History
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 M hominis, M genitalium, and/or Ureaplasma species in various patient populations:
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Urethritis
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Pyelonephritis
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cervicitis
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Cystitis
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Pelvic inflammatory disease
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Urinary calculi
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Endometritis or chorioamnionitis
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Bacterial vaginosis
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Infectious arthritis
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Surgical and nonsurgical wound infections
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Osteomyelitis
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Preterm labor
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Bacteremia
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Pneumonia
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Meningitis
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Hyperammonemia
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Endocarditis
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Abscesses
Mycoplasma and Ureaplasma organisms often play minor roles as causes of the above-named conditions, which may be caused by various other microorganisms. When present in patients with some of these conditions, such as pelvic inflammatory disease, 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 Chlamydia trachomatis and Neisseria gonorrhoeae. [9]
Physical
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 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.
Consider a Mycoplasma or Ureaplasma infection likely in any person who has received a lung transplant and develops hyperammonemia syndrome.
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:
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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.
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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.
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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.
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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.
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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.
Causes
The Ureaplasma genus now is subdivided into 2 species: U urealyticum and U parvum. For clinical purposes, separating infections caused by the 2 different species is not possible without molecular testing, nor is it necessary. In both the clinical setting and in the diagnostic laboratory, they are usually considered Ureaplasma species. Mycoplasma hominis and Mycoplasma genitalium may coexist with ureaplasmas and require separate laboratory detection and identification procedures.
Physical Examination
The clinical conditions associated with the genital mycoplasmas are syndrome-specific and not organism specific. As such, there may be polymicrobial causes for many of them. Clinical presentation and physical examination findings are not unique for any of these organisms. Physical findings for non-gonococcal urethritis, for example, which could be due to C trachomatis, U urealyticum, M genitalium, and/or Trichomonas vaginalis, would appear similar, ie, urethral discharge no matter which organism(s) were primarily responsible.
Complications
Women with M genitalium cervicitis may develop pelvic inflammatory disease as a complication. M hominis has been associated with a small portion of cases of pelvic inflammatory disease as well. Immunosuppressed hosts, which includes persons with congenital antibody deficiencies, iatrogenic immunosuppression following organ transplantation, and preterm neonates may become colonized on mucosal surfaces with these organisms, which then disseminate to involve the bloodstream and multiple organs, including joints. In the case of lung transplant recipients, the hyperammonemia syndrome is a significant and potentially life-threatening condition that is due to the metabolic byproduct ammonia being produced through breakdown of urea by Ureaplasma species and breakdown of arginine by M hominis.
