Ureaplasma parvum ventriculitis related to surgery and ventricular peritoneal drainage

Tiny but Nasty: A case report and a review of the literature on Ureaplasma parvum peritonitis

Ureaplasma parvum, a member of the Mollicutes class, is a rare but significant pathogen in extragenital infections. This case report is the tenth known case of Ureaplasma spp. peritonitis, occurring in a 36-year-old female post extensive surgery for metastatic sigmoid colon adenocarcinoma. Following the intervention, the patient exhibited post-surgical peritonitis with fever despite empirical broad-spectrum antibiotics. Conventional bacterial and fungal cultures remained negative, prompting the use of 16 S rRNA polymerase chain reaction (PCR) for diagnosis. Ureaplasma parvum was detected in both peritoneal and perihepatic fluid samples, and in the urine, leading to the initiation of doxycycline therapy. The patient responded positively to the treatment, with complete resolution of symptoms and no recurrence observed during a four-year follow-up. This report underscores the clinical challenge posed by Ureaplasma spp. due to its resistance to common antibiotics and difficulty in cultivation. It highlights the importance of molecular diagnostics in identifying such pathogens in culture-negative cases and the necessity of considering Ureaplasma spp. especially in female patients with persistent peritonitis post-urogenital procedures or surgeries. The case also reflects on the limited data regarding antimicrobial susceptibility, emphasizing the need for tailored therapeutic approaches based on local resistance patterns and the clinical context. Ultimately, this case contributes valuable insights into the diagnosis and management of Ureaplasma spp. peritonitis, advocating for heightened clinical suspicion and appropriate molecular testing to ensure effective patient outcomes.

Brain abscess with Ureaplasma parvum in a patient with granulomatosis with polyangiitis

PURPOSE

Ureaplasma species are associated with urogenital infections, infertility and adverse pregnancy outcomes as well as neonatal infections. Involvement of the central nervous system in adults is extremely rare. We report an unusual case of a brain abscess secondary to otitis media with Ureaplasma parvum in a patient with granulomatosis with polyangiitis (GPA).

METHODS

Imaging and laboratory findings, treatment decisions, and outcome of this case are explicated.

RESULTS

A young adult with GPA presented with progredient earache after ambulant diagnosis of otitis media. Despite different courses of broad-spectrum antibiotic therapy, she developed meningoencephalitis due to mastoiditis following temporal abscess formation. Mastoidectomy and neurosurgical abscess removal were performed. Standard cultures of cerebrospinal fluid, blood and intracranial abscess material, as well as polymerase chain reaction (PCR) for common bacterial and viral meningitis pathogens remained negative. Only eubacterial PCR of intracranial abscess material returned positive for Ureaplasma parvum. The patient finally improved under antibiotic therapy with moxifloxacin and doxycycline.

CONCLUSION

Ureaplasma species are rare causative pathogens in immunocompromised patients. They should be considered in patients with humoral immunodeficiencies with culture-negative infections failing standard therapy. Eubacterial PCR should be performed in early states of infection in these patients for immediate diagnosis and initiation of appropriate treatment to prevent adverse outcomes.

Diagnostic Value of Metagenomic Next Generation Sequencing for Ureaplasma urealyticum Infection: A Case Report

Ureaplasma urealyticum has high nutritional requirements for culture, and it requires special tools for identification. Theoretically, metagenomic next generation sequencing (mNGS) can be used to detect many pathogens in clinical specimens, especially for complex infectious diseases with rare and atypical causes. Here, our patient developed severe pneumonia caused by U. urealyticum infection after allogeneic hematopoietic stem cell transplantation, and the etiology is unclear. After continuous negative culture, U. urealyticum was detected in the bronchoalveolar lavage fluid by mNGS, and azithromycin was used. Because of the difficulty in its diagnosis, diagnosis and treatment of extragenital U. urealyticum infection is challenging. In addition, many broad-spectrum antibiotics are ineffective against this pathogen because it lacks a cell wall. Therefore, early diagnosis and treatment are key to preventing further complications and deaths.