astenia/tratamento farmacológico , Astenia/fisiopatologia , Bovinos , Distúrbios do Sono por Sonolência Excessiva/tratamento farmacológico , Distúrbios do Sono por Sonolência Excessiva/fisiopatologia , Doxiciclina/uso terapêutico , Equador , Gentamicinas/uso terapêutico , Humanos , Masculino , Orquite/tratamento farmacológico , Orquite/fisiopatologia , Testículo/microbiologia , Testículo/fisiopatologia , Resultado do TratamentoRESUMO
AIMS: We previously reported that recombinant human Secretory Leukocyte Protease Inhibitor (SLPI) inhibits mitogen-induced proliferation of human peripheral blood mononuclear cells. To determine the relevance of this effect in vivo, we investigated the immuno-regulatory role of SLPI in an experimental autoimmune orchitis (EAO) model. MAIN METHODS: In order to increase SLPI half life, poly-ε-caprolactone microspheres containing SLPI were prepared and used for in vitro and in vivo experiments. Multifocal orchitis was induced in Sprague-Dawley adult rats by active immunization with testis homogenate and adjuvants. Microspheres containing SLPI (SLPI group) or vehicle (control group) were administered s.c. to rats during or after the immunization period. KEY FINDINGS: In vitro SLPI-release microspheres inhibited rat lymphocyte proliferation and retained trypsin inhibitory activity. A significant decrease in EAO incidence was observed in the SLPI group (37.5%) versus the control group (93%). Also, SLPI treatment significantly reduced severity of the disease (mean EAO score: control, 6.33±0.81; SLPI, 2.72±1.05). In vivo delayed-type hypersensitivity and ex vivo proliferative response to testicular antigens were reduced by SLPI treatment compared to control group (p<0.05). SIGNIFICANCE: Our results highlight the in vivo immunosuppressive effect of released SLPI from microspheres which suggests its feasible therapeutic use.
Assuntos
Doenças Autoimunes/tratamento farmacológico , Imunidade Celular/efeitos dos fármacos , Fatores Imunológicos/farmacologia , Orquite/tratamento farmacológico , Inibidor Secretado de Peptidases Leucocitárias/farmacologia , Animais , Doenças Autoimunes/imunologia , Proliferação de Células/efeitos dos fármacos , Modelos Animais de Doenças , Composição de Medicamentos , Hipersensibilidade Tardia/tratamento farmacológico , Imunidade Celular/imunologia , Terapia de Imunossupressão , Linfócitos/efeitos dos fármacos , Masculino , Microesferas , Orquite/imunologia , Ratos , Ratos Sprague-Dawley , Proteínas RecombinantesRESUMO
OBJECTIVE: the different clinical and laboratory features and response to treatment of patients with acute brucellar epididymo-orchitis (BEO) reporting to the reference hospital in Southeastern Anatolia of Turkey. MATERIAL AND METHODS: in this study, 27 male patients with brucellosis, who presented with epididymitis or epididymo-orchitis (EO) at the university hospital in Diyarbakir from 1998 to 2006, were included. They were compared with the other male patients. Positive blood culture or high agglutination titers of > 1/160 and positive clinical manifestations of brucellosis were the main criteria for diagnosing brucellosis. RESULTS: fourteen patients had unilateral EO. Leukocytosis was present in 10 patients; all of them had initial agglutination titers of > 1/160 and 10 patients had a positive blood culture. All patients received combined therapy with streptomycin for the first 21 days (or oral rifampicin for 6-8 weeks) with doxycycline or tetracycline for 6-8 weeks. All showed improvement, fever subsided in 3-7 days, and the scrotal enlargement and tenderness regressed. Only one patient had a relapse within one year. CONCLUSION: in brucellosis-endemic areas, clinicians encountering EO should consider the likelihood of brucellosis. In this study, young age was the most common risk factor, and leukocytosis and high CRP level were the most common laboratory findings. Most cases were unilateral. All patients responded to medical management very well. Conservative management with combination antibiotic therapy was adequate for managing BEO. Conclusively, brucellosis must be considered as a cause of orchitis, especially in endemic regions like Turkey.
Assuntos
Brucelose/complicações , Epididimite/microbiologia , Orquite/microbiologia , Doença Aguda , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Brucelose/diagnóstico , Brucelose/tratamento farmacológico , Estudos de Casos e Controles , Quimioterapia Combinada , Epididimite/diagnóstico , Epididimite/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Orquite/diagnóstico , Orquite/tratamento farmacológico , Estudos Retrospectivos , Turquia , Adulto JovemRESUMO
OBJECTIVE: the different clinical and laboratory features and response to treatment of patients with acute brucellar epididymo-orchitis (BEO) reporting to the reference hospital in Southeastern Anatolia of Turkey. MATERIAL AND METHODS: in this study, 27 male patients with brucellosis, who presented with epididymitis or epididymo-orchitis (EO) at the university hospital in Diyarbakir from 1998 to 2006, were included. They were compared with the other male patients. Positive blood culture or high agglutination titers of > 1/160 and positive clinical manifestations of brucellosis were the main criteria for diagnosing brucellosis. RESULTS: fourteen patients had unilateral EO. Leukocytosis was present in 10 patients; all of them had initial agglutination titers of > 1/160 and 10 patients had a positive blood culture. All patients received combined therapy with streptomycin for the first 21 days (or oral rifampicin for 6-8 weeks) with doxycycline or tetracycline for 6-8 weeks. All showed improvement, fever subsided in 3-7 days, and the scrotal enlargement and tenderness regressed. Only one patient had a relapse within one year. CONCLUSION: in brucellosis-endemic areas, clinicians encountering EO should consider the likelihood of brucellosis. In this study, young age was the most common risk factor, and leukocytosis and high CRP level were the most common laboratory findings. Most cases were unilateral. All patients responded to medical management very well. Conservative management with combination antibiotic therapy was adequate for managing BEO. Conclusively, brucellosis must be considered as a cause of orchitis, especially in endemic regions like Turkey.
Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Brucelose/complicações , Epididimite/microbiologia , Orquite/microbiologia , Doença Aguda , Antibacterianos/uso terapêutico , Brucelose/diagnóstico , Brucelose/tratamento farmacológico , Estudos de Casos e Controles , Quimioterapia Combinada , Epididimite/diagnóstico , Epididimite/tratamento farmacológico , Orquite/diagnóstico , Orquite/tratamento farmacológico , Estudos Retrospectivos , Turquia , Adulto JovemRESUMO
We examined the clinical presentation and outcome of Brucellar infections of genitalia and the lower urinary tract through a review of the medical records of 10 cases of male patients with brucellar infections of the genitalia and lower urinary tract. The mean age of the patients with brucellosis was 49.2, (median 52, range 15-77 years). Eleven out of 17 patients were rural residents, 15 reported that they might have consumed unpasteurized dairy products) and four reported occupational exposure. Symptoms onset was acute in almost all cases. Scrotal pain, epidedimal swelling and fever were the most common symptoms. The Wright test was positive in 13 patients, while Brucella sp. was isolated from blood cultures in six cases. Only two patients were found with abnormal liver ultrasonography. All patients underwent treatment with doxycycline and aminoglycoside for seven days and doxycycline alone for two months. Most of them responded to antibiotic therapy with rapid regression of symptoms. One patient failed to respond to therapy and presented necrotizing orchitis, as well as abscesses, which required orchectomy. Brucellar infections of the genitalia and lower urinary tract have no specific clinical presentation; the usual laboratory examination is not sufficient to diagnose this kind of infection, therefore it could easily be misdiagnosed. An analytical medical history (including overall dietary habits and recent consumption of non-pasteurized dairy products) could indicate Brucelosis as would the persistence of symptoms despite a one-week antibiotic treatment. In general, patients afflicted by brucellar epididymoorchitis respond to Brucellosis antibiotic therapy, except for some rare cases that present necrotizing orchitis and require surgical treatment.
Assuntos
Adolescente , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Brucella melitensis/isolamento & purificação , Brucelose/diagnóstico , Epididimite/microbiologia , Orquite/microbiologia , Aminoglicosídeos/uso terapêutico , Brucelose/tratamento farmacológico , Doxiciclina/uso terapêutico , Epididimite/diagnóstico , Epididimite/tratamento farmacológico , Orquite/diagnóstico , Orquite/tratamento farmacológico , Adulto JovemRESUMO
We examined the clinical presentation and outcome of Brucellar infections of genitalia and the lower urinary tract through a review of the medical records of 10 cases of male patients with brucellar infections of the genitalia and lower urinary tract. The mean age of the patients with brucellosis was 49.2, (median 52, range 15-77 years). Eleven out of 17 patients were rural residents, 15 reported that they might have consumed unpasteurized dairy products, and four reported occupational exposure. Symptoms onset was acute in almost all cases. Scrotal pain, epidedimal swelling and fever were the most common symptoms. The Wright test was positive in 13 patients, while Brucella sp. was isolated from blood cultures in six cases. Only two patients were found with abnormal liver ultrasonography. All patients underwent treatment with doxycycline and aminoglycoside for seven days and doxycycline alone for two months. Most of them responded to antibiotic therapy with rapid regression of symptoms. One patient failed to respond to therapy and presented necrotizing orchitis, as well as abscesses, which required orchectomy. Brucellar infections of the genitalia and lower urinary tract have no specific clinical presentation; the usual laboratory examination is not sufficient to diagnose this kind of infection, therefore it could easily be misdiagnosed. An analytical medical history (including overall dietary habits and recent consumption of non-pasteurized dairy products) could indicate Brucellosis as would the persistence of symptoms despite a one-week antibiotic treatment. In general, patients afflicted by brucellar epididymoorchitis respond to Brucellosis antibiotic therapy, except for some rare cases that present necrotizing orchitis and require surgical treatment.
Assuntos
Brucella melitensis/isolamento & purificação , Brucelose/diagnóstico , Epididimite/microbiologia , Orquite/microbiologia , Adolescente , Adulto , Idoso , Aminoglicosídeos/uso terapêutico , Brucelose/tratamento farmacológico , Doxiciclina/uso terapêutico , Epididimite/diagnóstico , Epididimite/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Orquite/diagnóstico , Orquite/tratamento farmacológico , Adulto JovemRESUMO
Brucellosis is a zoonotic disease caused by Brucella sp. and may affect many parts of the body. Brucella epididymo-orchitis had been reported in up to 20% of patients with brucellosis. This is a case report of Brucella epididymo-orchitis in a Saudi male patient. He presented with a unilateral swelling of the left testicle. He had fever, arthralgia and night sweats. Ultrasound examination revealed enlarged left epididymis and testicle. Brucella serology was positive and the patient responded to treatment with doxycycline and gentamicin. Thus, brucella infection should be considered in the differential diagnosis of patients presenting with epididymo-orchitis from an endemic area.
Assuntos
Brucella/imunologia , Brucelose/diagnóstico , Epididimite/microbiologia , Orquite/microbiologia , Adulto , Antibacterianos/uso terapêutico , Anticorpos Antibacterianos/sangue , Brucelose/tratamento farmacológico , Doxiciclina/uso terapêutico , Doenças Endêmicas , Epididimite/diagnóstico por imagem , Epididimite/tratamento farmacológico , Gentamicinas/uso terapêutico , Humanos , Masculino , Orquite/diagnóstico por imagem , Orquite/tratamento farmacológico , Resultado do Tratamento , UltrassonografiaRESUMO
Brucellosis is a zoonotic disease caused by Brucella sp. and may affect many parts of the body. Brucella epididymo-orchitis had been reported in up to 20 percent of patients with brucellosis. This is a case report of Brucella epididymo-orchitis in a Saudi male patient. He presented with a unilateral swelling of the left testicle. He had fever, arthralgia and night sweats. Ultrasound examination revealed enlarged left epididymis and testicle. Brucella serology was positive and the patient responded to treatment with doxycycline and gentamicin. Thus, brucella infection should be considered in the differential diagnosis of patients presenting with epididymo-orchitis from an endemic area.
Assuntos
Adulto , Humanos , Masculino , Brucella/imunologia , Brucelose/diagnóstico , Epididimite/microbiologia , Orquite/microbiologia , Antibacterianos/uso terapêutico , Anticorpos Antibacterianos/sangue , Brucelose/tratamento farmacológico , Doxiciclina/uso terapêutico , Doenças Endêmicas , Epididimite/tratamento farmacológico , Epididimite , Gentamicinas/uso terapêutico , Orquite/tratamento farmacológico , Orquite , Resultado do TratamentoRESUMO
We report a 52 years old male admitted for fever lasting one month, dry cough, headache and malaise. Initial laboratory work up showed an AST of 172 U/l, and ALT of 252 U/l, a GGT of 353 U/l and alkaline phosphatases of 952 U/l. An abdominal CAT scan disclosed a mild hepatosplenomegaly. A liver biopsy showed a granulomatous hepatitis. During the evolution, the patient had a left testicle swelling with darkening of the surrounding skin. A testicular ultrasound showed a bilateral orchiepidydimitis. The patient was treated with non steroidal anti-inflammatory drugs and fever subsided. Three months later, these drugs were discontinued and the patient remained asymptomatic and with normal laboratory values until 36 months of follow up.