Clinical Presentations and Treatment Outcomes of Mycoplasma genitalium Infections at a Large New York City Health Care System.

BACKGROUND: Mycoplasma genitalium (MG) is an emerging sexually transmitted infection. Treatment of MG is complicated by increasing resistance to primary treatment regimens, including macrolides and fluoroquinolones. Understanding the various clinical presentations and relative effectiveness of treatments for MG is crucial to optimizing care. METHODS: Patients with a positive MG nucleic acid amplification test between July 1, 2019, and June 30, 2021, at a large health system in New York City were included in a retrospective cohort. Demographics, clinical presentations, coinfections, treatment, and follow-up microbiologic tests were obtained from the electronic medical record. Associations with microbiologic cure were evaluated in bivariate and multivariable logistic regression models. RESULTS: Five hundred two unique patients had a positive MG nucleic acid amplification test result during the study period. Male individuals presented predominantly with urethritis (117 of 187 [63%]) and female individuals with vaginal symptoms (142 of 315 [45%]). Among patients with follow-up testing who received a single antibiotic at the time of treatment, 43% (90 of 210) had persistent infection and 57% (120 of 210) had microbiologic cure. Eighty-two percent of patients treated with moxifloxacin had microbiologic cure compared with 41% of patients receiving azithromycin regimens ( P < 0.001). In multivariable analysis, treatment with moxifloxacin was associated with 4 times the odds of microbiologic cure relative to low-dose azithromycin (adjusted odds ratio [aOR], 4.18; 95% confidence interval, 1.73-10.13; P < 0.01). CONCLUSIONS: Clinical presentations of MG vary, with urethritis or vaginal symptoms in most cases. Among patients who received a single antibiotic, only treatment with moxifloxacin was significantly associated with microbiologic cure relative to low-dose azithromycin.

Mycoplasma hominis infections in solid organ transplant recipients: Clinical characteristics, treatment outcomes, and comparison of phenotypic and genotypic susceptibility profiles.

BACKGROUND: Mycoplasma hominis can cause significant infections after solid organ transplantation (SOT). Treatment should be guided by susceptibility testing, but conventional lab methods are laborious with prolonged turnaround time (TAT). This case series compares the phenotypic and genotypic susceptibility profiles of M. hominis isolates identified from SOT patients. METHODS: This is a single-center retrospective study evaluating SOT recipients with confirmed M. hominis infections. Patients' demographic, clinical, microbiological, and radiographic data were collected. Culture of M. hominis isolates was performed according to current Clinical and Laboratory Standards Institute guidelines. Phenotypic susceptibility testing was performed by University of Alabama Diagnostic Mycoplasma Laboratory. Whole genome sequencing (WGS) was performed followed by bioinformatic analysis of known genetic determinants of resistance. RESULTS: Seven SOT recipients with M. hominis infections were identified. Two out of seven (28.5%) patients had resistance detected by phenotypic susceptibility testing (Case 5 to levofloxacin and Case 7 to tetracycline). Genomic analyses confirmed the presence of mutations in the parC and parE topoisomerase genes at positions conferring to fluoroquinolone resistance in the isolate from Case 5, while the tetracycline-resistant isolate from Case 7 harbored the tetM gene. The median TAT from the date of specimen collection was 24 days for phenotypic susceptibility testing and 14 days for genotypic susceptibility testing. All seven patients received antimicrobials directed toward M. hominis and recovered with complete resolution of infection. CONCLUSIONS: WGS may offer a novel and more rapid methodology for M. hominis susceptibility testing to help optimize antimicrobial usage, but more data are needed.

Combination of procedure for ultra rapid extraction (PURE) and loop-mediated isothermal amplification (LAMP) for rapid detection of Mycoplasma bovis in milk.

Polymerase chain reaction (PCR) is typically used for the early detection of mycoplasma in bovine milk; it requires 3 days to obtain results because of the necessary enrichment process. A more rapid, simple, and accurate detection method is required to directly detect the Mycoplasma bovis (M. bovis) gene in milk. In this study, we assess the utility of combining the following two methods to achieve this goal: the loop-mediated isothermal amplification (LAMP), which is more sensitive than PCR, and the procedure for ultra rapid extraction (PURE), which adsorbs and filters components that inhibit DNA amplification/detection. LAMP was examined using DNA extracts obtained by four methods. This showed that PURE had the highest sensitivity and specificity and that the combination of PURE and LAMP was able to detect M. bovis in milk. We then showed that the detection limit of M. bovis was 102 colony-forming units per milliliter of milk using the PURE-LAMP. Finally, the respective sensitivities of the PURE-LAMP and PCR were 57% and 86% for bulk tank milk, 89% and 74% for mature milk, 85% and 92% for colostrum/transitional milk, and 97% and 95% for mastitis milk. The specificity was 100% for all milk samples in both LAMP and PCR. We conclude that PCR was suitable for detecting mycoplasma in bulk tank milk and that the PURE-LAMP could detect mycoplasma within 2 hr and was also effective for mature and mastitis milk.

Mycoplasma hominis profile in women: Culture, kit, molecular diagnosis, antimicrobial resistance, and treatment.

OBJECTIVES: Mycoplasma hominis (M.hominis) infections are sexually transmitted and usually associated with urogenital and respiratory diseases. The aim of our study was to (i) detect M. hominis in the vaginal and urine samples of sexually active women using three different detection methods and (ii) to determine the antimicrobial susceptibility and recurrence after the treatment. METHODS: Both vaginal and urine samples were collected from 110 sexually active women at the Obstetrics and Gynecology Clinic, Baskent University Ankara Hospital, Turkey, between March 2015 and February 2016. The presence of M. hominis in the vaginal and urine samples was detected by in vitro culture, two biochemical diagnostics kits (Mycoplasma IES (Autobio, China) and Mycoplasma IST-2 (BioMérieux, France) and PCR. The antibiotic susceptibility of each sample was tested using the kits. The women positive for M. hominis were treated either singly or along with their sexual partners by tetracycline. RESULTS: M. hominis was detected in 72 of 220 (32.7%) samples (both vaginal and urine). Of which 37 showed contrary results with two different kits and then were confirmed by PCR. In 13 samples the IES kit identified M. hominis missed by IST-2, and in 8 samples the MIST-2 kit identified M. hominis missed by IES, while both kits missed 6 samples that were agar culture positive for M. hominis." The highest susceptibility rate was observed against pristinamycin (100%), followed by 91%, 83%, and 75% for doxycycline, tetracycline, and josamycin, respectively. Twenty-five patients treated with tetracycline were followed after one month. The recurrence of M. hominis was not observed in any of the 18 cases where both sexual partners were treated but recurred in 5 of the 7 singly treated women. CONCLUSIONS: The rate of M. hominis detection was significantly higher in the vaginal samples compared to the urine samples. The probability of detecting M. hominis by IST-2 kit was 1.18 times less than IES kit (p < 0.001). When the relationship between the samples was examined, the difference between IES and IST-2 for detecting M. hominis was statistically significant (p < 0.01). Antibiotic susceptibility tests indicated that the tetracycline group of antibiotics was effective in eliminating M. hominis when given to both the sexual partners.

Dual infection in pregnancy: Disseminated Mycoplasma hominis and necrotizing herpes simplex 2 hepatitis.

Mycoplasma hominis is part of the genitourinary flora in sexually active people and can cause disseminated infection in immunocompromised patients. We describe a rare case of an immunocompetent pregnant woman with simultaneous necrotizing HSV hepatitis and disseminated M. hominis infection. Detection of M. hominis and antimicrobial susceptibility testing of this fastidious organism in the clinical laboratory is discussed.

Deployment of Transchromosomal Bovine for Personalized Antimicrobial Therapy.

For decades, intravenous immunoglobulin (IVIg) has provided safe and effective therapy for immunodeficient patients. This proof-of-principle study describes a novel approach to generate personalized IVIg for chronic, antibiotic-resistant infection in real time.

New Horizons in Mycoplasma genitalium Treatment.

Mycoplasmagenitalium is an important sexually transmitted pathogen responsible for both male and female genital tract disease. Appreciation of its significance in human disease has been hampered by its slow growth in culture, difficulty in isolating it, and lack of commercial molecular-based tests for rapid detection. Comparatively few in vitro data on antimicrobial susceptibility are available due to the scarcity of clinical isolates and difficulty in performing susceptibility tests to determine minimum inhibitory concentrations for M. genitalium. Antimicrobial agents that inhibit protein synthesis such as macrolides, along with fluoroquinolones that inhibit DNA replication, have been the treatments of choice for M. genitalium infections. Even though international guidelines recommend azithromycin as first-line treatment, rapid spread of macrolide resistance as well as emergence of quinolone resistance has occurred. Increasing rates of treatment failure have resulted in an urgent need for new therapies and renewed interest in other classes such as aminocyclitols, phenicols, and streptogramins as treatment alternatives. Limited data for new investigational antimicrobials such as the ketolide solithromycin suggest that this drug may eventually prove useful in management of some resistant M. genitalium infections, although it is not likely to achieve cure rates >80% in macrolide-resistant strains, in a similar range as recently reported for pristinamycin. However, agents with completely new targets and/or mechanisms that would be less likely to show cross-resistance with currently available drugs may hold the greatest promise. Lefamulin, a pleuromutilin, and new nonquinolone topoisomerase inhibitors are attractive possibilities that require further investigation.

Multiplex Assay for Simultaneous Detection of Mycoplasma genitalium and Macrolide Resistance Using PlexZyme and PlexPrime Technology.

Mycoplasma genitalium is a cause of non-gonoccocal urethritis (NGU) in men and cervicitis and pelvic inflammatory disease in women. Recent international data also indicated that the first line treatment, 1 gram stat azithromycin therapy, for M. genitalium is becoming less effective, with the corresponding emergence of macrolide resistant strains. Increasing failure rates of azithromycin for M. genitalium has significant implications for the presumptive treatment of NGU and international clinical treatment guidelines. Assays able to predict macrolide resistance along with detection of M. genitalium will be useful to enable appropriate selection of antimicrobials to which the organism is susceptible and facilitate high levels of rapid cure. One such assay recently developed is the MG 23S assay, which employs novel PlexZyme™ and PlexPrime™ technology. It is a multiplex assay for detection of M. genitalium and 5 mutations associated with macrolide resistance. The assay was evaluated in 400 samples from 254 (186 males and 68 females) consecutively infected participants, undergoing tests of cure. Using the MG 23S assay, 83% (331/440) of samples were positive, with 56% of positives carrying a macrolide resistance mutation. Comparison of the MG 23S assay to a reference qPCR method for M. genitalium detection and high resolution melt analysis (HRMA) and sequencing for detection of macrolide resistance mutations, resulted in a sensitivity and specificity for M. genitalium detection and for macrolide resistance of 99.1/98.5% and 97.4/100%, respectively. The MG 23S assay provides a considerable advantage in clinical settings through combined diagnosis and detection of macrolide resistance.

Epidemiological investigation and antimicrobial susceptibility analysis of ureaplasma species and Mycoplasma hominis in outpatients with genital manifestations.

AIMS: The aim of this study was to assess the prevalence and drug resistance of Ureaplasma species and Mycoplasma hominis in outpatients with genital manifestation from 2005 to 2013 in Hangzhou, China. METHODS: A total of 2689 female and 2336 male patients with various genital symptoms were included in this study. Species identification and antimicrobial susceptibility test were performed by using the mycoplasma IST-2 kit. RESULTS: The prevalence rate of Ureaplasma species was 39.9%, M hominis was 1.2% in female patients, and the coinfection rate was 13.4%; while in males, the prevalence rate of Ureaplasma species was 18.8%, M hominis was 0.4%, and the coinfection rate was 2.9%. Moreover, significantly high positive rates for mycoplasmas (Ureaplasma species M hominis) and were found in 16­20-year-old females (65.2%) and males (27.3%). Ureaplasma species and M hominis displayed relatively lower resistance rates (<5.0%) to doxycycline, josamycin, tetracycline and pristinamycin, and the resistance rates did not change during the study period, while the resistance rates of Ureaplasma species to quinolones (ofloxacin and ciprofloxacin) were much higher (>50%) and increased significantly from 2005 to 2013. CONCLUSIONS: Our study indicates that high positive rates of Ureaplasma species and M hominis were found in young outpatients with genital symptoms, and monitoring the local drug resistance is critical for prevention of the occurrence of resistant strains.

Diagnosis and antimicrobial treatment of Mycoplasma genitalium infection: sobering thoughts.

The discovery of Mycoplasma genitalium in 1980-1981 eventually led to it becoming recognized as an important cause of non-gonococcal urethritis in men and also some genital tract diseases in women. Subsequent to the original isolation, further attempts failed over the next decade and reliable detection only became possible with the use of nucleic acid amplification techniques. Although tetracyclines, particularly doxycycline, were the first choice for treatment of non-gonococcal urethritis prior to the finding of M. genitalium, they were unsatisfactory for the treatment of M. genitalium-associated disease; the organisms were often not eliminated leading, for example, to chronic urethritis. However, the introduction of azithromycin, used as single-dose therapy for chlamydial infections, resulted in clearance of the mycoplasmal organisms from the genital tract and clinical recovery without the development of chronic disease. Nevertheless, such success was short-lived as M. genitalium, through mutation, began to develop resistance to azithromycin and M. genitalium mutants also began to circulate in some populations. In an attempt to counteract this, clinicians should give extended therapy, and in the future, microbiologists, using real-time PCRs, might be able to determine the existence of resistant strains in the local population and so advise on the most appropriate antibiotic. Other than azithromycin, there are a few options, moxifloxacin being one, although the recently reported resistance to this antibiotic is disturbing. In the short to medium term, combination therapy and/or the advent of a new antibiotic might abate the spread of resistance, but in the long term, there is potential for increasing prevalence of untreatable M. genitalium disease. In the future, attempts to develop a vaccine and, of equal importance, one to Chlamydia trachomatis, would not be out of place.

Subtalar joint septic arthritis in a patient with hypogammaglobulinemia.

The clinical presentation of a monoarticular, red, hot, and swollen joint has many possible diagnoses, including septic arthritis, which is 1 of the most devastating. The morbidity associated with this pathologic process involves permanent joint damage and the potential for progression to systemic illness and, even, mortality. The common risk factors for joint sepsis include a history of rheumatoid arthritis, previous joint surgery, joint prosthesis, intravenous drug abuse, alcoholism, diabetes, previous intra-articular steroid use, and cutaneous ulceration. The diagnosis is primarily determined from the culture results after arthrocentesis and correlation with direct visualization, imaging, and various serologies, including synovial analysis. In the present report, a case of an insidious presentation of subtalar joint septic arthritis and its association with a unique patient presentation concomitant with primary immunodeficiency and culture-proven Myocplasma hominis infection is discussed. Septic arthritis has a predilection for the lower extremities and typically is isolated to the hip or knee, with less common involvement of the ankle or metatarsophalangeal joints. Owing to the uncommon nature of primary immunodeficiency disorders and the paucity of studies discussing their association with septic arthridites, we aimed to raise awareness of subtalar joint septic arthritis and to provide a brief overview of the pathogenesis as it presented in a 33-year-old male with X-linked hypogammaglobulinemia/agammaglobulinema.

Recent perspectives in the diagnosis and evidence-based treatment of Mycoplasma genitalium.

Mycoplasma genitalium is a globally important sexually transmitted pathogen. Men infected with M. genitalium frequently present with dysuria, while women may present with or without urogenital symptoms. In some populations, M. genitalium is significantly associated with HIV-1 infection, and is also an etiological agent in pelvic inflammatory disease. However, there is insufficient evidence to establish a causative role of the organism in obstetric complications, including tubal factor infertility. Although several nucleic acid amplification tests offer rapid, sensitive methods for detecting M. genitalium, there is no standardized assay. Available evidence supports treatment of M. genitalium infections with an extended regimen of azithromycin and resistant strains respond to moxifloxacin. Accumulating evidence indicates growing fluoroquinolone resistance, including against moxifloxacin, emphasizing the need for new therapeutic strategies to treat M. genitalium infections.

[Antibiotic resistance as a public health problem: the case of genital mycoplasmoses]. / L'antibiotico resistenza un problema di sanità pubblica: il caso delle micoplasmosi genitali.

Antibiotic resistance is an emerging public health problem especially due to the continuous use of antibiotics that selects more aggressive and resistant species. In the present study the authors determined the antibiotic sensitivity of 128 Mycoplasma hominis strains obtained from urethral swabs of male patients (mean age 36 years). The Mycoplasma IST 2 strip was used to test antibiotic susceptibility: 88% of analysed strains were found to be resistant to erythromycin and azithromycin, 75% to clarithromycin, 50% to ofloxacin and ciprofloxacin, and 12% to tetracycline. All strains were susceptible to josamycin, doxycycline and pristinamycin. Results were comparable to those of a recent study by Savarino-Mattei which also showed high resistance of M hominis to macrolide antibiotics and to ciprofloxacin and susceptibility to tetracyclines. Doxycycline is currently the antibiotic of first choice for treating M hominis infections.

Diagnosis and treatment of mycoplasma-contaminated cell cultures.

Mycoplasma contamination is a serious and frequent problem in the culture laboratory. Although mycoplasma contamination may be suspected by the failure of cells to thrive, the formal diagnosis rests on the detection of adenosine phosphorylase secretion by infected cell lines. This appendix describes how to test for mycoplasma contamination, and also presents methods for antibiotic treatment of infected cultures.

Mastitis in a 7-week old calf caused by Mycoplasma bovigenitalium.

This is the first report of an intramammary infection caused by Mycoplasma bovigenitalium in a 7-week old Holstein calf. The calf was initially presented for a non-weight bearing lameness in the left hind limb. The clinical examination revealed not only a septic arthritis of the tarsus but also an infection affecting the right rear mammary gland. The source of M. bovigenitalium was not found but the most likely explanation is spread from the infected left tarsus. This case report demonstrates that mycoplasma mastitis can occur in pre-weaned calves, which could play a role in the epidemiology of mycoplasma mastitis in dairy herds.

Otitis media in dairy calves: a retrospective study of 15 cases (1987 to 2002).

Epidemiological data, clinical signs, complementary examination findings, antimicrobial treatments, and outcome were reviewed in 15 calves diagnosed with otitis media at the Centre hospitalier universitaire vétérinaire de l'Université de Montréal between 1987 and 2002. Age at presentation ranged from 2 to 18 weeks. A purulent ear discharge and epiphora were seen in 8/12 and 6/15 cases, respectively. Neurological signs observed were head tilt (13), eyelid ptosis (7), paresis/paralysis of the pinna (8), ataxia (2), strabismus (2), and convulsions (1). Concurrent pneumonia was frequently diagnosed (n = 11). A Mycoplasma sp. was the principal pathogen isolated from ear discharge; 6 out of 6 samples submitted were positive for mycoplasma. Tympanic bullae radiographs were considered abnormal in 12 out of 13 cases. Cerebrospinal fluid analysis was considered abnormal in 2 out of 5 cases. The antibiotic most commonly used was enrofloxacin (n = 7). Average treatment duration was 19.6 days. Four out of 8 treated animals for which follow-up information was available completely recovered. These results suggest that M. bovis is a major pathogen of otitis media in dairy calves and effective antimicrobial therapy should be of long duration.

[Atypical encephalitis in a 20-year-old soldier]. / Atypische Enzephalitis eines 20-jährigen Wehrpflichtigen.

We report a patient with encephalitis who had been diagnosed with an unspecific aetiology. During follow-up, pneumonia was identified due to Mycoplasma pneumoniae infection that could also be confirmed as causal for the brain inflammation. Despite the initially critical clinical situation, the patient's condition improved under specific antibiotic treatment. Pathophysiologic, differential diagnostic, and therapeutic implications are discussed, and guidelines for diagnosis are proposed.

[Bronchopneumonia and polyarthritis due to Mycoplasma bovis in a calf]. / Bronchopneumonie und Polyarthritis mit Nachweis von Mycoplasma bovis bei einem Rind.

This case report describes gross lesions and histopathological findings in a 3-months-old calf originating from a feedlot with approximately 400 cattle. In this animal and additional 14 cattle of similar age, which were kept together in the same stable, swollen joints had occurred suddenly. The examination of this calf showed that a severe polyarthritis induced by haematogenous spread of Mycoplasma bovis following bronchopenumonia was present, which was characterised by necrotising lesions of the joint capsules and severe cartilage erosions.