Intracranial Mycoplasma hominis infection following emergent craniectomy

Intracranial infection in an adult caused by Mycoplasma hominis, diagnosed using mNGS technology: a case report

Mycoplasma hominis is a rare cause of adult central nervous system infections, posing significant diagnostic challenges due to its fastidious growth requirements and high false-negative rate in conventional cultures. We report a case of Mycoplasma hominis meningoencephalitis in a postpartum female, diagnosed via metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid (CSF). The patient presented with fever, headache, and progressive neurological deficits following a cesarean section. Neuroimaging revealed a subdural hematoma, and CSF analysis demonstrated an inflammatory response. mNGS identified Mycoplasma hominis, prompting targeted antimicrobial therapy with moxifloxacin and doxycycline, which led to significant clinical improvement. This case underscores the utility of mNGS in detecting rare intracranial infections and highlights the critical role of early pathogen identification in optimizing treatment outcomes.

Mycoplasma hominis Intracranial Abscess Diagnosed by Characteristic Colonies Obtained Through Extended Culture: Case Report and Literature Review

Mycoplasma hominis (M. hominis) causes genitourinary infections and pregnancy-related complications. Reports of intracranial abscesses due to M. hominis infection are rare. Here, we report a M. hominis intracranial abscess case following a traffic accident who was admitted to our hospital (day 0). The patient, a man in his 70s, underwent cystourethrography, and a urethral catheter was inserted. On day three, the patient underwent intracerebral hematoma evacuation, and on day seven, intravenous ceftazidime and vancomycin were administered after the patient developed a fever. On day 10, the antibiotics were switched to meropenem and vancomycin due to persistent fever. On day 17, magnetic resonance imaging revealed brain and epidural abscesses, and abscess drainage was performed. Gram staining of the abscess specimen showed numerous polymorphonuclear leukocytes, but no visible microorganisms. On day 19, two days after inoculating the culture, tiny pinpoint colonies were observed on the blood agar. Sequencing of the 16S rRNA gene from these colonies revealed the presence of M. hominis. On day 27, the treatment was changed to levofloxacin and clindamycin for treatment of the intracranial abscesses caused by M. hominis. Antibiotic therapy was continued for an additional 52 days until the abscesses disappeared. No recurrences were observed. When bacteria are suspected to be the cause of an intracranial abscess with a risk of M. hominis infection, and Gram staining does not show any microorganisms, considering M. hominis as one of the causative pathogens, conducting extended culture is important.

Chronic osteomyelitis with pathological fracture induced by Mycoplasma hominis infection: a case report and review of the literature

Mycoplasma hominis, commonly residing in the genitourinary tract, can cause rare extragenital infections, especially in immunocompromised individuals. This report details a case of chronic osteomyelitis with a pathological femur fracture in a 79-year-old woman. Despite a history of bone tuberculosis, the infection was identified as Mycoplasma hominis through culture and mass spectrometry, highlighting the diagnostic challenges due to the organism's lack of a cell wall. This case underscores the necessity for advanced diagnostic methods and awareness of Mycoplasma hominis in non-urogenital infections.

Infection of Mycoplasma hominis in the left lower leg amputation wound of a patient with diabetes: a case report

BACKGROUND

Mycoplasma hominis is typically found on the mucosal epithelium of the human genital tract, with infections being rare. However, when the mucosal barrier is compromised or in individuals with weakened immune systems, this microorganism can trigger infections in both intragenital and extragenital sites. This study offers a comprehensive overview of infections caused by the rare pathogen M. hominis. This overview helps laboratories identify M. hominis infections in a timely manner, thereby enabling earlier clinical intervention for patients.

CASE PRESENTATION

A 75-year-old Taiwanese man with type 2 diabetes mellitus initially underwent a left lower extremity amputation following a severe infection caused by necrotizing fasciitis. Subsequently, a poorly healing wound developed at the site of amputation. Upon culturing the wound abscess, M. hominis was isolated and identified as the causative agent.

CONCLUSIONS

Through this case, we present clinical and microbiological observations along with a review of the literature to deepen our understanding of M. hominis. Our findings can be used to develop laboratory diagnostic protocols and innovative therapeutic approaches.

Mycoplasma hominis peritonitis after oocyte donation

We report the case of a young, immunocompetent, non-pregnant woman diagnosed with acute abdomen 3 weeks after an ultrasound-guided transvaginal oocyte retrieval (TVOR). Peritoneal fluid, obtained during exploratory laparoscopy, yielded Mycoplasma hominis as the sole pathogen. The patient's symptoms and signs improved after 24-hour treatment with intravenous clindamycin, ampicillin and gentamycin. Complete resolution was achieved with oral doxycycline for 14 days.

Bilateral decompressive craniotomy complicated by postoperative mycoplasma hominis epidural empyema and meningitis: A case report

RATIONALE

Postoperative intracranial mycoplasma hominis infection was a rare complication. Timely diagnosis was difficult due to its growth characteristics and nonspecific clinical symptoms.

PATIENT CONCERNS

A 52-year-old man underwent bilateral decompressive craniotomy for severe traumatic brain injury. On the seventeenth day after surgery, the patient developed an unexplained high fever. Empirical anti-infective therapy was ineffective, and the fever persisted. In addition, viscous pus oozed from the head incision. Empiric therapy was still ineffective, the fever persisted, and the culture result was negative. The lumbar puncture pressure was 150 mmH2O and the cerebrospinal fluid white blood cell count was 3600 × 106/L, suggesting an intracranial infection.

DIAGNOSES

Culture growth morphologically consistent with mycoplasma species was obtained from multiple specimens (scalp incision fluid and cerebrospinal fluid) and the identification of mycoplasma hominis was confirmed by 16S rDNA sequencing.

INTERVENTION

Targeted anti-infective therapy (Minocycline), change of fresh wound dressing, and continued lumbar cerebrospinal fluid drainage.

OUTCOME

At the 3-month follow-up, the patient was still in the rehabilitation department of the local hospital for treatment, but there were no symptoms of intracranial infection.

LESSONS

Neurosurgeons should carefully examine postoperative incisions and be aware of the possibility of mycoplasma infection during clinical management.

A Case Report of Mycoplasma hominis Subdural Empyema Following Decompressive Craniotomy, and a Review of Central Nervous System Mycoplasma hominis Infections

Background

Mycoplasma hominis is a small cell-wall-free organism, part of the normal microbiota of the genitourinary tract. It is rarely involved in extragenital infections, mainly joint, surgical-site, and respiratory infections.

Methods

We describe a case of M. hominis subdural empyema and lower limb surgical site infections, following decompressive craniotomy, after traumatic brain and extremities injury. In addition, a literature review of 34 cases M. hominis CNS infections was done.

Results

Our case depicts a 25-years old patient who developed subdural empyema and surgical site infections in his cranium and fibula. Both sites were cultured, and small pinpoint colonies grew on blood agar. MALDI-TOF MS identified M. hominis. Simultaneously 16S-rDNA PCR from CSF detected M. hominis. Antimicrobial treatment was switched to doxycycline with improvement. Literature review revealed 21 adults and 13 pediatric cases of M. hominis CNS infection. Risk factors in adults were head trauma, neurosurgery, or post-partum period.

Conclusions

Based upon the literature reviewed, we postulate that adult patients with head trauma or neurosurgical procedure, rarely are infected either through direct contamination during the trauma, or by undergoing urgent, urinary catheterization, and may experience distant infection due to translocation of M. hominis into the bloodstream. In such cases diagnosis is delayed due to difficulties in growing and identifying the bacteria. Empiric antimicrobials are usually not effective against mycoplasmas. These factors contributed to the mortality in adult cases (15%). Our rare case highlights the necessity of combining classical microbiology routines with advanced molecular techniques to establish a diagnosis in complicated cases.