1
|
Wu J, Hu Y. A late-onset hyperammonemia syndrome caused by Ureaplasma parvum infection after kidney transplantation. Heliyon 2024; 10:e32134. [PMID: 38912440 PMCID: PMC11190536 DOI: 10.1016/j.heliyon.2024.e32134] [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: 09/06/2023] [Revised: 05/25/2024] [Accepted: 05/28/2024] [Indexed: 06/25/2024] Open
Abstract
Hyperammonemia syndrome has a high mortality rate in the immunosuppressed population due to its association with mental status changes. Recently studies have shown that Ureaplasma organisms' infection can lead to hyperammonemia in post-transplant patients. Symptoms typically occur within 30 days postoperatively. However, the late-onset hyperammonemia caused by Ureaplasma parvum infection after kidney transplantation has never been reported. In this case study, a 64-year-old Chinese male presented with symptoms such as nausea, vomiting, trouble sleeping, and deteriorating mental status 81 days after kidney transplantation. His plasma ammonia level was significantly elevated, and there was no evidence of liver synthetic dysfunction. Although common methods for ammonia clearance, such as haemodialysis and oral lactulose were initiated, his serum ammonia levels remained high. Metagenomic sequencing of serum determined Ureaplasma parvum infection. Levofloxacin and minocycline were administered respectively, which resulted in a decrease in ammonia levels, but normalization was not achieved. The computed tomographic scan revealed the presence of cerebral edema. Unfortunately, the patient eventually became brain dead with multiple organ failure. This case highlights that Ureaplasma parvum can cause late-onset hyperammonemia in kidney transplant patients. Once the mental status changes are identified, immediate empiric treatments should be initiated without waiting for a confirmed diagnosis of Ureaplasma spp. infection.
Collapse
Affiliation(s)
- Jing Wu
- Department of Laboratory Medicine, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China
| | - Yunjian Hu
- Department of Laboratory Medicine, Beijing Hospital, National Centre for Gerontology, Beijing, China
| |
Collapse
|
2
|
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.
Collapse
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.
| |
Collapse
|
3
|
Klein EJ, Almaghlouth NK, Weigel G, Farmakiotis D, Hardy E. Refractory Bilateral Tubo-Ovarian Abscesses in a Patient with Iatrogenic Hypogammaglobulinemia. Diagnostics (Basel) 2023; 13:3478. [PMID: 37998614 PMCID: PMC10670296 DOI: 10.3390/diagnostics13223478] [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: 10/10/2023] [Revised: 10/31/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023] Open
Abstract
Genital mycoplasmas are sexually transmitted Mollicutes with a high prevalence of urogenital tract colonization among females of reproductive age. Current guidelines recommend against routine screening for these organisms, since their role in the pathogenesis of pelvic inflammatory disease and tubo-ovarian abscesses (TOAs) remains unclear. However, genital mycoplasmas harbor pathogenic potential in immunocompromised hosts, especially patients with hypogammaglobulinemia. It is important to identify such infections early, given their potential for invasive spread and the availability of easily accessible treatments. We present a young adult female with multiple sclerosis and iatrogenic hypogammaglobulinemia, with refractory, bilateral pelvic inflammatory disease and TOAs due to Ureaplasma urealyticum, identified as a single pathogen via three distinct molecular tests. To our knowledge, this is the second case of TOAs caused by U. urealyticum in the literature, and the first diagnosed by pathogen cell-free DNA metagenomic next-generation sequencing in plasma.
Collapse
Affiliation(s)
- Elizabeth J. Klein
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA; (E.J.K.); (N.K.A.); (D.F.)
| | - Nouf K. Almaghlouth
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA; (E.J.K.); (N.K.A.); (D.F.)
| | - Gabriela Weigel
- Department of Obstetrics and Gynecology, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA;
| | - Dimitrios Farmakiotis
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA; (E.J.K.); (N.K.A.); (D.F.)
| | - Erica Hardy
- Divisions of Obstetric Medicine and Infectious Diseases, Women and Infants Hospital, Providence, RI 02905, USA
| |
Collapse
|
4
|
Chan JL, Cerón S, Horiuchi SM, Yap JP, Chihuahua EG, Tsan AT, Kamau E, Yang S. Development of a Rapid and High-Throughput Multiplex Real-Time PCR Assay for Mycoplasma hominis and Ureaplasma Species. J Mol Diagn 2023; 25:838-848. [PMID: 37683891 DOI: 10.1016/j.jmoldx.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 06/10/2023] [Accepted: 07/27/2023] [Indexed: 09/10/2023] Open
Abstract
Bacterial commensals of the human genitourinary tract, Mycoplasma hominis and Ureaplasma species (parvum and urealyticum) can be sexually transmitted, and may cause nongonococcal urethritis, pelvic inflammatory disease, and infertility. Mycoplasma hominis and Ureaplasma species may also cause severe invasive infections in immunocompromised patients. Current culture-based methods for Mycoplasma/Ureaplasma identification are costly and laborious, with a turnaround time between 1 and 2 weeks. We developed a high-throughput, real-time multiplex PCR assay for the rapid detection of M. hominis and Ureaplasma species in urine, genital swab, body fluid, and tissue. In total, 282 specimens were tested by PCR and compared with historic culture results; a molecular reference method was used to moderate discrepancies. Overall result agreement was 99% for M. hominis (97% positive percentage agreement and 100% negative percentage agreement) and 96% for Ureaplasma species (96% positive percentage agreement and 97% negative percentage agreement). Specimen stability was validated for up to 7 days at room temperature. This multiplex molecular assay was designed for implementation in a high-complexity clinical microbiology laboratory. With this method, >90 samples can be tested in one run, with a turnaround time of 4 to 5 hours from specimen extraction to reporting of results. This PCR test is also more labor effective and cheaper than the conventional culture-based test, thus improving laboratory efficiency and alleviating labor shortages.
Collapse
Affiliation(s)
- June L Chan
- Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, California
| | - Stacey Cerón
- Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, California
| | - Stephanie M Horiuchi
- Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, California
| | - Jewell P Yap
- Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, California
| | - Erika G Chihuahua
- Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, California
| | - Allison T Tsan
- Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, California
| | - Edwin Kamau
- Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, California
| | - Shangxin Yang
- Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, California.
| |
Collapse
|
5
|
Ahamad A, Zervou FN, Aguero-Rosenfeld ME. Extra-urogenital infection by Mycoplasma hominis in transplant patients: two case reports and literature review. BMC Infect Dis 2023; 23:601. [PMID: 37710154 PMCID: PMC10503128 DOI: 10.1186/s12879-023-08593-2] [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: 02/07/2023] [Accepted: 09/09/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Mycoplasma hominis is a facultative anaerobic bacterium commonly present in the urogenital tract. In recent years, M. hominis has increasingly been associated with extra-urogenital tract infections, particularly in immunosuppressed patients. Detecting M. hominis in a diagnostic laboratory can be challenging due to its slow growth rate, absence of a cell wall, and the requirements of specialized media and conditions for optimal growth. Consequently, it is necessary to establish guidelines for the detection of this microorganism and to request the appropriate microbiological work-up of immunosuppressed patients. CASE PRESENTATION We hereby present two cases of solid organ transplant patients who developed M. hominis infection. Microscopic examination of the bronchial lavage and pleural fluid showed no microorganisms. However, upon inoculating the specimens onto routine microbiology media, the organism was successfully identified and confirmation was performed using 16S rDNA sequencing. Both patients received appropriate treatment resulting in the resolution of M. hominis infection. CONCLUSIONS The prompt detection of M. hominis in a clinical specimen can have a significant impact on patient care by allowing for early intervention and ultimately resulting in more favorable clinical outcomes, especially in transplant patients.
Collapse
Affiliation(s)
- Afrinash Ahamad
- Clinical Laboratory Sciences Program, School of Health Profession, Stony Brook University, Stony Brook, NY, USA.
- Department of Neuroscience and Behavior, Stony Brook University, Stony Brook, NY, USA.
- Department of Pathology, Clinical Microbiology Laboratory, NYU Langone Health, New York, NY, USA.
| | | | - Maria E Aguero-Rosenfeld
- Department of Pathology, Clinical Microbiology Laboratory, NYU Langone Health, New York, NY, USA
- Department of Medicine, NYU Langone Health, New York, NY, USA
| |
Collapse
|
6
|
Liu H, Xu H, Liu H, Zhao Z, Zhang X. Metagenomic next-generation sequencing in the diagnose of pulmonary infection with airway complications in a lung transplant recipient. Heliyon 2023; 9:e19611. [PMID: 37809439 PMCID: PMC10558871 DOI: 10.1016/j.heliyon.2023.e19611] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 10/10/2023] Open
Abstract
We reported a case of a 60-year-old male with fever, cough, expectoration, and chest distress after right lung transplanted. Blood examination showed elevated C-reaction protein (CRP), white blood cell (WBC), and ammonia. Computed tomography (CT) revealed patchy high-density shadows and few pleural effusions in the transplanted lung. Bronchoscopy illustrated anastomotic fistula, and pseudomembrane and mucus plugs around the right main bronchial anastomosis. Carbapenem-resistant Klebsiella pneumoniae, Ureaplasma urealyticum, and Aspergillus flavus was successively detected by metagenomic next-generation sequencing (mNGS). Targeted anti-microbial agents were administered and patient was successfully discharged. Unfortunately, a year later, patient died of respiratory failure due to recurrent pulmonary infections.
Collapse
Affiliation(s)
- Hongmei Liu
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Huan Xu
- Department of Scientific Affairs, Vision Medicals Center for Infection Diseases, Guangzhou, China
| | - Hui Liu
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Zhigang Zhao
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Xiaoju Zhang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| |
Collapse
|
7
|
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.
Collapse
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.
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
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.
Collapse
|
10
|
Brell N, Overton K, Micallef MJ, Hurley S. Hyperammonaemia syndrome in disseminated Ureaplasma parvum infection. BMJ Case Rep 2022; 15:e250852. [PMID: 36351675 PMCID: PMC9664287 DOI: 10.1136/bcr-2022-250852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Hyperammonaemia syndrome secondary to Ureaplasma spp. infection is well documented in the post-lung transplant population. We report a case of a man in his fifties with hyperammonaemia syndrome secondary to disseminated Ureaplasma parvum infection. This occurred in the context of immunosuppression for chronic graft versus host disease and six years following an allogeneic stem cell transplant for diffuse large B-cell lymphoma. Following treatment of U. parvum septic arthritis with ciprofloxacin and doxycycline, the patient experienced a full neurological recovery, and continues on suppressive doxycycline therapy with no recurrence of symptoms to date.
Collapse
Affiliation(s)
- Nadiya Brell
- University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
- Infectious Diseases, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
| | - Kristen Overton
- University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
- Infectious Diseases, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
| | - Milton J Micallef
- Infectious Diseases, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
| | - Siobhan Hurley
- Infectious Diseases, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Delafoy M, Goutines J, Fourmont AM, Birgy A, Chomton M, Levy M, Naudin J, Zafrani L, Le Mouel L, Yakouben K, Cointe A, Caseris M, Lafaurie M, Bonacorsi S, Mechinaud F, Pereyre S, Boissel N, Baruchel A. Case Report: Hyperammonemic Encephalopathy Linked to Ureaplasma spp. and/or Mycoplasma hominis Systemic Infection in Patients Treated for Leukemia, an Emergency Not to Be Missed. Front Oncol 2022; 12:912695. [PMID: 35875088 PMCID: PMC9304698 DOI: 10.3389/fonc.2022.912695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/19/2022] [Indexed: 11/24/2022] Open
Abstract
Background Hyperammonemic encephalopathy caused by Ureaplasma spp. and Mycoplasma hominis infection has been reported in immunocompromised patients undergoing lung transplant, but data are scarce in patients with hematological malignancies. Case Presentation We describe the cases of 3 female patients aged 11–16 years old, developing initially mild neurologic symptoms, rapidly evolving to coma and associated with very high ammonia levels, while undergoing intensive treatment for acute leukemia (chemotherapy: 2 and hematopoietic stem cell transplant: 1). Brain imaging displayed cerebral edema and/or microbleeding. Electroencephalograms showed diffuse slowing patterns. One patient had moderate renal failure. Extensive liver and metabolic functions were all normal. Ureaplasma spp. and M. hominis were detected by PCR and specific culture in two patients, resulting in prompt initiation of combined antibiotics therapy by fluoroquinolones and macrolides. For these 2 patients, the improvement of the neurological status and ammonia levels were observed within 96 h, without any long-term sequelae. M. hominis was detected post-mortem in vagina, using 16S rRNA PCR for the third patient who died of cerebral edema. Conclusion Hyperammonemic encephalopathy linked to Ureaplasma spp. and M. hominis is a rare complication encountered in immunocompromised patients treated for acute leukemia, which can lead to death if unrecognized. Combining our experience with the few published cases (n=4), we observed a strong trend among female patients and very high levels of ammonia, consistently uncontrolled by classical measures (ammonia-scavenging agents and/or continuous kidney replacement therapy). The reversibility of the encephalopathy without sequelae is possible with prompt diagnosis and adequate combined specific antibiotherapy. Any neurological symptoms in an immunocompromised host should lead to the measurement of ammonia levels. If increased, and in the absence of an obvious cause, it should prompt to perform a search for Ureaplasma spp. and M. hominis by PCR as well as an immediate empirical initiation of combined specific antibiotherapy.
Collapse
Affiliation(s)
- Manon Delafoy
- Department of Hematology, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- *Correspondence: Manon Delafoy,
| | - Juliette Goutines
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Aude-Marie Fourmont
- Department of Hematology, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - André Birgy
- Department of Microbiology, Robert-Debré Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Infection, Antimicrobiens, Modélisation, Evolution, Unité Mixte de Recherche 1137, Institut National de la Santé Et de la Recherche Médicale, Université Paris Cité, Paris, France
| | - Maryline Chomton
- Paediatric Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Michaël Levy
- Paediatric Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Jérôme Naudin
- Paediatric Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Lara Zafrani
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Unité Mixte de Recherche 976, Institut National de la Santé Et de la Recherche Médicale, Paris, France
| | - Lou Le Mouel
- Department of Hematology, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Karima Yakouben
- Department of Hematology, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Aurélie Cointe
- Department of Microbiology, Robert-Debré Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Infection, Antimicrobiens, Modélisation, Evolution, Unité Mixte de Recherche 1137, Institut National de la Santé Et de la Recherche Médicale, Université Paris Cité, Paris, France
| | - Marion Caseris
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Matthieu Lafaurie
- Department of Infectious Diseases, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Stéphane Bonacorsi
- Department of Microbiology, Robert-Debré Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Infection, Antimicrobiens, Modélisation, Evolution, Unité Mixte de Recherche 1137, Institut National de la Santé Et de la Recherche Médicale, Université Paris Cité, Paris, France
| | - Françoise Mechinaud
- Department of Hematology, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Sabine Pereyre
- Department of Bacteriology, National Reference Center for Bacterial Sexually Transmitted Infections, Bordeaux University Hospital, Bordeaux, France
- Unité Mixte de Recherche 5234, Fundamental Microbiology and Pathogenicity, Université de Bordeaux, Centre National de la Recherche Scientifique, Bordeaux, France
| | - Nicolas Boissel
- Department of Hematology, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Research Unit EA-3518, Université Paris Cité, Paris, France
| | - André Baruchel
- Department of Hematology, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Research Unit EA-3518, Université Paris Cité, Paris, France
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Chang SY, Price TK, Beaird OE, Gaynor PT, Schaenman JM, Carlson ME, Kubak BM, Yang S, Multani A. Mycoplasma hominis
infections in solid organ transplant recipients: clinical characteristics, treatment outcomes, and comparison of phenotypic and genotypic susceptibility profiles. Transpl Infect Dis 2022; 24:e13822. [DOI: 10.1111/tid.13822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/25/2022] [Accepted: 02/22/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Sandy Y. Chang
- Division of Infectious Diseases Department of Medicine David Geffen School of Medicine at UCLA Los Angeles CA USA
- Division of Infectious Diseases Department of Medicine Loma Linda University Loma Linda CA USA
| | - Travis K. Price
- Department of Pathology and Laboratory Medicine David Geffen School of Medicine at UCLA Los Angeles CA USA
| | - Omer E. Beaird
- Division of Infectious Diseases Department of Medicine David Geffen School of Medicine at UCLA Los Angeles CA USA
| | - Pryce T. Gaynor
- Division of Infectious Diseases Department of Medicine David Geffen School of Medicine at UCLA Los Angeles CA USA
| | - Joanna M. Schaenman
- Division of Infectious Diseases Department of Medicine David Geffen School of Medicine at UCLA Los Angeles CA USA
| | - Margrit E. Carlson
- Division of Infectious Diseases Department of Medicine David Geffen School of Medicine at UCLA Los Angeles CA USA
| | - Bernard M. Kubak
- Division of Infectious Diseases Department of Medicine David Geffen School of Medicine at UCLA Los Angeles CA USA
| | - Shangxin Yang
- Department of Pathology and Laboratory Medicine David Geffen School of Medicine at UCLA Los Angeles CA USA
| | - Ashrit Multani
- Division of Infectious Diseases Department of Medicine David Geffen School of Medicine at UCLA Los Angeles CA USA
| |
Collapse
|
15
|
Moneke I, Hornuss D, Serr A, Kern WV, Passlick B, Senbaklavaci O. Lung Abscess and Recurrent Empyema After Infection With Mycoplasma hominis: A Case Report and Review of the Literature. Open Forum Infect Dis 2022; 9:ofab406. [PMID: 35028329 PMCID: PMC8753028 DOI: 10.1093/ofid/ofab406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/03/2021] [Indexed: 12/03/2022] Open
Abstract
Mycoplasma hominis is a rarely identified cause of respiratory infection that can cause significant morbidity and mortality in immunocompromised patients. It is often missed due to the difficult detection of the organism with routine laboratory methods. We present the case of a 63-year-old male with a history of lymphoma who was transferred to our hospital with recurrent right-sided empyema and lung abscess in the right lower lobe. Advanced microbiological analysis finally revealed infection with M hominis. Despite appropriate antibiotic treatment, prolonged drainage as well as repeated surgery, which eventually resulted in right lower bilobectomy, were necessary for clinical improvement of our patient. Infection with M hominis may be more prevalent than previously indicated and can cause severe morbidity and mortality in thoracic surgery patients. Due to the diagnostic challenge, the appropriate antimicrobial treatment is often delayed. Inherent resistance to macrolides and inactivity of cell wall-active agents potentially complicate empiric antibiotic therapy. A review of the currently available literature enables a better understanding of the diagnostic difficulties and importance of this infection.
Collapse
Affiliation(s)
- Isabelle Moneke
- Department of Thoracic Surgery, Medical Center – University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Division Cancer Research, Department of Thoracic Surgery, Medical Center – University of Freiburg, Freiburg, Germany
| | - Daniel Hornuss
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Institute of Infectious Diseases, Department of Medicine, Medical Centre-University Hospital of Freiburg, Freiburg, Germany
| | - Annerose Serr
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Institute of Microbiology and Hygiene, Medical Center – University of Freiburg, Freiburg, Germany
| | - Winfried V Kern
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Institute of Infectious Diseases, Department of Medicine, Medical Centre-University Hospital of Freiburg, Freiburg, Germany
| | - Bernward Passlick
- Department of Thoracic Surgery, Medical Center – University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Oemer Senbaklavaci
- Department of Thoracic Surgery, Medical Center – University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
16
|
Sharratt M, Sands K, Portal EAR, Boostrom I, Mondeja BA, Rodríguez NM, Jones LC, Spiller OB. Defining Fluoroquinolone Resistance-Mediating Mutations from Non-Resistance Polymorphisms in Mycoplasma hominis Topoisomerases. Antibiotics (Basel) 2021; 10:antibiotics10111379. [PMID: 34827317 PMCID: PMC8614649 DOI: 10.3390/antibiotics10111379] [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: 10/01/2021] [Revised: 10/26/2021] [Accepted: 10/30/2021] [Indexed: 12/02/2022] Open
Abstract
Often dismissed as a commensal, Mycoplasma hominis is an increasingly prominent target of research due to its role in septic arthritis and organ transplant failure in immunosuppressed patients, particularly lung transplantation. As a mollicute, its highly reductive genome and structure render it refractile to most forms of treatment and growing levels of resistance to the few sources of treatment left, such as fluoroquinolones. We examined antimicrobial susceptibility (AST) to fluoroquinolones on 72 isolates and observed resistance in three (4.1%), with corresponding mutations in the quinolone resistance-determining region (QRDR) of S83L or E87G in gyrA and S81I or E85V in parC. However, there were high levels of polymorphism identified between all isolates outside of the QRDR, indicating caution for a genomics-led approach for resistance screening, particularly as we observed a further two quinolone-susceptible isolates solely containing gyrA mutation S83L. However, both isolates spontaneously developed a second spontaneous E85K parC mutation and resistance following prolonged incubation in 4 mg/L levofloxacin for an extra 24–48 h. Continued AST surveillance and investigation is required to understand how gyrA QRDR mutations predispose M. hominis to rapid spontaneous mutation and fluoroquinolone resistance, absent from other susceptible isolates. The unusually high prevalence of polymorphisms in M. hominis also warrants increased genomics’ surveillance.
Collapse
Affiliation(s)
- Martin Sharratt
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, UK; (M.S.); (K.S.); (E.A.R.P.); (I.B.)
| | - Kirsty Sands
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, UK; (M.S.); (K.S.); (E.A.R.P.); (I.B.)
- Department of Zoology, Oxford University, Oxford OX1 3RE, UK
| | - Edward A. R. Portal
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, UK; (M.S.); (K.S.); (E.A.R.P.); (I.B.)
- Bacteriology Reference Department, UK Health Security Agency, London NW9 5EQ, UK
| | - Ian Boostrom
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, UK; (M.S.); (K.S.); (E.A.R.P.); (I.B.)
| | - Brian A. Mondeja
- Pedro Kourí Tropical Medicine Institute, Havana 11400, Cuba; (B.A.M.); (N.M.R.)
- Center for Advance Research of Cuba, Havana CP17100, Cuba
| | - Nadia M. Rodríguez
- Pedro Kourí Tropical Medicine Institute, Havana 11400, Cuba; (B.A.M.); (N.M.R.)
| | - Lucy C. Jones
- Department of Integrated Sexual Health, Cwm Taf Morgannwg University Health Board, Pontypridd CF37 1LB, UK;
| | - Owen B. Spiller
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, UK; (M.S.); (K.S.); (E.A.R.P.); (I.B.)
- Bacteriology Reference Department, UK Health Security Agency, London NW9 5EQ, UK
- Correspondence:
| |
Collapse
|
17
|
Severe hyperammonemia in chimeric antigen receptor T cells recipient-unusual differential diagnosis of encephalopathy syndrome. Bone Marrow Transplant 2021; 57:286-288. [PMID: 34718345 DOI: 10.1038/s41409-021-01505-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/03/2021] [Accepted: 10/12/2021] [Indexed: 01/09/2023]
|
18
|
Stewart AG, Sinclair H, Chapman P, Baboolal K, Barber BE, Townsend S. Cryptococcus neoformans infection as a cause of severe hyperammonaemia and encephalopathy. Intern Med J 2021; 51:1750-1751. [PMID: 34664364 DOI: 10.1111/imj.15516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/02/2021] [Accepted: 04/02/2021] [Indexed: 01/09/2023]
Affiliation(s)
- Adam G Stewart
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, Centre for Clinical Research, The University of Queensland, Royal Brisbane, Queensland, Australia
| | - Holly Sinclair
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Paul Chapman
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Keshwar Baboolal
- Department of Renal Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Bridget E Barber
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,QIMR Berghofer Institute of Medical Research, Brisbane, Queensland, Australia
| | - Shane Townsend
- Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| |
Collapse
|
19
|
Michel C, Raimo M, Lazarevic V, Gaïa N, Leduc N, Knoop C, Hallin M, Vandenberg O, Schrenzel J, Grimaldi D, Hites M. Case Report: About a Case of Hyperammonemia Syndrome Following Lung Transplantation: Could Metagenomic Next-Generation Sequencing Improve the Clinical Management? Front Med (Lausanne) 2021; 8:684040. [PMID: 34295911 PMCID: PMC8290067 DOI: 10.3389/fmed.2021.684040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Mycoplasma hominis and Ureaplasma spp. are responsible for opportunistic infections in transplant patients, sometimes causing a life-threatening hyperammonemia syndrome. Both pathogens are not identified with standard microbiology techniques, resulting in missed or delayed diagnosis. We present a clinical case that illustrates the added value that next-generation sequencing (NGS) may offer in the diagnosis of respiratory infections in immune-compromised patients. Results: A 55 years-old man with idiopathic pulmonary fibrosis underwent double lung transplantation. He received antibiotic prophylaxis with piperacillin-tazobactam and azythromycin. At day 4 post-transplantation (PTx), the patient presented an acute respiratory distress. A broncho-alveolar lavage (BAL) was performed. At day 5 PTx, the patient presented a status epilepticus due to diffuse cerebral oedema. Serum ammonia concentration was 661 μg/dL. BAL bacterial culture was negative. Because of the clinical presentation, special cultures were performed and identified 100.000 CFU/mL of M. hominis and Ureaplasma spp. and specific PCRs were positive for M. hominis and Ureaplasma parvum. Antibiotic therapy was shifted to therapeutic dose of azithromycin and doxycycline; within 48 h ammonia serum concentrations returned to normal but the coma persisted several weeks, followed by a persistent frontal lobe syndrome. A follow-up BAL was performed on day 11 Ptx. The Mycoplasma/Ureaplasma culture was negative, yet the specific PCRs remained positive. Bacterial culture found 100 CFU/mL of Staphylococcus aureus and viral culture was positive for Herpes Simplex Virus-1. These results were confirmed by metagenomic next-generation sequencing (mNGS). In the bacterial fraction, the majority of reads belonged to Corynebacterium propinquum (34.7%), S. aureus (24.1%) and Staphylococcus epidermidis (17.1%). Reads assigned to M. hominis, Ureaplasma urealyticum and parvum represented 0.71, 0.13, and 0.04% of the bacterial fraction and corresponded to 6.9 × 103, 9.7 × 102, and 3.7 × 102 genome equivalents per mL of BAL fluid, respectively. These results are in favor of a cure of the atypical infection. Conclusions: mNGS offered added diagnostic and quantitative values compared to PCR tests, which can remain positive after resolved infections. The initiation of appropriate antibiotic therapy would have occurred earlier on, possibly resulting in a better clinical outcome if mNGS had been performed in a routine fashion.
Collapse
Affiliation(s)
- Charlotte Michel
- Department of Microbiology, Laboratoire Hospitalier Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Michela Raimo
- Clinic of Infectious Diseases, Cliniques Universitaires de Bruxelles, Erasme Hospital, Brussels, Belgium
| | - Vladimir Lazarevic
- Genomic Research Laboratory, Geneva University Hospitals, Geneva, Switzerland
| | - Nadia Gaïa
- Genomic Research Laboratory, Geneva University Hospitals, Geneva, Switzerland
| | - Nina Leduc
- Department of Pneumology, Cliniques Universitaires de Bruxelles, Erasme Hospital, Brussels, Belgium
| | - Christiane Knoop
- Department of Pneumology, Cliniques Universitaires de Bruxelles, Erasme Hospital, Brussels, Belgium
| | - Marie Hallin
- Department of Microbiology, Laboratoire Hospitalier Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Olivier Vandenberg
- Department of Microbiology, Laboratoire Hospitalier Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques Schrenzel
- Genomic Research Laboratory, Geneva University Hospitals, Geneva, Switzerland
| | - David Grimaldi
- Intensive Care Unit, Cliniques Universitaires de Bruxelles, Erasme Hospital, Brussels, Belgium
| | - Maya Hites
- Clinic of Infectious Diseases, Cliniques Universitaires de Bruxelles, Erasme Hospital, Brussels, Belgium
| |
Collapse
|
20
|
Buzo BF, Preiksaitis JK, Halloran K, Nagendran J, Townsend DR, Zelyas N, Sligl WI. Association between Mycoplasma and Ureaplasma airway positivity, ammonia levels, and outcomes post-lung transplantation: A prospective surveillance study. Am J Transplant 2021; 21:2123-2131. [PMID: 33179447 DOI: 10.1111/ajt.16394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 11/01/2020] [Accepted: 11/02/2020] [Indexed: 01/25/2023]
Abstract
Hyperammonemia syndrome (HS) is a rare complication with high mortality described after lung transplantation. Its pathophysiology is still unclear, but previous studies, including murine models, have linked the identification of Mycoplasmataceae in airway specimens with HS occurrence. This study explores the association between Mycoplasmataceae polymerase chain reaction (PCR) positivity, ammonia levels, HS, and mortality post-lung transplant. Adults who underwent lung transplantation between July 2017 and August 2019 had prospective surveillance testing for Mycoplasma and Ureaplasma using PCR on post-operative bronchoscopy samples. One hundred and fifty-nine patients underwent lung transplantation during the study period. Mean age was 54 (±13) years; baseline diseases were predominantly pulmonary fibrosis (37.7%) and chronic obstructive pulmonary disease (35.8%). Mycoplasma and/or Ureaplasma airway positivity was found in 42 (26.4%) of tested patients, represented mostly by M. salivarium (26/43; 60.4%), U. parvum (7/43; 16.2%), and U. urealyticum (5/43; 11.6%). Median peak ammonia levels were higher in those with Ureaplasma colonization compared to uncolonized patients (p = .04), however, only three patients developed HS. Recipient airway Ureaplasma positivity was independently associated with younger (aOR 0.94, 95% CI 0.88-0.99, p = .04) and female donors (aOR 4.29; 95% CI 1.01-18.2, p = .05).
Collapse
Affiliation(s)
- Bruno F Buzo
- Transplant Infectious Diseases, Division of Infectious Diseases, University of Alberta, Edmonton, AB, Canada
| | - Jutta K Preiksaitis
- Transplant Infectious Diseases, Division of Infectious Diseases, University of Alberta, Edmonton, AB, Canada
| | - Kieran Halloran
- Lung Transplant Program, Division of Respiratory Medicine, University of Alberta, Edmonton, AB, Canada
| | - Jayan Nagendran
- Division of Cardiac Surgery, University of Alberta, Edmonton, AB, Canada
| | - Derek R Townsend
- Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
| | - Nathan Zelyas
- Division of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Wendy I Sligl
- Transplant Infectious Diseases, Division of Infectious Diseases, University of Alberta, Edmonton, AB, Canada.,Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
21
|
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.
Collapse
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
| |
Collapse
|
22
|
Fleming D, Karau M, Patel R. A novel bioreactor for the stable growth of Ureaplasma parvum and Ureaplasma urealyticum. J Microbiol Methods 2021; 181:106131. [PMID: 33385441 PMCID: PMC7870580 DOI: 10.1016/j.mimet.2020.106131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/20/2020] [Accepted: 12/21/2020] [Indexed: 11/25/2022]
Abstract
Ureaplasma species, including Ureaplasma parvum and Ureaplasma urealyticum, are challenging to culture and maintain. Here, we describe a novel bioreactor for growing high-titer liquid Ureaplasma cultures in a stable manner.
Collapse
Affiliation(s)
- Derek Fleming
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Melissa Karau
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America; Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, United States of America.
| |
Collapse
|
23
|
Leger RF, Silverman MS, Hauck ES, Guvakova KD. Hyperammonemia Post Lung Transplantation: A Review. Clin Med Insights Circ Respir Pulm Med 2020; 14:1179548420966234. [PMID: 33192115 PMCID: PMC7594252 DOI: 10.1177/1179548420966234] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/23/2020] [Indexed: 12/30/2022] Open
Abstract
Hyperammonemia is the pathological accumulation of ammonia in the blood, which can occur in many different clinical settings. Most commonly in adults, hyperammonemia occurs secondary to hepatic dysfunction; however, it is also known to be associated with other pathologies, surgeries, and medications. Although less common, hyperammonemia has been described as a rare, but consistent complication of solid organ transplantation. Lung transplantation is increasingly recognized as a unique risk factor for the development of this condition, which can pose grave health risks-including long-term neurological sequelae and even death. Recent clinical findings have suggested that patients receiving lung transplantations may experience postoperative hyperammonemia at rates as high as 4.1%. A wide array of etiologies has been attributed to this condition. A growing number of case studies and investigations suggest disseminated opportunistic infection with Ureaplasma or Mycoplasma species may drive this metabolic disturbance in lung transplant recipients. Regardless of the etiology, hyperammonemia presents a severe clinical problem with reported mortality rates as high as 75%. Typical treatment regimens are multimodal and focus on 3 main avenues of management: (1) the reduction of impact on the brain through the use of neuroprotective medications and decreasing cerebral edema, (2) augmentation of mechanisms for the elimination of ammonia from the blood via hemodialysis, and (3) the diminishment of processes producing predominantly using antibiotics. The aim of this review is to detail the pathophysiology of hyperammonemia in the setting of orthotopic lung transplantation and discuss methods of identifying and managing patients with this condition.
Collapse
Affiliation(s)
- Robert F Leger
- Department of Anesthesiology, Lewis Katz
School of Medicine, Temple University, Philadelphia, PA, USA
| | - Matthew S Silverman
- Department of Anesthesiology, Lewis Katz
School of Medicine, Temple University, Philadelphia, PA, USA
| | - Ellen S Hauck
- Department of Anesthesiology, Lewis Katz
School of Medicine, Temple University, Philadelphia, PA, USA
| | - Ksenia D Guvakova
- Department of Anesthesiology and
Critical Care, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, PA, USA
| |
Collapse
|
24
|
Roberts SC, Bharat A, Kurihara C, Tomic R, Ison MG. Impact of Screening and Treatment of Ureaplasma spp on Hyperammonemia Syndrome in Lung Transplant Recipients: A Single Center Experience. Clin Infect Dis 2020; 73:e2531-e2537. [PMID: 33068392 DOI: 10.1093/cid/ciaa1570] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Infection with Ureaplasma species (spp) has been linked to fatal hyperammonemia syndrome (HS) in lung transplant recipients. We sought to characterize the epidemiology of Ureaplasma spp in candidates and donors and describe outcomes of antimicrobial therapy in preventing and treating HS. METHODS Candidate testing for Ureaplasma spp was performed with urine culture and PCR pre-transplant. Positive candidates were treated with levofloxacin. Donor testing was performed with bronchoalveolar lavage culture and PCR intraoperatively. From 7/2014-2/2017 patients were treated according to results; from 2/2017-10/2018 recipients received empiric levofloxacin and azithromycin at transplant until testing returned negative. HS was defined as new onset altered mental status after transplant with ammonia > 200 µmol/L. RESULTS 60 patients who underwent lung transplant were included. 80% (n = 48) of patients had negative screening tests in donor and candidate pre-lung transplant, 8.3% (n = 5) of recipients had positive Ureaplasma spp testing in urine pre-transplant, and 13.3% (n = 8) had positive donor BAL testing at the time of lung transplant. 3 patients developed HS a median of 7 days post-transplant; 2 died of HS. Recipients of organs with Ureaplasma spp who received empiric therapy did not develop HS. Donors with Ureaplasma spp were younger and more sexually active. CONCLUSION Donor-derived Ureaplasma spp in lung transplant was associated with HS. Screening lung donors for Ureaplasma spp might allow for targeted therapy to reduce risk for development of HS, but future confirmatory studies are needed.
Collapse
Affiliation(s)
- Scott C Roberts
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ankit Bharat
- Division of Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Chitaru Kurihara
- Division of Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rade Tomic
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael G Ison
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
25
|
Cheema F, Kutzler HL, Olowofela AS, Maneckshana BT, Rochon C, Sheiner PA, Serrano OK. Successful management of noncirrhotic hyperammonemia syndrome after kidney transplantation from putative
Ureaplasma
infection. Transpl Infect Dis 2020; 22:e13332. [DOI: 10.1111/tid.13332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/20/2020] [Accepted: 05/12/2020] [Indexed: 02/01/2023]
Affiliation(s)
- Faiqa Cheema
- Hartford Hospital Transplant Program Hartford CT USA
- University of Connecticut School of Medicine Farmington CT USA
| | - Heather L. Kutzler
- Hartford Hospital Transplant Program Hartford CT USA
- Department of Pharmacy Hartford Hospital Hartford CT USA
| | | | - Bejon T. Maneckshana
- Hartford Hospital Transplant Program Hartford CT USA
- University of Connecticut School of Medicine Farmington CT USA
| | - Caroline Rochon
- Hartford Hospital Transplant Program Hartford CT USA
- University of Connecticut School of Medicine Farmington CT USA
| | - Patricia A. Sheiner
- Hartford Hospital Transplant Program Hartford CT USA
- University of Connecticut School of Medicine Farmington CT USA
| | - Oscar K. Serrano
- Hartford Hospital Transplant Program Hartford CT USA
- University of Connecticut School of Medicine Farmington CT USA
| |
Collapse
|
26
|
Higgins AB, Farmakiotis D, Rogers R, Osband AJ, Seo A, Chen B, Birkenbach MP, Crabb D, Xiao L, Leal S, Waites K, Gohh R, Morrissey P, Nau GJ. Hyperammonemia syndrome due to Ureaplasma urealyticum in a kidney transplant recipient: A case of disseminated disease from a fluoroquinolone-resistant isolate. Transpl Infect Dis 2020; 22:e13328. [PMID: 32416005 DOI: 10.1111/tid.13328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/02/2020] [Indexed: 12/20/2022]
Abstract
Ureaplasma species (spp.) are common colonizers of the urogenital tract but may cause systemic infection in immunocompromised patients. They release significant amounts of ammonia via urea hydrolysis and have been recently implicated in the pathogenesis of hyperammonemia syndrome after organ transplantation. We describe a unique case of hyperammonemia syndrome after kidney transplant caused by U urealyticum infection, and the first, to our knowledge, case of a fluoroquinolone-resistant Ureaplasma strain causing hyperammonemia syndrome. A 17-year-old female developed intermittent fevers, rising creatinine, sterile pyuria and debilitating polyarthritis approximately 1 year after kidney transplant. Serum ammonia level was elevated, and urine PCR was positive for U urealyticum. Near the end of treatment with levofloxacin, she had rebound hyperammonemia, which preceded clinical relapse of polyarthritis and encephalopathy. Blood and urine PCR and synovial fluid culture were positive for U urealyticum. Susceptibility testing showed fluoroquinolone resistance, but she responded well to azithromycin and doxycycline. The frequency of Ureaplasma spp. infection in immunocompromised patients is probably underestimated due to diagnostic challenges. Ammonia levels were helpful biomarkers of response to antimicrobial therapy in our case. Susceptibility testing of clinical isolates should be pursued. In serious Ureaplasma spp. infections, particularly in immunocompromised patients, two empiric antibiotics may be indicated given the potential for antimicrobial resistance.
Collapse
Affiliation(s)
- Andrea B Higgins
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Dimitrios Farmakiotis
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ralph Rogers
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Adena J Osband
- Department of Surgery (Transplantation), The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Angie Seo
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Brendan Chen
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Mark P Birkenbach
- Department of Pathology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Donna Crabb
- Division of Laboratory Medicine, Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Li Xiao
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sixto Leal
- Division of Laboratory Medicine, Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ken Waites
- Division of Laboratory Medicine, Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Reginald Gohh
- Division of Nephrology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Paul Morrissey
- Department of Surgery (Transplantation), The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Gerard J Nau
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| |
Collapse
|
27
|
Jhaveri VV, Lasalvia MT. Invasive Ureaplasma Infection in Patients Receiving Rituximab and Other Humoral Immunodeficiencies-A Case Report and Review of the Literature. Open Forum Infect Dis 2019; 6:ofz399. [PMID: 31660361 PMCID: PMC6790395 DOI: 10.1093/ofid/ofz399] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 09/05/2019] [Indexed: 11/14/2022] Open
Abstract
Ureaplasma species are small, fastidious bacteria that frequently colonize the lower reproductive tract of asymptomatic hosts. These organisms have been well described to cause chorioamnionitis, neonatal infection, and urethritis, and to a lesser degree surgical site infection and infection in transplant recipients. Outside of these settings, invasive Ureaplasma infections are rare. We describe the case of a young woman receiving rituximab for multiple sclerosis who presented with fever and bilateral renal abscesses due to Ureaplasma spp., which was successfully treated with oral doxycycline. We searched the literature for cases of invasive Ureaplasma infection and found a patient population that predominates with humoral immunodeficiency, either congenital or iatrogenic. Diagnostic and therapeutic interventions are discussed.
Collapse
Affiliation(s)
- Vimal V Jhaveri
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Mary T Lasalvia
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|