Diagnosis and treatment of mycoplasmal septic arthritis: a systematic review

Abstract

Purpose Septic arthritis caused by Mycoplasma is rare. The diagnosis and effective treatment of mycoplasmal septic arthritis remains a serious problem for clinicians. The aim of this systematic review was to document the available evidence on the diagnosis and treatment methods for mycoplasmal septic arthritis and to provide guidance for clinicians. Methods The PubMed, EMBASE, and Cochrane Library databases were searched in December 2018.The searches were limited to the English language. Article screening and data extraction and compilation were conducted by two independent reviewers. All the included studies were assessed using the Methodological Index for Non-randomized Studies (MINORS) tool. Results There was a total of 33 articles including 34 cases of mycoplasmal septic arthritis and eight of them were periprosthetic joint infection (PJI). Twenty-four patients (70.6%) were immunocompromised, and the synovial fluid white blood cell (WBC) count was significantly lower in the immunocompromised group than in the immunocompetent group (48,527 × 10 6 /L vs. 100,640 × 10 6 /L; P = 0.009). The traditional culture method took longer, and the positivity rate was lower than that of nucleic acid testing (50% vs. 100%; P = 0.016). Only 19.2% (5/26) of patients treated with empiric antibiotics were relieved of symptoms, while 82.4% (28/34) of patients achieved satisfactory results after being treated with antibiotics against Mycoplasma. Conclusion The possibility of mycoplasmal septic arthritis should be considered if patients with joint infections have a history of immunocompromised, repeated negative cultures, and poor empiric antibiotic treatment results. The rational use of nucleic acid testing technologies can help in the clinical diagnosis and treatment of mycoplasmal septic arthritis.

Septic polyarthritis with Mycoplasma salivarium in a patient with common variable immunodeficiency: case report and review of the literature

“…Septic arthritis is a relatively common type of infection which can arise through hematogenous dissemination, trauma, spread from a periarticular tissue infection, or postoperative infection of a prosthesis [ 16 ]. As illustrated by our patient, joint infections by mollicutes can be deceptively slow-moving, with lower joint fluid cell counts and relatively reduced signs of joint inflammation that can lull the unsuspecting clinician into attempting to treat a presumptive mechanical or rheumatologic joint process until joint destruction is far advanced.…”

An enemy in shadows—Mycoplasma hominis septic arthritis and iliopsoas abscess: Case report and review of the literature

“…Usually, immunocompromised hosts are at risk for extragenital infections, however, rarely cause infection in immunocompetent adults. Many risk factors have been reported for acquiring M. hominis septic arthritis such as organ transplantation, malignancies, hypogammaglobulinemia, AIDS, and immunosuppressant use including Rituximab [4] , [7] .…”

“…The clinical presentation is usually undistinguished M. hominis septic arthritis from typical infective arthritis raising the need for highly sensitive and specific identification methods [4] .…”

“…Usually, a combination of prolonged antibiotic therapy targeting the organism in addition to appropriate surgical interventions such as arthroscopy, joint washout, or abscess drainage is the mainstay of management [4] .…”

Cervical Arthroplasty in the Treatment of Cervical Angina: Case Report and Review of the Literature

“…As previously described, we considered a score of below 5 as poor, between 6 and 10 as moderate, and between 11 and 16 as good. 15 Because scores were averaged, noninteger values were rounded down to reduce the risk of overestimating study quality. Out of the 89 unique papers from the database search and review of reference lists, 75 papers were examined in full text.…”