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Tam PCK, Alexander BD, Lee MJ, Hardie RG, Reynolds JM, Haney JC, Waites KB, Perfect JR, Baker AW. Donor-derived Mycoplasma and Ureaplasma infections in lung transplant recipients: A prospective study of donor and recipient respiratory tract screening and recipient outcomes. Am J Transplant 2024:S1600-6135(24)00436-2. [PMID: 39025302 DOI: 10.1016/j.ajt.2024.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 07/11/2024] [Accepted: 07/13/2024] [Indexed: 07/20/2024]
Abstract
Mycoplasma hominis and Ureaplasma species are urogenital mollicutes that can cause serious donor-derived infections in lung transplant recipients. Best practices for mollicute screening remain unknown. We conducted a single-center prospective study analyzing lung transplants performed from October 5, 2020, to September 25, 2021, whereby donor and recipient bronchoalveolar lavage (BAL) samples obtained at time of transplant underwent mollicute screening via culture and polymerase chain reaction (PCR). Of 115 total lung transplants performed, 99 (86%) donors underwent combined mollicute BAL culture and PCR testing. The study cohort included these 99 donors and their matched recipients. In total, 18 (18%) of 99 donors screened positive via culture or PCR. Among recipients, 92 (93%) of 99 had perioperative BAL screening performed, and only 3 (3%) had positive results. After transplant, 9 (9%) recipients developed mollicute infection. Sensitivity of donor screening in predicting recipient mollicute infection was 67% (6/9) via culture and 56% (5/9) via PCR. Positive predictive value for donor culture was 75% (6/8), compared with 33% (5/15) for PCR. Donor screening via culture predicted all serious recipient mollicute infections and had better positive predictive value than PCR; however, neither screening test predicted all mollicute infections. Independent of screening results, clinicians should remain suspicious for posttransplant mollicute infection.
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Affiliation(s)
- Patrick C K Tam
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA; College of Medicine and Public Health, Flinders University, Adelaide, Australia.
| | - Barbara D Alexander
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA; Duke University Clinical Microbiology Laboratory, Durham, North Carolina, USA
| | - Mark J Lee
- Duke University Clinical Microbiology Laboratory, Durham, North Carolina, USA
| | - Rochelle G Hardie
- Division of Infectious Diseases, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - John M Reynolds
- Department of Medicine, Transplant Pulmonology, Duke University School of Medicine, Durham, North Carolina, USA
| | - John C Haney
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ken B Waites
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - John R Perfect
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Arthur W Baker
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA; Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA.
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2
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Tam PCK, Hardie R, Alexander BD, Yarrington ME, Lee MJ, Polage CR, Messina JA, Maziarz EK, Saullo JL, Miller R, Wolfe CR, Arif S, Reynolds JM, Haney JC, Perfect JR, Baker AW. Risk factors, management, and clinical outcomes of invasive Mycoplasma and Ureaplasma infections after lung transplantation. Am J Transplant 2024; 24:641-652. [PMID: 37657654 PMCID: PMC10902193 DOI: 10.1016/j.ajt.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/08/2023] [Accepted: 08/24/2023] [Indexed: 09/03/2023]
Abstract
Mollicute infections, caused by Mycoplasma and Ureaplasma species, are serious complications after lung transplantation; however, understanding of the epidemiology and outcomes of these infections remains limited. We conducted a single-center retrospective study of 1156 consecutive lung transplants performed from 2010-2019. We used log-binomial regression to identify risk factors for infection and analyzed clinical management and outcomes. In total, 27 (2.3%) recipients developed mollicute infection. Donor characteristics independently associated with recipient infection were age ≤40 years (prevalence rate ratio [PRR] 2.6, 95% CI 1.0-6.9), White race (PRR 3.1, 95% CI 1.1-8.8), and purulent secretions on donor bronchoscopy (PRR 2.3, 95% CI 1.1-5.0). Median time to diagnosis was 16 days posttransplant (IQR: 11-26 days). Mollicute-infected recipients were significantly more likely to require prolonged ventilatory support (66.7% vs 21.4%), undergo dialysis (44.4% vs 6.3%), and remain hospitalized ≥30 days (70.4% vs 27.4%) after transplant. One-year posttransplant mortality in mollicute-infected recipients was 12/27 (44%), compared to 148/1129 (13%) in those without infection (P <.0001). Hyperammonemia syndrome occurred in 5/27 (19%) mollicute-infected recipients, of whom 3 (60%) died within 10 weeks posttransplant. This study highlights the morbidity and mortality associated with mollicute infection after lung transplantation and the need for better screening and management protocols.
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Affiliation(s)
- Patrick C K Tam
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA.
| | - Rochelle Hardie
- Division of Infectious Diseases, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Barbara D Alexander
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA; Duke University Clinical Microbiology Laboratory, Durham, North Carolina, USA
| | - Michael E Yarrington
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA; Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA
| | - Mark J Lee
- Duke University Clinical Microbiology Laboratory, Durham, North Carolina, USA
| | - Chris R Polage
- Duke University Clinical Microbiology Laboratory, Durham, North Carolina, USA
| | - Julia A Messina
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Eileen K Maziarz
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jennifer L Saullo
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rachel Miller
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Cameron R Wolfe
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sana Arif
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - John M Reynolds
- Department of Medicine, Transplant Pulmonology, Duke University School of Medicine, Durham, North Carolina, USA
| | - John C Haney
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - John R Perfect
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Arthur W Baker
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA; Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA.
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Kurihara C, Kaiho T, Bharat A. Prevention of Mollicute transmitted infections from donor lungs after lung transplant. Am J Transplant 2024; 24:699-700. [PMID: 37931752 DOI: 10.1016/j.ajt.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 11/08/2023]
Affiliation(s)
- Chitaru Kurihara
- Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - Taisuke Kaiho
- Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ankit Bharat
- Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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4
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Walti LN, Del Sorbo L, Husain S. Hyperammonemia syndrome in lung transplant recipients: A survey on current clinical practice. J Heart Lung Transplant 2024; 43:357-358. [PMID: 37952586 DOI: 10.1016/j.healun.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 11/01/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023] Open
Affiliation(s)
- Laura N Walti
- Division of Infectious Diseases, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada; Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lorenzo Del Sorbo
- Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Shahid Husain
- Division of Infectious Diseases, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada.
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Farfour E, Vasse M, Vallée A. Mollicutes-related infections in thoracic surgery including lung and heart transplantation: A systematic review. J Heart Lung Transplant 2024; 43:169-180. [PMID: 37797819 DOI: 10.1016/j.healun.2023.09.023] [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] [Received: 07/20/2023] [Revised: 09/23/2023] [Accepted: 09/28/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Urogenital Mollicutes, that is, Mycoplasma hominis and Ureaplasma spp., can colonize the urogenital tract. While urogenital colonization is frequent, infections are rare but should not be missed. Furthermore, extragenital infections are even rarer. Over the past years, they have been increasingly documented as a cause of hyperammonemia syndrome (HS) and post-surgical infections. We review the literature on studies focused on post-surgical infections and HS involving urogenital Mollicutes after thoracic surgery including lung (LTR) and heart (HTR) transplantation. METHODS A systematic review was performed by searching PubMed/Medline case reports, case series, cohort studies, and clinical trials. Cases of infections and HS by urogenital Mollicutes after HTR and LTR transplantations were reported. RESULTS Overall, urogenital Mollicutes were associated with 15 HS, 31 infections in HTR and LTR, and 18 post-thoracic surgical infections in another context. Post-surgical infections were reported in all contexts. They were mainly due to M hominis, the only species that could cultivate on standard enriched agar forming pinpoint colonies after 3-5 days of incubation. Microbiologists should be prompted to pinpoint colonies even if the examination of Gram-staining is negative. The patients' management required surgical treatment and antimicrobials, almost always tetracyclines and/or fluoroquinolones. Conversely, HS occurred almost exclusively in bilateral LTR and is more likely due to Ureaplasma spp. As Ureaplasma spp. do not cultivate on standard media, the microbiological diagnosis was performed using molecular methods. CONCLUSIONS Infections involving urogenital Mollicute should be considered in LTR with HS. The overall rate of mortality is high and might be due in part to delay in etiologic diagnosis. Post-surgical infections were reported in all contexts. The route of contamination with Mollicutes remains unknown in HTR and non-transplant surgery, but evidence of transmission from donors has been documented for LTR.
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Affiliation(s)
- Eric Farfour
- Service de Biologie Clinique, Hôpital Foch, Suresnes, France.
| | - Marc Vasse
- Service de Biologie Clinique, Hôpital Foch, Suresnes, France; Université Paris-Saclay, INSERM Hémostase Inflammation Thrombose HITH U1176, Le Kremlin-Bicêtre, France
| | - Alexandre Vallée
- Département d'Epidémiologie et de Santé Publique, Hôpital Foch, Suresnes, France
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Yun S, Scalia C, Farghaly S. Treatment of Hyperammonemia Syndrome in Lung Transplant Recipients. J Clin Med 2023; 12:6975. [PMID: 38002590 PMCID: PMC10672283 DOI: 10.3390/jcm12226975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023] Open
Abstract
Hyperammonemia syndrome is a complication that has been reported to occur in 1-4% of lung transplant patients with mortality rates as high as 60-80%, making detection and management crucial components of post-transplant care. Patients are treated with a multimodal strategy that may include renal replacement therapy, bowel decontamination, supplementation of urea cycle intermediates, nitrogen scavengers, antibiotics against Mollicutes, protein restriction, and restriction of parenteral nutrition. In this review we provide a framework of pharmacologic mechanisms, medication doses, adverse effects, and available evidence for commonly used treatments to consider when initiating therapy. In the absence of evidence for individual strategies and conclusive knowledge of the causes of hyperammonemia syndrome, clinicians should continue to design multimodal regimens based on suspected etiologies, institutional drug availability, patient ability to tolerate enteral medications and nutrition, and availability of intravenous access.
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Affiliation(s)
- Sarah Yun
- The Mount Sinai Hospital, New York, NY 10029, USA;
| | - Ciana Scalia
- The Mount Sinai Hospital, New York, NY 10029, USA;
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Osborn R, Alamri M, Tomic R, Ison MG. Infectious Complications of Lung Transplant for Coronavirus Disease 2019-Associated Lung Injury: A Single-Center Case-Control Cohort Study. Clin Infect Dis 2023; 77:220-228. [PMID: 36942560 PMCID: PMC10517091 DOI: 10.1093/cid/ciad160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/12/2023] [Accepted: 03/15/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Lung transplantation is one of the only options for patients with severe coronavirus disease 2019 (COVID-19)-associated lung injury (CALI). Studies on patients who received a lung transplant for CALI have, to date, not looked at the infectious outcomes. METHODS After institutional review board approval, a retrospective case-control cohort study, matched 1:1, collected data on patients who underwent lung transplantation for CALI (case) and for non-COVID-19 end-stage lung disease (control) between 1 June 2020 and 1 April 2022 at a large academic hospital in Chicago. We assessed infectious complications and other key outcomes pre-transplant and for 1 year post-transplant. RESULTS Among 78 patients (39 CALI and 39 matched control lung transplant patients), those in the CALI cohort were less likely to be vaccinated pre-transplant and were more likely to have diabetes, to be obese, to not be ambulatory, and to require pre-transplant extracorporeal membrane oxygenation and mechanical ventilation. Patients transplanted for CALI had higher rates of infection pre-transplant (66.7% vs 15.4% of patients in the control) and in the first 30 days post-transplant (43.6% vs 20.5%). Numbers and types of infection were similar in both groups at other time points. One-year mortality was similar for CALI and control groups (12.8% vs 10.3%, respectively). CONCLUSIONS Patients who received a lung transplant for CALI are more deconditioned with prolonged hospital stays and experience more infectious complications immediately pre- and post-transplant. Infections due to multidrug-resistant organisms are important contributors to morbidity and mortality in this population. Antimicrobial stewardship is urgently needed.
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Affiliation(s)
- Rebecca Osborn
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Maha Alamri
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rade Tomic
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael G Ison
- Respiratory Diseases Branch, Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, Rockville, Maryland, USA
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8
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La Hoz RM. Minimizing the Risk of Donor-Derived Events and Maximizing Organ Utilization Through Education and Policy Development. Infect Dis Clin North Am 2023:S0891-5520(23)00044-2. [PMID: 37302913 DOI: 10.1016/j.idc.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Herein, we review the current knowledge of donor-derived disease and current US Organ Procurement and Transplantation Network policies to minimize the risk. During the process, we also consider actions to further mitigate the risk of donor-derived disease. The overarching goal is to provide an infectious disease perspective on the complex decision of organ acceptance for transplant programs and candidates.
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Affiliation(s)
- Ricardo M La Hoz
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9913, USA.
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9
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Wigston C, Lavender M, Long R, Sankhesara D, Ching D, Weaire-Buchanan G, Mowlaboccus S, Coombs GW, Lam K, Wrobel J, Yaw MC, Musk M, Boan P. Mycoplasma and Ureaplasma Donor-Derived Infection and Hyperammonemia Syndrome in 4 Solid Organ Transplant Recipients From a Single Donor. Open Forum Infect Dis 2023; 10:ofad263. [PMID: 37323424 PMCID: PMC10264062 DOI: 10.1093/ofid/ofad263] [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: 03/11/2023] [Accepted: 05/17/2023] [Indexed: 06/17/2023] Open
Abstract
Hyperammonemia syndrome (HS) is a life-threatening condition occurring in solid organ transplant patients, affecting primarily lung recipients, and is associated with Mycoplasma hominis and/or Ureaplasma spp infection. The organ donor was a young man who died of hypoxic brain injury and had urethral discharge antemortem. The donor and 4 solid organ transplant recipients had infection with M hominis and/or Ureaplasma spp. The lung and heart recipients both developed altered conscious state and HS associated with M hominis and Ureaplasma spp infections. Despite treatment with antibiotics and ammonia scavengers, both the lung and heart recipients died at day +102 and day +254, respectively. After diagnosis in the thoracic recipients, screening samples from the liver recipient and 1 kidney recipient were culture positive for M hominis with or without Ureaplasma spp. Neither the liver nor kidney recipients developed HS. Our case series demonstrates the unique finding of M hominis and Ureaplasma spp dissemination from an immunocompetent donor across 4 different organ recipients. Phylogenetic whole genome sequencing analysis demonstrated that M hominis samples from recipients and donor were closely related, suggesting donor-derived infection. Screening of lung donors and/or recipients for Mycoplasma and Ureaplasma spp is recommended, as well as prompt treatment with antimicrobials to prevent morbidity.
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Affiliation(s)
- Charlotte Wigston
- Correspondence: Charlotte Wigston, MBBCh, PGCertHPE, MRCP, Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, Perth, WA 6150, Australia (); Peter Boan, MBBS, FRACP, FRCPA, Department of Microbiology, PathWest Laboratory Medicine Western Australia, Fiona Stanley Hospital, Murdoch, Perth, WA 6150, Australia ()
| | - Melanie Lavender
- Advanced Lung Disease Unit, Fiona Stanley Hospital,Murdoch, Western Australia, Australia
| | - Rebecca Long
- Advanced Lung Disease Unit, Fiona Stanley Hospital,Murdoch, Western Australia, Australia
| | - Dipen Sankhesara
- Advanced Heart Failure Unit, Fiona Stanley Hospital,Murdoch, Western Australia, Australia
| | - David Ching
- Advanced Lung Disease Unit, Fiona Stanley Hospital,Murdoch, Western Australia, Australia
| | - Graham Weaire-Buchanan
- Department of Microbiology, PathWest Laboratory Medicine Western Australia, Fiona Stanley Hospital,Murdoch, Western Australia, Australia
| | - Shakeel Mowlaboccus
- Department of Microbiology, PathWest Laboratory Medicine Western Australia, Fiona Stanley Hospital,Murdoch, Western Australia, Australia
- College of Science, Health, Engineering and Education, Murdoch University, Perth, Western Australia, Australia
| | - Geoffrey W Coombs
- Department of Microbiology, PathWest Laboratory Medicine Western Australia, Fiona Stanley Hospital,Murdoch, Western Australia, Australia
- College of Science, Health, Engineering and Education, Murdoch University, Perth, Western Australia, Australia
| | - Kaitlyn Lam
- Advanced Heart Failure Unit, Fiona Stanley Hospital,Murdoch, Western Australia, Australia
| | - Jeremy Wrobel
- Advanced Lung Disease Unit, Fiona Stanley Hospital,Murdoch, Western Australia, Australia
- Department of Medicine, University of Notre Dame, Perth, Western Australia, Australia
| | - Meow Cheong Yaw
- Advanced Lung Disease Unit, Fiona Stanley Hospital,Murdoch, Western Australia, Australia
| | - Michael Musk
- Advanced Lung Disease Unit, Fiona Stanley Hospital,Murdoch, Western Australia, Australia
| | - Peter Boan
- Correspondence: Charlotte Wigston, MBBCh, PGCertHPE, MRCP, Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, Perth, WA 6150, Australia (); Peter Boan, MBBS, FRACP, FRCPA, Department of Microbiology, PathWest Laboratory Medicine Western Australia, Fiona Stanley Hospital, Murdoch, Perth, WA 6150, Australia ()
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Ranganath N, Issa NS, Rosenbaum AN, Beam E, Mahmood M. Use of Novel Diagnostic Approaches to Identify Disseminated Ureaplasma urealyticum Infection Causing Hyperammonemia Syndrome After Heart-Kidney Transplant. Mayo Clin Proc 2023; 98:804-806. [PMID: 37137649 DOI: 10.1016/j.mayocp.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 05/05/2023]
Affiliation(s)
- Nischal Ranganath
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, MN
| | - Naim S Issa
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Andrew N Rosenbaum
- Division of Circulatory Failure, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Elena Beam
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, MN
| | - Maryam Mahmood
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, MN
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Tadera K, Kitagawa H, Kitano H, Hara T, Kashiyama S, Nomura T, Omori K, Shigemoto N, Yokozaki M, Ohge H. Prevalence of Mycoplasma hominis, Ureaplasma urealyticum, and Ureaplasma parvum detection in urine and respiratory tract samples in Hiroshima, Japan. Heliyon 2023; 9:e14543. [PMID: 36967949 PMCID: PMC10036642 DOI: 10.1016/j.heliyon.2023.e14543] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 03/16/2023] Open
Abstract
Background Mycoplasma hominis, Ureaplasma parvum, and Ureaplasma urealyticum are commensal bacteria that are associated with colonization and infection of the urogenital tract. However, colonization of the respiratory tract by these microorganisms in adults has not been fully investigated. Methods Urine and respiratory tract samples (sputum, tracheal aspirates, and bronchoalveolar lavage) of patients aged 20-80 years were analyzed to detect the presence of M. hominis, U. parvum, and U. urealyticum using a conventional PCR method. The samples were submitted to the microbiological clinical laboratory of Hiroshima University Hospital from December 1, 2021 to May 31, 2022. Results In total, 334 urine and 238 respiratory tract samples were analyzed. The overall detection rates of M. hominis, U. parvum, and U. urealyticum were 2.9%, 1.7%, and 2.3% in male urine; 7.0%, 13.8%, and 1.9% in female urine; 2.2%, 0%, and 2.2% in male respiratory tract; and 0%, 2.0%, and 0% in female respiratory tract, respectively. In urine samples, the detection rates of M. hominis, U. parvum, and U. urealyticum were significantly higher (p < 0.001) for women (29/159; 18.2%) than for men (10/175; 5.7%); however, in respiratory tract samples, the detection rates were not significantly different (p = 0.70) between women (2/101; 2.0%) and men (5/137; 3.7%). Further, both the urine and respiratory samples of 83 patients were analyzed. Three male samples were positive for M. hominis or U. urealyticum, and M. hominis and U. urealyticum were matched in both the urine and respiratory tract samples: M. hominis (n = 1), U. urealyticum (n = 1), M. hominis + U. urealyticum (n = 1). Conclusion M. hominis, U. parvum, and U. urealyticum were detected in the respiratory tract of not only the young patients, but also of patients aged 50-60 years. Further studies are required to understand the relationship of these microorganisms in urogenital and respiratory tract samples with extra-genital infections.
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12
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Tian M, Han D, Ma S, Liu T, Yang W, Zheng X. Fatal multiple organ dysfunction caused by commensal bacteria of urogenital tract infection in adult lung transplant recipients: two case reports. Virol J 2023; 20:24. [PMID: 36755309 PMCID: PMC9906855 DOI: 10.1186/s12985-022-01958-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/22/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Infection following lung transplantation has been the focus of clinical concerns. The colonization rate of commensal bacteria of the urogenital tract, including Mycoplasma hominis, Ureaplasma urealyticum (UU), and herpes simplex virus type-2 (HSV-2), is high, which may cause secondary infection after transplantation. CASE PRESENTATION Twenty-three-year-old and 67-year-old women underwent lung transplantation for different causes. Shortly after the operation, they developed perineal skin ulcers, hypoxia, and intractable epilepsy. Subsequent computed tomography (CT) of the chest showed lung consolidation, and cranial CT showed shallowing sulci and gyri. UU and HSV-2 were detected in bronchoalveolar lavage fluid by next-generation sequencing, and HSV-2 was shown in the cerebrospinal fluid of both patients. Despite active treatment, both suffered irreversible brain function damage within 72 h of the seizure. CONCLUSIONS Clinicians should know that commensal bacteria of urogenital tract infections can lead to fatal multiple organ dysfunction after lung transplantation.
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Affiliation(s)
- Manman Tian
- grid.13402.340000 0004 1759 700XDepartment of Critical Care Units, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003 China
| | - Dongsheng Han
- grid.13402.340000 0004 1759 700XDepartment of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province and Institute of Laboratory Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003 China
| | - Subo Ma
- grid.13402.340000 0004 1759 700XDepartment of Critical Care Units, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003 China
| | - Tingting Liu
- grid.13402.340000 0004 1759 700XDepartment of Critical Care Units, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003 China
| | - Wu Yang
- grid.13402.340000 0004 1759 700XDepartment of Critical Care Units, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003 China
| | - Xia Zheng
- Department of Critical Care Units, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China.
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13
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Boutin CA, Pouch SM, Ison MG. Utility of deceased donor cultures in solid organ transplantation in preventing donor-derived bacterial and fungal infectious diseases transmission. Transpl Infect Dis 2023; 25:e14032. [PMID: 36748658 DOI: 10.1111/tid.14032] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/23/2023] [Accepted: 01/26/2023] [Indexed: 02/08/2023]
Abstract
Deceased donor and organ perfusion fluid cultures are obtained in order to inform recipient antimicrobial management and therefore reduce the risk of donor-derived bacterial and fungal infections. However, important heterogeneity exists in laboratory practice across organ procurement organizations and clinical management of culture results across transplant centers. While not standardized, the clinical approach to donors with positive bacterial and/or fungal cultures should be informed by the risk of donor-derived infection (DDI) and the consequence of organ non-utilization and account for potential unintended effects of antimicrobial use in the recipient. In this review, we summarize the literature on bacterial and fungal DDIs, describe the significance of positive cultures by anatomic site, and summarize current guidance on the management of positive cultures from donors or preservation fluids.
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Affiliation(s)
- Catherine-Audrey Boutin
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Stephanie M Pouch
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael G Ison
- Respiratory Diseases Branch, Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
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Buzo BF, Preiksaitis JK, Halloran K, Nagendran J, Townsend DR, Zelyas N, Sligl WI. Hyperammonemia syndrome post-lung transplantation: Case series and systematic review of literature. Transpl Infect Dis 2022; 24:e13940. [PMID: 36039822 DOI: 10.1111/tid.13940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/10/2022] [Accepted: 08/02/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hyperammonemia syndrome (HS) is a rare post-transplant complication associated with high morbidity and mortality. Its incidence appears to be higher in lung transplant recipients and its pathophysiology is not well understood. In addition to underlying metabolic abnormalities, it is postulated that HS may be associated with Ureaplasma or Mycoplasma spp. lung infections. Management of this condition is not standardized and may include preemptive antimicrobials, renal replacement, nitrogen scavenging, and bowel decontamination therapies, as well as dietary modifications. METHODS In this case series, we describe seven HS cases, five of whom had metabolic deficiencies ruled out. In addition, a literature review was performed by searching PubMed following PRISMA-P guidelines. Articles containing the terms "hyperammonemia" and "lung" were reviewed from 1 January 1997 to 31 October 2021. RESULTS All HS cases described in our center had positive airway samples for Mycoplasmataceae, neurologic abnormalities and high ammonia levels post-transplant. Mortality in our group (57%) was similar to that published in previous cases. The literature review supported that HS is an early complication post-transplant, associated with Ureaplasma spp. and Mycoplasma hominis infections and of worse prognosis in patients presenting cerebral edema and seizures. CONCLUSION This review highlights the need for rapid testing for Ureaplasma spp. and M. hominis after lung transplant, as well as the necessity for future studies to explore potential therapies that may improve outcomes in these patients.
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Affiliation(s)
- Bruno Fernando Buzo
- Tranplant Infectious Diseases, Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Jutta K Preiksaitis
- Tranplant Infectious Diseases, Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Kieran Halloran
- Lung Transplant Program, Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Jayan Nagendran
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Derek R Townsend
- Department of Critical Care Medicine, University of Alberta, Edmonton, Canada
| | - Nathan Zelyas
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - Wendy I Sligl
- Tranplant Infectious Diseases, Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Canada.,Department of Critical Care Medicine, University of Alberta, Edmonton, Canada
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15
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Lum JM, Roberts SC. Hyperammonemia in lung transplantation: recognizing the gaps of our knowledge. Transpl Infect Dis 2022; 24:e13937. [PMID: 35989541 DOI: 10.1111/tid.13937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 06/30/2022] [Indexed: 01/14/2023]
Affiliation(s)
- Jessica M Lum
- Department of Infectious Diseases, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Scott C Roberts
- Department of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, USA
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16
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Carugati M, Arif S, Sudan DL, Collins BH, Haney JC, Schroder JN, Reynolds JM, Lewis SS, Yarrington ME, Miller RA, Alexander BD. Epidemiology of surgical site infections after solid organ transplants in the period 2015-2019: A single-center retrospective cohort study. Am J Transplant 2022; 22:3021-3030. [PMID: 36056456 DOI: 10.1111/ajt.17189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/25/2022] [Accepted: 08/30/2022] [Indexed: 01/25/2023]
Abstract
Surgical site infections (SSI) are severe complications of solid organ transplant (SOT). This retrospective study assessed the epidemiology of and outcomes associated with invasive primary SSI (IP-SSI) occurring within 3 months of transplantation in adult SOT recipients at Duke University over a 5-year period (2015-2019). Among 2073 consecutive SOT recipients, 198 IP-SSI were identified. The IP-SSI rate declined over the period (14.4% in 2015 vs. 8.3% in 2019) and was higher among multi-organ compared with single-organ transplants (33.9% vs. 8.1%, p < .01). SOT recipients with IP-SSI had longer hospital stays than patients without SSI (30.0 vs. 17.0 days, p < .01). Transplant hospitalization (9.6% vs. 2.2%, p < .01), 6-month (11.6% vs. 3.3%, p < .01), and 1-year mortality (15.7% vs. 5.8%, p < .01) were higher in SOT recipients with IP-SSI than in those without. While Gram-positive bacteria were the most common pathogens, urogenital Mollicute and atypical Mycobacteria were identified as an unexpected cause of IP-SSI, particularly among lung transplant recipients. The median time to IP-SSI was 24.0 (IQR 13.8-48.3) days, although the time to IP-SSI varied based on organ transplanted and the causative pathogen. IP-SSI is an important and potentially modifiable complication of SOT, associated with prolonged hospitalizations and reduced survival, particularly in the lung transplant population.
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Affiliation(s)
- Manuela Carugati
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - Sana Arif
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - Debra Lynn Sudan
- Department of Surgery, Division of Abdominal Transplant Surgery, Duke University, Durham, North Carolina, USA
| | - Bradley Henry Collins
- Department of Surgery, Division of Abdominal Transplant Surgery, Duke University, Durham, North Carolina, USA
| | - John Carroll Haney
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University, Durham, North Carolina, USA
| | - Jacob Niall Schroder
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University, Durham, North Carolina, USA
| | - John Michael Reynolds
- Department of Medicine, Transplant Pulmonology, Duke University, Durham, North Carolina, USA
| | - Sarah Stamps Lewis
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | | | - Rachel Ann Miller
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - Barbara Dudley Alexander
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
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17
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Kok EJY, Lee YL. Ureaplasma urealyticum infection presenting as altered mental status in a post-chemotherapy patient: Case report and literature review. Front Med (Lausanne) 2022; 9:1057591. [PMID: 36507505 PMCID: PMC9733668 DOI: 10.3389/fmed.2022.1057591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022] Open
Abstract
Hyperammonemia due to Ureaplasma infection is rare but often fatal, largely due to the delayed recognition, diagnosis, and treatment of the condition. It has mostly been described in solid organ transplant patients in the literature. This case presents the diagnostic challenge of an immunocompromised patient with previous resected pancreatic head adenocarcinoma and chemotherapy, presenting with altered mental status due to hyperammonemia from Ureaplasma infection. It is imperative to consider this condition in unexplained hyperammonemia, especially in immunocompromised patients. Timely diagnosis of this condition can help to reduce complications from encephalopathy such as cerebral edema and seizures.
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18
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Vijayvargiya P, Esquer Garrigos Z, Kennedy CC, Daly RC, Wylam ME, Patel R, Beam E. Routine Donor and Recipient Screening for Mycoplasma hominis and Ureaplasma Species in Lung Transplant Recipients. Open Forum Infect Dis 2022; 9:ofac607. [PMID: 36467297 PMCID: PMC9709706 DOI: 10.1093/ofid/ofac607] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/03/2022] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Mycoplasma hominis, Ureaplasma urealyticum, and Ureaplasma parvum may cause post-transplant infections in lung transplant recipients. We evaluated routine pretransplant screening for these Mollicutes. METHODS We retrospectively reviewed records of lung transplant recipients at our tri-site institution from 01/01/2015 to 11/15/2019. M. hominis and/or Ureaplasma polymerase chain reaction (PCR) was performed on pretransplant recipient urine specimens and donor bronchial swabs at the time of transplantation. Development of Mollicute infection and hyperammonemia syndrome (HS) was recorded. RESULTS A total of 268 patients underwent lung transplantation during the study period, of whom 105 were screened with at least 1 Mollicute PCR. Twelve (11%) screened positive; 10 donors, 1 recipient, and 1 both. Among positive donors, 3 were positive for M. hominis, 5 for U. urealyticum, and 4 for U. parvum. Preemptive therapy included doxycycline, levofloxacin, and/or azithromycin administered for 1-12 weeks. Despite therapy, 1 case of M. hominis mediastinitis and 1 case of HS associated with Ureaplasma infection occurred, both donor-derived. Of those screened before transplant, cases with positive screening were more likely (P < 0.05) to develop Mollicute infection despite treatment (2/12, 17%) than those who screened negative (1/93, 1%). CONCLUSIONS Pretransplant recipient urine screening had a low yield and was not correlated with post-transplant Mollicute infection, likely because most M. hominis and U. parvum/urealyticum infections in lung transplant recipients are donor-derived. Routine donor bronchus swab PCR for M. hominis, U. urealyticum, and U. parvum followed by preemptive therapy did not obviously impact the overall incidence of Mollicute infection or HS in this cohort.
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Affiliation(s)
- Prakhar Vijayvargiya
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
- Division of Infectious Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Zerelda Esquer Garrigos
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
- Division of Infectious Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Cassie C Kennedy
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Richard C Daly
- Cardiovascular Surgery, Department of Surgery, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Mark E Wylam
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Robin Patel
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
- Division of Clinical Microbiology, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Elena Beam
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
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19
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Flurofamide Prevention and Treatment of Ureaplasma-Induced Hyperammonemia. Microbiol Spectr 2022; 10:e0192722. [PMID: 35993783 PMCID: PMC9602998 DOI: 10.1128/spectrum.01927-22] [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] [Indexed: 12/31/2022] Open
Abstract
Hyperammonemia (HA) syndrome caused by respiratory infection with ammonia (NH3)-producing Ureaplasma species occurs in 4% of lung transplant recipients (LTRs) and is associated with high mortality. Although Ureaplasma-targeted antibiotic intervention is effective, the threat of antibiotic resistance development and pre-existing resistance make an alternative to antibiotics desirable. Considering that the underlying pathology of Ureaplasma-induced hyperammonemia (UIHA) is dependent upon ureaplasmal urease converting urea to NH3, urease inhibition could represent a targeted treatment approach. Here, the ability of the urease inhibitor, flurofamide, to prevent and treat UIHA was investigated. To confirm that flurofamide is broadly active against Ureaplasma respiratory isolates, the minimum urease inhibitory concentration against 4 isolates of Ureaplasma parvum and 5 isolates of Ureaplasma urealyticum was first determined in vitro. NH3 production by all isolates was inhibited by ≤2 μM flurofamide. To test the ability of flurofamide to prevent and treat UIHA, a mouse model of Ureaplasma respiratory infection was utilized. When animals were administered 6 mg/kg flurofamide via intraperitoneal injection 1 h prior to infection with U. parvum, flurofamide-administered animals exhibited significantly lower blood NH3 levels than did non-prophylaxed animals (10.9 ± 4.0 μmol/L compared to 26.5 ± 17.7 μmol/L; P = 0.0146) 24 h post-treatment. When U. parvum-infected hyperammonemic mice were treated with 6 mg/kg flurofamide, treated animals had significantly greater decreases in blood-NH3 levels 6 h post-treatment than did untreated mice (56.4 ± 17.1% compared to 9.1 ± 33.5% reduction; P = 0.0152). Together, these results indicate that flurofamide is a promising non-antibiotic treatment for UIHA in LTRs. IMPORTANCE Ureaplasma-associated hyperammonemia syndrome occurs in 4% of lung transplant recipients and has historically been almost universally fatal. While Ureaplasma-targeted antibiotics have been shown to be protective, the possibility of underlying resistance and resistance selection render non-antibiotic interventions an interesting approach.
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20
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Phillips SM, Pouch SM, Lo DJ, Kandiah S, Lomashvili KA, Subramanian RA, Moran P, Killian A, Kandiah PA. A Case of "Cryptammonia": Disseminated Cryptococcal Infection Generating Profound Hyperammonemia in a Liver Transplant Recipient. J Investig Med High Impact Case Rep 2022; 10:23247096221129467. [PMID: 36214295 PMCID: PMC9549096 DOI: 10.1177/23247096221129467] [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] [Indexed: 11/07/2022] Open
Abstract
Mycoplasma and Ureaplasma infections have been
described as a cause of hyperammonemia syndrome leading to devastating
neurological injury in the post-transplant period, most commonly in lung
transplant recipients. The occurrence of significant hyperammonemia caused by
other urease-producing organisms remains unclear. We describe a case of
disseminated cryptococcosis presenting with profound hyperammonemia in a
55-year-old orthotopic liver transplant recipient. Through a process of
elimination, other potential causes for hyperammonemia were excluded revealing a
probable association between hyperammonemia and disseminated cryptococcosis.
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Affiliation(s)
- Steven M. Phillips
- Emory University, Atlanta, GA,
USA,Steven M. Phillips, DO, University of
Nebraska Medical Center, 988440 Nebraska Medical Center, Omaha, NE 68198-8440,
USA.
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21
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Undifferentiated non-hepatic hyperammonemia in the ICU: Diagnosis and management. J Crit Care 2022. [DOI: 10.1016/j.jcrc.2022.154042
expr 979693480 + 932749582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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22
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Abstract
PURPOSE OF REVIEW Hyperammonemia syndrome is an increasingly recognized and often fatal condition that occurs in immunosuppressed individuals, most commonly lung transplant recipients. Growing evidence suggests hyperammonemia syndrome is associated with systemic infections caused by urease-producing organisms, namely Ureaplasma spp., an organism unable to grow with routine culturing techniques. This review will summarize the epidemiology and clinical manifestations of hyperammonemia syndrome, as well as diagnostic and management strategies once hyperammonemia syndrome is suspected. RECENT FINDINGS Hyperammonemia syndrome is being described in increasing frequency in the solid organ transplant population. Morbidity and mortality, even with treatment, is high once hyperammonemia syndrome occurs. Surveillance studies indicate the prevalence of lung donor colonization with Ureaplasma spp. is high, suggesting screening and treatment may be of benefit. Antibiotic resistance is common, and rapid diagnostics can facilitate appropriate antimicrobial therapy in the peri-transplant period. SUMMARY Hyperammonemia syndrome is most commonly seen in lung transplant recipients and has a high mortality rate once it occurs. Screening for Ureaplasma spp. should be considered in all lung transplant donors.
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Affiliation(s)
- Scott C Roberts
- Division of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut
| | - Waleed Malik
- Division of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut
| | - Michael G Ison
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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23
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Undifferentiated non-hepatic hyperammonemia in the ICU: Diagnosis and management. J Crit Care 2022; 70:154042. [PMID: 35447602 DOI: 10.1016/j.jcrc.2022.154042] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/17/2022] [Accepted: 04/04/2022] [Indexed: 12/25/2022]
Abstract
Hyperammonemia occurs frequently in the critically ill but is largely confined to patients with hepatic dysfunction or failure. Non-hepatic hyperammonemia (NHHA) is far less common but can be a harbinger of life-threatening diagnoses that warrant timely identification and, sometimes, empiric therapy to prevent seizures, status epilepticus, cerebral edema, coma and death; in children, permanent cognitive impairment can result. Subsets of patients are at particular risk for developing NHHA, including the organ transplant recipient. Unique etiologies include rare infections, such as with Ureaplasma species, and unmasked inborn errors of metabolism, like urea cycle disorders, must be considered in the critically ill. Early recognition and empiric therapy, including directed therapies towards these rare etiologies, is crucial to prevent catastrophic demise. We review the etiologies of NHHA and highlight the first presentation of it associated with a concurrent Ureaplasma urealyticum and Mycoplasma hominis infection in a previously healthy individual with polytrauma. Based on this clinical review, a diagnostic and treatment algorithm to identify and manage NHHA is proposed.
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24
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Tantengco OAG, De Jesus FCC, Gampoy EFS, Ornos EDB, Vidal MS, Abad CLR. Hyperammonemia syndrome associated with Ureaplasma spp. Infections in immunocompromised patients and transplant recipients: A systematic review and meta-analysis. Clin Transplant 2021; 35:e14334. [PMID: 33948993 DOI: 10.1111/ctr.14334] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/15/2021] [Accepted: 04/26/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Hyperammonemia syndrome (HS) is reported to occur in patients with Ureaplasma spp. infections. We performed a systematic review and meta-analysis of studies reporting HS in patients with Ureaplasma spp. infection. METHODS We searched several databases (CINAHL, OVID, ProQuest, and Scopus) from inception to January 2021. We described case reports and series, and performed a meta-analysis for all cohort studies. The pooled risk ratio (RR) for the association between HS and Ureaplasma spp. infections was derived using a random-effects model. RESULTS The systematic review yielded 18 studies. HS was reported in 53 patients with Ureaplasma spp. infections. The most common clinical manifestations were neurologic. Meta-analysis showed a higher incidence of HS (41.67%) and peak ammonia concentration among Ureaplasma spp.-infected lung transplant recipients compared with Ureaplasma spp.-negative recipients (2.84%). The risk of HS was significantly increased in Ureaplasma spp.-infected recipients compared with Ureaplasma spp.-negative recipients (RR: 14.64; CI: 2.85-75.24). Mortality from Ureaplasma-associated HS was 27.27% compared with 5.24% in those with HS from other causes. CONCLUSIONS The risk of developing HS is higher among Ureaplasma-infected patients compared with uninfected patients. Lung transplant recipients appear to be disproportionally affected, and HS should be suspected in those who present with neurologic symptoms.
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Affiliation(s)
| | | | | | - Eric David B Ornos
- College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Manuel S Vidal
- College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Cybele Lara R Abad
- College of Medicine, University of the Philippines Manila, Manila, Philippines.,Division of Infectious Diseases, Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
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