Casella R, Leibundgut B, Lehmann K, Gasser T C
Urologic Clinics, Department of Surgery, University Hospital, Basel, Switzerland.
J Urol. 1997 Dec;158(6):2158-61. doi: 10.1016/s0022-5347(01)68186-2.
The incidence of mumps orchitis has declined dramatically since the introduction of vaccination. While in the past cases of mumps have only been seen occasionally at our institution, recently there has been a sharp increase in the number of confirmed cases.
Between June 1995 and April 1996, 11 patients with severe mumps orchitis were hospitalized at our clinic. Medical history, therapeutic measures and clinical outcome were recorded for each patient.
All patients showed marked scrotal swelling with a temperature above 38.5 C. Serum C-reactive protein was significantly elevated (mean 140 mg./l.). The vaccination status of 1 of the 11 patients (9%) was unknown. Medical records from the remaining 10 patients indicated that they had not been vaccinated. Nine patients (82%) had a typical mumps parotitis preceding the orchitis. In 2 patients the clinical diagnosis of parotitis was uncertain but mumps serology was positive. None of the patients showed other manifestations of mumps. Antibodies to the mumps virus (IgG and IgM) were determined in 6 patients and positive in all cases. The average interval between parotitis and onset of orchitis was 10 days. All patients were hospitalized for an average of 6 days. Treatment included bed rest with local cooling, scrotal support and systemic treatment with nonsteroidal anti-inflammatory drugs. Ciprofloxacin or clavulanic acid/amoxicillin was administered as bacterial orchitis could not be excluded at initial presentation. The mean time to cessation of fever was 3.6 days (range 3 to 5). Antibiotics were administered for an average of 8.8 days (range 7 to 13) and anti-inflammatory drugs were given an average of 8.6 days (range 7 to 11). One patient required scrotal exploration.
Since the introduction of a vaccine against the mumps virus there is a diminished risk for mumps and its complications. However, in case of scrotal swelling mumps orchitis should still be considered. Despite vaccination mumps has not been erradicated. Therefore, continued vaccination should be considered an important step in minimizing clinical outbreaks and working towards a possible eradication of this disease in the future.
自引入疫苗接种后，流行性腮腺炎睾丸炎的发病率已大幅下降。过去在我们机构偶尔才会见到腮腺炎病例，而最近确诊病例数量急剧增加。
1995年6月至1996年4月期间，11例重症流行性腮腺炎睾丸炎患者在我们诊所住院。记录每位患者的病史、治疗措施及临床结果。
所有患者均表现出明显的阴囊肿胀，体温高于38.5℃。血清C反应蛋白显著升高（平均140mg/L）。11例患者中有1例（9%）的疫苗接种情况不明。其余10例患者的病历显示他们未接种疫苗。9例患者（82%）在睾丸炎之前有典型的腮腺炎腮腺炎。2例患者腮腺炎的临床诊断不确定，但腮腺炎血清学呈阳性。所有患者均未表现出腮腺炎的其他症状。对6例患者检测了腮腺炎病毒抗体（IgG和IgM），所有病例均呈阳性。腮腺炎与睾丸炎发病的平均间隔时间为10天。所有患者平均住院6天。治疗包括卧床休息、局部冷敷、阴囊支撑以及使用非甾体抗炎药进行全身治疗。由于最初表现不能排除细菌性睾丸炎，因此给予环丙沙星或克拉维酸/阿莫西林治疗。发热停止的平均时间为3.6天（范围3至5天）。抗生素平均使用8.8天（范围7至13天），抗炎药平均使用8.6天（范围7至11天）。1例患者需要进行阴囊探查。
自引入腮腺炎病毒疫苗后，患腮腺炎及其并发症的风险降低。然而，出现阴囊肿胀时仍应考虑流行性腮腺炎睾丸炎。尽管进行了疫苗接种，但腮腺炎并未根除。因此，持续接种疫苗应被视为尽量减少临床疫情爆发以及未来努力可能根除该疾病的重要一步。
