Ureaplasma Infection Clinical Presentation
- Author: Ken B Waites, MD; Chief Editor: Michael Stuart Bronze, MD more...
The clinical history of patients with urogenital or extragenital infections caused by Mycoplasma or Ureaplasma species is syndrome-specific, not organism-specific, and, as in the case of M pneumoniae respiratory tract infection, no distinguishing features indicate the microbiologic etiology of these conditions.
Many clinicians are unfamiliar with Mycoplasma and Ureaplasma species as etiologic agents. This unfamiliarity is further complicated by a lack of facilities to diagnose mycoplasmal infections in many clinical settings. Subsequently, identification of these organisms may be achieved only as a last resort, particularly if initial treatment with drugs that are ineffective against Mycoplasma or Ureaplasma species is unsuccessful. The following conditions may be caused by infection with Mycoplasmahominis and/or Ureaplasma species in various patient populations:
Urethritis ( Ureaplasma only)
Pelvic inflammatory disease ( M hominis only)
Urinary calculi ( Ureaplasma only)
Endometritis or chorioamnionitis
Surgical and nonsurgical wound infections
Preterm labor ( Ureaplasma only)
Mycoplasma and Ureaplasma organisms often play minor roles as causes of the above-named conditions, which may be caused by various microorganisms. When present in patients with some of these conditions, such as salpingitis, urethritis, and septic arthritis, one of several etiologic organisms may be present simultaneously.
M genitalium is known to cause male urethritis, female cervicitis, and pelvic inflammatory disease, clinically indistinguishable from these conditions as caused by other microorganisms such as Neisseria gonorrhoeae.
Rather than listing the many nonspecific historical and clinical findings of various entities that may be associated with infection with Mycoplasma or Ureaplasma species, emphasizing the need to consider these organisms as potential etiologic agents in the conditions named above is more important in order to perform the necessary diagnostic tests and to provide appropriate antimicrobial treatment that provides coverage for them.
Consider a Mycoplasma or Ureaplasma infection when persons with hypogammaglobulinemia present with septic arthritis, chronic pulmonary infection, and any other inflammatory condition or infection that does not respond to antimicrobial treatment that is not likely to be effective against these organisms.
Refer to specific articles on urogenital (eg, Urethritis; Pyelonephritis, Acute; Pyelonephritis, Chronic), obstetric and gynecologic (eg, Pelvic Inflammatory Disease, Endometritis), and neonatal infections (eg, Pneumonia; Meningitis, Bacterial) for additional information regarding history and physical examination findings associated with these conditions.
Physical presentation of M hominis or Ureaplasma infection in neonates includes the following considerations:
Neonates, particularly those born preterm, are especially vulnerable to dissemination of infectious organisms (acquired in utero or at birth) in the bloodstream and, ultimately, the central nervous system.
Conventional gram-negative and gram-positive bacteria are usually considered the primary culprits of neonatal sepsis; however, when Mycoplasma and Ureaplasma organisms are specifically sought, evidence proves they may be of etiologic significance in neonatal lung disease, bacteremia, and meningitis.
As with most neonatal infections, no characteristic signs and symptoms predict the type of organism present. Subtle manifestations, such as temperature instability, blood pressure fluctuations, heart rate, and respiratory efforts, may be the only clues that an infection is present.
Consider Mycoplasma and Ureaplasma species if signs and symptoms of infection are present; if the neonate does not respond to beta-lactam drugs; and if cultures from blood, the lower respiratory tract, and CSF do not reveal a more common microbiological etiology.
Radiographic evidence of pneumonitis in the absence of a proven bacterial or viral etiology and mononuclear or polymorphonuclear pleocytosis of CSF with a negative Gram stain and culture result are consistent with infection associated with M hominis or Ureaplasma species.
The Ureaplasma genus now is subdivided into 2 species: U urealyticum and U parvum. For clinical purposes, separating infections caused by the different 2 species is not possible or necessary. In both the clinical setting and in the diagnostic laboratory, they are considered Ureaplasma species.
Waites KB, Katz B, Schelonka RL. Mycoplasmas and ureaplasmas as neonatal pathogens. Clin Microbiol Rev. 2005 Oct. 18(4):757-89. [Medline].
Xiao L, Paralanov V, Glass JI, Duffy LB, Robertson JA, Cassell GH, et al. Extensive horizontal gene transfer in ureaplasmas from humans questions the utility of serotyping for diagnostic purposes. J Clin Microbiol. 2011 Aug. 49(8):2818-26. [Medline]. [Full Text].
Deguchi T, Maeda S, Tamaki M, Yoshida T, Ishiko H, Ito M. Analysis of the gyrA and parC genes of Mycoplasma genitalium detected in first-pass urine of men with non-gonococcal urethritis before and after fluoroquinolone treatment. J Antimicrob Chemother. 2001 Nov. 48(5):742-4. [Medline].
Xiao L, Paralanov V, Glass JI, Duffy LB, Robertson JA, Cassell GH. Extensive horizontal gene transfer in ureaplasmas from humans questions the utility of serotyping for diagnostic purposes. J Clin Microbiol. 2011 Aug. 49(8):2818-26. [Medline].
Waites KB, Talkington DF. New Developments in Human Diseases Due to Mycoplasmas. Blanchard A, Browning G, eds. Mycoplasmas: Pathogenesis, Molecular Biology, and Emerging Strategies for Control. Norwich, United Kingdom: Horizon Bioscience; 2005. Chapter 9, pages 289-354.
Webster D, Windsor H, Ling C, Windsor D, Pitcher D. Chronic bronchitis in immunocompromised patients: association with a novel Mycoplasma species. Eur J Clin Microbiol Infect Dis. 2003 Sep. 22(9):530-4. [Medline].
Jensen JS. Mycoplasma genitalium: the aetiological agent of urethritis and other sexually transmitted diseases. J Eur Acad Dermatol Venereol. 2004 Jan. 18(1):1-11. [Medline].
Novy MJ, Duffy L, Axthelm MK, Sadowsky DW, Witkin SS, Gravett MG, et al. Ureaplasma parvum or Mycoplasma hominis as sole pathogens cause chorioamnionitis, preterm delivery, and fetal pneumonia in rhesus macaques. Reprod Sci. 2009 Jan. 16(1):56-70. [Medline].
Furr PM, Taylor-Robinson D, Webster AD. Mycoplasmas and ureaplasmas in patients with hypogammaglobulinaemia and their role in arthritis: microbiological observations over twenty years. Ann Rheum Dis. 1994 Mar. 53(3):183-7. [Medline].
Waites KB, Bebear CM, Robertson JA, et al. Laboratory Diagnosis of Mycoplasmal Infections. Cumulative Techniques and Procedures in Clinical Microbiology, ASM Press. 2001.
Beeton ML, Chalker VJ, Maxwell NC, Kotecha S, Spiller OB. Concurrent titration and determination of antibiotic resistance in ureaplasma species with identification of novel point mutations in genes associated with resistance. Antimicrob Agents Chemother. 2009 May. 53(5):2020-7. [Medline]. [Full Text].
Xiao L, Crabb DM, Duffy LB, Paralanov V, Glass JI, Hamilos DL. Mutations in ribosomal proteins and ribosomal RNA confer macrolide resistance in human Ureaplasma spp. Int J Antimicrob Agents. 2011 Apr. 37(4):377-9. [Medline].
Bebear CM, Renaudin H, Charron A, Gruson D, Lefrancois M, Bebear C. In vitro activity of trovafloxacin compared to those of five antimicrobials against mycoplasmas including Mycoplasma hominis and Ureaplasma urealyticum fluoroquinolone-resistant isolates that have been genetically characterized. Antimicrob Agents Chemother. 2000 Sep. 44(9):2557-60. [Medline].
Duffy L, Glass J, Hall G, Avery R, Rackley R, Peterson S, et al. Fluoroquinolone resistance in Ureaplasma parvum in the United States. J Clin Microbiol. 2006 Apr. 44(4):1590-1. [Medline].
Waites KB, Sims PJ, Crouse DT, Geerts MH, Shoup RE, Hamrick WB, et al. Serum concentrations of erythromycin after intravenous infusion in preterm neonates treated for Ureaplasma urealyticum infection. Pediatr Infect Dis J. 1994 Apr. 13(4):287-93. [Medline].
Waites KB, Crouse DT, Cassell GH. Therapeutic considerations for Ureaplasma urealyticum infections in neonates. Clin Infect Dis. 1993 Aug. 17 Suppl 1:S208-14. [Medline].
Jensen JS, Bradshaw CS, Tabrizi SN, Fairley CK, Hamasuna R. Azithromycin treatment failure in Mycoplasma genitalium-positive patients with nongonococcal urethritis is associated with induced macrolide resistance. Clin Infect Dis. 2008 Dec 15. 47(12):1546-53. [Medline].
Bradshaw CS, Jensen JS, Tabrizi SN, Read TR, Garland SM, Hopkins CA, et al. Azithromycin failure in Mycoplasma genitalium urethritis. Emerg Infect Dis. 2006 Jul. 12(7):1149-52. [Medline].
Schelonka RL, Katz B, Waites KB, Benjamin DK Jr. Critical appraisal of the role of Ureaplasma in the development of bronchopulmonary dysplasia with metaanalytic techniques. Pediatr Infect Dis J. 2005 Dec. 24(12):1033-9. [Medline].
Huang C, Zhu HL, Xu KR, Wang SY, Fan LQ, Zhu WB. Mycoplasma and ureaplasma infection and male infertility: a systematic review and meta-analysis. Andrology. 2015 Sep. 3 (5):809-16. [Medline].
Beeton ML, Chalker VJ, Jones LC, Maxwell NC, Spiller OB. Antibiotic resistance among clinical Ureaplasma isolates recovered from neonates in England and Wales between 2007 to 2013. Antimicrob Agents Chemother. 2015 Oct 12. [Medline].