SARS1 orkiitti

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https://academic.oup.com/biolreprod/article/74/2/410/2667029

Orchitis: A Complication of Severe Acute Respiratory Syndrome (SARS)¹

Jian Xu, Lihua Qi, Xiaochun Chi, Jingjing Yang, Xiaohong Wei, Encong Gong, Suatcheng Peh, Jiang Gu

Author Notes

Biology of Reproduction, Volume 74, Issue 2, 1 February 2006, Pages 410–416, https://doi.org/10.1095/biolreprod.105.044776

Published:

01 February 2006

Article history Abstract

Severe acute respiratory syndrome (SARS) coronavirus has been known to damage multiple organs (MOF, multiple organ failure); however, little is known about its impact on the reproductive system. In the present study, we analyzed the pathological changes of testes from six patients who died of SARS. Results suggested that SARS caused orchitis.
All SARS testes displayed widespread germ cell destruction, few or no spermatozoon in the seminiferous tubule, thickened basement membrane, and leukocyte infiltration. The numbers of CD3+ T lymphocytes and CD68+ macrophages increased significantly in the interstitial tissue compared with the control group (P < 0.05). SARS viral genomic sequences were not detected in the testes by in situ hybridization. Immunohistochemistry demonstrated abundant IgG precipitation in the seminiferous epithelium of SARS testes, indicating possible immune response as the cause for the damage. Our findings indicated that orchitis is a complication of SARS. It further suggests that the reproductive functions should be followed and evaluated in recovered male SARS patients.

Subject

Testis

Issue Section:

Testis

Introduction

Since the first appearance in Guangdong province, China, in November 2002, the global outbreak of severe acute respiratory syndrome (SARS) had spread to more than 28 countries in three continents, and resulted in more than 8000 infections and close to 800 deaths within the following 9 mo [1]. For what appeared initially as a mere infection of the respiratory tract like a common cold, the death toll was alarming, and many lives of health-care workers were claimed. With vigilant public health controls and strict preventive measures on further spread within the hospital environment, the epidemic was brought under control. The concern over this global outbreak brought together scientists from all over the world, and with their joint effort, the SARS virus, a novel coronavirus, was isolated, and subsequently the full genomic sequences of the SARS virus were determined [2–4]. Although a lot had been learned about the epidemiology, mode of spread, and certain aspects of the pathogenesis, a number of SARS-related complications are still waiting to be studied.
Pathological studies revealed that the lungs of SARS patients had the most dramatic changes, with severe degeneration of the epithelium, hyaline membrane formation, exudation of fibrin fluid, and vasculitis, with many alveoli collapsed [5, 6]. In addition, other organs were also infected and damaged by the SARS virus. The targets included the lymphocytes, the epithelium of the distal tubules of the kidney, and the submucosal lymphoid complex of the gut, the spleen, and the lymph nodes [7, 8]. However, only sporadic information is available regarding the involvement of reproductive organs in SARS patients [9, 10]. Because it is known that viruses such as HIV, HBV, and mumps can enter the testis and cause viral orchitis and, in some instances, result in male infertility and testicular tumor [11], we investigated the possible damage of the testis in SARS patients and the effects of SARS on spermatogenesis.

Materials 

 Autopsy specimens of testis were obtained from six patients (cases S01, S03, S05, S08, S11, and S15) who died of SARS in Ditan Hospital, Beijing, China. The case numbers were derived from the Department of Pathology, Peking University, and the gaps in numbers were female patients who were not included in this study. The patients’ ages ranged from 20 to 58 yr old (average 39 yr). All six patients met the diagnostic criteria for SARS defined by the World Health Organization (WHO) [12]. The average course of disease was 43 days, ranging from 21 to 62 days. Five of these patients were treated with steroids, except case S05. More clinical data are presented in Table 1.

In conclusion,
 orchitis is found to be a complication of SARS. In this study, all six cases had orchitis, including one case (S08) with the course of disease of only 21 days. All cases in this study were fatal and the incidence of orchitis in this cohort of patients was 100%. Although the number of cases in this study is limited, the data indicate that SARS infection affected the testes significantly. Like orchitis associated with HIV, mumps, and HBV, several possible mechanisms may be involved in causing testicular damages in SARS patients. Virus does not only cause orchitis, but also leads to sterility and increased incidence of testicular tumor [15–17]. This is particularly important for SARS patients, as most of them are males in the age range of 20–50 yr. Therefore, SARS orchitis should be a significant concern when evaluating the prognosis of SARS. Findings from this study strongly suggest that the reproductive functions of recovered male SARS patients should be followed and evaluated.