Periprosthetic Joint Infection Caused by Mycoplasma hominis, Diagnosed Using Metagenomic Sequencing

Abstract

To our knowledge, the periprosthetic joint infection (PJI) caused by Mycoplasma hominis is a rare postoperative complication after total knee arthroplasty (TKA). Just a few cases associated with Mycoplasma hominis infection after TKA were reported all over the world currently. In view of the difficulty involved in isolating this microorganism, Mycoplasma hominis infection may be under-recognized and should be considered in culture-negative cases where the microbial etiology is not easily identified. Metagenomic sequencing is a new tool to identify pathogens undetected by conventional methods. In this report, we present a case where metagenomic sequencing was used to identify Mycoplasma hominis as a novel PJI pathogen after TKA in our hospital.

Mycoplasmas as Host Pantropic and Specific Pathogens: Clinical Implications, Gene Transfer, Virulence Factors, and Future Perspectives

“…In addition, septic arthritis caused by M. hominis (Ali et al, 2021a) as well as U. parvum (MacKenzie et al, 2010) has been reported in immunosuppressed patients. M. hominis has been identified as a novel periprosthetic joint infection (a rare postoperative complication) using a new tool called "metagenomic sequencing" (Wang et al, 2021a). M. hominis also might cause brain abscesses (Whitson et al, 2014).…”

Optimization and standardization of mNGS-based procedures for the diagnosis of Mycoplasma periprosthetic joint infection: A novel diagnostic strategy for rare bacterial periprosthetic joint infection

“…mNGS can detect all pathogenic bacteria in samples without bias, and has significant advantages in detecting some rare bacteria, fastidious bacteria and other rare pathogenic bacteria (Thoendel et al, 2017;He et al, 2020). Wang et al (Wang et al, 2021) reported a case of knee PJI infected by Mycoplasma hominis, in which Wang et al innovatively introduced mNGS to detect pathogenic bacteria (Wang et al, 2021). mNGS results indicated that the pathogenic bacteria might be Mycoplasma hominis for twice.…”

“…They all isolated Mycoplasma by routine microbial culture methods. The difference was that Xiang et al (Wang et al, 2021) and Sneller et al (Sneller et al, 1986) isolated Mycoplasma from blood agar, but Muramatsu et al (Muramatsu et al, 2022), on the other hand, isolated pathogenic bacteria the blood bottles. Notably, Mycoplasma can be easily missed because its small well-defined colonies on agar.…”

Identification of sacrococcygeal and pelvic abscesses infected with invasive Mycoplasma hominis by MALDI‐TOF MS

“…What is more worrying is that M . hominis is gram‐negative due to its lack of cell wall and has no response to all antibiotics targeting cell wall synthesis 12 . This special biological characteristic makes it can not only escape the routine etiological examination such as Gram staining, but also escape the clinician's empirical anti‐infection treatment.…”

“…What is more worrying is that M. hominis is gram-negative due to its lack of cell wall and has no response to all antibiotics targeting cell wall synthesis. 12 This special biological characteristic makes it can not only escape the routine etiological examination such as Gram staining, but also escape the clinician's empirical anti-infection treatment. The growth rate of Mycoplasma on the blood agar medium routinely used for pathogen proliferation is slower than that of common bacteria, it usually takes 48 h or even longer, and the colony morphology is not typical.…”