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Potruch A, Rosenthal G, Michael-Gayego A, Temper V, Abdelrahman M, Ayalon O, Nir-Paz R, Oster Y. A Case Report of Mycoplasma hominis Subdural Empyema Following Decompressive Craniotomy, and a Review of Central Nervous System Mycoplasma hominis Infections. Front Med (Lausanne) 2022; 9:792323. [PMID: 35280893 PMCID: PMC8908106 DOI: 10.3389/fmed.2022.792323] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 02/01/2022] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- Assaf Potruch
- Department of Internal Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Guy Rosenthal
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Neurosurgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ayelet Michael-Gayego
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Violeta Temper
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Mohanad Abdelrahman
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Oshrat Ayalon
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ran Nir-Paz
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Yonatan Oster
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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2
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Diab A, AlMusawi SSM, Hudhaiah D, Magzoub R, Al Rashed AS, Al Musawi TS. Iatrogenic Ventriculitis Due to Mycoplasma Hominis: A Case Report and Review of the Literature. Am J Case Rep 2019; 20:406-411. [PMID: 30923306 PMCID: PMC6452781 DOI: 10.12659/ajcr.914284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Mycoplasma hominis, which rarely causes infection after neurosurgical procedures, is a small free-living organism, belonging to the genus Mycoplasma. M. hominis lacks a rigid cell wall and cannot be clearly visualized by routine light microscopy. Thus, it is challenging to diagnose infections caused by this pathogen. Here, we report a case of Mycoplasma hominis causing iatrogenic ventriculitis secondary to extraventricular drain. CASE REPORT A 25-year-old man who was a victim of a road traffic accident developed M. hominis ventriculitis secondary to extraventricular drain. Despite a delay in the diagnosis due to the difficulty of identifying M. hominis, the patient was successfully treated with intravenous ciprofloxacin 400 mg for 14 days. CONCLUSIONS The findings of this case report, coupled with a thorough review of the literature, demonstrate the pathogenic potential of M. hominis. Particularly in developing countries, in which laboratories may have limited access to advanced technologies, such rare infectious diseases remain major diagnostic challenges.
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Affiliation(s)
- Asim Diab
- Department of Microbiology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | - Safiya Sayed Mahmood AlMusawi
- Department of Microbiology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | - Dhoha Hudhaiah
- Department of Microbiology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | - Rania Magzoub
- Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | - Abdullatif S Al Rashed
- Department of Microbiology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | - Tariq S Al Musawi
- Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
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Bergin SM, Mendis SM, Young B, Binti Izharuddin E. Postoperative Mycoplasma hominis brain abscess: keep it in mind! BMJ Case Rep 2017; 2017:bcr2016218022. [PMID: 28069785 PMCID: PMC5255544 DOI: 10.1136/bcr-2016-218022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 01/29/2023] Open
Abstract
A temporal lobe abscess was diagnosed in a 57-year-old man. A urethral catheter had been inserted 12 days earlier, just prior to clot evacuation of a subacute haematoma secondary to an arterio-venous malformation. Fever persisted despite debridement and treatment with meropenem and vancomycin. Gram stains of operative samples showed no bacteria. Extended cultures grew pinpoint colonies after 5 days. Meanwhile, sequencing of bacterial 16S rDNA from operative specimens had identified Mycoplasma hominis; the bacterial colonies were subsequently similarly identified. The patient responded promptly following addition of oral doxycycline 100 mg two times per day. There is a growing literature of similar cases. Transient bacteraemia, following urinary catheterisation, with seeding of existing sites of inflammation is the proposed explanation. Urethral carriage of M. hominis is 15% and catheterisation is a common procedure. Mycoplasma hominis maybe more common than appreciated, especially as the need for extended cultures makes a correct diagnosis less likely.
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Affiliation(s)
- Sarah Maria Bergin
- Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Shehara M Mendis
- Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Barnaby Young
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
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4
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Zhou M, Wang P, Chen S, Du B, Du J, Wang F, Xiao M, Kong F, Xu Y. Meningitis in a Chinese adult patient caused by Mycoplasma hominis: a rare infection and literature review. BMC Infect Dis 2016; 16:557. [PMID: 27729031 PMCID: PMC5059901 DOI: 10.1186/s12879-016-1885-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 10/01/2016] [Indexed: 12/28/2022] Open
Abstract
Background Mycoplasma hominis, a well known cause of neonatal infection, has been reported as a pathogen in urogenital infections in adults; however, central nervous system (CNS) infections are rare. We report here the first case of M. hominis meningitis in China, post neurosurgical treatment for an intracerebral haemorrhage in a 71-year-old male. Case presentation We describe a 71-year-old man who developed M. hominis meningitis after neurosurgical treatment and was successfully treated with combined azithromycin and minocycline therapy of 2 weeks duration, despite delayed treatment because the Gram stain of cerebrospinal fluid (CSF) yielded no visible organisms. The diagnosis required 16S rDNA sequencing analysis of the cultured isolate from CSF. Literature review of M. hominis CNS infections yielded 19 cases (13 instances of brain abscess, 3 of meningitis, 1 spinal cord abscess and 1 subdural empyema each). Delay in diagnosis and initial treatment failure was evident in all cases. With appropriate microbiological testing, antibiotic therapy (ranging from 5 days to 12 weeks) and often, multiple surgical interventions, almost all the patients improved immediately. Conclusions Both our patient findings and the literature review, highlighted the pathogenic potential of M. hominis together with the challenges prompted by rare infectious diseases in particular for developing countries laboratories with limited diagnostic resources. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1885-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Menglan Zhou
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China.,Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Peng Wang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Sharon Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Pathology West, Westmead Hospital, University of Sydney Darcy Road, Westmead, New South Wales, 2145, Australia
| | - Bin Du
- Department of Medical Intensive Care Unit, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jinlong Du
- Department of Clinical Laboratory, Fu Xing Hospital, Capital Medical University, Beijing, China
| | - Fengdan Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Meng Xiao
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Fanrong Kong
- Centre for Infectious Diseases and Microbiology Laboratory Services, Pathology West, Westmead Hospital, University of Sydney Darcy Road, Westmead, New South Wales, 2145, Australia
| | - Yingchun Xu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China.
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Morel F, Abdennour L, Belaid H, Renvoisé A, Jarlier V, Aubry A. Answer to March 2016 Photo Quiz. J Clin Microbiol 2016; 54:823-823. [DOI: 10.1128/jcm.00351-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Hos NJ, Bauer C, Liebig T, Plum G, Seifert H, Hampl J. Autoinfection as a cause of postpartum subdural empyema due to Mycoplasma hominis. Infection 2014; 43:241-4. [PMID: 25491170 DOI: 10.1007/s15010-014-0713-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 12/03/2014] [Indexed: 01/29/2023]
Abstract
Mycoplasma hominis is a commensal of the genitourinary tract, which is infrequently associated with urogenital infections. Extra-urogenital infections due to M. hominis are rare. Here, we report an unusual case of M. hominis subdural empyema in a woman occurring shortly after delivery. The patient presented with symptoms suggestive of bacterial meningitis. Spinal imaging revealed a subdural empyema that required neurosurgical intervention. Cultures from intraoperatively obtained biopsies identified M. hominis as the causative pathogen. The patient was treated with oral moxifloxacin for 4 weeks resulting in the resolution of the spinal lesion. The subdural empyema was presumably caused by a contaminated epidural blood patch performed with the patient's own blood during an episode of transient M. hominis bacteremia after delivery. The blood patch was indicated for the treatment of cerebrospinal fluid leakage, which had occurred after epidural anesthesia. Our findings highlight the significance of transient M. hominis bacteremia after delivery and implicate that M. hominis should be considered as a causative agent of extra-genitourinary tract infections particularly during the postpartum period or after genitourinary manipulation.
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Affiliation(s)
- N J Hos
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstr. 19-21, 50935, Cologne, Germany,
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7
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Lee EHL, Winter HLJ, van Dijl JM, Metzemaekers JDM, Arends JP. Diagnosis and antimicrobial therapy of Mycoplasma hominis meningitis in adults. Int J Med Microbiol 2012; 302:289-92. [PMID: 23085510 DOI: 10.1016/j.ijmm.2012.09.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 09/05/2012] [Accepted: 09/10/2012] [Indexed: 01/14/2023] Open
Abstract
Meningitis in adults due to infection with Mycoplasma hominis is rarely reported. Here, we document the third case of M. hominis meningitis in an adult individual, developed upon neurosurgery following a subarachnoid haemorrhage. Our findings are noteworthy, because the presence of M. hominis in cerebrospinal fluid cannot be identified by standard culturing, Gram-staining, or matrix-assisted laser desorption ionization time-of-flight mass spectrometry. Importantly, however, 16S rDNA sequencing did lead to an unambiguous diagnosis and guided successful antimicrobial therapy. Based on our present findings and a review of the respective literature, we conclude that M. hominis should be considered as a candidate causative agent of infections of the central nervous system following neurosurgical procedures, especially if there is no response to standard antimicrobial therapy, and routine culturing yields negative results.
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Affiliation(s)
- Elisabeth H L Lee
- Dept. of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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8
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Henao-Martínez AF, Young H, Nardi-Korver JJL, Burman W. Mycoplasma hominis brain abscess presenting after a head trauma: a case report. J Med Case Rep 2012; 6:253. [PMID: 22913832 PMCID: PMC3459716 DOI: 10.1186/1752-1947-6-253] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 06/08/2012] [Indexed: 11/21/2022] Open
Abstract
Introduction Mycoplasma hominis brain abscess is a rare occurrence, and treatment is not well defined. The mechanism by which M. hominis infects sites outside the genitourinary tract, including the central nervous system, is unclear. Case presentation We report the case of a 40-year-old Somali man who sustained a traumatic brain injury that required initial neurosurgical hematoma evacuation and that subsequently was complicated by a hospital-acquired M. hominis brain abscess. Our patient was successfully treated with neurosurgical debridement and an antibiotic course of intravenous doxycycline. Conclusions Head trauma or neurosurgical procedures or both might be a predisposing factor for this type of infection.
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Affiliation(s)
- Andrés F Henao-Martínez
- Department of Medicine, Division of Infectious Diseases, 12700 E, 19th Avenue, Mail Stop B168, Aurora, CO 80045, USA.
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Al Masalma M, Drancourt M, Dufour H, Raoult D, Fournier PE. Mycoplasma hominis brain abscess following uterus curettage: a case report. J Med Case Rep 2011; 5:278. [PMID: 21722404 DOI: 10.1186/1752-1947-5-278] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 07/03/2011] [Indexed: 01/29/2023] Open
Abstract
Introduction Mycoplasma hominis is mostly known for causing urogenital infections. However, it has rarely been described as an agent of brain abscess. Case presentation We describe a case of M. hominis brain abscess in a 41-year-old Caucasian woman following uterus curettage. The diagnosis was obtained by 16S rDNA amplification, cloning and sequencing from the abscess pus, and confirmed by a specifically designed real-time polymerase chain reaction assay. Conclusions Findings from our patient's case suggest that M. hominis should be considered as a potential agent of brain abscess, especially following uterine manipulation.
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10
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McCarthy KL, Looke DFM. Successful treatment of post-neurosurgical intracranial Mycoplasma hominis infection using gatifloxacin. J Infect 2008; 57:344-6. [PMID: 18708262 DOI: 10.1016/j.jinf.2008.06.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Revised: 06/26/2008] [Accepted: 06/28/2008] [Indexed: 01/29/2023]
Abstract
We describe two cases of intracerebral infection with Mycoplasma hominis following neurosurgery, the first after removal of a colloid cyst, the other after a craniotomy following a motor vehicle accident (MVA). Both infections were successfully treated with parenteral gatifloxacin, with ongoing clindamycin or moxifloxacin for associated osteomyelitis.
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Affiliation(s)
- K L McCarthy
- Sullivan Nicolaides Pathology, Taringa, QLD 4068, Australia.
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Kupila L, Rantakokko-Jalava K, Jalava J, Peltonen R, Marttila RJ, Kotilainen E, Kotilainen P. Brain abscess caused by Mycoplasma hominis: A clinically recognizable entity? Eur J Neurol 2006; 13:550-1. [PMID: 16722987 DOI: 10.1111/j.1468-1331.2006.01209.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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