Epididimitis y Orquitis

Descripción General

Definiciones

• Epididimitis: inflamación aguda del epidídimo, causada por infecciones virales o bacterianas
• Orquitis: inflamación aguda de los LOS Neisseria testículos, causada por infecciones virales o bacterianas
• Espectro de la enfermedad: La epididimitis puede evolucionar, con frecuencia, a una epidídimo-orquitis si no se trata.

Epidemiología y etiología

La epididimitis y la orquitis son las causas más comunes de dolor Dolor Inflammation escrotal en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum adultos (> 600 000 casos al AL Amyloidosis año en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum Estados Unidos).

Causas:

• Epididimitis aguda (a menudo relacionada con causas infecciosas):
  • < 35 años de edad: Chlamydia trachomatis Chlamydia trachomatis Type species of Chlamydia causing a variety of ocular and urogenital diseases. Chlamydia (C. trachomatis), Neisseria Neisseria Neisseria is a genus of bacteria commonly present on mucosal surfaces. Several species exist, but only 2 are pathogenic to humans: N. gonorrhoeae and N. meningitidis. Neisseria species are non-motile, gram-negative diplococci most commonly isolated on modified Thayer-Martin (MTM) agar. Neisseria gonorrhea Gonorrhea Gonorrhea is a sexually transmitted infection (STI) caused by the gram-negative bacteria Neisseria gonorrhoeae (N. gonorrhoeae). Gonorrhea may be asymptomatic but commonly manifests as cervicitis or urethritis with less common presentations such as proctitis, conjunctivitis, or pharyngitis. Gonorrhea (N. gonorrhea Gonorrhea Gonorrhea is a sexually transmitted infection (STI) caused by the gram-negative bacteria Neisseria gonorrhoeae (N. gonorrhoeae). Gonorrhea may be asymptomatic but commonly manifests as cervicitis or urethritis with less common presentations such as proctitis, conjunctivitis, or pharyngitis. Gonorrhea)
  • > 35 años de edad: Escherichia coli Escherichia coli The gram-negative bacterium Escherichia coli is a key component of the human gut microbiota. Most strains of E. coli are avirulent, but occasionally they escape the GI tract, infecting the urinary tract and other sites. Less common strains of E. coli are able to cause disease within the GI tract, most commonly presenting as abdominal pain and diarrhea. Escherichia coli (E. coli) y Pseudomonas Pseudomonas Pseudomonas is a non-lactose-fermenting, gram-negative bacillus that produces pyocyanin, which gives it a characteristic blue-green color. Pseudomonas is found ubiquitously in the environment, as well as in moist reservoirs, such as hospital sinks and respiratory equipment. Pseudomonas relacionadas con infecciones del tracto urinario (ITU) o prostatitis Prostatitis Prostatitis is inflammation or an irritative condition of the prostate that presents as different syndromes: acute bacterial, chronic bacterial, chronic prostatitis/chronic pelvic pain, and asymptomatic. Bacterial prostatitis is easier to identify clinically and the management (antibiotics) is better established. Prostatitis
• Epididimitis crónica (de origen no infeccioso o infeccioso crónico):
  • Antecedentes de traumatismos genitourinarios
  • Duración de síntomas superior a 3 meses
  • Vasculitis Vasculitis Inflammation of any one of the blood vessels, including the arteries; veins; and rest of the vasculature system in the body. Systemic Lupus Erythematosus autoinmune por inmunoglobulina A ( IgA IgA Represents 15-20% of the human serum immunoglobulins, mostly as the 4-chain polymer in humans or dimer in other mammals. Secretory iga is the main immunoglobulin in secretions. Immunoglobulins: Types and Functions)
• Amiodarona:
  • Casos secundarios a altas concentraciones del medicamento en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la cabeza del epidídimo
  • Ocurre en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum aproximadamente 3%–11% de los LOS Neisseria pacientes
• En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum raras ocasiones, se produce una orquitis aislada secundaria a las paperas u otros virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology ( en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum individuos no inmunizados).

Presentación clínica

• Dolor Dolor Inflammation testicular de aparición gradual, aumento de volumen y sensibilidad
• Fiebre
• Enrojecimiento y calor Calor Inflammation en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el escroto
• Síntomas del tracto urinario inferior:
  • Disuria
  • Hematuria Hematuria Presence of blood in the urine. Renal Cell Carcinoma
  • Polaquiuria
  • Urgencia urinaria

Diagnóstico y Tratamiento

Hallazgos clínicos

• Signo de Prehn positivo: disminución del dolor Dolor Inflammation con la elevación del testículo
• Análisis de orina/urocultivo: generalmente con piuria y/o bacteriuria Bacteriuria The presence of bacteria in the urine which is normally bacteria-free. These bacteria are from the urinary tract and are not contaminants of the surrounding tissues. Bacteriuria can be symptomatic or asymptomatic. Significant bacteriuria is an indicator of urinary tract infection. Urinary Tract Infections (UTIs) in Children
• Tamizaje de infecciones de transmisión sexual (ITS):
  • Prueba de amplificación del ácido nucleico en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum orina para N. gonorrhoeae N. gonorrhoeae A species of gram-negative, aerobic bacteria primarily found in purulent venereal discharges. It is the causative agent of gonorrhea. Neisseria y C. trachomatis
  • Considerar la posibilidad de tratar a la pareja cuando corresponda

Ultrasonido Doppler Doppler Ultrasonography applying the doppler effect, with frequency-shifted ultrasound reflections produced by moving targets (usually red blood cells) in the bloodstream along the ultrasound axis in direct proportion to the velocity of movement of the targets, to determine both direction and velocity of blood flow. Ultrasound (Sonography) color del escroto

• Revela un aumento del flujo sanguíneo e inflamación del epidídimo o del testículo
• Ayuda a distinguir la torsión testicular con una disminución del flujo sanguíneo testicular

Tratamiento

• Suspensorio escrotal y antiinflamatorios no esteroideos (AINE).
• Para pacientes con riesgo de ITS, considerar la cobertura de ITS:
  • Régimen: ceftriaxona + doxiciclina
  • Fluoroquinolonas, no son una opción si se sospecha gonorrea debido a la resistencia
• Para pacientes muy probablemente infectados con patógenos entéricos (e.g., instrumentación urológica), y se descarta ITS, considerar cobertura con:
  • Levofloxacino
  • Trimetoprim-sulfametoxazol si no tolera las fluoroquinolonas

Diagnóstico Diferencial

• Infección del tracto urinario (ITU): infección bacteriana muy común del sistema genitourinario inferior, que se trata eficazmente con antibióticos. El paciente presenta disuria, hematuria Hematuria Presence of blood in the urine. Renal Cell Carcinoma, sensibilidad suprapúbica o, a veces, dolor Dolor Inflammation de costado. El diagnóstico es clínico con análisis de orina y urocultivo.
• Torsión testicular: dolor Dolor Inflammation testicular intenso de aparición aguda en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum un varón adolescente, normalmente sin un acontecimiento incitante, es altamente sospechoso de torsión. Los LOS Neisseria hallazgos clínicos adicionales incluyen un testículo indurado, un escroto inflamado y un reflejo cremastérico negativo. El ultrasonido Doppler Doppler Ultrasonography applying the doppler effect, with frequency-shifted ultrasound reflections produced by moving targets (usually red blood cells) in the bloodstream along the ultrasound axis in direct proportion to the velocity of movement of the targets, to determine both direction and velocity of blood flow. Ultrasound (Sonography) (que muestra la ausencia de flujo sanguíneo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el testículo afectado) no debe retrasar el tratamiento definitivo, que es la exploración quirúrgica inmediata y la orquidopexia.
• Prostatitis Prostatitis Prostatitis is inflammation or an irritative condition of the prostate that presents as different syndromes: acute bacterial, chronic bacterial, chronic prostatitis/chronic pelvic pain, and asymptomatic. Bacterial prostatitis is easier to identify clinically and the management (antibiotics) is better established. Prostatitis: infección bacteriana de la glándula prostática que provoca síntomas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el tracto urinario inferior. Los LOS Neisseria pacientes suelen presentar disuria, dolor Dolor Inflammation pélvico, polaquiuria, urgencia miccional, micción irritativa y fiebre. El diagnóstico es clínico con apoyo del análisis de orina, cultivo y, si es necesario, un ultrasonido transrectal. El tratamiento consiste en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum antibióticos de cobertura gramnegativa a largo plazo.