Male infertility: the intracellular bacterial hypothesis

An overview regarding the relationship between Mollicutes, infertility and antibiotic resistance (Review)

Throughout the past decades, physicians have increasingly conferred regarding the role of Mollicutes in infertility in both male and female patients. Although Ureaplasma and Mycoplasma do not represent a leading cause of infertility, whether dermatovenerologists, gynecologists and urologists should not disregard them when screening patients with infertility problems is discussed in the present review. While these infections are completely asymptomatic in ~80% of cases, they do lead to both chronic inflammation of the genital tract and reproductive disorders. Different Mollicute strains and/or serovars, genomic traits and proteomic markers have been examined in order to understand not only the exact mechanism by which they cause infertility, but also their relationship with the worldwide spreading resistance to antibiotics. The current review provided an overview of the latest studies regarding the new findings on the relationship between Mollicutes, infertility and antibiotic resistance. Awareness should be raised among clinicians to screen sexually active adults wishing to conceive who have failed to achieve a pregnancy; in addition, an antibiogram should be performed and treatment should be carried out according to the guidelines.

Mechanisms of Male Reproductive Sterility Triggered by Dysbiosis of Intestinal Microorganisms

The intestinal microbiota, comprised of bacteria, archaea, and phages, inhabits the gastrointestinal tract of the organism. Male reproductive sterility is currently a prominent topic in medical research. Increasing research suggests that gut microbiota dysbiosis can result in various reproductive health problems. This article specifically investigates the impact of gut microbiota dysbiosis on male reproductive infertility development. Gut microbiota imbalances can disrupt the immune system and immune cell metabolism, affecting testicular growth and sperm production. This dysfunction can compromise the levels of hormones produced and secreted by the endocrine glands, affecting male reproductive health. Furthermore, imbalance of the gut microbiota can disrupt the gut-brain-reproductive axis, resulting in male reproductive infertility. This article explores how the imbalance of the gut microbiota impacts male reproductive infertility through immune regulation, endocrine regulation, and interactions of the gut-brain-reproductive axis, concluding with recommendations for prevention and treatment.

Microbial Dysbiosis and Male Infertility: Understanding the Impact and Exploring Therapeutic Interventions

The human microbiota in the genital tract is pivotal for maintaining fertility, but its disruption can lead to male infertility. This study examines the relationship between microbial dysbiosis and male infertility, underscoring the promise of precision medicine in this field. Through a comprehensive review, this research indicates microbial signatures associated with male infertility, such as altered bacterial diversity, the dominance of pathogenic species, and imbalances in the genital microbiome. Key mechanisms linking microbial dysbiosis to infertility include inflammation, oxidative stress, and sperm structural deterioration. Emerging strategies like targeted antimicrobial therapies, probiotics, prebiotics, and fecal microbiota transplantation have shown potential in adjusting the genital microbiota to enhance male fertility. Notably, the application of precision medicine, which customizes treatments based on individual microbial profiles and specific causes of infertility, emerges as a promising approach to enhance treatment outcomes. Ultimately, microbial dysbiosis is intricately linked to male infertility, and embracing personalized treatment strategies rooted in precision medicine principles could be the way forward in addressing infertility associated with microbial factors.

Ureaplasma urealyticum and Mycoplasma hominis urogenital infections associate with semen inflammation and decreased sperm quality

Ureaplasma urealyticum and Mycoplasma hominis are among the most prevalent sexually transmitted infections proposed to induce urogenital inflammation and impair sperm quality. However, the topic remains controversial since contradictory findings have been reported. Herein, we performed a comprehensive analysis of U. urealyticum and M. hominis urogenital infections and their association with urogenital inflammation (i.e., leukocyte subsets and inflammatory cytokines in semen,) and sperm quality parameters in a cohort of men with couple's primary infertility undergoing initial infertility evaluation or with lower urinary tract symptoms and no infertility-related complaints. Overall, U. urealyticum and M. hominis infection was detected in 17.0% and 23.6% of patients, respectively, whereas the coinfection was detected in 3.8% of patients only. Remarkably, similar infection frequencies were found in the different patient subpopulations analyzed. Moreover, infections were associated with elevated semen levels of TNF, IL-1β, and IL-6 and/or increased counts of total leukocytes and their subsets, including CD4 and CD8 T lymphocytes and neutrophils. In addition, M. hominis infection and the coinfection with U. urealyticum were associated with impairments in sperm quality variables. Our results indicate that U. urealyticum and M. hominis male urogenital infections induce urogenital inflammation and decrease sperm quality, thus impairing male fertility potential. Screening for U. urealyticum and M. hominis infections and performing a comprehensive analysis of different leukocyte subsets and inflammatory cytokines in semen may be clinically helpful in the diagnosis and follow-up of male urogenital infection.

Prevalence of Chlamydia trachomatis, Ureaplasma parvum and Mycoplasma genitalium in Infertile Couples and the Effect on Semen Parameters

Background

Chlamydia trachomatis, Ureaplasma parvum, and Mycoplasma genitalium are common sexually transmitted microorganisms. Our study aimed to determine the prevalence of C. trachomatis, U. parvum, and M. genitalium in infertile and fertile couples and the effect of these microorganisms on semen parameters.

Materials and Methods

In this case-control study, samples were collected from 50 infertile couples and 50 fertile couples and were subjected to the routine semen analysis and Polymerase chain reaction (PCR).

Results

C. trachomatis and U. parvum were detected in 5 (10%) and 6 (12%) of semen samples from infertile men. Also, out of 50 endocervical swabs from the infertile women, C. trachomatis and M. genitalium were detected in 7(14%) and 4 (8%) of swab specimens, respectively. In the control groups, all of the semen samples and endocervical swabs were negative. Also, in the group of infertile patients infected with C. trachomatis and U. parvum, sperm motility was lower than uninfected infertile men.

Conclusions

The results of this study showed that C. trachomatis, U. parvum, and M. genitalium are widespread among the infertile couples in Khuzestan Province (Southwest of Iran). Also, our results showed that these infections can decrease the quality of semen. For the prevention of the consequences of these infections, we suggest a screening program for infertile couples.

A correlative interaction between thyroid dysfunction and semen parameters in male infertility: A prospective case control study

The role of thyroid function on sperm quality has not been well studied from a pathological aspect. This study aimed to report the degree of association between the status of thyroid hormones, sperm quality and aetiology in infertile men compared to healthy subjects. A prospective case control investigative study was conducted on 100 infertile males and age matched healthy controls. Semen samples were collected for sperm quality examination, and the serum levels of tetraiodothyronine (T4), triiodothyronine (T3), and thyroid stimulation hormone (TSH) were measured. Out of 100 infertile men, oligozoospermia (32%), asthenozoospermia (48%), and oligo-asthenozoospermia (20%) were found. There was a statistical difference between the group I and group II groups related to sperm count (28.32 ± 14.60 vs 66.50 ± 10.50 x 106/ml), sperm motility (40.1 ± 13.8 vs 64.8 ± 7.85%), and sperm morphology (55.92 ± 5.27 vs 83.50 ± 5.25%, p<0.05). There was a statistical difference among the oligozoospermia, asthenozoospermia, and oligo-asthenozoospermia groups related to T3 (115 + 0.40 vs 1.29 ± 0.59 vs 1.25 ± 0.32 ng/ml), T4 (7.35 ± 1.42 vs 9.15 ± 1.85 vs 7.85 ± 1.65 μg/dl), and TSH (1.69 ± 0.55 vs 2.12 ± 1.45 vs 1.98 ± 0.4 μIU/ml) (P<0.05). There was a significant inverse correlation of TSH levels with sperm volume (r = -0.12, p= 0.02), sperm motility (r = -0.26, p= 0.02), and sperm morphology (r = -0.304, p = 0.02) observed. T4 levels were significantly correlated with sperm count (r = -0.278, p = 0.02), and sperm motility (r = -0.249, p = 0.032). T4 levels were very highly associated with asthenozoospermia. Relative operating curve analysis shows that Sperm motility of >40.1%, T3 levels of <1.29 ng/ml, total T4 levels of <8.42 μg/dl, TSH levels of <1.98 μIU/ml inferred the male infertility.

Although thyroid function screening is not currently recommended as a part of the diagnostic workup of the infertile male, it may be reconsidered in light of the physiopathological background. Studies will be necessary to initiate the trial of a small dose of anti-thyroid drug in asthenozoospermic patients.

Diagnosis of bacteriospermia and its impact on spermogram parameters in adolescents with varicocele

Infectious etiology is the cause of about 15% of cases of male infertility. And if sexually transmitted infections are easily diagnosed, the role of asymptomatic bacteriospermia in the formation of infertility in men, and especially in adolescents against the background of the existing pathology of the reproductive sphere (varicocele), remains insufficiently studied. A microbiological study in the ejaculate of adolescents revealed the following types of bacteria: Escherichia coli, Enterococcus faecalis, Corynebacterium glucuronolyticum, Corynebacterium minitissimum, Streptococcus anginosus, Staphylococcus epidermidis, Staphylococcus haemolyticus. Bacteria in the ejaculate were also detected during semen analysis and electron microscopic examination of spermatozoa. With abundant growth of microorganisms in a monoculture or an association of two microorganisms present in a moderate amount, in all cases, violations of sperm motility, an increase in the viscosity of the ejaculate, the presence of leukocytes in the seminal fluid were detected, and damage to the chromatin, acrosome and mitochondria was recorded at the ultrastructural level, which may indicate active infection. When bacterial flora was detected in a small and moderate amount (<10 CFU/ml), no pathological changes in the ejaculate were observed. The microflora of the ejaculate of the examined adolescents is represented by gram-positive microflora. Simultaneous study of the ejaculate sample by bacteriological seeding, the performance of spermogram and EMIS allowed to increase the detection of bacteriospermia. Opportunistic pathogens with abundant growth or their various combinations can serve as a factor in the development of pathospermia. It is possible to distinguish an active infection from commensal microflora or sample contamination not only by the presence of bacteria in the ejaculate and their quantitative accounting, but also by the degree of damage to the function of spermatozoa and pathological changes in the parameters of the ejaculate, by combining diagnostic methods. Most often, in the presence of bacteria in the ejaculate, asthenozoospermia is diagnosed.

The effects of Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum loads on semen quality: Detection and quantitative analysis

BACKGROUND

The loads of Chlamydia trachomatis (CT), Mycoplasma hominis (MH), and Ureaplasma urealyticum (UU) may impact infertility, as well as cause risk of transmission. The quality and quantity of semen demonstrate male reproductive health. This study aimed to investigate the semen quality affected by CT, MH, and UU loads.

MATERIALS AND METHODS

130 semen samples, including infertile and fertile cases, were collected and analyzed. The whole genomic DNA was extracted, and the desired genes' plasmids were constructed. The CT, MH, and UU loads were quantified by real-time PCR. The data were analyzed using SPSS version 24.

RESULTS

The average age of participants was 35.2 ± 6.8 years. CT, MH, and UU frequency were 9.2% vs. 3.1%, 15.4% vs. 3.1%, and 15.4 vs. 3.1% in infertile and fertile men, respectively. The mean loads of CT, MH, and UU in infertile men were 6.44 log₁₀ copies/ml (range 5.31-7), 4.24 log₁₀ copies/ml (range 3.37-4.7), and 6.94 log₁₀ copies/ml (range 5.08-8.69) respectively, which was significantly higher than fertile men. The findings revealed a significant correlation between CT and UU loads and semen parameters, whereas the load of MH displayed significant effects just on sperm motility, morphology, and the number of leukocytes.

CONCLUSION

The absence of clinical manifestations may not indicate the quality of semen. The pathogens' loads may significantly influence the quality and properties of male reproductive health.

Bacteriospermia and Male Infertility: Role of Oxidative Stress

Male infertility is one of the major challenging and prevalent diseases having diverse etiologies of which bacteriospermia play a significant role. It has been estimated that approximately 15% of all infertility cases are due to infections caused by uropathogens and in most of the cases bacteria are involved in infection and inflammation leading to the development of bacteriospermia. In response to bacterial load, excess infiltration of leukocytes in the urogenital tract occurs and concomitantly generates oxidative stress (OS). Bacteria may induce infertility either by directly interacting with sperm or by generating reactive oxygen species (ROS) and impair sperm parameters such as motility, volume, capacitation, hyperactivation. They may also induce apoptosis leading to sperm death. Acute bacteriospermia is related with another clinical condition called leukocytospermia and both compromise male fertility potential by OS-mediated damage to sperm leading to male infertility. However, bacteriospermia as a clinical condition as well as the mechanism of action remains poorly understood, necessitating further research in order to understand the role of individual bacterial species and their impact in male infertility.

Protective role of Cytoglobin and Neuroglobin against the Lipopolysaccharide (LPS)-induced inflammation in Leydig cells ex vivo

Leydig cells are responsible for testosterone production in male testis upon stimulation by luteinizing hormone. Inflammation and oxidative stress related Leydig cell dysfunction is one of the major causes of male infertility. Cytoglobin (CYGB) and Neuroglobin (NGB) are two globin family member proteins which protect cells against oxidative stress. In the current study, we established a Lipopolysaccharide (LPS)-induced inflammation model in TM3 Leydig cell culture to study the function of CYGB and NGB proteins under inflammatory conditions. CYGB and NGB were downregulated using siRNA and shRNA based experimental strategies. Overexpression was conducted using lentiviral pLenti-III-CYGB-2A-GFP, and pLenti-III-NGB-2A-GFP vector systems. As testicular macrophages regulate immune function upon inflammation and steroidogenesis of Leydig cells, we generated direct/indirect co-culture systems of TM3 and mouse macrophage (RAW264.7) cells ex vivo. Downregulation of CYGB and NGB induced nitride oxide (NO) release, blocked cell cycle progression, reduced testosterone production and increased inflammatory and apoptotic pathway gene expression in the presence and absence of LPS. On the other hand, CYGB and NGB overexpression reduced TNFα and COX-2 protein expressions and increased the expression of testosterone biogenesis pathway genes upon LPS stimulation. In addition, CYGB and NGB overexpression upregulated testosterone production. The present study successfully established an inflammatory interaction model of TM3 and RAW264.7 cells. Suppression of CYGB and NGB in TM3 cells changed macrophage morphology, enhanced macrophage cell number and NO release in co-culture experiments upon LPS exposure. In summary, these results demonstrate that globin family members might control LPS induced inflammation by regulating apoptotic mechanisms and macrophage response.

A comparison of different O-antigen serogroups of Escherichia coli in semen samples of fertile and infertile men

Objective

Male genital tract infections have been associated with infertility, and Escherichia coli has drawn increasing attention as an important bacterium in this context. This investigation aimed to characterize and compare the distributions of O-antigen serogroups of E. coli in the semen samples of fertile and infertile men.

Methods

In this case-control study, semen samples were collected from 618 fertile and 1,535 infertile men. The E. coli-positive samples were evaluated in terms of concentration, morphology, viability, and motility parameters according to the World Health Organization 2010 guidelines. Finally, different serogroups of E. coli were identified by multiplex polymerase chain reaction targeting the O-antigen variations of the bacterium.

Results

The prevalence of E. coli among fertile men was significantly higher than among infertile men (p<0.001). The sperm morphology, viability, and motility in the E. coli-positive fertile group were significantly higher than in the E. coli-positive infertile group (p<0.001). E. coli O6 was the most prevalent serogroup found in both groups. However, there was no significant difference in the frequency of different serogroups of E. coil between the two groups (p=0.55).

Conclusion

Despite the higher prevalence of E. coli among fertile men, E. coli had more detrimental effects on semen parameters in infertile men. There was no significant difference in E. coli serogroups between the fertile and infertile groups.

Downregulation of microRNA-96-5p protects TM3 cells against zearalenone toxicity via targeting ATG9A

Male infertility factor accounts for ~50% of all infertility cases, and traditional treatments for male infertility are limited. The association between the dysfunction of Leydig cells and hypospermatogenesis is essential for developing novel treatment methods for male infertility. It was previously stated that elevated expression of microRNA (miR)-96-5p was associated with the toxicological response of Leydig cells to treatment with zearalenone (ZEN). However, the exact role of miR-96-5p in Leydig cells remains to be illustrated. The mouse Leydig cell line TM3 was used in the present study to investigate the role of miR-96-5p. ZEN was used to induce cell injury in TM3 cells. Cell Counting Kit-8 assay and the Ki67 staining method were used to evaluate cell viability. Reverse transcription-quantitative PCR was used to determine the expression levels of miR-96-5p. In addition, a dual luciferase assay was used to investigate the target of miR-96-5p. Annexin V/propidium iodide staining was performed to detect cell apoptosis. Western blot analysis was used to detect the expression levels of certain proteins. Finally, monodansylcadaverine (MDC) and LC3 staining were applied for monitoring the level of autophagy. ZEN inhibited the proliferation of TM3 cells in a dose-dependent manner. In addition, the level of miR-96-5p were significantly increased in ZEN-treated TM3 cells. Meanwhile, inhibition of miR-96-5p could reverse ZEN-induced decrease in viability in TM3 cells. Moreover, ZEN notably inhibited autophagy in TM3 cells and this phenomenon was reversed by the application of the miR-96-5p inhibitor. Autophagy related 9A (ATG9A) was identified as the biological target of miR-96-5p. The results derived from MDC and LC3 staining demonstrated that downregulation of miR-96-5p expression levels protected TM3 cells against ZEN toxicity by regulating autophagy. Inhibition of miR-96-5p expression protected TM3 cells against ZEN via targeting ATG9A. Therefore, miR-96-5p may serve as a potential biomarker for male infertility.

Results from a large cross-sectional study assessing Chlamydia trachomatis, Ureaplasma spp. and Mycoplasma hominis urogenital infections in patients with primary infertility

Female and male infertility have been associated to Chlamydia trachomatis, Ureaplasma spp. and Mycoplasma hominis urogenital infections. However, evidence from large studies assessing their prevalence and putative associations in patients with infertility is still scarce. The study design was a cross-sectional study including 5464 patients with a recent diagnosis of couple's primary infertility and 404 healthy control individuals from Cordoba, Argentina. Overall, the prevalence of C. trachomatis, Ureaplasma spp. and M. hominis urogenital infection was significantly higher in patients than in control individuals (5.3%, 22.8% and 7.4% vs. 2.0%, 17.8% and 1.7%, respectively). C. trachomatis and M. hominis infections were significantly more prevalent in male patients whereas Ureaplasma spp. and M. hominis infections were more prevalent in female patients. Of clinical importance, C. trachomatis and Ureaplasma spp. infections were significantly higher in patients younger than 25 years. Moreover, Ureaplasma spp. and M. hominis infections were associated to each other in either female or male patients being reciprocal risk factors of their co-infection. Our data revealed that C. trachomatis, Ureaplasma spp. and M. hominis are prevalent uropathogens in patients with couple's primary infertility. These results highlight the importance of including the screening of urogenital infections in the diagnostic workup of infertility.

Prevalence Determination of m. Hominis and m. Genitalium in the Semen Samples in the Northeast of Iran Using Culture and Multiplex Polymerase Chain Reaction

Infertility has recently become a growing social and economic world problem. Genital mycoplasmas, such as Mycoplasma hominis and M. genitalium, are most frequently associated with several adverse effects on men&amp;rsquo;s fertility. The present study aimed to determine the prevalence of M. hominis and M. genitalium in the semen samples in thenortheast of Iran. During thiscross-sectional study from February to May, 2018, 100 semen samples were collected from 100 infertile men in Mashhad, Khorasan Razavi province, northeast of Iran. The presence of M. hominis and M. genitalium was detected by cultivation, polymerase chain reaction (PCR), and Multiplex PCR assays. The colony of mycoplasma was confirmed by Diene&amp;rsquo;s stain; moreover, arginine hydrolysis, glucose, and urea utilization were evaluated. The following semen indices were analyzed according to World Health Organization guidelines for semen analysis: color, volume, appearance, liquefaction, viscosity, concentration, pH, leukocyte concentration, progressive motility, morphological normality, motile sperm concentration, functional sperm concentration, sperm motility index, and functional sperm. The gene of 16SrRNA (GPO1&amp;amp; MGSO primers) was used as the target gene of the Mycoplasma genus in PCR assay. Multiplex-PCR was performed with a specific primer for conserved regions in the 16SrRNA gene for M. hominis (RNAH1&amp;amp; RNAH2 primers) and the 140-kDa Adhesion Protein Gene for M. genitalium (MG1 &amp;amp; MG2 primers).According to the results,9 (9%) samples were PCR-positive for Mycoplasma spp , while there were 7 (7%) cases isolated by cultivation. M. hominis was detected in 8 (8%) samples by Multiplex PCR, while there was no evidence for M. genitalium. The mean age scores of all infertile and infected men were obtained at 31 and 30 years, respectively. The study could not show any statistical correlation between mycoplasma infection and abnormal semen parameters. The heterogeneity of mycoplasma prevalence in the reports can be ascribed to differences in geographic areas, the sensitivity of the identification method, condition of the group (fertile/infertile), sample size, and operator proficiency. Various results have been reported in numerous studies conducted on the relationship between mycoplasma infection and abnormal semen parameters.

Male infertility due to testicular disorders

CONTEXT

Male infertility is defined as the inability to conceive following 1 year of regular unprotected intercourse. It is the causative factor in 50% of couples and a leading indication for assisted reproductive techniques (ART). Testicular failure is the most common cause of male infertility, yet the least studied to date.

EVIDENCE ACQUISITION

The review is an evidence-based summary of male infertility due to testicular failure with a focus on etiology, clinical assessment, and current management approaches. PubMed-searched articles and relevant clinical guidelines were reviewed in detail.

EVIDENCE SYNTHESIS/RESULTS

Spermatogenesis is under multiple levels of regulation and novel molecular diagnostic tests of sperm function (reactive oxidative species and DNA fragmentation) have since been developed, and albeit currently remain as research tools. Several genetic, environmental, and lifestyle factors provoking testicular failure have been elucidated during the last decade; nevertheless, 40% of cases are idiopathic, with novel monogenic genes linked in the etiopathogenesis. Microsurgical testicular sperm extraction (micro-TESE) and hormonal stimulation with gonadotropins, selective estrogen receptor modulators, and aromatase inhibitors are recently developed therapeutic approaches for men with the most severe form of testicular failure, nonobstructive azoospermia. However, high-quality clinical trials data is currently lacking.

CONCLUSIONS

Male infertility due to testicular failure has traditionally been viewed as unmodifiable. In the absence of effective pharmacological therapies, delivery of lifestyle advice is a potentially important treatment option. Future research efforts are needed to determine unidentified factors causative in "idiopathic" male infertility and long-term follow-up studies of babies conceived through ART.

Prevalence of Chlamydia trachomatis and Listeria monocytogenes in Infertile Men and the Effect on Semen Parameters

Background: Infertility is one of the serious problems in gynecology and one of the most important issues of concern in couples. Meanwhile, a significant rise in infertility is recently reported in Iran due to the infections and harsh environmental conditions. Objectives: The current study aimed to detect Chlamydia trachomatis and Listeria monocytogenes in males with infertility using PCR, and to evaluate bacteriospermia effects of the studied bacteria on semen parameters. Methods: Semen specimens of 100 infertile men were collected. Then, each specimen was divided into two parts: the first part was tested by semen analysis according to the WHO guidelines and the second was tested using the PCR method. The PCR intended to identify C. trachomatis and L. monocytogenes. Results: Out of 100 semen samples, 20% were positive for C. trachomatis, 3% were positive for L. monocytogenes, and 3% were positive for both bacteria (co-infection). The leukocyte count was higher than the normal range (0 - 1 Mil/mL) in all semen specimens. The prevalence of C. trachomatis in azoospermic patients was significantly higher than that of nonazoospermic (P < 0.05). However, there was no significant difference between the two groups in terms of the detection of L. monocytogenes (P > 0.05). Detection of C. trachomatis and L. monocytogenes had no significant association with abnormal semen parameters in asymptomatic patients (P > 0.05). Conclusions: The results indicated that precise analysis of semen parameters and diagnosis of leukocytospermia in patients using the PCR can be considered as a rapid and accurate technique to detect bacteria such as C. trachomatis and L. monocytogenes in semen specimens. Therefore, the utilization of this technique in the screening programs for asymptomatic infertile couples can be helpful for early treatment.

Proteome array of antibody responses to Chlamydia trachomatis infection in nonhuman primates

AIMS

Nonhuman primates have been used to investigate pathogenic mechanisms and evaluate immune responses following Chlamydia trachomatis inoculation. This study aimed to systemically profile antibody responses to C. trachomatis infection in nonhuman primates.

MATERIALS AND METHODS

Sera were obtained from 4 pig-tailed and 8 long-tailed macaques which were intravaginally or ocularly infected with live C. trachomatis organisms, and analyzed by C. trachomatis proteome array of antigens.

KEY FINDINGS

The sera from 12 macaques recognized total 172 C. trachomatis antigens. While 84 antigens were recognized by pig-tailed macaques intravaginally infected with serovar D strain, 125 antigens were recognized by long-tailed macaques ocularly infected with serovar A, and 37 antigens were recognized by both. Ocular inoculation with virulent A2497 strain induced antibodies to more antigens. Among the antigens uniquely recognized by A2497 strain infected macaques, outer membrane complex B antigen (OmcB) induced robust antibody response. Although macaques infected by less virulent A/HAR-13 strain failed to develop antibodies to OmcB, reinfection by A2497 strain induced high levels of antibodies to OmcB.

SIGNIFICANCE

Proteome array has revealed a correlation of chlamydial infection invasiveness with chlamydial antigen immunogenicity, and identified antibody responses to OmcB potentially as biomarkers for invasive infection with C. trachomatis.

Next-generation-sequencing technology used for the detection of Mycoplasma hominis in renal cyst fluid: a case report

Background:Mycoplasma is an opportunistic pathogen causing both urogenital and extragenital infections. The lack of cell wall renders Mycoplasma difficult to culture and identify with ordinary methods. Next-generation sequencing (NGS) is a new technology helping a lot in the diagnosis of infective diseases. In this case, NGS played a key role in the diagnosis of Mycoplasma infection.

Case presentation: A mid-aged man suffering from renal cyst underwent cyst incision followed by invasive treatments to eliminate hematoma caused by renal artery hemorrhage. After the cyst incision operation, the patient had a persistent high temperature. The persistent increase of blood neutrophile granulocyte count and C-reaction protein suggested an unresolved infection. The empirically chosen anti-infective agents were meropenem and linezolid since the ordinary bacterial cultures of surgical site drainage and blood yielded a negative result. At postoperation day (POD) 17, NGS result of his drainage clearly indicated the pathogen was Mycoplasma hominis. At POD 24, the drug sensitivity test showed resistance to quinolones, clarithromycin and erythromycin, but intermediate to azithromycin. Since then, the antimicrobial agents were changed into azithromycin and kept unchanged until the patient was fully recovered and discharged at POD 39.

Conclusion: When the ordinary laboratory diagnostic methods failed, NGS diagnosis could reduce the hospitalization expenses and shorten the lengths of hospital stay.