Clinical Characteristics and Pathogen Spectrum of Male Genital Fungal Infections in Nanchang Area, South China

The cutaneous fungal infections in male genitalia are relatively rare, and often present with various atypical clinical symptoms. It was mainly reported in a small number of case reports, while data with large number of patients were rarely reported. In this study, we reported 79 male patients with cutaneous fungal infections on scrotum or penis. The fungal infections were confirmed by microscopic examination directly and fungus culture. Clinical characteristics and predisposing factors were also collected. Of these 79 patients, 72 has lesions on scrotum, 5 on penis and 2 on both scrotum and penis. Trichophyton (T.) rubrum is the most common pathogen, found in 50 (67.6%) patients, which presented diverse clinical manifestation such as majorly erythematous, dry diffused scaly lesions without a clear border, slightly powdery and scutular scalings. Candida (C.) albicans is the secondly common pathogen, found in 21 (28.4%) patients, which also presented diverse lesions such as erythematous with dry whitish scaly lesions and erythematous erosion. The predisposing factors mainly included concomitant fungal infections on sites other than genitalia, especially inguinal region (tinea cruris), application of corticosteroid and high moisture. In conclusion, cutaneous fungal infections in male genitalia could be caused by different fungi, showed atypical or mild clinical appearances in most cases and might be a fungus reservoir, emphasizing the necessity to timely perform the fungi examinations and corresponding therapy.

Favus of Scrotum Due to Trichophyton rubrum in Immunocompetent Patients: A Clinical, Mycological and Ultrastructural Study

PURPOSE

To characterize the clinical and mycological features of favus of scrotum due to Trichophyton rubrum.

METHODS

A single-site prospective study was carried out in an outpatient dermatology clinic. Microscopic examination and fungal culture were done using skin scrapings. Scales on the scrotum were stained with PAS and visualized by microscopy, including in vivo reflectance confocal microscopy (RCM). Two strains were analyzed by RAPD typing. Scutular lesions were fixed for scanning electron microscopy (SEM) and transmission electron microscopy (TEM).

RESULTS

Cultures of the scale from the scrotum and/or groin in all patients showed a growth of T. rubrum. T. rubrum strains from scrotum and groins in one patient were demonstrated as the same strain by RAPD typing. The average age of patients was 34.1 ± 12.78 years. The mean course was 8.2 ± 5.07 days. All the patients received only topical treatment for 2 weeks without recurrence. Direct smear, calcofluor-white staining and in vivo RCM study of the scrotal favus in patients showed a massive number of septate branching hyphae, while fewer septate hyphae in scales in the groin. Abundant hyphae were found only in the outer layer of the stratum corneum of the scrotum under SEM and TEM with intact bilateral cell walls, and normal nucleus, liposomes and reticulum. Few distorted hyphae structures, cell wall degeneration, degenerated cytoplasm and the autophagy phenomenon could be seen in scales from groin under TEM.

CONCLUSIONS

Scrotal favus due to T. rubrum is still a true infection, which most often occurred in immunocompetent patients.

Fournier's Gangrene: Clinical Presentation of 13 Cases

BACKGROUND Fournier's gangrene (FG) is a fulminant form of infective, polymicrobial, necrotizing fasciitis of the perineal, genital, and perianal regions. It commonly affects men, but women and children may also develop this type of tissue necrosis. MATERIAL AND METHODS This study is a retrospective analysis of the management of 13 cases of Fournier's gangrene, diagnosed from among about 45 000 patients (men, women, and children) treated in the Department of General, Oncological, and Functional Urology (Medical University of Warsaw) from 1995 to 2013. All patients with Fournier's gangrene underwent adequate surgical debridement of the necrotic tissues. Additional procedures (suprapubic cystostomy and orchiectomy) were necessary in 10 out of 13 (77.0%) patients. Seven out of 13 (53.8%) patients required subsequent reconstructive surgery of the scrotum. RESULTS All 13 patients were males, with a median age of 59.6 years (range: 42-68 years). The average hospital stay was 31.9 days (range: 16-46 days). None of our patients died due to Fournier's gangrene. Bacteriological cultures of samples from the wounds showed polymicrobial flora, including the following genera of aerobes and anaerobes: Escherichia, Proteus, Klebsiella, Moraxella, Gemella, Enterococcus, Streptococcus, Staphylococcus, Bacteroides, Pseudoflavonifractor, Parabacteroides, Porphyromonas, Prevotella, Peptoniphilus, Peptostreptococcus, Actinomyces, Collinsella, and Lactobacillus. CONCLUSIONS Favorable outcome of FG treatment with low morbidity and no mortality can be achieved with rapid diagnosis, urgent surgical debridement of all necrotic tissues, and broad-spectrum empirical antimicrobial therapy, usually with combined antibiotics, against aerobic and anaerobic bacteria. Prevention of uroseptic shock by treating localized infection is compulsory.

[Results of surgical treatment of five cases with phlegmon of the scrotum for the 2012-2015 period]

Phlegmon of the serotum is a severe form of suppurative inflammatory process, which causes are extremely various. For the 2012 - 2015 year period at the department of urology we had five cases of phlegmon of the scrotum, where incision was performed as well as debridement and drainage and the wound was closed with the available tissues of the scrotum. Aggressive debridement of all necrotic tissues and all fascial planes that were separating easily during the blunt dissection were excised until well vascularized tissue was reached. The wounds were left wide opened until the appearance of healthy granulation tissue and then assessment of their secondary closing. Tissues were sent for histological and microbiological assessment.

Incidence and etiological agents of genital dermatophytosis in males

AIM

To determine the incidence and etiological agents of dermatophytosis of male genitalia in Sarajevo area, Bosnia and Herzegovina, during a 5-year period (2009-2013).

METHODS

A total of 313 male patients with confirmed dermatophyte infection elsewhere in the body was analyzed. All samples (skin scrapings and hairs) were treated with lactophenol to detect a possible presence of fungal elements and then cultured on Sabouraud glucose agar. Dermatophytes species were identified based on macroscopic and microscopic morphology.

RESULTS

Dermatopyte infection of penis and/or scrotum was confirmed by positive cultures in 17 (5.4%) patients, of which four had lesions on the penis alone, five had lesions on scrotum and eight patients had lesions on both penis and scrotum. Majority of patients, 12 (70.0%) belonged to the age group 21-40. Fifteen patients (88.2%) had associated foci of dermatophyte infection, but the inguinal area was most frequently affected, in 10 (66.6%) patients. Microsporum canis was the most frequent dermatophyte found on culture, in 10 (58.8%) patients.

CONCLUSION

Dermatophytosis of male genitalia is a rare entity, occurring more often in young males and the main causative species is Microsporum canis.

Multidisciplinary intensive care in extensive necrotizing fasciitis

This is a case report of extensive necrotizing fasciitis (NF). A 65-year-old man presented with high fever, pain, swelling, and redness of the perineum, scrotum, and right lower limb. Based on the clinical symptoms and an imaging examination, a diagnosis of NF was made. The patient underwent an extensive exploration followed by daily bedside debridement. A diversion colostomy and six additional debridement procedures on the right thigh and perineum were subsequently performed. Although the patient had an eventful course, he recovered well under a multidisciplinary treatment regimen. The treatment and hospital course of the patient are described.

Multidrug resistant tuberculosis with multiple organ involvement

Multidrug resistant tuberculosis has been a challenging situation in the clinical practice with respect to appropriate clinical treatment and management of the disease. The likelihood of resistance development is known to be lower in lesions with lesser percentages of the bacterial population. The present paper was designed to present a rare case of pulmonary multidrug resistant tuberculosis with extrapulmonary involvement to emphasize the consideration of genital tuberculosis with possible infertility in patients admitting with a scrotal mass.

Scrotal tuberculosis in adult patients: a 10-year clinical experience

Twenty-nine adults (mean age, 59.9 +/- 13.5 years) with scrotal tuberculosis (TB) were retrospectively analyzed. The mean interval from emergence of symptoms suggestive of scrotal TB to diagnosis established was 142.44 +/- 227.66 days. Scrotal TB was initially suspected in only five (17.2%) patients, and infection caused by bacteria other than Mycobacterium tuberculosis (55.2%) was the leading presumptive diagnosis. Of 28 patients with chest radiographs available, 7 (25%) disclosed active pulmonary TB, and 9 (32.1%) showed a TB scar. All patients received anti-TB chemotherapy; 20 (69%) additionally underwent surgery. Pathologic examination of resected tissue at therapeutic surgery, biopsy, or polymerase chain reaction assay of urine led to rapid diagnosis of scrotal TB. Although evidence of scrotal TB was easily obtainable, the lack of alertness made clinicians avert from the appropriate diagnostic approaches and rendered a delayed diagnosis. Our report underscores the urgent need for improving clinicians' awareness of scrotal TB.

Penoscrotal histoplasmosis following bladder carcinoma

Histoplasmosis is caused by a dimorphic fungus Histoplasma capsulatum. Transmission is via inhalation and lungs are the most commonly affected site. Other sites are involved uncommonly and genitals are rarely involved. The case is reported herein of a man with penoscrotal histoplasmosis following bladder carcinoma that had been treated with intravesical bacille Calmette-Guerin. He presented with multiple ulcers on the penis and scrotum that coalesced, followed by the appearance of cutaneous lesions. The condition responded well to itraconazole. To the best of our knowledge, this is the first case of penoscrotal histoplasmosis following bladder carcinoma.

Drug-resistant genital tuberculosis of the penis in a human immunodeficiency virus non-reactive individual

The genitourinary tract is the most common site for extrapulmonary tuberculosis (TB). Penile TB is extremely rare comprising less than 1 % of all genital TB cases in males. It most commonly presents either as a superficial ulcer on the glans or around the corona. Diagnosis of penile TB is often difficult because it can mimic numerous other diseases. The association of TB with AIDS, and the increasing incidence of multiple drug resistance has further compounded the problem. The case described herein involves a patient with multidrug-resistant smear-positive penile TB that was undiagnosed initially due to the lack of clinical suspicion of TB, and once diagnosed failed to respond to first line antitubercular drugs because of multiple drug resistance.

Community-acquired MRSA bacteremic necrotizing pneumonia in a patient with scrotal ulceration

Methicillin-resistant Staphylococcus aureus (MRSA) is being recognized increasingly as a cause of community-acquired infection. The organism usually causes skin and soft tissue infection. Here, we present a patient with community-acquired MRSA pneumonia and review the literature. The patient, a 37-year-old Saudi male with no significant medical history was admitted with fever, respiratory distress and scrotal ulceration. Scrotal swabs and blood cultures grew MRSA. Imaging studies showed necrotizing pneumonia. Physical examination and echocardiographic findings revealed no evidence of endocarditis. The patient was treated successfully with 4 weeks of intravenous vancomycin. The infection appears to have originated in the skin and subcutaneous tissues of the scrotum, and subsequently led to necrotizing pneumonia. Community-acquired MRSA pneumonia has been associated with the production of Panton-Valentine leukocidin.

Superficial skin infection caused by Streptococcus pneumoniae in children

Pneumococcal superficial skin infections are rarely described. We present 3 cases of Streptococcus pneumoniae superficial skin infections in previously healthy children. In 2 cases, lesions occurred on facial skin; in the third case they occurred on the scrotal raphe. One isolate was fully penicillin-resistant.

Group C Streptococcal Sepsis Complicating Fournier Gangrene

Fournier gangrene is a life-threatening necrotizing fasciitis of the perineal-scrotal area that occurs in diabetic males. Patients typically present with systemic toxicity and significant inflammatory changes in the scrotum and perineum. Most cases of Fournier gangrene are polymicrobic and require urgent surgical debridement and broad-spectrum antibiotic therapy. We describe a case of Fournier gangrene in a young diabetic man that was associated with group C streptococcal bacteremia, an association previously unreported in the literature to our knowledge.

Nine male cases of tinea genitalis

Nine cases of tinea genitalis observed in Siena and Terni (Italy) between 1988 and 2003 are reported because of their infrequency. The patients were males ranging in age from 23 to 45 years. The lesions, situated on the penis, glans and scrotum, were preceded by dermatophytosis in other sites (groin five cases; feet two cases; toenails two cases; hands in one; beard in another). Mycological examination consisting of direct microscopy and culture led to isolation of Trichophyton rubrum in five cases, Epidermophyton floccosum in two and T. mentagrophytes var. interdigitalis in the others. Clinical diagnosis is not always easy. In three cases the lesions had been misdiagnosed as eczema.

Scutular tinea of the scrotum: report of two cases

Infections caused by dermathophytes in the scrotal skin are uncommon especially due to Microsporum gypseum, which may form scutular or favus-like lesions. We report two patients with this type of tinea: one immune suppressed by HIV infection and another immunocompetent without comorbidity. In the literature we found only two reports in immunocompetent patients and some in immune suppressed with similar symptoms.

Early-onset Escherichia coli sepsis presenting as acute scrotum in preterm infant

Epididymitis, or epididymo-orchitis, and infected hydrocele are unusual in the neonatal period. It is critical to differentiate them rapidly from testicular torsion to salvage the affected testis and avoid unnecessary surgical exploration. Escherichia coli is an important gram-negative bacteria causing diverse neonatal infections and is also the common bacteria causing epididymo-orchitis from an ascending route. We report the case of a preterm infant affected with epididymo-orchitis and infected hydrocele caused by early-onset E. coli sepsis. We highlight the importance of sampling proper cultures and using suitable antibiotics after excluding testicular torsion in a neonate with an acute scrotum.

Lactobacillus gasseri causing Fournier's gangrene

Fournier's gangrene is characterized as an aggressive necrotizing process caused by a polymicrobial infection that includes virulent organisms. We report the first case of Fournier's gangrene caused by a low-virulence organism, Lactobacillus gasseri.

A human bite to the scrotum: a case report and review of the literature

Human bites to the scrotum are rare and can be associated with a high morbidity rate if poorly managed. We report a case of a human bite to the scrotum that was successfully treated with a 5-day course of antibiotics, surgical debridement and healing by secondary intention.

Ultrasound of Tropical and Infectious Diseases That Affect the Scrotum

Ultrasonography of the scrotum permits assessment of testicular and extratesticular masses with high sensitivity. It can differentiate a variety of conditions involving the scrotum, testicles, and epididymis with similar clinical manifestations, including infectious and tropical diseases. The authors performed conventional and color Doppler ultrasonographic examinations in 76 patients who presented with scrotal pain, swelling, and/or tenderness. Their diagnoses included sexually transmitted disease (eg, gonorrhea, syphilis, chlamydial infection), tuberculosis, mumps, and various tropical diseases (eg, filariasis, leishmaniasis, schistosomiasis, paracoccidioidomycosis). The most common imaging findings were enlarged hypoechoic testes, hypervascularity, small hydroceles, and cutaneous edema. This report reviews these and other possible presentations of tropical and infectious diseases affecting the scrotum, emphasizing ultrasound findings that facilitate diagnosis.

Borrelia burgdorferi-associated lymphocytoma cutis simulating a primary cutaneous large B-cell lymphoma

The distinction between primary cutaneous B-cell lymphoma and B-cell pseudolymphoma on a histologic basis may be difficult, particularly in some cases of Borrelia burgdorferi-associated lymphoid proliferations. We report two cases of B. burgdorferi-associated pseudolymphoma that showed a dense infiltrate with a predominance of large atypical B cells. Because of this misleading histologic feature, a diagnosis of primary cutaneous large B-cell lymphoma was first suspected in both cases. In one case, successive recurrences led to aggressive therapies before the B. burgdorferi infection was recognized. However, a detailed review of histologic and immunohistochemical features was finally suggestive of a B. burgdorferi-associated pseudolymphoma in both cases. The etiologic role of B. burgdorferi was confirmed by serology, polymerase chain reaction analysis of B. burgdorferi DNA within the lesional skin, and response to antibiotic therapy. Because the distinction between B. burgdorferi-associated pseudolymphoma and primary cutaneous B-cell lymphomas may be difficult and true B. burgdorferi-associated B-cell lymphomas have been described, we suggest that antibiotic therapy should be considered as a first-line treatment in suspected or confirmed cases of primary cutaneous B-cell lymphoma in regions with endemic B. burgdorferi infection.

An unusual presentation of acute scrotum after appendicitis

Acute scrotum following perforated appendicitis is a rare complication. This usually occurs in the presence of a patent processus vaginalis in children. We report a case of acute scrotum presenting after appendectomy for perforated appendicitis in a young adult.

Chlamydia trachomatis disguised as an asymptomatic scrotal mass in adolescents

We present two cases of adolescents who presented with painless scrotal masses suggestive of testicular cancer. Diagnostic workup of both these patients revealed Chlamydia trachomatis and both patients were successfully treated with doxycycline. Both patients initially denied sexual activity. We suggest that a high index of suspicion is warranted in adolescent patients that present with asymptomatic scrotal masses and precise tests for C. trachomatis be done to rule out an infectious cause.

Invasive group A streptococcus infection of the scrotum and streptococcal toxic shock syndrome

We report a case of invasive group A streptococcus infection of the scrotum that presented as epididymoorchitis and rapidly progressed to streptococcal toxic shock syndrome. The presentation, pathophysiology, and management of invasive group A streptococcus and streptococcal toxic shock syndrome are reviewed. Rapid recognition is necessary to avoid the significant morbidity and mortality associated with these invasive infections.

[Fournier's gangrene. A study of 12 patients and a review]

We present the clinicoepidemiological and therapeutic characteristics of 12 patients with Fournier's gangrene. The mean age of the patients was 66 years and all had a known predisposing factor for the disease. In all cases there was a predominance of mixed flora (four Gram-positive cocci, nine Gram-negative bacilli and ten anaerobic pathogens), with only one case of bacteremia reported. Initial surgery was conducted and was complemented by antimicrobial administration (imipenem, cefotaxime, clindamycin, penicillin and gentamicin alone and in combination) and local treatment with sugar and povidone-iodine. Hyperbaric oxygen was not used in any cases. At the end of treatment a mesh graft could be applied in 11 patients, all of whom showed an excellent functional and aesthetic recovery. The mean time of hospital stay was lengthy (49 days). The good evolution of the lesions after starting the local treatments with the sugar povidone-iodine combination should be emphasized.

A case of Fournier gangrene complicating idiopathic nephrotic syndrome of childhood

A 10-year-old boy presenting with steroid resistant nephrotic syndrome developed Fournier gangrene of the scrotum. Antimicrobial drug therapy, intravenous albumin, excision of necrotic scrotum and left orchidectomy followed by skin grafting 3 weeks later led to an excellent cosmetic and medical result. Six months later he remains nephrotic on diuretic and angiotensin converting enzyme inhibitor medication.

[Epididymal manifestations of urogenital tuberculosis]

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.

Scrotal gray-scale and color Doppler sonographic findings in genitourinary brucellosis

PURPOSE

Brucellosis is an enzootic disease that is frequently transmitted from Brucella-infected animals and their products to humans through the gastrointestinal tract. Genitourinary complications are seen in 2-10% of cases. We used sonography to investigate such complications in patients from a Brucella-endemic area.

METHODS

Between 1992 and 1996, 246 patients were clinically and serologically diagnosed as having brucellosis and were examined by sonography.

RESULTS

Genitourinary complications were identified by sonography in 26 patients. Fifteen of these patients had unilateral epididymo-orchitis, 6 had diffuse orchitis, and 5 had a focal hypoechoic testicular lesion. An increase in the vascularity of the lesions was seen in the 14 patients who also underwent color Doppler examination. Spectral waveform analysis showed a decrease in the resistance index in 9 patients. After medical treatment, all but 1 of the lesions disappeared within 2 months; the last lesion persisted for 6 months.

CONCLUSIONS

In areas in which brucellosis is endemic, when scrotal abnormalities are seen with gray-scale or color Doppler sonography, the possibility of genitourinary tract complications of brucellosis should be considered. Simple Brucella tests may prevent unnecessary surgery.

Prostatodynia in United Nations peacekeeping forces in Haiti

Prostatodynia is a clinical entity associated with voiding symptoms and pelvic pain suggestive of prostatitis but with a normal prostate examination and without evidence of inflammation or infection in expressed prostatic secretions. The problem tends to be chronic and is vexing in its management. Although thought to be a common condition, prevalence data are generally lacking. From June to October 1995, the U.S. Army's 86th Combat Support Hospital provided medical support to a multinational United Nations peacekeeping force in Haiti. Patients diagnosed with prostatodynia were more common (13 cases) than men with other urologic problems (urolithiasis, 6 cases; urinary tract infection, 6 cases; scrotal abscess/mass, 2 cases; epididymitis, 1 case). Patients tended to be young (mean age 29.8), had multiple visits, failed to respond to multiple courses of antibiotics for presumed "prostatitis," and denied recent sexual relations. Some patients reported having had similar symptoms on prolonged separation from their spouses in the past that resolved with resumption of normal intercourse. Masturbation, however, had no impact on symptoms and was painful in some individuals. Terazosin, an alpha-antagonist, and stress-reduction therapy led to improvement in some patients' symptoms. A discussion of these retrospective findings in light of what is known about the possible etiologies and treatment of prostatodynia is presented. Prostatodynia appears to be a common problem in deployed troops and can lead to frequent use of medical services. Physicians supporting long deployments need to be aware of this entity.

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.

[Chancroid in Algeria: the status of this sexually transmitted disease in 1995]

Absent for several decades, the chancroid reappeared in Algeria in 1988. In the unique department of Dermatology and Venereology of the University Hospital of the country of Tlemcen (more than 700,000 inhabitants), we wanted to know the state of this STD seven years after the report of the first cases. The file of the consulting patients were examined. We looked for the principal characteristics of this STD: age, sex, incubation period, place infection contact, type of relation, clinical presentation, evolution without and with treatment, other associated STD (syphilis, HIV). From August 1988 (1st case) to December 1995, 144 cases of chancroid were collected = 1988: 6, 1989: 5, 1990: 7, 1991: 18, 1992: 11, 1993: 33, 1994: 48, 1995: 16. The presentation is quite stereotyped; it concerns males only, singles in must cases, having had sexual relations with prostitutes. The incubation period is short (less than 10 days), the characteristic ulceration presents, very often, some adenopathies. The treatment by cotrimoxazole is efficient. They are no concomitant syphilis or HIV infection. The chancroid is the first cause of genital ulceration in the world. Since 1991, it is the principal STD in our department. It spreads within a male population, young singles associated with prostitutes. It is well installed in Algeria, and its role, although minor, in the transmission of the HIV infection, should not be neglected.

Sporothrix schenckii isolated from a cat in Japan

A yeast-like fungus isolated from a granulomatous and ulcerative skin lesion in a mongrel cat was mycologically examined. The isolate was identified as Sporothrix schenckii from the morphological findings and its pathogenicity in a mouse, confirming the first case of feline sporotrichosis in Japan. Fortunately, no transmission to humans occurred in this case, however the risk of humans contracting Sporothrix schenckii infection increases with the increase in the number of animals with sporotrichosis. Consequently when handling such animals protective clothing such as gloves should be worn to reduce the risk of transmission of the fungus through open wounds.

Fournier's gangrene: report of a case associated with paralytic and mechanical ileus throughout the management of the gangrene

A 65-year-old Japanese male, who was treated for Fournier's gangrene, developed an enlarged erythema over the right thigh and right lower quadrant. The area was surgically debrided, and he was given antibiotics. However, he complained of abdominal swelling with a metallic bowel sound, pain, and vomiting and was then treated for paralytic ileus. Although his symptoms initially improved, he complained again of the same symptoms and underwent surgery for mechanical ileus occurring at the site of a surgical scar from an appendectomy 43 years earlier. This is a very rare case of Fournier's gangrene which caused mechanical ileus of the small intestine and adherence to a peritoneal scare after paralytic ileus due to inflammation of the abdominal fascia following scrotal gangrene.

Replication of equid herpesvirus-1 in the vaginal tunics of colts following local inoculation

Equid herpesvirus-1 (EHV-1; Ab4 isolate) was inoculated unilaterally into the cavum vaginale of four pony colts under general anaesthesia. The animals were monitored daily for evidence of scrotal or testicular swelling and euthanased electively on days 3, 4, 6 and 12 after infection. Detailed pathological examination of the male genital tract was carried out. In animals examined at days 3 and 4 after infection, replication of EHV-1 was detected bilaterally in mesothelial and endothelial cells of the parietal and visceral vaginal tunics. The mesothelial infection had resolved by day 12 after infection, with no evidence of direct extension to deeper genital organs. None of the four colts showed significant scrotal or testicular swelling.

Recent advances in the management of Fournier's gangrene: preliminary observations

Twenty consecutive cases of Fournier's gangrene managed conservatively with systemic antibiotics and topical application of unprocessed honey (group A) were compared with 21 similar cases of Fournier's gangrene managed by the orthodox method (group B) during the same period. Group A received oral amoxicillin/clavulanic acid and metronidazole in addition to daily topical application of honey to the gangrenous scrotum, whereas group B underwent wound debridement, wound excision, secondary suturing, and in some cases scrotal plastic reconstruction in addition to receiving a mixture of systemic antibiotics dictated by culture and sensitivity results. The organisms cultured in both groups were similar. Even though the average duration of hospitalization was slightly longer in group A (4.5 weeks) as opposed to group B (4 weeks), topical application of honey showed distinct advantages over the orthodox method. Three deaths occurred in group B, whereas no deaths occurred in group A. The need for anesthesia and expensive surgical operation was obviated. Response to treatment and alleviation of morbidity were faster in group A. Honey may revolutionize the treatment of this dreadful disease by reducing morbidity and mortality.

What to do about pruritus scroti

Pruritus scroti is a common clinical disorder that is caused by various inflammatory disorders, infections, infestations, and neoplasms. Laboratory evaluation, including bacterial and fungal cultures, microscopic examination, skin biopsies, and measurement of blood glucose levels, is useful in establishing the diagnosis. Management of pruritus scroti includes avoidance of irritants, allergens, and restrictive clothing and use of topical and systemic agents that provide both symptomatic relief and specific treatment of the underlying cause.

Excretion of porcine parvovirus through the genital tract of boars

The putative binding of porcine parvovirus (PPV) to semen components in vitro was examined along with the shedding pattern of PPV in oronasally infected boars. Porcine parvovirus DNA was determined to be bound to spermatozoa that had been incubated in vitro with PPV and washed to remove loosely adherent virus. To determine whether PPV was shed in the semen, four 8-month-old boars, seronegative for PPV, were inoculated oronasally with a virulent strain of PPV. Prior to virus inoculation, a catheter was surgically implanted in the vas deferens for the purpose of collecting cauda epididymal semen free of extrinsic contamination. Epididymal semen specimens were collected prior to inoculation and daily thereafter for 21 days. A fifth boar was inoculated oronasally with PPV, but semen was collected by electroejaculation twice weekly for an equal period of time. Reproductive glands and semen specimens from all boars were examined by nucleic acid hybridization for the presence of viral DNA. All boars seroconverted to PPV, as evidenced by serum antibody titers ranging from 512 to 8,192 hemagglutinating inhibition units/50 microliters. Porcine parvovirus DNA was detected in epididymal semen of 3 of 4 catheterized boars on postinoculation days 5 through 9, but not in semen obtained by electroejaculation. Viral DNA was consistently detected in tissue samples collected on postinoculation days 8 and 21 from the scrotal lymph nodes (4 of 5 boars) and epididymides (3 of 5 boars).