Brucellar Epididymo-orchitis in Southwest Anatolia, Turkey: a Retrospective Study of 14 Patients

Introduction: Brucellar epididymo-orchitis (BEO) is the most common variant of genitourinary brucellosis and is encountered in 2 to 20% of patients with brucellosis. This report details clinical and laboratory features, diagnostic evaluations, treatment modalities, and final outcomes for 14 patients with brucellar epididymo-orchitis. Material and Methods: In this retrospective study, we describe the medical records of 14 adult patients diagnosed with brucellar epididymo-orchitis between 2009 and 2012. The diagnosis of brucellosis was based on the presence of a positive blood culture or Standard tube agglutination testing with a titer ≥ 1/160 accompanying positive clinical manifestations. Scrotal pain, enlargement, and swelling with gradual onset were considered as signs of epididymo-orchitis. Findings: The median age of patients was 41 year (range 22 to 61); most of the patients (64%) were under age of 45. All patients presented with acute or sub-acute symptoms of epididymo-orchitis. Brucella melitensis was isolated in the blood cultures of two patients. The patients were treated with a combined antibiotherapy comprising doxycycline, rifampicin, ciprofloxacin, and streptomycin. None of the patients required surgical intervention. All of the patients showed improvement; relapse occurred in only one patient, who was subsequently treated. Discussion: Brucella infection should be considered in the differential diagnosis of patients presenting with epididymo-orchitis in endemic areas of brucellosis such as our country. Clinical and serological evaluation and imaging techniques such as Doppler ultrasound are sufficient for diagnosis. In most cases, a combination antibiotherapy is sufficient for management of BEO.