rifampin and Epididymitis

Genitourinary tuberculosis was diagnosed in 543 patients in Spanish hospital from 1978 through 2003. Of the 371 male 34 (9.2%) had orchiepididymitis. Mean age was 52.7 years and the presenting symptom was scrotal swelling and/or pain. Over 50% of cases involved the right ovotestis. Associated renal tuberculosis and active disease in extraurological organs presented in 64% and 19.2% of cases, respectively. Diagnosis was established by culture of Mycobacterium tuberculosis recovery from urine and/or purulent scrotal exudate. Genomic amplification techniques aided the diagnosis in 8 patients. Treatment was rifampin, isoniazide, and pyrazinamide or ethambutol. Eight patients required combined medical and surgical treatment.

Topics: Adult; Aged; Aged, 80 and over; Antitubercular Agents; Combined Modality Therapy; Comorbidity; Epididymitis; Ethambutol; Exudates and Transudates; HIV Infections; Humans; Isoniazid; Male; Middle Aged; Mycobacterium tuberculosis; Orchitis; Prostatitis; Pyrazinamide; Retrospective Studies; Ribotyping; Rifampin; RNA, Ribosomal, 16S; Scrotum; Spain; Tuberculosis, Male Genital; Tuberculosis, Renal; Urine

To focus on the need of including tuberculosis among differential diagnoses of any epidymo-testicular mass, especially if its evolution is torpid.. A 73-year-old man who presented with scrotum abscess underwent surgical drainage and antibiotic treatment, but suppuration relapsed through cutaneous fistulae. A epipidymectomy was then performed, which demonstrated tuberculous granulomas. Torax Rx showed a cystic apical pulmonary wound which was treated with 3 antituberculostatics for 12 months. Sputum culture was positive for Micobacterium Bovis.. Aspirative punction under sonographic control is a valuable technique to avoid mutilating surgeries and to permit an almost always effective treatment, before the appearance of permanent lesions which lead to sterility.

Topics: Abscess; Aged; Animal Husbandry; Animals; Anti-Bacterial Agents; Antitubercular Agents; Cattle; Drug Therapy, Combination; Epididymitis; Humans; Isoniazid; Male; Mycobacterium bovis; Occupational Diseases; Pyrazinamide; Rifampin; Scrotum; Tuberculosis, Bovine; Tuberculosis, Male Genital

To review the clinical and laboratory features and response to treatment of patients with acute brucellar epididymo-orchitis reporting to a tertiary care hospital in Riyadh, and to compare these with other cases reported previously.. In this retrospective study, records of all 26 adult patients with brucellosis, who presented with epididymitis or epididymo-orchitis at a tertiary hospital in Riyadh from 1983 to 2000, were reviewed. Positive blood culture or high agglutination titres of > or = 1 : 320 and positive clinical manifestations of brucellosis were the main criteria for diagnosing brucellosis. Among these cases, epididymitis or epididymo-orchitis was diagnosed on the basis of a typical history of gradual onset of scrotal pain and findings of enlarged tender testes and/or epididymis.. Epididymo-orchitis occurred in 1.6% of all patients with brucellosis. Most (58%) were 25--44 years old; approximately 77% of the patients presented with acute symptoms of < 2 weeks' duration. All patients complained of swollen painful testicles. Other presenting symptoms included undulant fever (96%), chills (54%) and arthralgia (23%). Four patients had dysuria and one haematuria. Ten patients gave a positive history of ingestion of raw milk and milk products; one patient had laboratory-acquired brucellosis. Six patients had unilateral epididymo-orchitis (two with features of florid presentation); the remaining 20 had only orchitis (bilateral in two, right in 10 and left in eight). Leucocytosis was present in six patients; 25 had initial agglutination titres of > 1 : 320 and the remaining patient had a positive blood culture. All patients received combined therapy with streptomycin for the first 2 weeks (or oral rifampicin for 6 weeks) with doxycycline or tetracycline for 6 weeks. All showed improvement, fever subsided in 2--5 days and the scrotal enlargement and tenderness regressed. Only one patient had a relapse within one year.. In brucellosis-endemic areas, clinicians encountering epididymo-orchitis should consider the likelihood of brucellosis. A careful history, a meticulous physical examination and a rapid laboratory evaluation help in diagnosis. Clinical and serological data are sufficient for diagnosis. Leucocytosis is not an atypical feature of brucellar epididymo-orchitis and so cannot be used for differentiating it from the nonspecific variety. Conservative management with combination antibiotic therapy is adequate for managing brucellar epididymo-orchitis.

Topics: Adolescent; Adult; Aged; Brucellosis; Doxycycline; Drug Therapy, Combination; Epididymitis; Fever; Humans; Length of Stay; Male; Middle Aged; Orchitis; Retrospective Studies; Rifampin; Saudi Arabia; Streptomycin; Tetracycline

Brucellosis is an endemic disease in Turkey, and testicular abscess is a rare and frequently misdiagnosed complication of brucellosis. In the literature there are only seven reported cases, and all were treated with both medical and surgical therapy. We report a case of brucellar testicular abscess treated with medical therapy only. Although the patient recovered clinically at the end of 6 weeks, the regression of the testicular lesion could not be observed until after 5 months.

Topics: Abscess; Adult; Anti-Bacterial Agents; Brucellosis; Doxycycline; Epididymitis; Humans; Male; Orchitis; Rifampin; Testicular Diseases; Turkey

Diagnosis of extrapulmonary tuberculosis (TB) is often missed or delayed because of nonspecific clinical and laboratory findings. Novel detection methods, such as polymerase chain reaction and QuantiFERON-TB Gold In Tube, can aid in the diagnosis of active extrapulmonary TB. Here, we demonstrate a case of epididymo-orchitis as the sole presentation of TB in a 32-year-old man.

Topics: Adult; Antibiotics, Antitubercular; Enzyme-Linked Immunosorbent Assay; Epididymitis; Humans; Male; Orchitis; Polymerase Chain Reaction; Rifampin; Testis; Tuberculosis, Male Genital; Ultrasonography

Topics: Adult; Anti-Bacterial Agents; Brucellosis; Doxycycline; Drug Therapy, Combination; Epididymitis; Humans; Male; Orchitis; Recurrence; Rifampin; Scrotum; Treatment Outcome; Ultrasonography

Brucellosis is a significant public health problem particularly in developing countries. People are frequently infected through milk, milk products, urine and pregnancy material of animals with brucellosis. Epididymoorchitis is the most frequent genitourinary complication of brucellosis and is often unilateral. In this report, a 35 years old male patient who was diagnosed as epididymoorchitis based on clinical presentation, laboratory findings and imaging techniques, has been presented. Brucella melitensis was isolated from blood, bone marrow and ejaculate cultures of the patient. The patient was treated with rifampicine and doxycycline combination therapy for six weeks and no complication has developed in the one year follow-up period. In areas where brucellosis is endemic, such as our country, Brucella infection should be considered in the differential diagnosis of epididymoorchitis and in addition to blood and bone marrow cultures, ejaculate cultures should also be evaluated.

Topics: Adult; Anti-Bacterial Agents; Bacteremia; Bone Marrow; Brucella melitensis; Brucellosis; Diagnosis, Differential; Doxycycline; Epididymitis; Humans; Male; Orchitis; Rifampin; Semen

We describe a case of bilateral tuberculous epididymitis that occurred two weeks after intravesical Bacillus Calmette-Guerin (BCG) instillation. A 72-year-old man received transuretheral resection of bladder transitional cell carcinoma in November 2000. Although he had no recurrence for about 4 years, cystoscopy revealed small papillary tumors in the bladder in September 2004. A course of 8 weekly intravesical instillations of BCG was started. After the second BCG instillation (160 mg) he had bilateral painful scrotal swelling. Although he was administered isoniazid (INH) and rifampicin (RFP), scrotal swelling got worse. Right orchiectomy and left epididymectomy was performed in December 2004. Histological diagnosis was bilateral tuberculous epididymitis. Postoperatively, he was administered INH and RFP and had no recurrence for 3 months.

Topics: Administration, Intravesical; Aged; Antitubercular Agents; BCG Vaccine; Carcinoma, Transitional Cell; Combined Modality Therapy; Drug Therapy, Combination; Epididymitis; Humans; Isoniazid; Male; Orchiectomy; Rifampin; Tuberculosis, Male Genital; Urinary Bladder Neoplasms

The incidence of tuberculosis in the United States is on the rise, in part, because of its association with acquired immunodeficiency syndrome. Genitourinary tuberculosis remains one of the most common forms of secondary or extrapulmonary disease. We present an unusual case of tuberculous epididymitis with extensive retroperitoneal and mediastinal spread. The possible routes of dissemination, as well as the efficacy of antimycobacterial therapy in the management of tuberculous epididymitis, are discussed and the relevant literature is reviewed.

Topics: Adult; Antitubercular Agents; Diagnostic Imaging; District of Columbia; Drug Therapy, Combination; Epididymitis; Humans; Isoniazid; Male; Mediastinum; Pyrazinamide; Retroperitoneal Space; Rifampin; Sierra Leone; Tuberculosis, Male Genital

Topics: Anti-Bacterial Agents; Brucella abortus; Brucellosis; Doxycycline; Drug Therapy, Combination; Epididymitis; Humans; Male; Middle Aged; Oligospermia; Orchitis; Recurrence; Rifampin

To present epidemiologic, clinical and laboratory features, treatment and outcome of patients suffering from Brucella melitensis-induced epididymo-orchitis, in comparison with cases of nonspecific epididymo-orchitis. Distinction between these two entities is essential, as treatment and outcome are entirely different.. In this retrospective study, records of 17 patients serologically diagnosed as suffering from B. melitensis epididymo-orchitis were reviewed in comparison with 141 cases of non-Brucella epididymo-orchitis. All patients presented consecutively at a tertiary hospital in southwestern Greece, from 1991 to 2000. Statistical analysis was performed using the chi-square test.. B. melitensis epididymo-orchitis differed from nonspecific epididymo-orchitis, due to its high occupational risk, seasonal pattern, gradual onset (P<0.01), longer duration, typical undulatory fever (P<0.05), absence of serious leukocytosis (P<0.05) and lower urinary tract symptoms, and relatively minimal local signs of florid inflammation (P<0.01). Oral medication with doxycycline and rifampicin for 6 weeks was effective, and no relapses or serious side effects were recorded during the follow-up period.. B. melitensis-induced epididymo-orchitis is a recognized clinical problem in endemic regions, requiring early detection and appropriate medication. Clinicians encountering epididymo-orchitis should consider the likelihood of brucellosis and initiate anti-Brucella medication upon clinical diagnosis and not only after serologic confirmation.

Topics: Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Doxycycline; Endemic Diseases; Epididymitis; Greece; Humans; Male; Orchitis; Retrospective Studies; Rifampin; Treatment Outcome

Whether endolymphatic intranodular injection (ELII) of isoniazid can be used in the combined treatment of male genital tuberculosis is considered. Clinical trials were performed and this method used in the combined treatment of tuberculous epididymitis was assessed. The bacteriostatic activity and blood and tissue concentration of the agent given as ELII were studied and compared with its intramuscular route of administration. The authors show it possible to employ scrotum ultrasound studies to evaluate the efficiency of treatment and estimate the scope of a surgical intervention. Based on the data of morphological study of postoperative specimens, the authors defined the time and worked out criteria for epididymectomy in tuberculous epididymitis.

Topics: Adult; Antibiotics, Antitubercular; Antitubercular Agents; Epididymitis; Ethambutol; Humans; Injections, Intralymphatic; Injections, Intramuscular; Isoniazid; Male; Middle Aged; Rifampin; Tuberculosis, Male Genital; Ultrasonography

This paper describes a case of systemic brucellosis accompanied by brucellar orchitis that resolved favourably. There was however a relapse at the testicular level inappropriately treated that triggered a new episode of systemic brucellosis.

Topics: Adult; Anti-Infective Agents; Brucellosis; Doxycycline; Epididymitis; Humans; Male; Orchitis; Recurrence; Rifampin; Streptomycin

Eighteen patients with epididymo-orchitis were reviewed clinically, microbiologically and serologically. While there were positive urine culture in 5 patients before treatment, only one of them had positive culture in the epididymal aspirate. The epididymo-orchitis in two patients was the complications of the brucellosis. Ofloxacin or doxycycline was used in the treatment of 16 patients for 2-3 weeks and all, except one patient were recovered completely. The cases secondary to the brucellosis were treated with rifampicin plus doxycycline combination for 6 weeks. After treatment, no positive urine cultures were noted in all patients. As a result the epididymal aspiration to clarify etiological agent is not necessarily needed and empirical treatment may be generally curative.

Topics: Adolescent; Adult; Bacteriuria; Brucellosis; Doxycycline; Drug Therapy, Combination; Epididymitis; Escherichia coli; Escherichia coli Infections; Humans; Male; Middle Aged; Ofloxacin; Orchitis; Prospective Studies; Rifampin

Topics: 4-Hydroxycoumarins; Aged; Drug Antagonism; Epididymitis; Ethambutol; Humans; Isoniazid; Male; Phenprocoumon; Rifampin; Thrombophlebitis; Tuberculosis, Male Genital

Topics: Aminosalicylic Acids; Calcinosis; Drug Synergism; Epididymitis; Ethambutol; Female; Humans; Hypertension, Renal; Isoniazid; Kidney Calculi; Male; Mycobacterium tuberculosis; Nephrectomy; Prednisolone; Rifampin; Streptomycin; Tuberculosis, Urogenital; Ureteral Obstruction; Urinary Bladder; Urinary Diversion; Urine