Can Indirect Inflammatory Markers Differentiate Brucella Epididymo-Orchitis From Non-Brucella Epididymo-Orchitis?

Objective: This study aimed to evaluate the value of direct and indirect markers showing inf-lammation in the diagnosis of Brucella epidid-ymo-orchitis (BEO) and its differentiation from non-Brucella epididymo-orchitis. Material and Methods: A total of 152 pa-tients that presented to our clinic with acute sc-rotal complaints and were diagnosed with epidid-ymo-orchitis between January 2015 and January 2019 were retrospectively evaluated. Excluded from the study were 15 patients with a hemato-logic disease, coronary artery disease or malig-nant diagnosis, eight patients aged below 18 years, and 13 patients whose hemogram and C-reactive protein (CRP) values were not available in their medical records. The diagnosis of epididymo-or-chitis was based on laboratory (leukocytosis, CRP elevation) and radiological findings. The diagnosis of BEO was defined as ≥1/160 titer value and/or positive blood culture in the standard tube aggluti-nation (STA) test in addition to orchitis symptoms and signs. Results: The median WBC (p=0.033), neut-rophil (p=0.013) and monocyte (p=0.006) counts and NL (p=0.014) and ML (p=0.002) ratios were statistically significantly lower in the BEO group. The ML ratio had the highest predictive value with an AUC of 0.725 (95% CI = 0.146-0.424; p=0.002), as well as high specificity (97.3%) and diagnostic accuracy (83.5%) in predicting a BEO diagnosis. No parameter was an independent factor in the differentiation of BEO and NBEO. Conclusions: Easy, fast and low-cost hemoto-logical inflammatory markers provide diagnostic benefits complementing serological tests in dis-tinguishing BEO from NBEO cases. In particular, MLR has a high diagnostic accuracy compared to other parameters.

Direk ve İndirek İnflamatuar Belirteçler Brusella Epididimo-Orşiti Non-Brusella Epididimo-Orşitten Ayırabilir Mi?

Amaç: Çalışmamızda inflamasyonu gösteren direk ve indirek belirteçlerin Brusella epididi-mo-orşit (BEO) tanısında ve Brusella dışı epidi-dimo-orşit (NBEO) ayırıcı tanısındaki değerinin araştırılması amaçlanmıştır. Gereç ve Yöntemler: Ocak 2015 ve Ocak 2019 yılları arasında akut skrotum kliniği ile baş-vuran epididim-orşit tanısı alan 152 hasta retros-pektif olarak değerlendirildi. Hematolojik hastalı-ğı, koroner arter hastalığı, malignite tanısı olan 15 hasta, 18 yaşından küçük 8 hasta, hemogram ve C-reaktif protein (CRP) sonuçlarına ulaşılamayan 13 hasta çalışma dışı bırakıldı. Epidimo-orşit tanısı fizik muayene bulgularına ek olarak laboratuvar (lökositoz, CRP yüksekliği) ve radyolojik bulgular baz alınarak koyuldu. BEO tanısı orşit semptom ve bulgularına ek olarak pozitif kan kültürü ve standart tüp aglütinasyon (STA) testinde ≥1/160 titre değeri olarak tanımlandı. Bulgular: Ortalama WBC (p=0.033), nötrofil (p=0.013), monosit sayısı (p=0.006), nötrofil len-fosit oranı (NLR) (p=0.014) ve monosit lenfosit oranı (MLR) (p=0.002) BEO grubunda istatis-tiksel olarak anlamlı şekilde daha düşük izlendi. BEO tanısını öngörmede MLR yüksek prediktif değere (AUC değeri: 0.725, 0.146-0.424; p=0.002), yüksek özgüllük (97.3%) ve tanı doğruluk oranına (83.5%) sahipti. BEO ve NBEO ayırıcı tanısında bağımsız bir öngörü değeri olan belirteç saptan-mamıştır. Sonuç: Kolay, hızlı ve düşük maliyetli he-matolojik inflamatuar belirteçler, BEO ve NBEO ayırıcı tanısında serolojik testlere ek olarak tanısal fayda sağlamaktadır. Özellikle MLR diğer para-metrelere nazaran yüksek tanı doğruluk oranına sahiptir.

Kaynakça

1. Yuce A, Alp C. S. Brucellosis in Turkey: An Overview. Kli-mik Journal 2006;19:87-97.

2. Galińska EM, Zagórski J. Brucellosis in humans--etio-logy, diagnostics, clinical forms. Ann Agric Environ Med 2013;20:233-8.

3. Kandemir Ö. Bruselloz. Turkiye Klinikleri J Inf Dis-Special Topics 2015;8:1–9.

4. Colmenero JD, Muñoz-Roca NL, Bermudez P, et al. Clini-cal findings, diagnostic approach, and outcome of Brucella melitensis epididymo-orchitis. Diagn Microbiol Infect Dis 2007;57:367-72.

5. Erdem H, Elaldi N, Ak O, et al. Genitourinary brucello-sis: results of a multicentric study. Clin Microbiol Infect 2014;20:847-53.

6. Bosilkovski M, Kamiloski V, Miskova S, et al. Testicular infection in brucellosis: Report of 34 cases. J Microbiol Im-munol Infect 2018;51:82-7.

7. Aktar F, Tekin R, Bektaş MS, et al. Diagnostic role of inf-lammatory markers in pediatric Brucella arthritis. Ital J Pe-diatr 2016;42:3.

8. Canpolat FE, Yurdakök M, Armangil D, et al. Mean platelet volume in neonatal respiratory distress syndrome. Pediatr Int 2009;51:314-6.

9. Albayrak Y, Albayrak A, Albayrak F, et al. Mean platelet volume: a new predictor in confirming acute appendicitis diagnosis. Clin Appl Thromb Hemost 2011;17:362-6.

10. Acmaz G, Aksoy H, Unal D, et al. Are neutrophil/lymp-hocyte and platelet/lymphocyte ratios associated with en-dometrial precancerous and cancerous lesions in patients with abnormal uterine bleeding? Asian Pac J Cancer Prev 2014;15:1689-92.

11. Kahramanca S, Ozgehan G, Seker D, et al. Neutrophil-to-l-ymphocyte ratio as a predictor of acute appendicitis. Ulus Travma Acil Cerrahi Derg 2014;20:19-22.

12. Kounis NG, Soufras GD, Tsigkas G, et al. White blood cell counts, leukocyte ratios, and eosinophils as inflammatory markers in patients with coronary artery disease. Clin Appl Thromb Hemost 2015;21:139-43.

13. Cift A, Yucel MO. Comparison of inflammatory markers between brucella and non-brucella epididymo-orchitis. Int Braz J Urol 2018;44:771-8.

14. Aydin E, Karadag MA, Cecen K, et al. Association of mean platelet volume and the monocyte/lymphocyte ratio with brucella-caused epididymo-orchitis. Southeast Asian J Trop Med Public Health 2016;47:450-6.

15. Pappas G, Papadimitriou P, Akritidis N, et al. The new glo-bal map of human brucellosis. Lancet Infect Dis 2006;6:91– 9.

16. Zheng R, Xie S, Lu X, et al. A Systematic Review and Meta-Analysis of Epidemiology and Clinical Manifes-tations of Human Brucellosis in China. Biomed Res Int 2018;22:5712920. 17. Hardy AV. Undulant (Malta) fever: clinical aspects of ca-ses which have occurred in Iowa. J Iowa State Med Soc 1928;18:387e91.

18. Khan MS, Humayoon MS, Al Manee MS. Epididymo-orc-hitis and Brucellosis. Br J Urol 1989;63:87–9.

19. Papatsoris AG, Mpadra FA, Karamouzis MV, et al. Ende-mic brucellar epididymo-orchitis: a 10-year experience. Int J Infect Dis 2002;6:309–13.

20. Ibrahim AI, Awad R, Shetiy SD, et al. Genito-urinary complications of brucellosis. Br J Urol 1988;61:294–8.

21. Efesoy O,Saylam B, Cayan S. Are the symptoms and signs of brucella epididimo-orchitis as the first presenting sign of brusellosis different from non-spesific epididimo-orchitis? Androl Bul 2018;20:103−7.

22. Beyazit Y, Sayilir A, Torun S, et al. Mean platelet volume as an indicator of disease severity in patients with acute panc-reatitis. Clin Res Hepatol Gastroenterol 2012;36:162-8.

23. Okan DH, Gökmen Z, Seyit B, et al. Mean platelet volu-me in brucellosis: correlation between brucella standard serum agglutination test results, platelet count, and C-re-active protein. Afr Health Sci 2014;14:797-801.

24. Küçükbayrak A, Tas T, Tosun M, et al. Could thrombocyte parameters be an inflammatory marker in the brucellosis? Med Glas 2013;10:35-9.

25. Togan T, Narci H, Turan H, et al. The impact of acute bru-cellosis on mean platelet volume and red blood cell distri-bution. Jundishapur J Microbiol 2015;8:e20039.

26. Küçükbayrak A, Taş T, Tosun M, et al. Erythrocytes Pa-rameters in The Course of Brucellosis. Abant Med J 2013;2:36-9.

27. Lippi G, Targher G, Montagnana M, et al. Relation betwe-en red blood cell distribution width and inflammatory bi-omarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med 2009;133:628-32.

28. Buyukkaya E, Karakas MF, Karakas E, et al: Correlation of neutrophil to lymphocyte ratio with the presence and se-verity of metabolic syndrome. Clin Appl Thromb Hemost 2014;20:159-63.

29. Wang J, Yin Y, Wang X, et al. Ratio of monocytes to ly-mphocytes in peripheral blood in patients diagnosed with active tuberculosis. Braz J Infect Dis 2015;19:125-31.

30. Bozdemir SE, Altıntop YA, Uytun S, et al. Diagnostic role of mean platelet volume and neutrophil to lympho-cyte ratio in childhood brucellosis. Korean J Intern Med 2017;32:1075-81.

Kaynak Göster

Yeni Üroloji Dergisi
  • ISSN: 1305-2489
  • Yayın Aralığı: Yılda 3 Sayı
  • Başlangıç: 2005

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