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

Abstract

Introduction: This study aimed to evaluate the value of direct and indirect markers showing inflammation in the diagnosis of Brucella epididymo-orchitis (BEO) and its differentiation from non-Brucella epididymo-orchitis.

Materials and Methods: A total of 152 patients that presented to our clinic with acute scrotal complaints and were diagnosed with epididymo-orchitis between January 2015 and January 2019 were retrospectively evaluated. Excluded from the study were 15 patients with a hematologic disease, coronary artery disease or malignant 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-orchitis 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 agglutination (STA) test in addition to orchitis symptoms and signs.

Results: The median WBC (p=0.033), neutrophil (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 hemotological inflammatory markers provide diagnostic benefits complementing serological tests in distinguishing BEO from NBEO cases. In particular, the ML ratio has a high diagnostic accuracy rate compared to other parameters.

Keywords

• Brucella,epididymo-orchitis,infectious diseases,monocyte/lymphocyte ratio

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

Abstract

Giriş: Çalışmamızda inflamasyonu gösteren direk ve indirek belirteçlerin Brusella epididimo-orşit (BEO) tanısında ve Brusella dışı epididimo-orşit (NBEO) ayırıcı tanısındaki değerinin araştırılması amaçlanmıştır.

Materyal Metod: Ocak 2015 ve Ocak 2019 yılları arasında akut skrotum kliniği ile başvuran epididim orşit tanısı alan 152 hasta retrospektif olarak değerlendirildi. Hematolojik hastalığı, kroner arter hastalığı, malignite tanısı olan 15 hasta, 18 yaşından küçük 8 hasta ve hemogram ve CRP sonuçlarına ulaşılamayan 13 hasta çalışma dışı bırakıldı. Epidimo-orşit tanısı fizik muayene bulguları yanında 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 lenfosit (NL) (p=0.014) oranı ve monosit lenfosit (ML) (p=0.002) oranı BEO grubunda istatistiksel olarak anlamlı şekilde daha düşük izlendi. BEO tanısını öngörmede ML oranı 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. Hiçbir parametre BEO ve NBEO tanısını öngörmede bağımsız bir belirteç değildi.

Sonuç: Kolay, hızlı ve düşük maliyetli hemotolojik inflamatuar belirteçler, BEO tanılı olguları NBEO tanılı olgulardan ayırmada etkili olduğu bulunmuştur. Özellikle ML oranı diğer parametrelere nazaran yüksek tanı doğruluk oranına sahiptir.

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Keywords

• Brusella,Epididimo-orşit,Enfeksiyöz hastalıklar,Monosit/Lenfosit oranı

References

1. Yüce A, Alp C. S. Brucellosis in Turkey: An Overview. Klimik Journal 2006;19:87-972.
2. Galińska EM, Zagórski J. Brucellosis in humans--etiology, 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. Clinical 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 brucellosis: results of a multicentric study. Clin Microbiol Infect 2014;20:O847-53.
6. Bosilkovski M, Kamiloski V, Miskova S, et al. Testicular infection in brucellosis: Report of 34 cases. J Microbiol Immunol Infect 2018;51:82-7.
7. Aktar F, Tekin R, Bektaş MS, et al. Diagnostic role of inflammatory markers in pediatric Brucella arthritis. Ital J Pediatr 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/lymphocyte and platelet/lymphocyte ratios associated with endometrial 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-lymphocyte 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. 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.
14. Cift A, Yucel MO. Comparison of inflammatory markers between brucella and non-brucella epididymo-orchitis. Int Braz J Urol 2018;44:771-8.
15. Pappas G, Papadimitriou P, Akritidis N, et al. The new global 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 Manifestations of Human Brucellosis in China. Biomed Res Int. 2018;22:5712920.
17. Hardy AV. Undulant (Malta) fever: clinical aspects of cases which have occurred in Iowa. J Iowa State Med Soc 1928;18:387e91.
18. Khan MS, Humayoon MS, Al Manee MS. Epididymo-orchitis and Brucellosis. Br J Urol 1989;63:87–9.
19. Papatsoris AG, Mpadra FA, Karamouzis MV, et al. Endemic 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 pancreatitis. Clin Res Hepatol Gastroenterol. 2012;36:162-8.
23. Okan DH, Gökmen Z, Seyit B, et al. Mean platelet volume in brucellosis: correlation between brucella standard serum agglutination test results, platelet count, and C-reactive 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 brucellosis on mean platelet volume and red blood cell distribution. Jundishapur J Microbiol 2015;8:e20039.
26. Küçükbayrak A, Taş T, Tosun M, et al. Erythrocytes Parameters in The Course of Brucellosis. Abant Med J 2013;2:36-9.
27. Lippi G, Targher G, Montagnana M, et al. Relation between red blood cell distribution width and inflammatory biomarkers 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 severity of metabolic syndrome. Clin Appl Thromb Hemost 2014;20:159-63.
29. Wang J, Yin Y, Wang X, et al. Ratio of monocytes to lymphocytes 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 lymphocyte ratio in childhood brucellosis. Korean J Intern Med 2017;32:1075-81.