Objectives-To study the occurrence of mycoplasmas and ureaplasmas in patients with hypogammaglobulinaemia and the relationship of these micro-organisms to septic arthritis. Methods-Over a period ofabout 20 years, 53 men and 38 women with hypogammaglobulinaemia, most of whom were less than 50 years old, were examined clinically and microbiologically. Mycoplasmas and ureaplasmas were sought in the throat, urogenital tract and joints by standard cultural methods, although not consistently in the three sites of all patients.Results-Arginine-hydrolysing mycoplasmas and ureaplasmas occurred with similar frequency in the sputum/throat of the hypogammaglobulinaemic patients, but no more often than might be expected in immunocompetent patients. Ureaplasmas, however, dominated in the urogenital tracts of both men and women, being found in 75% of vaginal specimens. Arginine-hydrolysing mycoplasmas occurred two to six times more frequently and ureaplasmas two to three times more frequently in urine specimens from hypogammaglobulinaemic patients than they did in such specimens from sex-and agematched non-venereal disease, hospital patients or healthy subjects; these differences were statistically significant (p< 0.05). Enhanced mucosal colonisation probably increases the chance of spread to distant sites, such as the joints. Of the 91 patients, 21 (23%) had septic arthritis involving one or more joints. Mycoplasmas and/or ureaplasmas, but not bacteria, were isolated from the joints of eight (38%) of these patients. However, dissemination to joints apparently had not occurred in some despite the opportunity by virtue of mycoplasmal or ureaplasmal colonisation at a mucosal site. Sometimes antibiotic therapy failed clinically, and microbiologically and recommendations for management are outlined.Conclusions-Hypogammaglobulinaemic patients appear to be more susceptible to colonisation of mucous membranes, especially of the urogenital tract, with mycoplasmas and ureaplasmas than are immunocompetent individuals. These micro-organisms are responsible for about two fifths of the septic arthritides occurring in these patients. (Ann Rheum Dis 1994; 53: 183-187) Members of the family Mycoplasmataceae, within the order Mycoplasmatales, are the smallest free-living organisms and are subdivided into two genera; the genus Mycoplasma (the organisms of which we term trivially, mycoplasmas) and the genus Ureaplasma which provides a separate status for the urea-hydrolysing organisms, termed trivially ureaplasmas. Ureaplasmas of human origin belong to the species, U urealyticum.' In both human and veterinary medicine mycoplasmas and ureaplasmas have predilection for mucous membranes. Hence, disease occurs primarily in the respiratory and urogenital tracts. In addition, for several animal species there is a proven association between mycoplasmas and arthritis.2 Such knowledge stimulated attempts to culture these microorganisms from the joints of patients with rheumatoid arthritis and to associate them with the disease,3 but there has ...

A survey of 358 patients with primary antibody deficiency shows that mycoplasmal infection is the commonest cause of severe chronic erosive arthritis. We review our experience with 18 patients with confirmed or probable mycoplasmal arthritis. There was a broad spectrum of severity from a monoarthritis rapidly responding to tetracyclines to severe debilitating polyarthritis, sometimes with antibiotic-resistant organisms which in two cases were eliminated following hyperimmune animal serum therapy. Most patients had very low serum 1gG levels at the onset of arthritis, suggesting that maintaining levels within the normal range with immunoglobulin replacement may prevent infection. The unique susceptibility of these patients to mycoplasmal arthritis shows that antibodies play a crucial role in protection against these organisms.

Eighteen male and eight female primates, representing five subhuman species, were inoculated urogenitally with Mycoplasma genitalium, a microorganism recovered from men with nongonococcal urethritis. Male rhesus (Macaca mulatta) and cynomolgus (Macaca fascicularis) monkeys apparently were resistant. Female squirrel monkeys (Saimiri sciureus) and female tamarins (Saguinus mystax) exhibited low-level, genital-tract infections. Male chimpanzees (Pan troglodytes) developed an obvious genital-tract infection, with some shedding organisms for 21 weeks. M. genitalium was recovered from the blood of two of the male chimpanzees, usually when large numbers of organisms were in the urethra. Female chimpanzees generally shed organisms for 12-15 weeks. Most chimpanzees colonized with the organism exhibited increased numbers of polymorphonuclear leukocytes in the genital tract and developed a significant antibody response. The results offer substantial evidence for the pathogenicity of M. genitalium for the urogenital tract of higher primates and suggest the microorganism may have a role in human genital-tract infections.