IgG-mediated haemolysis masquerading as cold agglutinin-induced anaemia complicating severe infection with mycoplasma pneumoniae

Haemolytic anaemia complicating Mycoplasma infection has usually been attributed to IgM cold agglutinins. This report describes a patient with pneumonia due to Mycoplasma pneumoniae in whom severe haemolysis persisted despite declining thermal amplitude and titre of cold agglutinins as the infection resolved. Class-specific anti-globulin (Coombs) testing defined an IgG warm agglutinin coating the patient's erythrocytes that was distinct from the IgM cold agglutinin identified by Sephadex G-200 gel filtration and dithiothreitol inactivation. Monoclonal IgM(gamma) and IgK(k) circulating proteins were identified and immuno-electrophoresis of the cold agglutinin-containing cryoglobulin fraction identified the cold agglutinin as an IgM(gamma). In this patient initially presumed to have cold agglutinin induced haemolysis secondary to Mycoplasma infection, an IgG warm agglutinin was identified as the aetiology for the patient's haemolysis, underscoring the clinical relevance of careful evaluation of the mechanism of haemolysis accompanying Mycoplasma pneumonia.

Importance of Mycoplasma hominis in acute salpingitis assessed by culture and serological tests

In 95 women with a provisional diagnosis of pelvic inflammatory disease, a final diagnosis of acute salpingitis was confirmed by laparoscopy in 46 and 10 had strong clinical evidence of acute salpingitis. The findings in the remaining 39 patients without signs of acute salpingitis by laparoscopy were used as a standard of reference. Criteria for the diagnosis of possible mycoplasmal salpingitis were tentatively defined as the isolation of Mycoplasma hominis from the cervix together with positive test results for M hominis antibodies (a titre of greater than or equal to 1/1280 or a change in titre, or both); these criteria were fulfilled in 12 patients with acute salpingitis. A positive correlation between mycoplasmal salpingitis and chlamydial salpingitis or gonococcal salpingitis, or both, was significant. Mycoplasmal salpingitis was not associated with any characteristic clinical feature different from those of patients with non-mycoplasmal salpingitis. Our findings do not support the view that M hominis is an important primary pathogen in acute salpingitis.

Exacerbation of murine respiratory mycoplasmosis in gnotobiotic F344/N rats by Sendai virus infection

Six- to eight-week-old gnotobiotic F344/N rats were inoculated intranasally with 10(5.0) colony-forming units of Mycoplasma pulmonis or were sham inoculated, then one week later were given 10(0.2) 50% tissue culture infective doses of Sendai virus or sterile medium. Groups of rats were killed immediately after virus inoculation and three, five, ten, and 20 days later. Lesions in nasal passages, middle ears, larynxes, tracheas, and lungs from half of the rats in each group were subjectively scored. Organs from the other rats were quantitatively cultured for M. pulmonis and for Sendai virus. Rats given Sendai virus alone had mild, patchy, necrotizing rhinitis, laryngitis, tracheitis, and bronchitis, but not bronchiolitis or interstitial pneumonia. M. pulmonis alone induced mild lesions of murine respiratory mycoplasmosis including mild to moderate suppurative rhinitis, otitis media, laryngitis, and tracheitis with submucosal lymphoid accumulation and epithelial hyperplasia, but not lung lesions. Rats given M. pulmonis and Sendai virus had severe lesions characteristic of advanced mycoplasmal disease throughout the respiratory tract, including suppurative bronchitis with extensive lymphoid accumulations and epithelial hyperplasia; some rats also had suppurative pneumonia and bronchiectasis. Larger numbers of M. pulmonis colony-forming units were in rats given Sendai virus, but there was no statistically significant difference in Sendai virus infectious units between rats also given M. pulmonis and those given virus only.

Repercussion of mycoplasmas on male and female sterility

The importance of genital mycoplasmas has been widely discussed since the beginning of 1970 and is still considered as controversial. This paper will attempt to evaluate critically the new information and try to outline current concepts concerning the role of this unique group of microorganisms in involuntary infertility and pregnancy losses.

[Mycoplasma infection: a disease of reproduction? Apropos of 271 cases]

We investigated by culture the presence of mycoplasmal infection in all reproductive abnormalities. 271 charts were studied, comprising problems of sterility with abnormal sperm, cystitis, urethritis, spontaneous abortions, fetal death in utero, premature deliveries and small for gestational age fetuses. Antimycoplasmal therapy lead to recovery in cases where this infection was the only cause, notably in sterility. Is Mycoplasma a risk factor or does it simply represent current infection?

Spontaneous abortion--an infectious aetiology?

The role of Chlamydia trachomatis, genital mycoplasmas, Campylobacter spp. and other aerobic and anaerobic bacteria in the aetiology of spontaneous abortion was investigated prospectively in 241 pregnant women at a community hospital. Sixteen women who had threatened abortions were a little younger, of lower social class and had had more previous spontaneous abortions than the 76 women who aborted or the 149 women whose pregnancies were not complicated in the early stages by haemorrhage. The demographic characteristics of the latter two groups of women were similar. C. trachomatis was isolated from the cervix of only one woman and she had no genital-tract bleeding at any stage in her pregnancy. Mycoplasma hominis was isolated most often from the women who had threatened abortions but otherwise the prevalence of the other various micro-organisms was similar in women who had spontaneous abortions, threatened abortions, and in those who had pregnancies uncomplicated by vaginal bleeding. It was clear, therefore, that C. trachomatis played no role in the aetiology of spontaneous abortion in the population studied and there was no suggestion that any of the other micro-organisms were involved either.

Experimental infection of sheep with Mycoplasma ovipneumoniae and Pasteurella haemolytica

A group of Caesarian-derived, colostrum-deprived lambs was inoculated intranasally and intratracheally with a virulent Mycoplasma ovipneumoniae isolate selected from ovine mammary studies and propagated in an ovine mammary gland. Other groups of lambs were inoculated with M. ovipneumoniae in combination with Pasteurella haemolytica type Al or P. haemolytica alone. The M. ovipneumoniae isolate alone did not induce any specific pneumonic lesions in the lambs and when combined with P. haemolytica type Al did not increase the severity of the P. haemolytica-type lesions. Fifty percent of lambs inoculated with P. haemolytica developed a purulent and exudative bronchopneumonia with pleurisy and high titres of P. haemolytica were recovered from these lesions.

Eperythrozoon ovis and copper poisoning as causes of jaundice in lamb carcases

A total of 126 lamb carcases, of which 80 were jaundiced and 46 were grossly normal at routine meat inspection, were examined. Two specific diseases were demonstrated to be associated with jaundiced carcases. Eperythrozoon infection was demonstrated in 65% of jaundiced, and 12% of non-jaundiced carcases from jaundice-affected lots, but not in 5 normal carcases from unaffected killing lots. Copper poisoning was demonstrated in 2 of the jaundiced carcases. Infection with Eperythrozoon ovis was therefore the condition most commonly associated with, and presumably the major cause of jaundice in these lamb carcases. Copper poisoning was a less common cause of jaundice.

Utilization of temperature-sensitive mutants of Mycoplasma gallisepticum to prevent air sac infections

Three stable temperature-sensitive (ts) mutants were obtained by treating the S6 strain of Mycoplasma gallisepticum with 50 micrograms/ml of nitrosoguanidine. These mutants were morphologically and serologically indistinguishable from the parent S6 strain. Mutants ts 37 and ts 102 were apathogenic, and ts 100 was moderately pathogenic to chickens when inoculated directly into the air sac. To turkeys, ts 37 remained apathogenic, ts 102 was slightly pathogenic, and ts 100 was highly pathogenic, Intranasal immunization of newly hatched chickens with any of the mutants resulted in antibody production, but only ts 100 and ts 102 protected chickens against experimental M. gallisepticum infections 3 weeks later. Vaccination of 2-day-old turkeys with ts resulted in erratic antibody response; however, 5 weeks after immunization, turkeys were able to resist challenge with the virulent S6 strain at a highly significant level.

Pathogenetic mechanisms of Mycoplasma mycoides subsp. mycoides septicemia in goats

The variant best known as the large-colony type of M. mycoides subsp. mycoides is responsible for severe outbreaks of septicemia with coagulopathy in goats. Our objective was to study aspects of the pathogenesis that might explain the coagulopathy, the persistence of mycoplasmas in the blood of septicemic goats, and the host specificity. The endothelial cells of caprine aorta tissue cultured in vitro and exposed to the M. mycoides underwent severe ultrastructural damage. There was no evidence of cytotoxicity to 51Cr-labeled adherent cells from peripheral blood of goats. Complement from goat, sheep, calf and guinea pig was activated by the mycoplasma, resulting in consumption of complement and lysis of mycoplasmas. Goat complement had the poorest mycoplasmacidal effect, whereas guinea pig complement had the highest cidal activity. Complement was activated through the classical pathway, since selective chelation of Ca++ inhibited activation, and serum from C4-deficient guinea pigs was not mycoplasmacidal. Complement activity was restored in chelated serum of sheep, calf and guinea pig after Ca++ supplementation, but not in goat serum, suggesting a difference in the classical pathway activity between these species. Activation of complement may be an important generator of inflammation in this disease. However, species variation in mycoplasmacidal efficiency of complement cannot wholly explain why goats and sheep are susceptible to septicemia and calves and guinea pigs are not. Both endothelial damage and complement activation may be important features of the pathogenesis of tissue damage, and may help explain the coagulopathy in this disease.

Acute salpingitis. Diagnostic and therapeutic dilemmas

Acute salpingitis is occurring with increasing frequency among sexually active young women and is associated with a significant risk of long term morbidity, especially infertility. Clinical diagnosis is difficult because symptoms and signs are nonspecific and their severity is not always commensurate with the tubal pathology. No antibiotic is ideal; the choice should depend on the most likely pathogen in each patient and the severity of her disease.

Surgical treatment of infected pseudoaneurysms after replacement of the ascending aorta

The best management of infected pseudoaneurysms after prosthetic graft replacement of the ascending aorta has not yet been established. The successful surgical treatment of three patients with this complication following replacement of the aortic valve and ascending aorta is reported. Because of the poor preoperative clinical condition of these patients, an effort was made to carry out the operative repair as expeditiously as possible. The prosthetic material was never entirely removed and replaced, but less radical operations were performed in combination with extensive and accurate debridement of the mediastinum and local antiseptic irrigation.

The anti-chlamydial effect of experimental Mycoplasma pulmonis infection in the murine genital tract

Experimental Chlamydia trachomatis infection of the genital tract of female CBA and TO mice was greatly curtailed by a concurrent genital infection with Mycoplasma pulmonis. TO mice in which chlamydial infection had been suppressed by the mycoplasma infection were treated with the anti-mycoplasma agent, gentamicin. This did not cause a reappearance of the chlamydiae, suggesting that these organisms had been eliminated completely. The M. pulmonis infection stimulated a striking and persistent polymorphonuclear leukocyte response, which may have been the cause of the curtailment of the chlamydial infection.

Microbial flora in semen of asymptomatic infertile men

A microbiological examination has been carried out in 116 patients with unexplained infertility and with asymptomatic bacteriospermia. Organisms more frequently isolated were Staphylococcus epidermidis (81.9%), non hemolytic streptococci (23.3%), diphtheroids (25%) and alpha-hemolytic streptococci (18.1%). None of the 103 patients were positive for C. trachomatis. Mycoplasmas were isolated in 56 (48.3%) of the 116 examined samples, U. urealyticum was present in 49 (42.2%), M. hominis in 3 (2.6%) and both species in 4 (3.5%) samples of examined fluids. Forty-one of the 56 mycoplasmas-positive patients have been treated with doxycycline therapy. The treatment improved motility and caused decrease of coiled tails in 12 cases. Conception occurred in 5 (26.3%) of the 19 treated patients whose cultures were negative for mycoplasmas. These 5 pregnancies occurred in the patients that had high titers (greater than 10(5) c.c.u./ml) of ureaplasmas and in which the antibiotic therapy was successful. No pregnancy was seen in the other 22 patients where treatment failed to eradicate mycoplasmas.

Detection of Mycoplasma hominis antigen in clinical specimens by using a four-layer modification of enzyme immunoassay (EIA)

A 4-layer modification of enzyme immunoassay (EIA) was developed for the detection of Mycoplasma hominis antigen in clinical specimens. Microtiter plates were sensitized with rabbit anti-mycoplasma immunoglobulin, guinea pig anti-mycoplasma immunoglobulin was used as the secondary antibody, and horseradish peroxidase-conjugated anti-guinea pig immunoglobulin was used as the indicator antibody. The specificity of the assay was confirmed by using guinea pig immunoglobulins from preimmunization sera. The sensitivity of the assay is down to 10 ng/ml of antigen protein. Marked cross-reactivity was demonstrated for different strains within the species M. hominis, whereas the other genital mycoplasma species tested showed no reactivity in the assay. A comparison was made of EIA and conventional culture of vaginal specimens from 24 women. All 6 specimens positive by culture were also positive for M. hominis antigen by EIA. Antigen detection by EIA is a sensitive, rapid and simple method for the detection of M. hominis in clinical specimens.

Lack of association between genital mycoplasmas and infertility

We studied the relation between colonization with Mycoplasma hominis and Ureaplasma urealyticum, and the results of infertility studies in 205 women with involuntary infertility of at least one year's duration. Isolation of M. hominis (but not of U. urealyticum) was significantly (P = 0.002) more common in patients with a history of pelvic inflammatory disease. However, no relation could be shown between these genital mycoplasmas and any of the following: evidence of prior pelvic inflammatory disease as determined by hysterosalpingography and laparoscopy; cervical inflammation; numbers and motility of spermatozoa on postcoital test; pyosemia; quality of cervical mucus; whether the cause of infertility was related to male or female factors, both, or neither; and occurrence and outcome of subsequent pregnancy. Mycoplasmas were cultured from only 10 of 203 endometrial biopsy specimens (4.9 per cent), and in no instance was inflammation associated with this finding. Out studies do not support a role for genital mycoplasmas in the cause of infertility.

Increased incidence of airsacculitis in broilers infected with mycoplasma synoviae and chicken-passaged infectious bronchitis vaccine virus

Infectious bronchitis vaccine virus is thought to cycle (i.e., pass from vaccine-virus-infected to susceptible chickens) in commercial broiler and pullet flocks. To simulate the effect of this cycling, mild infectious bronchitis vaccine virus was passaged in chickens serially six times. This sixth passage virus was used to infect chickens, which were then exposed to a moderately cold environment of 10 +/- 2 C and to Mycoplasma synoviae. In two separate experiments, the chicken-passaged vaccine virus resulted in a marked increase in the incidence of airsacculitis compared with nonpassaged vaccine virus. Intermediate passage levels also increased airsacculitis incidence but not as much as the sixth passage virus. In another experiment, virus chicken-passaged by contact transmission also caused increased airsacculitis incidence.