Septic arthritis of the shoulder due to Ureaplasma urealyticum after emergency caesarean section: a case report

Ureaplasma infections: update on epidemiology, antimicrobial resistance, and pathogenesis

Human Ureaplasma species are being increasingly recognized as opportunistic pathogens in human genitourinary tract infections, infertility, adverse pregnancy, neonatal morbidities, and other adult invasive infections. Although some general reviews have focused on the detection and clinical manifestations of Ureaplasma spp., the molecular epidemiology, antimicrobial resistance, and pathogenesis of Ureaplasma spp. have not been adequately explained. The purpose of this review is to offer valuable insights into the current understanding and future research perspectives of the molecular epidemiology, antimicrobial resistance, and pathogenesis of human Ureaplasma infections. This review summarizes the conventional culture and detection methods and the latest molecular identification technologies for Ureaplasma spp. We also reviewed the global prevalence and mechanisms of antibiotic resistance for Ureaplasma spp. Aside from regular antibiotics, novel antibiotics with outstanding in vitro antimicrobial activity against Ureaplasma spp. are described. Furthermore, we discussed the pathogenic mechanisms of Ureaplasma spp., including adhesion, proinflammatory effects, cytotoxicity, and immune escape effects, from the perspectives of pathology, related molecules, and genetics.

Disseminated Ureaplasma urealyticum Infection and Hyperammonemic Encephalopathy in a Patient With Activated PI3K Delta Syndrome 2

Hyperammonemia syndrome (HS) from Ureaplasma infection is typically reported in posttransplant recipients, particularly lung transplant. We describe a young woman with activated PI3K delta syndrome 2 who presented with HS from disseminated Ureaplasma urealyticum infection with septic arthritis. We also performed a literature review of Ureaplasma-associated HS in nontransplant patients.

Rare case of postpartum septic arthritis of the shoulder caused by multi-drug resistant Kingella kingae: A case report

INTRODUCTION

Septic arthritis is a severe joint infection that can cause permanent damage if not promptly treated. Although the shoulder is an uncommon site for this condition, Kingella kingae, typically associated with pediatric infections, can occasionally be a causative agent. Postpartum septic arthritis is rare, making this case particularly unique.

PRESENTATION OF CASE

We report a case of a 28-year-old woman who developed severe pain, swelling, and restricted movement in her left shoulder three weeks postpartum. Septic arthritis due to multi-drug resistant Kingella kingae was diagnosed via PCR analysis of the synovial fluid. The patient was successfully managed with intravenous antibiotics and arthroscopic drainage.

DISCUSSION

This case represents a rare instance of postpartum septic arthritis of the shoulder caused by Kingella kingae. The unusual presentation highlights the importance of considering septic arthritis in postpartum women presenting with shoulder pain, even without typical risk factors. The multi-drug resistance observed in this strain underscores the necessity for comprehensive antibiotic susceptibility testing and individualized treatment strategies.

CONCLUSION

This case demonstrates that successful management of postpartum septic arthritis caused by Kingella kingae can be achieved through early diagnosis, targeted antibiotic therapy, and minimally invasive surgical intervention. It emphasizes the importance of a multidisciplinary approach, thorough diagnostic evaluation, and heightened clinical suspicion in postpartum women with shoulder pain to prevent long-term complications.

Hyperammonemia in a septic patient with Ureaplasma parvum arthritis: a case report

BACKGROUND

Septic arthritis requires prompt diagnosis and treatments. Rare pathogens should be considered when patients respond poorly to the initial antibiotic treatments. Ureaplasma parvum is an opportunistic pathogen that commonly resides in the human urogenital tract. Its infection commonly causes hyperammonemia. Hyperammonemia from Ureaplasma parvum septic arthritis has never been reported previously.

CASE PRESENTATION

A 65-year-old male presented with fever and left lower leg pain and swelling for more than ten days. Septic arthritis and sepsis were considered after laboratory tests and arthrocentesis. However, he responded poorly to the antibiotic treatments, including cefoperazone-sulbactam, imipenem-cilastatin, and linezolid. His mental status deteriorated rapidly with elevated blood ammonia levels with unremarkable liver function test and sonogram examination results. Despite the treatments with lactulose, L-ornithine L-aspartate, mannitol, and hemodialysis therapy to lower his ammonia level, his blood ammonia level remained persistently high. Finally, metagenomic sequencing of the left knee synovial fluid reported Ureaplasma parvum, which was considered to contribute to his hyperammonemia.

CONCLUSION

Ureaplasma parvum could cause septic arthritis with hyperammonemia. Genetic tests, such as polymerase chain reaction and next-generation sequencing techniques, could provide a sensitive and fast diagnosis of Ureaplasma parvum.

Diagnostic Value of Metagenomic Next Generation Sequencing for Ureaplasma urealyticum Infection: A Case Report

Ureaplasma urealyticum has high nutritional requirements for culture, and it requires special tools for identification. Theoretically, metagenomic next generation sequencing (mNGS) can be used to detect many pathogens in clinical specimens, especially for complex infectious diseases with rare and atypical causes. Here, our patient developed severe pneumonia caused by U. urealyticum infection after allogeneic hematopoietic stem cell transplantation, and the etiology is unclear. After continuous negative culture, U. urealyticum was detected in the bronchoalveolar lavage fluid by mNGS, and azithromycin was used. Because of the difficulty in its diagnosis, diagnosis and treatment of extragenital U. urealyticum infection is challenging. In addition, many broad-spectrum antibiotics are ineffective against this pathogen because it lacks a cell wall. Therefore, early diagnosis and treatment are key to preventing further complications and deaths.