Internal Medicine

P1: OXT/OZN/JDO P2: PSB

0521779407-E-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10

Enteroviruses Epididymitis and Orchitis 535

Small % develop congestive heart failure, chronic myocarditis,

or dilated cardiomyopathy.

■Neonatal sepsis: up to 10% mortality

➣Diabetes mellitus: an association has been suggested with

enterovirus, but this remains unproven

Epididymitis and Orchitis..............................

ARTHUR I. SAGALOWSKY, MD

history & physical

■acute severe pain; secondary acute infection vs dull chronic pain

from infections or trauma

■fever, dyuria common

■painful, fleshy swelling of epididymus or entire testis

■secondary reactive hydrocele common and obscures P.E.

■scrotal skin may be inflamed

tests

■urinalysis – pyuria, bactiuria common

■urine culture and sensitivity

■elevated WBC

■fever common

■ultrasound and/or nuclear scan reveal characteristic epididymal

enlargement, increased blood flow

differential diagnosis

■must exclude torsion (see below)

■primary (infection, trauma) vs secondary (testis tumor, chronic

infection, ascites)

management

n/a

specific therapy

■analgesics

■anti-inflammatories

■antibiotics

follow-up

n/a

complications and prognosis

n/a