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Testicular Abscess

Testis Abscess


Presentation

  • We present the sixth case of epididymo-orchitis attributable to this organism. A 78-year-old man presented to the Mayo Clinic with fever and weight loss after being treated with cyclophosphamide and prednisone for an immune-mediated vasculitis.[ncbi.nlm.nih.gov]
  • To report relatively uncommon presentations of epididymo-orchitis and testicular abscess caused by Salmonella spp. in 2 immunocompromised patients.[ncbi.nlm.nih.gov]
  • The clinical spectrum of presentation of Salmonella infection has widened as increasing reports are being published about the unusual forms of presentation.[cjhr.org]
  • In most cases epididymo-orchitis has been present for some time, and thus typically patients present with testicular pain, often accompanied by fever and swelling, which have lasted a number of days.[radiopaedia.org]
  • Presents a section devoted to clinical scenarios-organized by presenting signs or disease processes-covering those you're most likely to encounter in daily practice.[books.google.com]
Inguinal Lymphadenopathy
  • Inguinal lymphadenopathy may be present (due to metastases or infection). Investigations [ 1 ] Clinically suspected testicular cancer: do not wait for investigations, but refer urgently to be seen within two weeks by a urologist .[patient.info]
  • [Campbell’s] Patients may present with pain, erythema and swelling in the groin region with or without a palpable cord, fever and inguinal lymphadenopathy. Chyluria may occur due to fistula development between lymphatics and the urinary tract.[ispub.com]
Fever
  • A 78-year-old man presented to the Mayo Clinic with fever and weight loss after being treated with cyclophosphamide and prednisone for an immune-mediated vasculitis. He was found to have a testicular abscess, and orchiectomy was performed.[ncbi.nlm.nih.gov]
  • In both cases, the chief complaints were high fever and painful scrotal swelling.[ncbi.nlm.nih.gov]
  • In most cases epididymo-orchitis has been present for some time, and thus typically patients present with testicular pain, often accompanied by fever and swelling, which have lasted a number of days.[radiopaedia.org]
  • He had a history of lower urinary tract symptoms and low-grade fever since 15 days. The fever subsided with antipyretics but recurred again. There is no history of contact with a typhoid case/carrier.[cjhr.org]
  • Further findings of low grade fever and the subsequent finding of elevated WBC count and positive blood culture led to the correct diagnosis of scrotal abscess.[home.earthlink.net]
High Fever
  • In both cases, the chief complaints were high fever and painful scrotal swelling.[ncbi.nlm.nih.gov]
  • Because high fever is uncommon and indicates a complicated infection, these patients should be admitted for further evaluation.[cdc.gov]
  • Because high fever is uncommon and indicates a complicated infection, hospitalization for further evaluation is recommended.[cdc.gov]
Inguinal Pain
  • The possible positioning of the testis in the inguinal canal should be kept in mind when a young boy presents with abdominal or inguinal pain following trauma to the area.[ispub.com]
Nausea
  • The symptoms of epididymitis may include pain (from mild to severe), swelling of the testicles or scrotum, nausea and vomiting, and fever. Hydrocele Hydrocele is a buildup of fluid around the testicles.[beaumont.org]
  • Fever, nausea Discharge from the penis Ache in the groin region, especially while urination or voiding. Treatment Rest is advised. Inflammation is reduced by giving anti inflammatory drugs. Cold ice packs may be applied over the affected side.[buddymd.com]
  • Seek care immediately. * Urinary symptoms * Discharge from your penis * Pain or burning with urination * Urinary frequency (more often than normal) * Fever and chills * Nausea * Abdominal or flank pain Testicle Infection (Epididymitis) Exams and Tests[justanswer.com]
  • Discharge from the urethra (at the end of the penis; especially in men younger than 39 years of age) Fever and chills Nausea What Causes Epididymitis? The cause of epididymitis is usually a bacterial infection.[emedicinehealth.com]
  • […] back Tender, swollen or hardened testicle Tender, swollen or hardened epididymis (ep-ih-DID-uh-miss), the soft, comma-shaped tube above and behind the testicle that stores and transports sperm Swelling in the scrotum Redness of the skin of the scrotum Nausea[mayoclinic.org]
Vomiting
  • This whole incident started with Muttley vomiting once soon after he had his morning meal. After vomiting he was quite restless for a few hours, couldn't find a single spot to lay down or a single comfortable position.[wagwalking.com]
  • The symptoms of epididymitis may include pain (from mild to severe), swelling of the testicles or scrotum, nausea and vomiting, and fever. Hydrocele Hydrocele is a buildup of fluid around the testicles.[beaumont.org]
  • Abdominal pain, nausea and vomiting (can occur with testicular torsion). Back pain, weight loss, dyspnoea (can occur with metastatic testicular cancer). Parotid swelling (mumps orchitis).[patient.info]
  • […] swollen or hardened testicle Tender, swollen or hardened epididymis (ep-ih-DID-uh-miss), the soft, comma-shaped tube above and behind the testicle that stores and transports sperm Swelling in the scrotum Redness of the skin of the scrotum Nausea or vomiting[mayoclinic.org]
  • These are those with intractable pain; those with nausea or vomiting that inhibit oral medications; those with evidence of an abscess; those who fail to improve after 72 hours of outpatient treatment, and those who are immunocompromised with significant[my.clevelandclinic.org]
Abdominal Pain
  • Abdominal pain, nausea and vomiting (can occur with testicular torsion). Back pain, weight loss, dyspnoea (can occur with metastatic testicular cancer). Parotid swelling (mumps orchitis).[patient.info]
  • Case No 2 A 4-year-old male complained of lower abdominal pain, fever and swelling of the left scrotal sac of two days duration.[casesjournal.biomedcentral.com]
  • pain, blood in stool, swollen scrotum. seen as: mass that may contain air or bowel, both echogenic and anechoic, shadowing from air, look for peristalsis. twisting of spermatic cord that results in loss of blood supply to the testis and blocks venous[quizlet.com]
  • pain similar to a hernia (see referred pain ).[en.wikipedia.org]
Tachycardia
  • Patients with epididymitis and orchitis often have tachycardia or fever. Patients may also be uncomfortable while seated, but this is also common with testicular torsion.[aafp.org]
Scrotal Pain
  • General May mimic a testicular tumour. [1] Clinical: [2] Scrotal pain. Scrotal swelling. Microscopic Features: Abundant neutrophils . /-Microorganisms. DDx: Germ cell neoplasia in situ . Lymphoma of the testis. Necrotic germ cell tumour .[librepathology.org]
  • In both cases, fever and scrotal pain subsided after antibiotic chemotherapy, and inflammatory reactions on routine blood studies were normalized within 2 weeks.[ncbi.nlm.nih.gov]
  • Fig. 6 Perineal abscess presenting as scrotal pain. a Transverse color Doppler US image in a 33-year-old patient with scrotal pain and history of suppurativa hidradenitis shows an encapsulated heterogeneous fluid collection ( arrowheads ) in the perineum[criticalultrasoundjournal.springeropen.com]
  • If you have scrotal pain or urinary symptoms and cannot be seen by your health care provider (or if you do not have one), then you should go to a hospital’s emergency department.[justanswer.com]
  • Symptoms Scrotal pain Pain in the testicles Swelling of the testicles Redness in the scrotum area Pain during sexual intercourse Pain during urination Fever Chills Diagnosis During a general examination, the doctor will examine the patient’s testicles[bookinghealth.com]
Testicular Pain
  • In most cases epididymo-orchitis has been present for some time, and thus typically patients present with testicular pain, often accompanied by fever and swelling, which have lasted a number of days.[radiopaedia.org]
  • If you have testicular pain, you should contact your doctor right away. And if you experience a sudden onset of testicular pain, you should seek emergency medical care to rule out serious conditions like testicular torsion.[beaumont.org]
  • If it is left untreated, it could lead to chronic epididymo-orchitis, where persistent testicular inflammation leads to recurring testicular pain. It can also lead to testicular shrinkage or testicular abscess (pus collection within the testicle).[leedssexualhealth.com]
  • Chronic epididymitis refers to inflammation characterized by persistent testicular pain in the absence of scrotal swelling. This condition is usually more difficult to treat and may result in long-term pain.[innerbody.com]
Scrotal Mass
  • Scrotal mass in a neonate: Testicular abscess. Am J Dis Child 1975; 129 1361–1362. PubMed Google Scholar 6. McCartney ET, Stewart I. Suppurative orchitis due to Pseudomonas. J Paed 1958; 52: 451–453. CrossRef Google Scholar 7.[link.springer.com]
  • Anorchia (Medical Encyclopedia) Hydrocele (Medical Encyclopedia) Hydrocele repair (Medical Encyclopedia) Hypogonadotropic hypogonadism (Medical Encyclopedia) Orchitis (Medical Encyclopedia) Scrotal masses (Medical Encyclopedia) Testicle lump (Medical[icdlist.com]
  • A scrotal mass is an abnormal bulge or lump inside your scrotum. The scrotum is a sac of skin that contains your testicles. A scrotal mass can be a swollen testicle or it can contain fluid or other tissue.[healthline.com]
  • See your doctor if you detect a lump in your scrotum, even if it's not painful or tender, or if you experience other symptoms of a scrotal mass. Some scrotal masses are more common in children.[mayoclinic.org]
  • All new scrotal masses whose onset was sudden in nature should be considered torsion until proven otherwise.[clinicaladvisor.com]
Swelling of the Scrotum
  • It can affect one or both testicles, and it can cause swelling in the scrotum and groin area. Hydrocele is not usually painful or harmful, and it may not need treatment. However, any swelling in the scrotum should be evaluated by a doctor.[beaumont.org]
  • Diagnosis and Treatment In acute epididymitis, the physical examination shows tenderness and swelling of the scrotum, discharge from the penis, enlarged groin lymph nodes , and fever.[innerbody.com]
  • A small amount of fluid in this space is normal, but the excess fluid of a hydrocele usually results in a painless swelling of the scrotum.[mayoclinic.org]
  • See a nice article on differential diagnosis of swelling of the scrotum: Reference: (free article and images.. excellent article).[ultrasound-images.com]
  • A scrotal hematoma will appear as a discoloration and swelling of the scrotum usually following trauma.[ispub.com]
Pelvic Pain
  • The perineum may be easily overlooked during imaging examinations, but it can potentially contain numerous acute conditions in patients presenting with pelvic pain.[appliedradiology.com]
  • pain, discharge, burning sensation, blood in urine. can be acute or chronic type of epididymitis. seen on ultrasound as enlarged, hypoechoic epididymis. mainly involves head. entire epididymis involved half of the time. hypo echoic areas secondary to[quizlet.com]
  • As the vas deferens extend from the seminal vesicles to the epididymes via the inguinal canal, infection can extend into the peritoneum and be a cause of pelvic pain or referred pain to the scrotum.[criticalultrasoundjournal.springeropen.com]

Workup

  • Clinical signs may not be convincing, and a complete workup is necessary. This article highlights the role of microbiological investigation in identifying the causative organism and confirming the diagnosis.[cjhr.org]
Nocardia Asteroides
  • A case of a localized testicular abscess due to Nocardia asteroides in a patient on immunosuppressive therapy for a myeloproliferative disorder is reported. Subsequent fatal dissemination of the infection to the prostate, lungs, and liver occurred.[ncbi.nlm.nih.gov]
  • Nocardia asteroides complex is a rare human pathogen chiefly affecting immunosuppressed patients. We present the sixth case of epididymo-orchitis attributable to this organism.[ncbi.nlm.nih.gov]
Salmonella Typhi
  • Salmonella typhi is a very rare condition.[cjhr.org]
  • Testicular abscess caused by Salmonella typhi. South Med J 1991;84(9):1156–7. Gerridzen RG, Ooi TC, Mc Kendry JBR. Salmonella epididymitis with recurrent septicemia in a diabetic patient. Urology 1981;17:172–4. Greene JB, Adler M, Holzman RS.[jamc.ayubmed.edu.pk]

Treatment

  • Extrapulmonary forms of nocardiosis must be recognized so that appropriate treatment can be instituted prior to dissemination.[ncbi.nlm.nih.gov]
  • Treatment Conservative treatment, such as antibiotics, may be prescribed to fight the infection and prevent a future recurrence. Antibiotics need to be taken for a defined period of time if they are to be effective.[bookinghealth.com]
  • Stay abreast of new AUA and ICI Incontinence guidelines, and access up-to-date information on the latest treatment recommendations, therapy for castrate-resistant prostate cancer, and active surveillance for prostate cancer.[books.google.com]
  • Treatment and prognosis Management may include prolonged antibiotics, surgical debridement or even orchidectomy 1,4 .[radiopaedia.org]
  • Treatments include drainage and antibiotics.[icdlist.com]

Prognosis

  • Treatment and prognosis Management may include prolonged antibiotics, surgical debridement or even orchidectomy 1,4 .[radiopaedia.org]
  • […] requiring intravenous antibiotics and debridement (surgical removal) of necrotic (dead) tissue. [2] In addition to surgery and antibiotics, hyperbaric oxygen therapy may be useful and acts to inhibit the growth of and kill the anaerobic bacteria. [7] Prognosis[en.wikipedia.org]
  • Prognosis and Patient Counseling. Prognosis is highly dependent on pathology and staging of radical orchiectomy specimen.[clinicaladvisor.com]
  • […] tumors. most common type of testicular neoplasm. constitute 40-50% of primary testicular tumors. usually in men between 35-39. most common malignant disease associated with undescended testicles. not very aggressive and radiosensitive. has the best prognosis[quizlet.com]
  • If treated appropriately with antibiotics, epididymitis should be cured and the individual will have an excellent prognosis (outlook). The pain should improve within 1-3 days; however, swelling may take several days to resolve.[emedicinehealth.com]

Etiology

  • Urinalysis, urine culture and complete blood count help to differentiate infectious etiologies from non-infectious etiologies. Furthermore, in the case of infectious etiologies, urine culture results guide antimicrobrial selection.[clinicaladvisor.com]
  • In patients with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome, fungal and viral etiologies, including cytomegalovirus, have been reported. 7 , 8 Noninfectious etiologies of epididymitis have been identified in numerous groups[aafp.org]
  • Differentiating those etiologies that require immediate surgical intervention form those that can be treated medically is often challenging.[ispub.com]
  • The etiology of superficial scrotal abscess is infected hair follicles and infections of scrotal lacerations or minor scrotal surgeries.[emedicine.medscape.com]
  • Acute scrotal conditions due to traumatic, infectious, vascular, or neoplastic etiologies can all present with pain as the initial complaint.[criticalultrasoundjournal.springeropen.com]

Epidemiology

  • "Fournier's gangrene: Population based epidemiology and outcomes" . The Journal of Urology . 181 (5): 2120–6. doi : 10.1016/j.juro.2009.01.034 . PMC 3042351 . PMID 19286224 .[en.wikipedia.org]
  • […] epididymitis will eventually "burn out" of patient's system if left untreated, though this might take years or even decades. [5] However, some prostate -related medications have proven effective in treating chronic epididymitis, including doxazosin . [14] Epidemiology[en.wikipedia.org]
  • Epidemiology A study of UK general practices during the years 2003-2008 reported a highest incidence of 25/10,000 in 2004-2005. The incidence declined during the latter part of the study [ 11 ] .[patient.info]
  • C 12 Epidemiology In 2002, epididymitis or orchitis accounted for 1 in 144 outpatient visits (0.69 percent) in men 18 to 50 years of age. 1 There are approximately 600,000 cases of epididymitis per year in the United States, most of which occur in men[aafp.org]
  • Washington, DC American Society for Microbiology (pg. 382 - 6 ) 25 , Practical statistics for medical research , 1992 London Chapman and Hall 26 , Epi Info, version 6: a word processing, data base, and statistics program for epidemiology on micro-computers[academic.oup.com]
Sex distribution
Age distribution

Pathophysiology

  • Etiology and Pathophysiology Epididymitis is the most common cause of intrascrotal inflammation, 5 and retrograde ascent of pathogens is the usual route of infection.[aafp.org]
  • Sandlow, Varicocele: current concepts in pathophysiology, diagnosis, and treatment. Urol Clin North Am, 2002. 29(4): p. 921-37. 10. Dreyer, G., et al., Pathogenesis of lymphatic disease in bancroftian filariasis: a clinical perspective.[ispub.com]

Prevention

  • Treatment Conservative treatment, such as antibiotics, may be prescribed to fight the infection and prevent a future recurrence. Antibiotics need to be taken for a defined period of time if they are to be effective.[bookinghealth.com]
  • Treatment of Acute Epididymitis The goals are to cure the infection, prevent transmission of the infection to others, and prevent infertility or chronic pain.[innerbody.com]
  • The scrotal wound is left open and packed to prevent reoccurrence of the abscess.[emedicine.medscape.com]
  • Other prevention methods are as follows: abstinence (no sexual relations); condom use (reduces chances for infection by about 90%); monogamy with only one uninfected sex partner; preventing child abuse in pediatric patients; and mumps vaccination.[emedicinehealth.com]
  • If you are treated for epididymo-orchitis, it is really important that your partner also gets treated before you have sex again to prevent reinfection.[leedssexualhealth.com]

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