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Ehrnström B, Haugan MS, Andreasen JB, Ellingsen A. Immunocompromised teenager with meningitis caused by Ureaplasma parvum. BMJ Case Rep 2024; 17:e257261. [PMID: 38453229 PMCID: PMC10921514 DOI: 10.1136/bcr-2023-257261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
Infection in the immunocompromised patient is often challenging on multiple levels. It can be difficult to distinguish between manifestations of the underlying disease, infection or malignancy. Symptoms may be vague or even absent, deviations in the common inflammatory parameters discrete, imaging findings scarce and the causative microbe may be a true pathogen as well as opportunistic. Here, we report an immunosuppressed female in her late teens with a purulent meningitis due to Ureaplasma parvum-a very rare cause of infection in the central nervous system of adults. We wish to highlight the relevance of intracellular pathogens and the need to actively search for these microbes, especially when response to broad-spectrum antibiotic treatment is absent. Furthermore, we emphasise the need for adequate molecular microbial diagnostics in search of microbes that are difficult to identify by culture and where serology and antigen tests may be absent or unreliable due to immune suppression.
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Affiliation(s)
- Birgitta Ehrnström
- Department of Infectious Diseases, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Clinic of Anaesthesia and Intensive Care, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Maria Schei Haugan
- Department of Medical Microbiology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jo Bønding Andreasen
- Clinic of Anaesthesia and Intensive Care, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Thoracic Intensive Care Unit, Aalborg Universitetshospital, Aalborg, Denmark
| | - Asbjørn Ellingsen
- Department of Infectious Diseases, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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2
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Yeoh K, Aikeremu D, Aw-Yeong B, Slavin MA, Williams E. An Unusual and Difficult to Detect Cause of Infection in Two Trauma Patients. Clin Infect Dis 2023; 77:154-157. [PMID: 36202767 PMCID: PMC10320131 DOI: 10.1093/cid/ciac748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kim Yeoh
- Department of Microbiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity . Melbourne, Victoria, Australia
| | - Dilare Aikeremu
- Department of Microbiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Benjamin Aw-Yeong
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Monica A Slavin
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity . Melbourne, Victoria, Australia
- Department of Infectious Diseases, and National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Eloise Williams
- Department of Microbiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity . Melbourne, Victoria, Australia
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3
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Karczewski D, Müllner M, Perka C, Müller M. Clostridium difficile septic arthritis and periprosthetic joint infection in a patient with acute lymphoblastic leukaemia, T-/B-lymphocytopenia and hypogammaglobulinemia - a case report and review of the literature. Access Microbiol 2021; 3:000233. [PMID: 34151183 PMCID: PMC8209633 DOI: 10.1099/acmi.0.000233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/11/2021] [Indexed: 11/29/2022] Open
Abstract
To the best of our knowledge, we report the first Clostridium difficile infection in a native hip joint with subsequent prosthetic joint infection in a patient at a state of hypogammaglobulinemia. The infection developed following chemotherapy for B-cell precursor acute lymphoblastic leukaemia (BCP-ALL). After chemotherapy, hip arthroplasty was performed for destructive septic arthritis. However, infection in the hip persisted with several failing revisions for more than 3 years, until ultimately hypogammaglobulinemia and T-/B-lymphocytopenia were diagnosed, and supplementation with i.v. immunoglobulins was able to achieve infection control.
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Affiliation(s)
- Daniel Karczewski
- Department of Orthopaedics, Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Maximilian Müllner
- Department of Orthopaedics, Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Carsten Perka
- Department of Orthopaedics, Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Michael Müller
- Department of Orthopaedics, Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
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4
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Gómez Rufo D, García Sánchez E, García Sánchez JE, García Moro M. [Clinical implications of the genus Mycoplasma]. REVISTA ESPANOLA DE QUIMIOTERAPIA 2021; 34:169-184. [PMID: 33735544 PMCID: PMC8179937 DOI: 10.37201/req/014.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dentro del género Mycoplasma, las especies que tradicionalmente se han relacionado con cuadros infecciosos han sido principalmente M. pneumoniae, M. genitalium, M. hominis o U. urealyticum. Sin embargo, existen otras muchas que están implicadas y, que muchas veces, son desconocidas para los profesionales sanitarios. El objetivo de esta revisión es identificar todas las especies del género Mycoplasma que se han aislado en el hombre y determinar su participación en la patología infecciosa humana.
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Affiliation(s)
| | - E García Sánchez
- Enrique García Sánchez, Departamento de Ciencias Biomédicas. Facultad de Medicina. Universidad de Salamanca. Spain.
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5
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Ball ND, Snape SE. Periprosthetic joint infection with Ureaplasma parvum detected by 16S rRNA PCR. BMJ Case Rep 2021; 14:14/3/e239858. [PMID: 33674296 PMCID: PMC7939010 DOI: 10.1136/bcr-2020-239858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Usual culture methods to identify pathogenic bacteria can be unsuccessful, particularly when working with fastidious organisms. We present a case of early periprosthetic knee joint infection with Ureaplasma parvum only identified using 16S ribosomal RNA PCR. This case represents the impact molecular methods of bacterial identification can have on clinical care allowing for more targeted antimicrobial therapy; something which is imperative in an era of increasing antimicrobial resistance.
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Affiliation(s)
- Nicola Diane Ball
- Infectious Diseases, Nottingham University Hospitals NHS Trust, Nottingham, UK
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6
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Roerdink RL, Huijbregts HJTAM, van Lieshout AWT, Dietvorst M, van der Zwaard BC. The difference between native septic arthritis and prosthetic joint infections: A review of literature. J Orthop Surg (Hong Kong) 2020; 27:2309499019860468. [PMID: 31284831 DOI: 10.1177/2309499019860468] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Current literature occasionally considers septic arthritis in native joints and prosthetic joint infections as equal pathologies. However, significant differences can be identified. The aim of this review of literature is to describe these differences in definitions, pathology, diagnostic workups, treatment strategies, and prognosis.
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Affiliation(s)
- Ramon Lucas Roerdink
- 1 Department of Orthopedic Surgery, Jeroen Bosch General Hospital, Henri Dunantstraat, 's-Hertogenbosch, The Netherlands
| | | | | | - Martijn Dietvorst
- 4 Department of Orthopedic Surgery at Máxima Medical Center, The Netherlands
| | - Babette Corine van der Zwaard
- 1 Department of Orthopedic Surgery, Jeroen Bosch General Hospital, Henri Dunantstraat, 's-Hertogenbosch, The Netherlands
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7
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Jhaveri VV, Lasalvia MT. Invasive Ureaplasma Infection in Patients Receiving Rituximab and Other Humoral Immunodeficiencies-A Case Report and Review of the Literature. Open Forum Infect Dis 2019; 6:ofz399. [PMID: 31660361 PMCID: PMC6790395 DOI: 10.1093/ofid/ofz399] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 09/05/2019] [Indexed: 11/14/2022] Open
Abstract
Ureaplasma species are small, fastidious bacteria that frequently colonize the lower reproductive tract of asymptomatic hosts. These organisms have been well described to cause chorioamnionitis, neonatal infection, and urethritis, and to a lesser degree surgical site infection and infection in transplant recipients. Outside of these settings, invasive Ureaplasma infections are rare. We describe the case of a young woman receiving rituximab for multiple sclerosis who presented with fever and bilateral renal abscesses due to Ureaplasma spp., which was successfully treated with oral doxycycline. We searched the literature for cases of invasive Ureaplasma infection and found a patient population that predominates with humoral immunodeficiency, either congenital or iatrogenic. Diagnostic and therapeutic interventions are discussed.
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Affiliation(s)
- Vimal V Jhaveri
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Mary T Lasalvia
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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8
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Early prosthetic joint infection due to Ureaplasma urealyticum: Benefit of 16S rRNA gene sequence analysis for diagnosis. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2019; 52:167-169. [DOI: 10.1016/j.jmii.2017.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/08/2017] [Accepted: 07/12/2017] [Indexed: 11/20/2022]
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9
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Chotanaphuti T, Courtney PM, Fram B, In den Kleef NJ, Kim TK, Kuo FC, Lustig S, Moojen DJ, Nijhof M, Oliashirazi A, Poolman R, Purtill JJ, Rapisarda A, Rivero-Boschert S, Veltman ES. Hip and Knee Section, Treatment, Algorithm: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S393-S397. [PMID: 30348575 DOI: 10.1016/j.arth.2018.09.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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10
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Liu TH, Cheng SS, You HL, Lee MS, Lee GB. Bacterial detection and identification from human synovial fluids on an integrated microfluidic system. Analyst 2019; 144:1210-1222. [DOI: 10.1039/c8an01764f] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
An integrated microfluidic system was developed for detecting and identifying four bacteria in human joint fluid with the limit of detection as low as 100 colony forming units (CFUs) per milliliter (or 20 CFUs per reaction).
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Affiliation(s)
- Ting-Hang Liu
- Department of Power Mechanical Engineering
- National Tsing Hua University
- Hsinchu
- Taiwan
| | - Shu-Shen Cheng
- Department of Laboratory Medicine
- Kaohsiung Chang Gung Memorial Hospital
- Kaohsiung
- Taiwan
| | - Huey-Ling You
- Department of Laboratory Medicine
- Kaohsiung Chang Gung Memorial Hospital
- Kaohsiung
- Taiwan
| | - Mel S. Lee
- Department of Orthopaedic Surgery
- Kaohsiung Chang Gung Memorial Hospital
- Kaohsiung
- Taiwan
| | - Gwo-Bin Lee
- Department of Power Mechanical Engineering
- National Tsing Hua University
- Hsinchu
- Taiwan
- Institute of Biomedical Engineering
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11
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Gassiep I, Gore L, Dale JL, Playford EG. Ureaplasma urealyticum necrotizing soft tissue infection. J Infect Chemother 2017; 23:830-832. [PMID: 28803865 DOI: 10.1016/j.jiac.2017.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 06/10/2017] [Accepted: 07/17/2017] [Indexed: 11/30/2022]
Abstract
Ureaplasma urealyticum is a urogenital commensal and often associated with localised infection. With the advent of monoclonal immunosuppressive therapy and improved diagnostic methods, reports of non-urogenital infections are accumulating. We report a rare case of U. urealyticum necrotizing soft tissue infection and left hip septic arthritis in a hypogammaglobulinaemic patient. Consideration of this organism as an etiological agent, and potential early use of nucleic-acid diagnostic investigation with empiric therapy including activity against Ureaplasma in this patient population may be warranted.
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Affiliation(s)
- Ian Gassiep
- Department of Infectious Diseases, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, QLD, 4102, Australia; School of Medicine, University of Queensland, St Lucia, QLD, 4072, Australia.
| | - Letitia Gore
- School of Medicine, University of Queensland, St Lucia, QLD, 4072, Australia; Pathology Queensland Central Laboratory, Royal Brisbane and Women's Hospital, Block 7, Level 9, Herston Road, Herston, QLD, 4006, Australia
| | - Joanne L Dale
- School of Medicine, University of Queensland, St Lucia, QLD, 4072, Australia; Department of Colorectal Surgery, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, QLD, 4102, Australia
| | - E Geoffrey Playford
- Department of Infectious Diseases, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, QLD, 4102, Australia; School of Medicine, University of Queensland, St Lucia, QLD, 4072, Australia
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