Paper Title
Brucellar Epididymo-orchitis in Kashmir: Clinical presentation, Diagnosis, Treatment and six- month follow up: A Prospective observational Study

Abstract
Background Brucellosis remains an important zoonotic disease in many developing regions, including areas where animal husbandry and consumption of unpasteurized dairy products are common. Genitourinary involvement represents one of the most frequent focal complications of brucellosis, and brucellar epididymo-orchitis (BEO) is among its most significant manifestations. Because its presentation often mimics nonspecific bacterial epididymo-orchitis, delayed diagnosis may result in unnecessary investigations, prolonged morbidity, and serious complications. Aims and objectives To evaluate the demographic profile, clinical manifestations, laboratory findings, diagnostic characteristics, treatment outcomes, and six-month follow-up of patients with brucellar epididymo-orchitis presenting to a tertiary care hospital in Kashmir. Methods This prospective observational study was conducted between January 2021 and December 2023 at a tertiary care center in Kashmir. Forty consecutive patients with clinically suspected epididymo-orchitis underwent detailed clinical evaluation, laboratory investigations, serological testing for brucellosis, and scrotal ultrasonography. Diagnosis of BEO was established on the basis of compatible clinical findings, ultrasonographic evidence of epididymo-orchitis, and positive Brucella serology. All patients received oral doxycycline and rifampicin for six weeks and were followed for six months after completion of therapy. Results All 40 patients had not been previously diagnosed with brucellosis before referral. The mean age was 40± 8.5 years (22-65 years). Testicular pain and swelling were present in all patients (100%), while fever was documented in 64%. Right-sided disease occurred in 20 patients (50%), left-sided involvement in 14 patients (35%), and bilateral disease in 6 patients (15 %). The mean duration of symptoms before diagnosis was 11.26 ± 14.12 days (range 1–60 days). Animal exposure was reported by 75% of patients and consumption of unpasteurized dairy products by 25%. Fever with chills (80%), sweating (60%), arthralgia (34%), urinary symptoms (32%), anorexia (24%), nausea and vomiting (20%), weakness (16%), myalgia (14%), weight loss (10%), headache and dizziness (6%), and diarrhea (2%) were observed. All patients had positive standard agglutination tests with titers exceeding 1:160. Thirty patients were positive for Brucella melitensis and ten for Brucella abortus. Elevated inflammatory markers were common. Blood cultures were negative in all cases. All patients completed treatment successfully without relapse, treatment failure, drug-related adverse effects, or disease-related complications during six months of follow-up. Conclusion Brucellar epididymo-orchitis should be routinely considered in the differential diagnosis of epididymo-orchitis in endemic regions such as Kashmir. A thorough exposure history, serological testing, and prompt initiation of appropriate antimicrobial therapy result in excellent outcomes and prevention of complications. Keywords - Brucellosis, Brucellar epididymo-orchitis, Epididymo-orchitis, Kashmir, Brucella melitensis, Brucella abortus