Molecular diagnosis of ureaplasma urealyticum in an immunocompetent patient with destructive reactive polyarthritis

Abstract

Polymerase chain reaction (PCR) amplification, which is a useful method for detecting infectious agents in joints, has potential utility in the molecular diagnosis of venereal-associated arthritis. Among pathogens detected by this technique, Ureuplusrnu ureulyticum, which is primarily associated with reactive arthritis (ReA), is also implicated in septic arthritis in immunocompromised patients. We report here a case of destructive polyarthritis, initially suggestive of septic arthritis, in an immunocompetent patient whose PCR positivity for U ureulyticum DNA in one joint, in conjunction with the disease outcome and histologic findings, led to the diagnosis of destructive ReA.Mycoplasmal organisms (mycoplasmas and ureaplasmas), which have a predilection for mucous membrancs, are responsible for a broad spectrum of clinical diseases. In immunocompetent individuals, the respiratory (Mycoplasma pneumoniae) and urogenital (Mycoplasma hominis, Ureaplasma urealyticum) tracts are primarily involved. In immunocompromised patients, these microorganisms are able to disseminate to other anatomic sites, particularly the joints, and some cases of septic arthritis due to U urealyticum have been described (1-7). These infectious agents have also been implicated in the pathogenesis of reactive arthritis (ReA) (8) and, possibly, rheumatoid arthritis (9). These arthritides should be considered the result of an immunologic ~~

Septic arthritis of the shoulder due to Ureaplasma urealyticum after emergency caesarean section: a case report

“…In the absence of antibodies, these organisms are phagocytized by neutrophils but are not degraded and remain viable and able to proliferate [4]. To date and to our knowledge, only two cases of U. urealyticum septic arthritis have been reported in healthy patients, both with involvement of the knee [6,7].…”

“…Genital tract infection and premature birth have been associated to infection with U. urealyticum [5].. Some twenty cases of patients with septic arthritis due to U. urealyticum have been described in the literature and in all but two cases antibody deficiencies were identified [6][7][8].…”

2014 European Guideline on the management of sexually acquired reactive arthritis

“…DNA and/or surface antigens of C . trachomatis , 13,23–29 U. urealyticum 28,30 and other mycoplasmas 31 may be detected within joint material from individuals with SARA. It is likely that the persistence of viable micro-organisms intra-articularly is an important factor in the causation and perpetuation of the arthritis.…”

How can a causal role for small bacteria in chronic inflammatory arthritides be established or refuted?

“…38 Furthermore, these organisms and Mycoplasma fermentans were detected by a PCR technique and culture, respectively, in joint fluid specimens from a B27 negative woman who developed monarthritis after an episode of cervicovaginitis 39. In addition, synovial fluid lymphocytes, more than peripheral blood lymphocytes, have been shown to proliferate specifically in response to ureaplasmal antigens 40-42.…”