SARS-CoV-2 News: Ultrasound Diagnostic Imaging Shows That SARS-CoV-2 Causes Acute Testicular Infection In A High Proportion Of Male COVID-19 Patients

SARS-CoV-2 News:  Researchers from University Of Renmin Hospital, Wuhan-China have found in a new study involving ultrasound diagnostic imaging that a high proportion of male COVID-19 patients developed acute testicular infections (22.5%).


 
The study team  enrolled male patients with a confirmed diagnosis of COVID‐19 and performed a bedside ultrasound (US) examination of the scrotum, focused on findings of acute inflammation such as tunica albuginea thickening, enlargement and heterogeneous echogenicity of the testis, epididymis, or both, an abscess, scrotal wall edema, and hydrocele. They then compared the proportions of observed epididymo‐orchitis in patients from different age groups and COVID‐19 severity groups.
 
A total of 142 patients with COVID‐19 were enrolled in the study, and 32 (22.5%) patients had acute orchitis, epididymitis, or epididymo‐orchitis on scrotal ultrasound imaging, according to the diagnosis criteria. The observed risk of acute scrotal infection increased with age, with the incidence reaching 53.3% in men older than 80 years. It was also observed that men with severe COVID‐19 had a significantly higher possibility of epididymo‐orchitis compared to the non-severe COVID‐19 group (P = .037).
 
This study shows ultrasound imaging evidence that SARS‐CoV‐2 may cause infection of the testis or epididymis, and the risk is worthy of the attention of clinicians.
 
The study findings were published in the peer reviewed Journal of Ultrasound in Medicine. https://onlinelibrary.wiley.com/doi/10.1002/jum.15558
 
Thailand Medical News had already warned as early February that the SARS-CoV-2 coronavirus could infect the testis and also cause infertility issues in males.
 
https://www.thailandmedical.news/news/breaking-news!-latest-research-published-by-chinese-scientists-say-coronavirus-might-render-certain-male-patients-infertile
 
https://www.thailandmedical.news/news/breaking-male-infertility-research-shows-that-sars-cov-2-coronavirus-may-indirectly-cause-testicular-damage-in-male-covid-19-patients-and-also-orchiti
 
This new study supports the hypothesis that SARS-CoV-2 can cause infection of the testis or epididymis and put patients at risk for further complications.
 
Past research have already shown that SARS-CoV-2 that causes COVID-19, enters a host cell by utilizing its receptor‐binding domain (RBD) that recognizes a specific cell surface receptor. In humans, angiotensin‐converting enzyme 2 (ACE2) has been pinpointed as the major functional receptor for the RBD of SARS‐CoV and SARS‐CoV‐2.
 
The discovered expression pattern of ACE2 implies that SARS‐CoV‐2 could affect the function of multiple organs in the human body. More specifical ly, some previous and recent studies on coronaviruses have demonstrated that this virus can indeed affect many organs beyond the lungs, such as the kidneys, digestive tract, brain, liver, heart, thyroid gland, and testicles.
 
In the human testis tissue, ACE2 is essentially expressed in undifferentiated male germ cells (spermatogonia), Setoli cells, and Leydig cells. Hence, if we assume receptor interaction regarding the distribution of ACE2, there are reasons to believe that SARS‐CoV‐2 can attack both the testis and the epididymis. https://pubmed.ncbi.nlm.nih.gov/32283711/
 
The study team led by Dr Liao Chen from the Department of Ultrasound Imaging at the Wuhan University Renmin Hospital, acquired direct ultrasound imaging findings of acute scrotal infection in patients hospitalized with COVID‐19 during the pandemic.
 
The retrospective study included male patients with a confirmed diagnosis of COVID‐19 during their hospitalization in the early days of the pandemic, which also had a bedside ultrasound examination of the scrotum with a delay of 1 week to 1 month after the initial symptoms of the disease.
 
For the study, the scrotal ultrasound examinations concentrated on the imaging manifestations related to the acute orchitis, epididymitis, and epididymo-orchitis, with the subsequent use of specific diagnostic criteria. Furthermore, the proportion of observed epididymo-orchitis was compared in patients belonging to different age and COVID‐19 severity groups.
 
In the study ,the ultrasound images for every case were read by two ultrasound specialists; in instances when their impressions were in disagreement, the final verdict was made by a senior professor specialized in imaging diagnosis of male urogenital/reproductive system diseases and with more than twenty years of professional experience.
 
Interestingly, from a total of 142 patients with COVID‐19 enrolled in this study, 39 of them (27.5%) showed inflammatory imaging hallmarks such as a thickened fibrous covering of the testis (tunica albuginea), increased blood flow in blood vessels tissue enlargement, scrotal swelling due to hydrocele or abscesses.
 
Alarmingly, a total of 32 patients (22.5%) had a diagnosis of acute inflammation of one or both testicles, epididymitis, or both (epididymo‐orchitis) in accordance with the diagnostic criteria. The observed risk of acute scrotal infection also increased with age, reaching 53.3% in patients that were older than 80 years of age.
 
The study team has also observed that men presenting with severe COVID‐19 had a substantially higher possibility of developing epididymo-orchitis in comparison to the COVID‐19 group without severe disease. All of this means that the testicles are indeed a potential target of SARS-CoV-2.
 
However it must also be noted that many patients with COVID‐19 are in a state of diminished immunity, which enables bacteria from the ascending urinary tract to break out and cause scrotal infections. In addition, hormonal dysregulation is also present and may compound this problem.
 
The research findings support the notion that SARS‐CoV‐2 infection may specifically affect the testis, epididymis, or both. Of course, systemic inflammatory reaction and present co-morbidities have to be taken into account because they can also result in tissue enlargement and testicular swelling.
 
Dr Chen told Thailand Medical News, "We suggest that clinicians remain aware of the risk of acute scrotal infection in hospitalized patients with COVID‐19, and for young male patients with COVID‐19 especially those who wish to have children, local symptoms and fertility should be carefully monitored and treated early.”
 
It should also be noted that another recent research performed at Zhongnan Hospital, Wuhan University that focused on the effects of SARS‐CoV‐2 infection on male gonadal function had their results demonstrating that serum luteinizing hormone was significantly increased, and the ratio of testosterone to luteinizing hormone and the ratio of follicle‐stimulating hormone to luteinizing hormone were also dramatically decreased. The researchers suggested that SARS‐CoV‐2 was responsible for the reproductive system dysregulation. https://www.medrxiv.org/content/10.1101/2020.03.21.20037267v2
 
Hence, more attention is warranted towards the damages caused by the SARCoV-2 coronavirus on the male reproductive system.
 
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