Brucellosis of Testis and Epididymis: An Update of the Literature

Background: Brucellosis is a zoonotic disease which has the ability to afflict a number of organs and
tissues. Brucellosis epididymoorchitis (BEO), a complication of human brucellosis, can emanate in
complications. In brucellosis non-endemic areas, some clinicians may be unfamiliar with the disease
entity which may lead to delay in the diagnosis.
Aim: To review the literature on BEO, in order to document its presentation, diagnosis, management
and outcome following treatment as well as update the literature related to the disease.
Methods: Various internet data bases were used to obtain literature on BEO.
Results / Literature Review: BEO (epididymitis plus or minus orchitis) is a complication of an
infection caused by brucella species which can be transmitted via contact through the respiratory
tract, skin, or conjunctiva, and through the gastrointestinal tract pursuant to ingestion of unpasteurized
milk/milk products or raw infected meat. BEO does in endemic areas affect 2% to 20% of patients who
have been afflicted by brucellosis but the disease can also be encountered sporadically globally in
non-endemic areas. BEO could at times be bilateral. The manifestation of BEO is non-specific and it
could be mistaken for non-specific epididymo-orchitis or epididymitis or testicular tumour or abscess.
Ultrasound scan and MRI scan findings are not specific to BEO. Diagnosis of BEO may be
established by (a) history of contact, (b) cultures from blood/epididymal aspirations, (c) various types
of laboratory studies including: (I) Culture, (II) PCR, and (III) serology. Laboratory test criteria for the
diagnosis of Brucellosis is divided into (I) those for presumptive diagnosis and (II) those for
confirmatory diagnosis: BEO can be effectively treated by means of combination chemotherapy for
about six weeks but at times orchidectomy or drainage of testicular collection may be necessitated for
persistence of symptoms or suspicion of a tumour / testicular abscess. Relapses of brucellosis can
occur hence careful follow-up of patients is required.
Conclusions: BEO can occur anywhere globally. A high index of suspicion is thus required from
clinicians in order to establish early diagnosis of the disease. Most cases of BEO can be effectively
treated with combination chemotherapy for about 6 weeks. Clinicians should be aware that brucellosis
epididymo-orchitis, brucellosis epididymitis and epididymo-orchitis exist and this condition could be
unilateral or bilateral, though more commonly encountered in brucellosis endemic areas because of
global travel the disease entity may be encountered sporadically globally.