Postoperative Mycoplasma hominis infections after neurosurgical intervention

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p><jats:italic>Mycoplasma hominis</jats:italic> is a rare cause of infection after neurosurgical procedures. The <jats:italic>Mycoplasma</jats:italic> genus contains the smallest bacteria discovered to date. <jats:italic>Mycoplasma</jats:italic> are atypical bacteria that lack a cell wall, a feature that complicates both diagnosis and treatment. The Gram stain and some types of culture media fail to identify these organisms, and typical broad-spectrum antibiotic regimens are ineffective because they act on cell wall metabolism. <jats:italic>Mycoplasma hominis</jats:italic> commonly colonizes the genitourinary tract in a nonvirulent manner, but it has caused postoperative, postpartum, and posttraumatic infections in various organ systems.</jats:p> <jats:p>The authors present the case of a 17-year-old male with a postoperative intramedullary spinal cord abscess due to <jats:italic>M. hominis</jats:italic> and report the results of a literature review of <jats:italic>M. hominis</jats:italic> infections after neurosurgical procedures. Attention is given to time to diagnosis, risk factors for infection, ineffective antibiotic regimens, and final effective antibiotic regimens to provide pertinent information for the practicing neurosurgeon to diagnose and treat this rare occurrence.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A PubMed search was performed to identify reports of <jats:italic>M. hominis</jats:italic> infections after neurosurgical procedures.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Eleven cases of postneurosurgical <jats:italic>M. hominis</jats:italic> infection were found. No other cases of intramedullary spinal cord abscess were found. Initial antibiotic coverage was inadequate in all cases, and diagnosis was delayed in all cases. Multiple surgical interventions were often needed. Once appropriate antibiotics were started, patients typically experienced rapid resolution of their neurological symptoms. In 27% of cases, a suspicious genitourinary source other than urinary catheterization was identified.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Postoperative <jats:italic>M. hominis</jats:italic> infections are rarely seen after neurosurgical procedures. They are typically responsive to appropriate antibiotic therapy. <jats:italic>Mycoplasma</jats:italic> infection may cause prolonged hospitalization and multiple returns to the operating room due to delay in diagnosis. Early clinical suspicion with appropriate antibiotic coverage could help prevent these significant complications.</jats:p></jats:sec>

Meningitis in a Chinese adult patient caused by Mycoplasma hominis: a rare infection and literature review

“…By carefully reading all the papers, we found that there were only 19 reported non-neonatal-associated cases of CNS infection caused by M. hominis ; none was reported from China (Table 1 ). Of these 20 cases, brain abscess was the most common CNS infections ( n = 13) [ 3 , 10 , 14 – 23 ], followed by meningitis ( n = 4) [ 8 , 24 – 26 ], spinal cord abscess ( n = 1) [ 2 ], subdural empyema ( n = 1) [ 27 ], (Table 1 ).…”

“…Mycoplasma hominis , initially described as pleuropneumonia-like organism, is a commensal of the human oral cavity, respiratory tract, and genitourinary tract [ 1 – 3 ]. However, its role in the pathogenesis of infections in adult patients, especially extragenital infections such as central nervous system (CNS) infection, post-operative wound infections, mediastinitis, and septic arthritis [ 2 , 4 – 7 ], has been difficult to determine. M. hominis , which does not possess a cell wall and hence is not identifiable by Gram staining of clinical specimens, is difficult to detect [ 3 , 8 , 9 ].…”

“…Culturing M. hominis which is fastidious in nature, is both resource- and time-consuming because specialized media and incubation conditions are required. Direct 16S rDNA PCR amplification/sequencing on clinical specimens may be performed but sensitivity is moderate at best, and not all laboratories perform this test [ 2 , 3 , 8 ]. The true incidence of M. hominis infections is thus probably underestimated and delayed diagnosis leads to delayed treatment with suboptimal outcomes [ 10 ].…”

A case report of Mycoplasma hominis brain abscess identified by MALDI-TOF mass spectrometry

“…In adults, CNS infections due to M. hominis are very rare and only 13 cases of brain abscesses have been reported to date. [1][2][3] We report herein the occurrence of an M. hominis brain abscess after a head trauma, which was rapidly identified by matrix-assisted laser desorption/ ionization time-of-flight mass spectrometry (MALDI-TOF MS; VITEK MS, bioMé rieux).…”

N-Terminal Polypeptide of Annexin A2 Decreases Infection of Mycoplasma hyorhinis to Gastric Cancer Cells

“…Effective antimicrobials do exist, but their continuous applications in cell culture is not recommended because of the toxicity to cells. Finally, mycoplasma is a atypical bacteria, causing difficulities in correct diagnosis [ 34 ].…”