Neonatal central nervous system infection due to Mycoplasma hominis

Mycoplasma hominis Meningitis Diagnosed by Metagenomic Next-Generation Sequencing in a Preterm Newborn: a Case Report and Literature Review

Mycoplasma hominis is mainly colonized in the genital tract and vertically transmitted to newborns; however, it rarely causes neonatal meningitis. We report a case of M. hominis meningitis in a premature infant. She was admitted to our hospital for treatment after 6 days of repeated fever. After admission, repeated cerebrospinal fluid (CSF) analysis showed that leukocytes and protein in CSF increased substantially and glucose decreased, but there was no growth in conventional CSF culture. The patient was diagnosed with M. hominis meningitis by metagenomic next-generation sequencing (mNGS). The antibiotic therapy used for the neonate was meropenem, vancomycin, and ampicillin against bacterial infection and azithromycin against mycoplasma infection. The child was subsequently considered cured and discharged from the hospital and followed up regularly in the neurology clinic. The mNGS may be a promising and effective diagnostic technique for identifying uncommon pathogens of meningitis in patients with meningitis symptoms and signs without microbial growth in routine CSF culture.

An infant case with hydrocephalus as the initial manifestation of Mycoplasma hominis-associated meningitis

We report an infant with hydrocephalus as the initial manifestation of Mycoplasma hominis-associated meningitis, who recovered without appropriate antimicrobial treatment. The analysis of the 16S rRNA gene by polymerase chain reaction amplification using universal primers and pathogen-specific primers was useful for the diagnosis and the investigation of serial detection status of the pathogen. This method may be helpful for the assessment of the frequency and the prediction of severity in M. hominis-associated central nervous system infection in infants, and investigating the association between M. hominis and the development of hydrocephalus.

Neonatal CNS infection and inflammation caused by Ureaplasma species: rare or relevant?

Colonization with Ureaplasma species has been associated with adverse pregnancy outcome, and perinatal transmission has been implicated in the development of bronchopulmonary dysplasia in preterm neonates. Little is known about Ureaplasma-mediated infection and inflammation of the CNS in neonates. Controversy remains concerning its incidence and implication in the pathogenesis of neonatal brain injury. In vivo and in vitro data are limited. Despite improving care options for extremely immature preterm infants, relevant complications remain. Systematic knowledge of ureaplasmal infection may be of great benefit. This review aims to summarize pathogenic mechanisms, clinical data and diagnostic pitfalls. Studies in preterm and term neonates are critically discussed with regard to their limitations. Clinical questions concerning therapy or prophylaxis are posed. We conclude that ureaplasmas may be true pathogens, especially in preterm neonates, and may cause CNS inflammation in a complex interplay of host susceptibility, serovar pathogenicity and gestational age-dependent CNS vulnerability.

[Genital mycoplasmas]

The mycoplasmas frequently isolated in genital tract, and potentially pathogenic, are M. hominis, U. urealyticum and M. genitalium. M. hominis and U. urealyticum are very frequent in the vaginal tract and they can be, according to circumstances, either commensal or pathogenic. M. hominis and/or U. urealyticum, have been considered as responsible for many types of genital infectious diseases (such as cervicitis, pelvis inflammatory disease), for infertility, obstetrical pathologies (premature delivery, premature rupture of membranes, chorio-amniotitis) and neonatal infections. Yet, most of the time, their actual responsibility has not been conclusively proven. Published data lack indisputable conclusions and in many fields, doubts still exist whether these mycoplasmas are pathogens or mere co-factors associated with genital infections. On the other hand, M. genitalium has been much less studied but it seems to be an unquestionable pathogen of genital tract; new studies will be necessary so that one has a better understanding of the pathologies it can induce.

Seeding of a cavernous angioma with Mycoplasma hominis: case report

OBJECTIVE AND IMPORTANCE

To describe a unique case of hematogenous seeding of a cavernous angioma with the commensal organism Mycoplasma hominis.

CLINICAL PRESENTATION

A 40-year-old female patient presented with a severe headache and acute left facial nerve palsy. Imaging studies revealed a right frontal mass lesion with characteristics of a cavernous angioma.

INTERVENTION

The patient underwent a craniotomy for cavernous angioma resection. Purulent material was noted at the time of resection, and no hemorrhage was observed. Despite antibiotic therapy, the patient required repeat craniotomies for subsequent abscess treatment. M. hominis was identified as the pathogen.

CONCLUSION

M. hominis is a rare cause of brain abscesses and can be difficult to eradicate. Cavernous angiomas can be seeded hematogenously.

A case of Mycoplasma hominis meningo-encephalitis in a full-term infant: rapid recovery after start of treatment with ciprofloxacin

The role of Mycoplasma hominisas a causative agent for neonatal sepsis and meningitis is still unclear. Meningitis secondary to M. hominisis well-described in the literature; however, M. hominiscan also be isolated from cerebrospinal fluid (CSF) obtained from infants without signs of meningitis. We present a case of a full-term infant with meningo-encephalitis with seizures, epileptic activity on the EEG, inflammation of brain tissue on a CT scan, and cloudy CSF containing elevated cell counts, decreased glucose levels and elevated protein levels. M. hominiswas identified from the CSF by culture and by polymerase chain reaction (PCR) as the only possible causative agent. Furthermore, while empiric antibiotic and antiviral treatment for neonatal sepsis had failed, the meningo-encephalitis promptly responded upon antibiotic treatment with ciprofloxacin (20 mg/kg per day i.v.), to which M. hominisis susceptible.

CONCLUSION

A meningo-encephalitis developed due to infection with M. hominisin a full-term infant, from which he recovered rapidly after start of treatment with ciprofloxacin.

Perinatal infections and brain injury: current treatment options

Antimicrobial therapy can ameliorate infection and prevent long-term morbidity caused by several pathogens that infect the fetus and neonate. Ultimately, however, preventive strategies need to be developed and incorporated into routine preconceptional care. The future of prevention lies in immunizations, and if past and current successes with smallpox, polio, rubella, and measles vaccination programs are any indication, the future is bright for the developing fetus.

A fatal case of Mycoplasma hominis meningoencephalitis in a full-term newborn

We report the case of a 20-day-old full-term baby, born to a mother who had had an uncomplicated pregnancy and delivery, who died 13 days after the onset of meningitis. Mycoplasma hominis was the sole agent repeatedly recovered from cerebrospinal fluid and from postmortem brain tissue.

[Prospective study of neonatal genital mycoplasma colonization and infection]

Genital mycoplasmas have been implicated in different neonatal diseases as pneumonia, sepsis and meningitis. This prospective study was conducted to specify their role in these diseases. POPULATION AND METHODS--A pharyngeal or tracheal swab specimen for mycoplasmas culture was obtained from 100 infants admitted consecutively to the Neonatal Care Unit (NCU) during the first 24 hours of life. Mycoplasma culture of blood and cerebrospinal fluid was also performed. Pharyngeal and/or tracheal specimens were collected again on days 5, 15 and 28 if the child was still in the NCU. Mycoplasma hominis (Mh) and Ureaplasma urealyticum (Uu) were identified by culture in a modified Hayflick's medium. RESULTS--Three-hundred and ten pharyngeal or tracheal swabs were obtained (100 on day 0, 89 on day 5, 72 on day 15 and 49 on day 28). Twenty-one infants had one or more positive swabs in the first five days of life (20 on day 0 and one on day 5); those forming the "Myco+" group and the others forming the "Myco-" group. Uu was isolated alone from 20 infants, associated with Mh from one. Both groups were similar for gestational age, birth weight, maternal fever during labor, prolonged rupture of the fetal membranes or chorioamnionitis and for the incidence of acute respiratory distress. There was a statistically significant difference for the route of delivery (chi 2 < 0.02). One blood culture (from 92 performed) was positive for Uu and another positive for Uu and Mh. Both children were cured without any specific mycoplasmacidal therapy. Three children had probable Uu infection and were also cured without specific therapy. CONCLUSIONS--A pharyngeal colonization with genital mycoplasmas is common in the first days of life (21%) but our data do not allow us to conclude that they are accountable for newborn infections.

Frequency and significance of isolation of Ureaplasma urealyticum and Mycoplasma hominis from cerebrospinal fluid and tracheal aspirate specimens from low birth weight infants

To investigate the pathogenicity of Ureaplasma urealyticum and Mycoplasma hominis in preterm infants, we conducted a study to determine (1) frequency of isolation from cerebrospinal fluid and tracheal aspirate specimens and (2) clinical outcomes and effect of erythromycin treatment in ureaplasma-colonized infants. From the cerebrospinal fluid of 920 infants, U. urealyticum was isolated from 2 (0.2%) and M. hominis from none. From tracheal aspirate specimens from 224 infants, U. urealyticum was recovered from 37 (17%) and M. hominis from 4 (2%). Demographic characteristics and clinical outcomes were compared in very low birth weight infants (< 1500 gm) who were culture-positive or -negative for U. urealyticum. Although infants with positive results were less mature than their cohorts with negative results, there were no substantive differences in clinical outcomes between the two groups. Initiation of erythromycin treatment of infants with positive ureaplasma culture results at a mean age of 16.4 days did not appear to alter the clinical outcome. We conclude that in preterm infants (1) infection of the cerebrospinal fluid by U. urealyticum is infrequent, (2) ureaplasma organisms are frequently present in tracheal aspirate specimens but do not appear to be related to the presence or the subsequent development of respiratory disease, and (3) initiation of erythromycin treatment at 1 to 3 weeks of age does not alter the clinical course.

Mycoplasma hominis sternal wound infection and bacteraemia

Mycoplasma hominis is a rare cause of bacteraemia in adult males. We believe this report to be the first of Mycoplasma hominis bacteraemia and wound infection complicating cardiac surgery. Because of difficulties in isolating the organism, cases may be missed. Review of the literature on M. hominis bacteraemia in adult males reveals that infection is often mild and most often associated with urethral catheterisation. M. hominis is resistant to many antibiotics including erythromycin. If treatment is indicated, tetracycline or clindamycin is the drug of choice.

Mycoplasma hominis in maternal and fetal infections

Although prevalence of M. hominis colonization during pregnancy varies from 12-50%, its role in infections of the mother and newborn infants is unclear. Definite correlations exist with chorioamnionitis and amniotic fluid infections, but as it is rarely isolated alone during these infections, its pathogenic role is uncertain. Its association with septic abortion is similarly questioned. Prevalence and antibody titers to M. hominis increase with increasing parity. Transient bacteremia occurs in approximately 2.5% of normal deliveries. M. hominis does have a significant role in postpartum fever. Women harboring the organism during labor with low predelivery antibody titers are at risk. Approximately 30% of exposed infants are colonized (4% of all infants) but there are only a few reports of neonatal meningitis, pneumonia, or skin abscesses due to M. hominis. Most recover without specific therapy. The role of antimicrobial therapy of M. hominis in pregnancy and the neonatal period is unclear. Further studies of these issues should simultaneously consider all potential genital tract pathogens.

Postcesarean wound infection by Mycoplasma hominis in a patient with persistent postpartum fever

Mycoplasma hominis was isolated in pure culture from a wound infection following delivery by cesarean section. The importance of recognizing this organism as a potential pathogen of the female genital tract is emphasized. Two commercially available isolation systems that allow the recovery of this organism are also described.

Role of genital mycoplasmas in young infants with suspected sepsis

To establish the prevalence of Mycoplasma hominis and Ureaplasma urealyticum in infants up to 3 months of age with suspected sepsis, blood, cerebrospinal fluid, and urine specimens from 203 patients with clinical signs and symptoms of sepsis were cultured for Mycoplasma in addition to routine bacterial cultures. Proved bacterial infections were identified in 24 patients, four of whom had bacteremia. M. hominis and U. urealyticum were not isolated from any of the 191 blood and 199 CSF specimens tested. Of 170 specimens of urine cultured for Mycoplasma, M. hominis was isolated in six patients, U. urealyticum in nine patients, and both organisms in one patient. Twelve of the positive cultures were voided urine specimens, and four were suprapubic bladder aspiration specimens. Genital mycoplasmas appear to be uncommon causes of sepsis or meningitis in young infants. Further studies are required to assess their role in abnormal conditions of the urinary tract in childhood.

Neonatal mycoplasmaemia: Mycoplasma hominis as a significant cause of disease?

A full-term baby boy had respiratory distress, fever and pneumonia within 20 h of birth. Isolation of Mycoplasma hominis from blood taken after 20 h and 11 days was accompanied by an antibody response. Although chlamydial IgM antibody was detected, chlamydial infection probably did not cause the pneumonia. Penicillin was ineffective but treatment with gentamicin, and particularly tetracycline, was associated with slow improvement. Mycoplasma hominis should be considered as a cause of respiratory disease and fever in neonates.

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.

A prospective study of chlamydial, mycoplasmal, and viral infections in a neonatal intensive care unit

In a prospective study of non-bacterial infection in a neonatal intensive care unit in north west London, Chlamydia trachomatis infection was identified in 4 of 280 babies (1.4%) and was the most common cause of neonatal ophthalmia. One of the four developed pneumonitis. Ureaplasma urealyticum was found to colonise the nasopharynx in 53 of 235 babies (22.6%), with Mycoplasma hominis present in 6 of 235 babies (2.6%). There was a statistically significant association between U urealyticum colonisation and preterm birth or prolonged rupture of membranes. Colonisation occurred more commonly in babies with apnoea. Viral infection was detected in 16 of 280 babies (5.7%). Rotavirus was identified in 5 of 170 babies (2.9%) and was associated with necrotising enterocolitis in two infants and with bloody diarrhoea in another. Respiratory syncytial virus, which was identified in 4 of 280 babies (1.4%), was not associated with lower respiratory tract infection.

Septicemia due to Mycoplasma hominis

Mycoplasma hominis was recovered from the blood of 7 patients with various underlying disorders. One patient had a legal abortion, another a Caesarian section, both followed by septicemia. Three patients had genital infections in pregnancy, followed by septicemia and spontaneous abortion. M. hominis was also recovered from cervix and urethra in 2 of these women. High serum antibody levels against M. hominis were demonstrated in 3 women. One female developed septicemia after cancer surgery, one male after heart surgery. In the first 6 patients described the septicemia was of short duration and self-limiting, in the 7th patient it was of long duration and appropriate antimicrobial treatment was required. From this patient M. hominis was also isolated from infected operation wounds.

Comparative evaluation of media for isolation of ureaplasma urealyticum and genital mycoplasma species

Two media systems were compared for isolation of Ureaplasma urealyticum and genital Mycoplasma sp. System 1 (S-1) consisted of arginine agar and an arginine biphasic medium for isolation of Mycoplasma sp. and urea agar and urea broth for isolation of U. urealyticum. System 2 (S-2) utilized Boston broth, which is a urea-containing broth, and A7 agar, both of which support the growth of both species. Urine samples, some freshly collected and some known-positive frozen samples, were used as inocula for the two media systems. With S-1, U. urealyticum was recovered in 68% of U. urealyticum-positive cultures: 58% were detected in urea broth, and 60% were identified on urea agar. When the S-2 system was used for culture of the same samples. U. urealyticum was recovered in 98% of the cultures, with 94% detected in Boston broth and 92% identified on A7 agar. Mycoplasma sp. was recovered in S-1 and S-2 in 97 and 100% of Mycoplasma sp.-positive cultures, respectively. The S-1 arginine broth gave positive results for 89% of the cultures, and the arginine agar was positive for 97% of the cultures. The S-2 Boston broth and A7 agar gave positive results for 92 and 97% of the cultures, respectively. For the isolation of U. urealyticum, colony counts were higher, growth was seen sooner, and colonies were larger when the S-2 media system was used. Overall, the cost per test of the S-2 system was less both in technologist time and in reagent costs.

Infection of a brain abscess of Mycoplasma hominis

Persistent fever in a young man after evacuation of a subdural hematoma caused by a depressed skull fracture made it necessary to carry out a computerized tomographic exam of the head that demonstrated a left frontal lobe brain abscess. Mycoplasma hominis was recovered from this abscess as the sole infecting organism. Serial computerized tomographic scans showed resolution after aspiration and antibiotic therapy.

Meningitis in a newborn infant caused by Mycoplasma hominis

When 10 days old an infant born after 34-35 weeks of gestation developed meningitis with pleocytosis and a low glucose concentration in the cerebrospinal fluid. Mycoplasma hominis was recovered from the cerebrospinal fluid and treatment with doxycycline was given. The strain was later found to be resistant to tetracycline. After institution of lincomycin, cultures for mycoplasmas were negative. The infant, who during the course of the meningitis had developed a transient increase in intracranial pressure, was healthy and normally developed at the age of one year.--This is the first report on an infection caused by a tetracycline-resistant strain of Mycoplasma hominis.

Mycoplasma hominis. A cause of neonatal meningitis

Two cases of Mycoplasma hominis meningitis in the newborn are described. These infants demonstrate the need to consider M. hominis as a cause of neonatal meningitis, especially if the Gram stain is negative, conventional cultures yield no growth, and there is a history of maternal infection. CSF cultures on appropriate medium can quickly confirm the diagnosis.