Hyperammonemia syndrome associated with <i>Ureaplasma</i> spp. Infections in immunocompromised patients and transplant recipients: A systematic review and meta‐analysis

Tantengco, Ourlad Alzeus G.; Jesus, Federico Cristobal C. De; Gampoy, Eloina Faye S.; Ornos, Eric David B.; Vidal, Manuel S.; Abad, Cybele Lara

doi:10.1111/ctr.14334

Cited by 17 publications

(26 citation statements)

References 45 publications

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“…As previously described, the risk of developing HS is higher in lung transplant recipients, in comparison to other solid organ recipients. 33 One hypothesis to explain this disparity is the lack of pulmonary defensive mechanisms against mollicutes (as opposed to genitourinary host defenses, such as the urinary tract microbiome and acidic environ- We note one of our cases (Case 5) presented atypically very early post-op with only mild ammonia elevation, but we included this case given the absence of an alternate diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Hyperammonemia syndrome post‐lung transplantation: Case series and systematic review of literature

Buzo

Preiksaitis

Halloran

et al. 2022

Transplant Infectious Dis

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Background Hyperammonemia syndrome (HS) is a rare post‐transplant complication associated with high morbidity and mortality. Its incidence appears to be higher in lung transplant recipients and its pathophysiology is not well understood. In addition to underlying metabolic abnormalities, it is postulated that HS may be associated with Ureaplasma or Mycoplasma spp. lung infections. Management of this condition is not standardized and may include preemptive antimicrobials, renal replacement, nitrogen scavenging, and bowel decontamination therapies, as well as dietary modifications. Methods In this case series, we describe seven HS cases, five of whom had metabolic deficiencies ruled out. In addition, a literature review was performed by searching PubMed following PRISMA‐P guidelines. Articles containing the terms “hyperammonemia” and “lung” were reviewed from 1 January 1997 to 31 October 2021. Results All HS cases described in our center had positive airway samples for Mycoplasmataceae, neurologic abnormalities and high ammonia levels post‐transplant. Mortality in our group (57%) was similar to that published in previous cases. The literature review supported that HS is an early complication post‐transplant, associated with Ureaplasma spp. and Mycoplasma hominis infections and of worse prognosis in patients presenting cerebral edema and seizures. Conclusion This review highlights the need for rapid testing for Ureaplasma spp. and M. hominis after lung transplant, as well as the necessity for future studies to explore potential therapies that may improve outcomes in these patients.

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Section: Discussionmentioning

confidence: 99%

Hyperammonemia syndrome post‐lung transplantation: Case series and systematic review of literature

Buzo

Preiksaitis

Halloran

et al. 2022

Transplant Infectious Dis

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“…Evidence came from immunocompromised patients post-lung transplant who experienced HE associated with M. hominis or Ureaplasma spp. infections (10,11). In a recent meta-analysis ( 11), Ureaplasma spp.-infected lung transplant recipients showed a higher incidence of hyperammonemia syndrome and peak ammonia concentration compared with other recipients (41.67% vs. 2.84%), with an increased risk of 14.64 (CI: 2.85-75.24).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Hyperammonemic Encephalopathy Linked to Ureaplasma spp. and/or Mycoplasma hominis Systemic Infection in Patients Treated for Leukemia, an Emergency Not to Be Missed

et al. 2022

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BackgroundHyperammonemic encephalopathy caused by Ureaplasma spp. and Mycoplasma hominis infection has been reported in immunocompromised patients undergoing lung transplant, but data are scarce in patients with hematological malignancies.Case PresentationWe describe the cases of 3 female patients aged 11–16 years old, developing initially mild neurologic symptoms, rapidly evolving to coma and associated with very high ammonia levels, while undergoing intensive treatment for acute leukemia (chemotherapy: 2 and hematopoietic stem cell transplant: 1). Brain imaging displayed cerebral edema and/or microbleeding. Electroencephalograms showed diffuse slowing patterns. One patient had moderate renal failure. Extensive liver and metabolic functions were all normal. Ureaplasma spp. and M. hominis were detected by PCR and specific culture in two patients, resulting in prompt initiation of combined antibiotics therapy by fluoroquinolones and macrolides. For these 2 patients, the improvement of the neurological status and ammonia levels were observed within 96 h, without any long-term sequelae. M. hominis was detected post-mortem in vagina, using 16S rRNA PCR for the third patient who died of cerebral edema.ConclusionHyperammonemic encephalopathy linked to Ureaplasma spp. and M. hominis is a rare complication encountered in immunocompromised patients treated for acute leukemia, which can lead to death if unrecognized. Combining our experience with the few published cases (n=4), we observed a strong trend among female patients and very high levels of ammonia, consistently uncontrolled by classical measures (ammonia-scavenging agents and/or continuous kidney replacement therapy). The reversibility of the encephalopathy without sequelae is possible with prompt diagnosis and adequate combined specific antibiotherapy. Any neurological symptoms in an immunocompromised host should lead to the measurement of ammonia levels. If increased, and in the absence of an obvious cause, it should prompt to perform a search for Ureaplasma spp. and M. hominis by PCR as well as an immediate empirical initiation of combined specific antibiotherapy.

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“…Hyperammonemia refers to a high blood ammonia level [1]. Ureaplasma parvum is a rare cause to induce hyperammonemia [2]. Ureaplasma parvum is an opportunistic pathogen that commonly resides in the human urogenital tract [3].…”

Section: Introductionmentioning

confidence: 99%

Hyperammonemia in a septic patient with Ureaplasma parvum arthritis: a case report

Pan

et al. 2022

BMC Infect Dis

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Background Septic arthritis requires prompt diagnosis and treatments. Rare pathogens should be considered when patients respond poorly to the initial antibiotic treatments. Ureaplasma parvum is an opportunistic pathogen that commonly resides in the human urogenital tract. Its infection commonly causes hyperammonemia. Hyperammonemia from Ureaplasma parvum septic arthritis has never been reported previously. Case presentation A 65-year-old male presented with fever and left lower leg pain and swelling for more than ten days. Septic arthritis and sepsis were considered after laboratory tests and arthrocentesis. However, he responded poorly to the antibiotic treatments, including cefoperazone-sulbactam, imipenem-cilastatin, and linezolid. His mental status deteriorated rapidly with elevated blood ammonia levels with unremarkable liver function test and sonogram examination results. Despite the treatments with lactulose, L-ornithine L-aspartate, mannitol, and hemodialysis therapy to lower his ammonia level, his blood ammonia level remained persistently high. Finally, metagenomic sequencing of the left knee synovial fluid reported Ureaplasma parvum, which was considered to contribute to his hyperammonemia. Conclusion Ureaplasma parvum could cause septic arthritis with hyperammonemia. Genetic tests, such as polymerase chain reaction and next-generation sequencing techniques, could provide a sensitive and fast diagnosis of Ureaplasma parvum.

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Hyperammonemia syndrome associated with Ureaplasma spp. Infections in immunocompromised patients and transplant recipients: A systematic review and meta‐analysis

Cited by 17 publications

References 45 publications

Hyperammonemia syndrome post‐lung transplantation: Case series and systematic review of literature

Hyperammonemia syndrome post‐lung transplantation: Case series and systematic review of literature

Case Report: Hyperammonemic Encephalopathy Linked to Ureaplasma spp. and/or Mycoplasma hominis Systemic Infection in Patients Treated for Leukemia, an Emergency Not to Be Missed

Hyperammonemia in a septic patient with Ureaplasma parvum arthritis: a case report

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