Ureaplasma urealyticum overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Fatimo Biobaku M.B.B.S [2]
Overview
Ureaplasma species (U. urealyticum and U. parvum) are commensal organisms commonly found in the urogenital tract of sexually active men and women.[1] These organisms are considered to be of low virulence although several studies have demonstrated an association between vaginal colonization by Ureaplasma species and adverse pregnancy outcomes including perinatal morbidity and mortality.[2][3][4][5] Some studies also show an association between urogenital colonization by U. urealyticum and nongonococcal urethritis in men.[6][7][8] However, the pathogenic role of Ureaplasma urealyticum in nongonococcal urethritis is still not clear.[9][10][11] Colonization with Ureaplasma species occur in asymptomatic and symptomatic infants and adults, and further investigations to determine the exact pathogenic role of Ureaplasma is required.[5] There is often a medical dilemma as to whether an isolation of Ureaplasma represents a 'true' infection or 'mere' colonization. Hence, the challenge in making a decision whether medical treatment is necessary.
Historical Perspective
T-strain mycoplasma (now known as Ureaplasma urealyticum) was first discovered in the human urogenital tract in 1954 by Shepard et al.[10][7] Tiny (T)-strain mycoplasma was renamed Ureaplasma urealyticum in 1974.[10][7]
Classification
U. urealyticum was previously classified into two biotypes:[7][10]
- Biovar 1 ( parvo biovar): Ureaplasma urealyticum biovar 1 is now known as U. parvum.
- Biovar 2 (T960 biovar): Ureaplasma urealyticum biovar 2 strain retained its designation as U. urealyticum.
Pathophysiology
Ureaplasma raises the pH of the vagina by hydrolyzing urea into carbon dioxide and ammonia, increasing the susceptibility to mixed infection with other pathogenic bacteria.[5] These pathogens stimulate the secretion of pro-inflammatory cytokines and chemokines, leading to the recruitment of leukocytes and production of prostaglandins, which subsequently result in preterm birth.[1][5] Vertical transmission of Ureaplasma has also been associated with neonatal complications such as pneumonitis, bacteremia, and meningitis, following stimulation of fetal inflammatory responses by the organism.[12][13] Some studies conducted in men show there is an association between urogenital colonization by Ureaplasma urealyticum and nongonococcal urethritis, however, the pathogenic role of Ureaplasma urealyticum in nongonococcal urethritis is not clear.[6][7][8][9][10][11]
Causes
Ureaplasma species are bacteria belonging to the family Mycoplasmataceae.[14]
Differentiating Ureaplasma from other Bacteria
There are no specific signs and symptoms that can distinguish Ureaplasma infection from infection caused by other microorganisms. Ureaplasma species cannot be cultured on conventional culture media for most bacteria and special culture media for Mycoplasma is often needed.
Epidemiology and Demographics
Ureaplasma species colonize 40-80% of the genital tract of healthy women.[13] [4][15][12] They are the most common pathogen identified in VLBW infants.[12] Ureaplasma colonization of the respiratory tract is more common in preterm VLBW infants compared to term infants.[16][17] 20-45% of VLBW infants have Ureaplasma colonization of the respiratory tract.[4]
Risk factors
Several risk factors have been identified for Ureaplasma infection such as heavy urogenital colonization in adults, multiple sexual partners, immunosuppression, and prematurity in neonates.[13][4][12][5][18][19]
Natural History, Complications and Prognosis
The genital tract of adult men and women serve as the main reservoirs for Ureaplasma species.[7][4] Pregnancy complications such as chorioamnionitis, preterm labor, and miscarriages have been associated with Ureaplasma.[5][20][18][21][19] Neonatal complications associated with Ureaplasma include prematurity, pneumonia, pneumonitis, bronchopulmonary dysplasia, respiratory distress syndrome of the newborn and sepsis. Urogenital tract infections such as nongonococcal urethritis in men have also been associated with Ureaplasma urealyticum.[11][22]
History and Symptoms
It is important to take a history of the underlying risk factors for Ureaplasma colonization/infection. Nonspecific symptoms such as irritability, lethargy, convulsions and dyspnea can be seen in neonatal infection associated with Ureaplasma.[23]
Physical Examination
There is no physical examination finding that is specific or pathognomonic for Ureaplasma infection, and a laboratory diagnosis is required.
Laboratory Findings
Ureaplasma species are diagnosed based on culture results and/or PCR.[24][25]
X ray
Early dysplastic pulmonary changes have been observed to occur more frequently in preterm infants with Ureaplasma colonization, although a previous study suggests there are no unique radiographic changes associated with Ureaplasma.[1][26]
CT
There are no specific CT findings associated with Ureaplasma colonization or infection.
Other Diagnostic Studies
Microbial culture methods and/or PCR-based techniques are the only reliable methods for diagnosing Ureaplasma colonization/infection.
Medical Therapy
Antibiotics are the mainstay of treatment for Ureaplasma infection, and antibiotic susceptibility testing is advised prior to treatment due to geographical differences in antibiotic resistance pattern. Doxycycline is recommended as the drug of first choice in non-pregnant women and adults. Josamycin is often recommended for neonates and pregnant women, especially when mixed infection is present. Clarithromycin and pristinamycin are also effective for treating Ureaplasma infection.[27][4][28]
Prevention
There are no guidelines for the prevention of Ureaplasma colonization or infection.
References
- ↑ 1.0 1.1 1.2 Waites KB, Schelonka RL, Xiao L, Grigsby PL, Novy MJ (2009). "Congenital and opportunistic infections: Ureaplasma species and Mycoplasma hominis". Semin Fetal Neonatal Med. 14 (4): 190–9. doi:10.1016/j.siny.2008.11.009. PMID 19109084.
- ↑ Waites KB, Crouse DT, Cassell GH (1993). "Systemic neonatal infection due to Ureaplasma urealyticum". Clin Infect Dis. 17 Suppl 1: S131–5. PMID 8399903 Check
|pmid=value (help). - ↑ Waites KB, Crouse DT, Philips JB, Canupp KC, Cassell GH (1989). "Ureaplasmal pneumonia and sepsis associated with persistent pulmonary hypertension of the newborn". Pediatrics. 83 (1): 79–85. PMID 2909979.
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 Resch B, Gutmann C, Reiterer F, Luxner J, Urlesberger B (2016). "Neonatal Ureaplasma urealyticum colonization increases pulmonary and cerebral morbidity despite treatment with macrolide antibiotics". Infection. 44 (3): 323–7. doi:10.1007/s15010-015-0858-7. PMID 26518581.
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Harada K, Tanaka H, Komori S, Tsuji Y, Nagata K, Tsutsui H; et al. (2008). "Vaginal infection with Ureaplasma urealyticum accounts for preterm delivery via induction of inflammatory responses". Microbiol Immunol. 52 (6): 297–304. doi:10.1111/j.1348-0421.2008.00039.x. PMID 18577163.
- ↑ 6.0 6.1 Povlsen K, Bjørnelius E, Lidbrink P, Lind I (2002). "Relationship of Ureaplasma urealyticum biovar 2 to nongonococcal urethritis". Eur J Clin Microbiol Infect Dis. 21 (2): 97–101. PMID 11939406.
- ↑ 7.0 7.1 7.2 7.3 7.4 7.5 Deguchi T, Yoshida T, Miyazawa T, Yasuda M, Tamaki M, Ishiko H; et al. (2004). "Association of Ureaplasma urealyticum (biovar 2) with nongonococcal urethritis". Sex Transm Dis. 31 (3): 192–5. PMID 15076934.
- ↑ 8.0 8.1 Maeda S, Deguchi T, Ishiko H, Matsumoto T, Naito S, Kumon H; et al. (2004). "Detection of Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma parvum (biovar 1) and Ureaplasma urealyticum (biovar 2) in patients with non-gonococcal urethritis using polymerase chain reaction-microtiter plate hybridization". Int J Urol. 11 (9): 750–4. doi:10.1111/j.1442-2042.2004.00887.x. PMID 15379939.
- ↑ 9.0 9.1 Couldwell DL, Gidding HF, Freedman EV, McKechnie ML, Biggs K, Sintchenko V; et al. (2010). "Ureaplasma urealyticum is significantly associated with non-gonococcal urethritis in heterosexual Sydney men". Int J STD AIDS. 21 (5): 337–41. doi:10.1258/ijsa.2009.009499. PMID 20498103.
- ↑ 10.0 10.1 10.2 10.3 10.4 Shimada Y, Ito S, Mizutani K, Sugawara T, Seike K, Tsuchiya T; et al. (2014). "Bacterial loads of Ureaplasma urealyticum contribute to development of urethritis in men". Int J STD AIDS. 25 (4): 294–8. doi:10.1177/0956462413504556. PMID 24047884.
- ↑ 11.0 11.1 11.2 Esen B, Gozalan A, Sevindi DF, Demirbas A, Onde U, Erkayran U; et al. (2017). "Ureaplasma urealyticum: Presence among Sexually Transmitted Diseases". Jpn J Infect Dis. 70 (1): 75–79. doi:10.7883/yoken.JJID.2015.258. PMID 27000449.
- ↑ 12.0 12.1 12.2 12.3 Viscardi RM, Hashmi N, Gross GW, Sun CC, Rodriguez A, Fairchild KD (2008). "Incidence of invasive ureaplasma in VLBW infants: relationship to severe intraventricular hemorrhage". J Perinatol. 28 (11): 759–65. doi:10.1038/jp.2008.98. PMC 5334544. PMID 18596706.
- ↑ 13.0 13.1 13.2 Waites KB, Crouse DT, Cassell GH (1993). "Systemic neonatal infection due to Ureaplasma urealyticum". Clin Infect Dis. 17 Suppl 1: S131–5. PMID 8399903.
- ↑ Robertson JA, Stemke GW, Davis JW, Harasawa R, Thirkell D, Kong F; et al. (2002). "Proposal of Ureaplasma parvum sp. nov. and emended description of Ureaplasma urealyticum (Shepard et al. 1974) Robertson et al. 2001". Int J Syst Evol Microbiol. 52 (Pt 2): 587–97. doi:10.1099/00207713-52-2-587. PMID 11931172.
- ↑ Okogbule-Wonodi AC, Gross GW, Sun CC, Agthe AG, Xiao L, Waites KB; et al. (2011). "Necrotizing enterocolitis is associated with ureaplasma colonization in preterm infants". Pediatr Res. 69 (5 Pt 1): 442–7. doi:10.1203/PDR.0b013e3182111827. PMC 3968774. PMID 21258263.
- ↑ Waites KB, Katz B, Schelonka RL (2005). "Mycoplasmas and ureaplasmas as neonatal pathogens". Clin Microbiol Rev. 18 (4): 757–89. doi:10.1128/CMR.18.4.757-789.2005. PMC 1265909. PMID 16223956.
- ↑ Patterson AM, Taciak V, Lovchik J, Fox RE, Campbell AB, Viscardi RM (1998). "Ureaplasma urealyticum respiratory tract colonization is associated with an increase in interleukin 1-beta and tumor necrosis factor alpha relative to interleukin 6 in tracheal aspirates of preterm infants". Pediatr Infect Dis J. 17 (4): 321–8. PMID 9576388.
- ↑ 18.0 18.1 Kikhney J, von Schöning D, Steding I, Schulze J, Petrich A, Hiergeist A; et al. (2017). "Is Ureaplasma spp. the leading causative agent of acute chorioamnionitis in women with preterm birth?". Clin Microbiol Infect. 23 (2): 119.e1–119.e7. doi:10.1016/j.cmi.2016.10.010. PMID 27756710.
- ↑ 19.0 19.1 Koucký M, Malíčková K, Cindrová-Davies T, Smíšek J, Vráblíková H, Černý A; et al. (2016). "Prolonged progesterone administration is associated with less frequent cervicovaginal colonization by Ureaplasma urealyticum during pregnancy - Results of a pilot study". J Reprod Immunol. 116: 35–41. doi:10.1016/j.jri.2016.04.285. PMID 27172838.
- ↑ Vogel I, Thorsen P, Hogan VK, Schieve LA, Jacobsson B, Ferre CD (2006). "The joint effect of vaginal Ureaplasma urealyticum and bacterial vaginosis on adverse pregnancy outcomes". Acta Obstet Gynecol Scand. 85 (7): 778–85. doi:10.1080/00016340500442423. PMID 16817073.
- ↑ Joste NE, Kundsin RB, Genest DR (1994). "Histology and Ureaplasma urealyticum culture in 63 cases of first trimester abortion". Am J Clin Pathol. 102 (6): 729–32. PMID 7801884.
- ↑ García-de-la-Fuente C, Miñambres E, Ugalde E, Sáez A, Martinez-Martinez L, Fariñas MC (2008). "Post-operative mediastinitis, pleuritis and pericarditis due to Mycoplasma hominis and Ureaplasma urealyticum with a fatal outcome". J Med Microbiol. 57 (Pt 5): 656–7. doi:10.1099/jmm.0.47632-0. PMID 18436601.
- ↑ Fanaroff AA, Korones SB, Wright LL, Verter J, Poland RL, Bauer CR; et al. (1998). "Incidence, presenting features, risk factors and significance of late onset septicemia in very low birth weight infants. The National Institute of Child Health and Human Development Neonatal Research Network". Pediatr Infect Dis J. 17 (7): 593–8. PMID 9686724.
- ↑ Resch B, Gutmann C, Reiterer F, Luxner J, Urlesberger B (2016). "Neonatal Ureaplasma urealyticum colonization increases pulmonary and cerebral morbidity despite treatment with macrolide antibiotics". Infection. 44 (3): 323–7. doi:10.1007/s15010-015-0858-7. PMID 26518581 26518581 Check
|pmid=value (help). - ↑ Yoneda N, Yoneda S, Niimi H, Ueno T, Hayashi S, Ito M; et al. (2016). "Polymicrobial Amniotic Fluid Infection with Mycoplasma/Ureaplasma and Other Bacteria Induces Severe Intra-Amniotic Inflammation Associated with Poor Perinatal Prognosis in Preterm Labor". Am J Reprod Immunol. 75 (2): 112–25. doi:10.1111/aji.12456. PMID 26668114.
- ↑ Cordero L, Coley BD, Miller RL, Mueller CF (1997). "Bacterial and Ureaplasma colonization of the airway: radiologic findings in infants with bronchopulmonary dysplasia". J Perinatol. 17 (6): 428–33. PMID 9447527.
- ↑ De Francesco MA, Caracciolo S, Bonfanti C, Manca N (2013). "Incidence and antibiotic susceptibility of Mycoplasma hominis and Ureaplasma urealyticum isolated in Brescia, Italy, over 7 years". J Infect Chemother. 19 (4): 621–7. doi:10.1007/s10156-012-0527-z. PMID 23192735.
- ↑ Lee MY, Kim MH, Lee WI, Kang SY, Jeon YL (2016). "Prevalence and Antibiotic Susceptibility of Mycoplasma hominis and Ureaplasma urealyticum in Pregnant Women". Yonsei Med J. 57 (5): 1271–5. doi:10.3349/ymj.2016.57.5.1271. PMC 4960396. PMID 27401661.