What is Parotid Orchitis?
Parotid orchitis (parotidite orchitis) is a testicular inflammation caused by a paramyxovirus. When inflammation spreads from the testicle to the appendage, orchiepididymitis can develop.
Causes of Parotid Orchitis
The most common orchitis caused by the epidemic (infectious) mumps virus. Orchitis complicates infectious parotitis in 20-30% of men in the postpubertal period. Involvement of the testicles in the process (bilateral in 3-17% of cases) occurs 4-10 days after the onset of the disease, but may precede or develop at the same time. Sometimes mumps orchitis develops without a clinical picture of mumps (orchitis without mumps). In 50% of cases, testicular hypotrophy develops after orchitis, but even with bilateral lesions, sterility is rarely observed.
Pathogenesis during Parotid Orchitis
The gateway of the infection is the mucous membrane of the upper respiratory tract (possibly the tonsils). The pathogen enters the salivary glands not through the parotid (stenon) duct, but by the hematogenous route. Viremia is an important link in the pathogenesis of mumps, which is proved by the possibility of isolating the virus from the blood already in the early stages of the disease. The virus spreads throughout the body and finds favorable conditions for reproduction (reproduction) in the glandular organs.
When parotitis in the body produces specific antibodies (neutralizing, complement-binding, etc.), detectable for several years, and develops an allergic restructuring of the body, continuing for a very long time (perhaps throughout life).
Symptoms of Parotid Orchitis
The clinical picture of acute viral orchitis begins with the appearance of pain in the testicle, the cause of which is the stretching of the albumin membrane as a result of edema.
Symptoms of orchitis are noted on the 5-7th day of the onset of the disease and are characterized by a new wave of fever (up to 39-40 ° C), the appearance of severe pain in the scrotum and testicle, sometimes radiating to the lower abdomen. The testicle increases, reaching the size of a goose egg. Fever lasts 3-7 days, testicular increase – 5-8 days. Then the pain passes, and the testicle gradually decreases in size. In the future (after 1-2 months), signs of testicular atrophy may occur, which are observed in 50% of patients undergoing orchitis (if corticosteroids were not prescribed at the onset of complications). With parotid orchitis, a lung infarction was observed as a rare complication, as a result of venous thrombosis of the prostate and pelvic organs. An even more rare, but extremely unpleasant complication of parotid orchitis is priapism (prolonged painful erection of the penis with blood filling the cavernous bodies, not associated with sexual arousal).
The frequency of orchitis depends on the severity of the disease (with moderate and severe forms of orchitis occur in about half of the patients).
Complications of epididymitis and orchitis. Complications of epididymitis and orchitis are abscess formation, fistula formation, piocele formation – suppuration of testicular edema (hydrocele) exudate, infertility.
Diagnosis of Parotid Orchitis
In typical cases, the recognition of mumps orchitis is not difficult. Orchitis is differentiated from tuberculosis, brucellosis, gonorrhea and traumatic orchitis.
In case of acute orchitis, an increase in body temperature is recorded in the patient. On examination, there may be an increase in the scrotum on the affected side. On palpation, the skin of the scrotum over the affected testicle is hot, edematous; testicle enlarged, swollen, sharply painful.
Of the laboratory methods for confirming the diagnosis, the most evidential is the isolation of the mumps virus from the blood, swabs from the pharynx, secretion of the parotid salivary gland, cerebrospinal fluid and urine. Immunofluorescent methods can detect viruses on cell culture after 2-3 days (with a standard study method – only after 6 days). Immunofluorescence method allows to detect viral antigen directly in the cells of the nasopharynx, which makes it possible to get the answer most quickly. Serological methods allow to detect an increase in antibody titer only after 1-3 weeks from the onset of the disease, for which various methods are used.
The most informative is the enzyme-linked immunosorbent assay, later results are obtained using more simple reactions (RSK and RTGA). Examine paired sera; the first is taken at the beginning of the disease, the second – after 2-4 weeks. Diagnostic is the increase in titer 4 times or more. An intradermal test with an antigen (allergen) can be used. Diagnostic is the transition from negative to positive. If the skin test is positive already in the first days of the disease, then this indicates that the person has previously suffered a parotitis.