Hematoma and abscess formation caused by Mycoplasma hominis following cesarean section

Abstract

Mycoplasma species cannot be identified by routine bacteriological culture methods and are resistant to common antimicrobial agents. Mycoplasma hominis usually colonizes the lower urogenital tract and causes pyelonephritis, pelvic inflammatory disease, chorioamnionitis, rupture of fetal membranes, preterm labor, postpartum fever, postabortal fever, and neonatal infection. This organism is highly prevalent in cervicovaginal cultures of sexually active women. M. hominis, M. genitalis, Ureaplasma urealyticum, and U. parvum may invade and infect placental and fetal tissues, leading to adverse pregnancy outcomes. M. hominis occasionally causes nongenitourinary infection of the blood, wounds, central nervous system, joints, or respiratory tract. We present a case of a 27-year-old woman who developed abdominal wound hematoma and abscess after cesarean section. The wound was drained, but her high fever persisted, in spite of antibiotic treatment using flomoxef sodium and imipenem·cilastatin sodium. Because the exudate exhibited M. hominis growth in an anaerobic environment, we administered the quinolone ciprofloxacin. This therapy resolved her fever, and her white blood cell count and C-reactive protein level diminished to the normal ranges. To our knowledge, there are four published articles regarding the isolation of M. hominis from postcesarean incisions. Based on the current study and the literature, infection by this pathogen may cause hematoma formation with or without abscess after cesarean section or in immunosuppressed postoperative patients. In such cases, physicians may need to suspect Mycoplasma infection and initiate appropriate antibacterial treatment as soon as possible in order to avoid persistent fever.

Mycoplasma hominis empyema following caesarean section

“…M. hominis is predominantly found colonizing the urogenital tract and forms small pinpoint colonies on blood agar plates . Its identification is challenging because it cannot be stained by Gram stain as it lacks a cell wall . Therefore, PCR has been recommended for diagnosing M. hominis infections .…”

“…Its identification is challenging because it cannot be stained by Gram stain as it lacks a cell wall . Therefore, PCR has been recommended for diagnosing M. hominis infections .…”

“…Because M. hominis is not visualized on Gram staining and shows slow growth on blood agar compared to general bacteria, its detection has occasionally been challenging . Moreover, M. hominis is resistant to beta‐lactam antimicrobials that are frequently used for empyema . Here, we report the first case of M. hominis empyema following caesarean section.…”

“…However, M. hominis empyema is rare, and to our knowledge, cases of M. hominis empyema after caesarean section are absent in the literature. Because M. hominis is not visualized on Gram staining and shows slow growth on blood agar compared to general bacteria, its detection has occasionally been challenging . Moreover, M. hominis is resistant to beta‐lactam antimicrobials that are frequently used for empyema .…”

Molecular mechanism of fluoroquinolones resistance in Mycoplasma hominis clinical isolates

“…The colonization rates for MH range between 20% and 30% worldwide (Sweih et al , 2012; Garcia-de-la-Fuente et al , 2008). MH can cause a wide range of diseases, such as genital infections in adults and may be involved in infections in premature and low birth-weight infants with clinical manifestations of septicaemia (Gonzalez-Jimenez et al , 2006; Karabay et al , 2006; Koshiba et al , 2011). This tiny microorganism can also invade in central nervous system, joint, peritonitis, pyelonephritis and respiratory tract (Garcia et al , 2007; Kacerovsky et al , 2009; Koshiba et al , 2011; Krijnen R. et al , 2006; Myers et al , 2010; Pascual 2010).…”