Hidrocele infectado / Infected hidrocele

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Atypical testicular pain.

Testicular tuberculosis (TB) is rare, and, because of this, the lack of pathognomonic clinical features and its tendency to mimic other commoner conditions, the diagnosis is frequently delayed or may be missed. In this case, the initial clinical presentation was typical for bacterial epididymo-orchitis in a 38-year-old man. When the patient failed to improve with standard treatment including broadening of antibiotics, the diagnosis was re-considered because some unusual signs suggested testicular malignancy or lymphoma. Further, history-taking and subsequent cross-sectional imaging with CT/MRI identified co-existent pulmonary nodularity, thoracic and abdominal lymphadenopathy and bony changes that, together, raised the suspicion of TB. Mycobacterium tuberculosis was confirmed on DNA-based testing of the hydrocele fluid, although standard acid-fast bacilli culture was negative. This case prompted a review of the literature to explore the optimal steps in the investigation and diagnosis of this rare disease.

Integrated morbidity mapping of lymphatic filariasis and podoconiosis cases in 20 co-endemic districts of Ethiopia.

BACKGROUND: Lymphatic filariasis (LF) and podoconiosis are neglected tropical diseases (NTDs) that pose a significant physical, social and economic burden to endemic communities. Patients affected by the clinical conditions of LF (lymphoedema and hydrocoele) and podoconiosis (lymphoedema) need access to morbidity management and disability prevention (MMDP) services. Clear estimates of the number and location of these patients are essential to the efficient and equitable implementation of MMDP services for both diseases. METHODOLOGY/PRINCIPLE FINDINGS: A community-based cross-sectional study was conducted in Ethiopia using the Health Extension Worker (HEW) network to identify all cases of lymphoedema and hydrocoele in 20 woredas (districts) co-endemic for LF and podoconiosis. A total of 612 trained HEWs and 40 supervisors from 20 districts identified 26,123 cases of clinical morbidity. Of these, 24,908 (95.3%) reported cases had leg lymphoedema only, 751 (2.9%) had hydrocoele, 387 (1.5%) had both leg lymphoedema and hydrocoele, and 77 (0.3%) cases had breast lymphoedema. Of those reporting leg lymphoedema, 89.3% reported bilateral lymphoedema. Older age groups were more likely to have a severe stage of disease, have bilateral lymphoedema and to have experienced an acute attack in the last six months. CONCLUSIONS/SIGNIFICANCE: This study represents the first community-wide, integrated clinical case mapping of both LF and podoconiosis in Ethiopia. It highlights the high number of cases, particularly of leg lymphoedema that could be attributed to either of these diseases. This key clinical information will assist and guide the allocation of resources to where they are needed most.

Retroperitoneal, Psoas, and Scrotal Abscesses Due to an Uncommon Organism - Aggregatibacter aphrophilus: Case Report and Review of Literature.

Aggregatibacter aphrophilus is an uncommon cause of vertebral infections and its complications are infrequently seen. We believe ours is the first reported case of scrotal abscess as a complication of vertebral osteomyelitis. We have also reviewed nine cases with complications similar to this report. Epidural abscess is the most commonly found complication, having been reported in six patients, followed closely by psoas abscess, which was seen in five patients. All except one patient underwent surgical drainage, with all patients showing complete resolution of infection.

Chronic tuberculous epididymo-orchitis manifesting as a non-tender scrotal swelling: magnetic resonance imaging-histological correlation.

Clinically, chronic tuberculous epididymo-orchitis often is nonspecific and subsequently is indistinguishable from other various scrotal lesions. Gray-scale and color Doppler ultrasound is most commonly used for distinguishing these conditions. However, there are few reports on the magnetic resonance imaging (MRI) features of chronic tuberculous epididymo-orchitis. We describe MRI features of this lesion clinically manifesting as non-tender scrotal swelling with a correlation of the histological findings.

Characterization of antibody responses to Wolbachia surface protein in humans with lymphatic filariasis.

Symbiotic Wolbachia organisms of filarial nematodes have received much attention as possible chemotherapy targets and disease-causing organisms. In order to further investigate the association between anti-Wolbachia immune responses and chronic filarial disease in humans, antibody responses to Wolbachia surface protein (WSP) were assayed in serum samples collected from 232 individuals living in Leogane, Haiti, an area where Wuchereria bancrofti infection is endemic, and from 67 North Americans with no history of lymphatic filariasis. As opposed to antifilarial antibody responses, which were largely influenced by the patient's infection status, the prevalence and levels of anti-WSP immunoglobulin G (IgG) antibodies among individuals with lymphedema or hydrocele were significantly greater than those in gender- and infection-matched individuals without disease. In at least one case, the anti-WSP IgG response was coincident with the onset of lymphedema development, and among anti-WSP-positive women with lymphedema, anti-WSP IgG levels were negatively correlated with the duration of lymphedema. The presence of anti-WSP IgG was also associated with the severity of inguinal adenopathy among men with hydrocele. In addition to the presence of anti-WSP antibodies among Haitians, 15 of 67 (22%) serum samples collected from individuals from North America, where filariasis is not endemic, were also positive for anti-WSP antibodies. In comparison to those from Haitians, anti-WSP antibodies from North Americans primarily recognized a distinct region of WSP located within the highly conserved second transmembrane domain. The results of this study demonstrate that anti-WSP antibody responses are associated with the presence of chronic filarial morbidity and not filarial infection status in humans and suggest that WSP should be further studied as a potential trigger for the development of filarial disease.

Infected hydrocoele of the canal of Nuck in a neonate.

Hydrocoele of the canal of Nuck is an uncommon presentation in the neonate and complications are rare. A 6-day-old girl presented with a right groin swelling from birth. The swelling remained static until age 3 days when it increased rapidly in size. There was no fever or gastrointestinal symptoms. Physical examination showed a large nontender mass extending from the right groin into the ipsilateral labium majus with distortion of the external genitalia. Needle aspiration yielded cloudy fluid, which gave a growth of Klebsiella on culture. A hydrocoele of the canal of Nuck was confirmed at surgery and was excised. Postoperative course was uneventful and there has been no recurrence at 2 years of follow-up.

Group A streptococcal hydrocele infection and sepsis in a renal transplant recipient.

A case of hydrocele infection secondary to a cutaneous b-hemolytic group A streptococcal infection is described in a renal transplant recipient. Sepsis and renal failure occurred in the setting of this severe, life-threatening infection. This case represents the first description of a group A streptococcal hydrocele infection in an adult. This type of infection can progress rapidly to sepsis and its attendant complications, especially in an immunocompromised patient. Early diagnosis and treatment is crucial in order to optimize the outcome.

Infected hydrocele in a neonate.

A case of infected hydrocele in a neonate is presented. We describe this unusual condition, and discuss the diagnosis, pathophysiology and treatment.

A four year follow up study of filaria specific IgE response in individuals with hydrocele.

BACKGROUND & OBJECTIVES: Hydrocele is the most common clinical manifestation in males infected with Wuchereria bancrofti. IgE response to a filarial allergen Sd30 was evaluated in hydrocele patients living in a W. bancrofti endemic region of Orissa, India. METHODS: IgE levels to Sd30, an antigenic fraction isolated from Setaria digitata, were determined by ELISA in sera from patients of filariasis (n = 93). IgG and IgM levels were also determined. RESULTS: It was observed that microfilaraemic patients with hydrocele (n = 16) exhibited considerably reduced (P < 0.01) IgE levels in comparison to hydrocele patients without microfilariae (n = 27) and to other filarial groups (elephantiasis, asymptomatic microfilaraemics). The reduced IgE response in microfilariae positive patients with hydrocele persisted even after a gap of four years in the majority of patients. INTERPRETATION & CONCLUSIONS: The results show low IgE levels in microfilaraemic patients with hydrocele in comparison to other groups in filaria endemic regions. The exact mechanism of this reduction in IgE is not known but these patients make a distinct group in filaria endemic regions and should be considered separately for immunological evaluation.

[Epididymal manifestations of urogenital tuberculosis]. / Les manifestations épididymaires de la tuberculose uro-génitale.

OBJECTIVE: To define the epidemiological, anatomical, clinical and therapeutic aspects of tuberculous epididymitis in adults in the tropics. MATERIAL AND METHODS: This was a retrospective study of 11 cases of confirmed and treated tuberculous epididymitis. RESULTS: The most frequently affected age-group was 40-49 years. The commonest expression was that of a chronic epididymal nodule. The diagnosis was confirmed by histological examination of the epididymectomy specimen (10 cases) and bacteriology in one case. Combination antituberculous chemotherapy was systematically administered and epididymectomy was performed in all patients. CONCLUSION: The diagnosis of tuberculous epididymitis is often very difficult in the absence of a history of recent or active tuberculosis. However, this diagnosis must be considered in any case of chronic epididymal nodule, particularly in a context of infertility. The very mutilating treatment consists of epididymectomy in chronic forms, which also constitutes a diagnostic confirmation procedure, hence the value of prevention based on eradication of tuberculosis.

Infected hydrocele following laparoscopic appendectomy: case report.

In the literature, specific reported complications after laparoscopic appendectomy include bowel injury, hemorrhage, wound infection, and cecal fistula. We report the occurrence of infected hydrocele after laparoscopic appendectomy in a 20-year-old man. This complication, to our knowledge, has not yet been described in the literature.

Chlamydia trachomatis in hydrocele fluid.

OBJECTIVE: To determine the presence of Chlamydia trachomatis in hydrocele fluid. METHODS: 90 male patients with hydrocele of tunica vaginalis from an endemic area for bancroftian filariasis were investigated for the presence of Chlamydia trachomatis in their hydrocele fluids. C trachomatis antigen detection tests-a direct immunofluorescence assay and an enzyme immunoassay along with polymerase chain reaction assay for amplification of a 517 bp fragment of C trachomatis endogenous plasmid-were used in this study. The patients were also tested for the presence of microfilaria in their hydrocele fluids and night blood. Histopathological examination was carried out to detect adult filarial worm in tunica vaginalis testes. RESULTS: Eight (8.88%) patients had chlamydia antigen in the hydrocele fluids; C trachomatis plasmid sequences could be amplified from five of these. Seven (7.77%) patients had microfilaria in the hydrocele fluids, three of them having adult worm in tunica vaginalis. CONCLUSION: C trachomatis infection might be associated with hydrocele in some of these patients.

Sclerotherapy for hydroceles.

Sclerotherapy with 3% sodium tetradecyl sulfate and 3.5% rolitetracycline on an outpatient basis was applied to 55 hydroceles. The over-all cure rate was 96% with an average followup of 13 months. Of the patients 64% were cured after only 1 sclerosant instillation. A post-sclerotherapy operation was necessary in 4% of the patients. Pain of a significant degree occurred after sclerotherapy in only 29% of the patients. Sclerotherapy appears to be an effective, economical and safe form of outpatient therapy for hydroceles.