Brusella epididimo-orsit: 22 olgunun retrospektif değerlendirilmesi

Amaç: Brusella epididimo-orsitli (BEO) hastaların klinik semptomları, laboratuvar bulguları, komplikasyonları ve tedavi sonuçlarını retrospektif olarak değerlendirmek. Materyal ve metod: Ocak 2012 - Ocak 2017 tarihleri arasında, kliniğimizde epididimo-orsit tanısı ile takip edilen 110 olgu retrospektif olarak değerlendirildi. Bu olgulardan 22’si brusella epididimo-orsiti idi. Testiküler ağrı, hassasiyet ve skrotal şişme gibi pozitif klinik tablo, pozitif Rose Bengal test sonuçları, ≥1/ 160 standart tüp aglütinasyon (STA) testi titre değerleri veya pozitif kan kültürü ve orşitin ultrasonografik bulguları, BEO tanısının ana kriteri olarak kabul edildi. Bulgular: Ortalama hasta yaşı 34.6±17.8 idi. BEO tüm hastalarda tek taraflıydı. 15 hastada (%68.2) sol, 7 hastada (%31.8) sağ taraf testis tutulumu görüldü. Testiküler ağrı ve şişme en yaygın semptomlardı. Terleme, ateş, yorgunluk ve anoreksiya daha az sıklıkta görüldü. En sık rastlanan laboratuvar bulgusu ESR ve CRP yükselmesiydi, sırasıyla %57.1, %47.4. Tüm hastalarda Rose Bengal test pozitifliği ve ≥1/ 160 STA testi titre değerleri tespit edildi. Kan kültürü 5 hastanın 1’inde (%20) Brucella türü için pozitifti. Relaps olması ve malignite ayırıcı tanısı tam olarak yapılamadığından bir hastaya radikal orşiektomi yapıldı. BEO’lu 22 hastanın 3’ü hariç tamamı rifampisin-doksisiklin veya streptomisin-doksisiklin kombine antibiyotik tedavisi ile başarılı bir şekilde tedavi edildi. Doğru ön tanılı hastalarda genel olarak medikal tedaviye yanıt oranı % 86.3 oranında bulundu. Sonuç: Bruselloz, endemik bölgelerde epididimo-orşitin yaygın bir nedenidir. BEO’da erken teşhis ve uygun tıbbi tedavi, apse oluşumu gibi komplikasyonların gelişimini engellemektedir. Bu nedenle BEO, endemik bölgelerde epididimiorşit nedeni olarak düşünülmeli ve nonendemik bölgelerde de mutlaka ayırıcı tanıda yer almalıdır.

Anahtar Kelimeler:

brusella, epididimo-orsit, medikal tedavi, orşiektomi

Brusella epididymoorchitis: a retrospective evaluation of 22 cases

Objective: To evaluate retrospectively the clinical symptoms, laboratory findings, complications and treatment outcomes of patients with Brucellar epididymo-orchitis (BEO). Material and method: Between January 2012 and January 2017, 110 cases followed up with epididymoorchitis in our clinic were evaluated retrospectively. Of these, 22 were brusella epididymoorchitis. Positive clinical findings such as testicular pain, tenderness and scrotal swelling, positive Rose Bengal test results, ≥1 / 160 standard tube agglutination test titers or positive blood culture and ultrasonographic findings of orchitis were accepted as the main criteria for BEO diagnosis. Results: The mean patient age was 34.6 ± 17.8 years. BEO was one-sided in all patients. In 15 patients (68.2%) left, 7 patients (31.8%) had right-sided testicular involvement. Testicular pain and swelling were the most common symptoms. Sweating, fever, fatigue and anorexia were seen less frequently. The most common laboratory findings were increased ESR and CRP, 57.1% and 47.4%, respectively. Rose Bengal test positivity and ≥1 / 160 STA test titers were determined in all patients. Blood culture was positive for Brucella spp in 1 of 5 patients (20%). Since relapsing and the malignancy differential diagnosis can not be performed completely, in a patient radical orchiectomy was performed. All but 3 of 22 patients with BEO were successfully treated with rifampicin- doxycycline, or streptomycin-doxycycline combined antibiotic therapy. The overall medical care response rate was 86.3% in patients with correct pre-diagnosis. Conclusion: Brucellosis is a common cause of epididymo-orchitis in endemic areas. Early diagnosis and appropriate medical treatment in BEO prevent the development of complications such as abscess formation. For this reason, BEO should be considered as the cause of epididymorhosis in endemic regions and should be included in differential diagnosis in non-endemic regions.

Keywords:

Brucella, epididymo-orchitis, medical treatment, orchiectomy,

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