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| | binomial_authority = Shepard et al., 1974 | | | binomial_authority = Shepard et al., 1974 |
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| | {{Ureaplasma urealyticum}} |
| {{CMG}}{{AE}}{{FB}} | | {{CMG}}{{AE}}{{FB}} |
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| '''''Synonyms and Keywords''''': ''Ureaplasma parvum'', ''U. urealyticum'' biovar 1, ''U. urealyticum'' biovar 2, T-strain Mycoplasma
| | {{SK}} ''Ureaplasma parvum'', ''U. urealyticum'' biovar 1, ''U. urealyticum'' biovar 2, T-strain Mycoplasma |
| __NOTOC__ | | __NOTOC__ |
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| {{SI}}
| | ==[[Ureaplasma urealyticum overview|Overview]]== |
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| ==Overview== | | ==[[Ureaplasma urealyticum historical perspective|Historical Perspective]]== |
| Ureaplasma species (''U. urealyticum'' and ''U. parvum'') are commensal organisms commonly found in the [[urogenital tract]] of sexually active men and women.<ref name="pmid19109084">{{cite journal| author=Waites KB, Schelonka RL, Xiao L, Grigsby PL, Novy MJ| title=Congenital and opportunistic infections: Ureaplasma species and Mycoplasma hominis. | journal=Semin Fetal Neonatal Med | year= 2009 | volume= 14 | issue= 4 | pages= 190-9 | pmid=19109084 | doi=10.1016/j.siny.2008.11.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19109084 }} </ref> These organisms are considered to be of low virulence although several studies have demonstrated an association between vaginal colonization by Ureaplasma species and adverse pregnancy outcomes including perinatal morbidity and mortality.<ref name="pmid 8399903">{{cite journal| author=Waites KB, Crouse DT, Cassell GH| title=Systemic neonatal infection due to Ureaplasma urealyticum. | journal=Clin Infect Dis | year= 1993 | volume= 17 Suppl 1 | issue= | pages= S131-5 | pmid= 8399903 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8399903 }} </ref><ref name="pmid 2909979">{{cite journal| author=Waites KB, Crouse DT, Philips JB, Canupp KC, Cassell GH| title=Ureaplasmal pneumonia and sepsis associated with persistent pulmonary hypertension of the newborn. | journal=Pediatrics | year= 1989 | volume= 83 | issue= 1 | pages= 79-85 | pmid= 2909979 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2909979 }} </ref><ref name="pmid26518581">{{cite journal| author=Resch B, Gutmann C, Reiterer F, Luxner J, Urlesberger B| title=Neonatal Ureaplasma urealyticum colonization increases pulmonary and cerebral morbidity despite treatment with macrolide antibiotics. | journal=Infection | year= 2016 | volume= 44 | issue= 3 | pages= 323-7 | pmid=26518581 | doi=10.1007/s15010-015-0858-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26518581 }} </ref><ref name="pmid18577163">{{cite journal| author=Harada K, Tanaka H, Komori S, Tsuji Y, Nagata K, Tsutsui H et al.| title=Vaginal infection with Ureaplasma urealyticum accounts for preterm delivery via induction of inflammatory responses. | journal=Microbiol Immunol | year= 2008 | volume= 52 | issue= 6 | pages= 297-304 | pmid=18577163 | doi=10.1111/j.1348-0421.2008.00039.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18577163 }} </ref> Some studies also show an association between urogenital colonization by ''U. urealyticum'' and [[nongonococcal urethritis]] in men.<ref name="pmid11939406">{{cite journal| author=Povlsen K, Bjørnelius E, Lidbrink P, Lind I| title=Relationship of Ureaplasma urealyticum biovar 2 to nongonococcal urethritis. | journal=Eur J Clin Microbiol Infect Dis | year= 2002 | volume= 21 | issue= 2 | pages= 97-101 | pmid=11939406 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11939406 }} </ref><ref name="pmid15076934">{{cite journal| author=Deguchi T, Yoshida T, Miyazawa T, Yasuda M, Tamaki M, Ishiko H et al.| title=Association of Ureaplasma urealyticum (biovar 2) with nongonococcal urethritis. | journal=Sex Transm Dis | year= 2004 | volume= 31 | issue= 3 | pages= 192-5 | pmid=15076934 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15076934 }} </ref><ref name="pmid15379939">{{cite journal| author=Maeda S, Deguchi T, Ishiko H, Matsumoto T, Naito S, Kumon H et al.| title=Detection of Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma parvum (biovar 1) and Ureaplasma urealyticum (biovar 2) in patients with non-gonococcal urethritis using polymerase chain reaction-microtiter plate hybridization. | journal=Int J Urol | year= 2004 | volume= 11 | issue= 9 | pages= 750-4 | pmid=15379939 | doi=10.1111/j.1442-2042.2004.00887.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15379939 }} </ref> However, the pathogenic role of ''Ureaplasma urealyticum'' in [[nongonococcal urethritis]] is still not clear.<ref name="pmid20498103">{{cite journal| author=Couldwell DL, Gidding HF, Freedman EV, McKechnie ML, Biggs K, Sintchenko V et al.| title=Ureaplasma urealyticum is significantly associated with non-gonococcal urethritis in heterosexual Sydney men. | journal=Int J STD AIDS | year= 2010 | volume= 21 | issue= 5 | pages= 337-41 | pmid=20498103 | doi=10.1258/ijsa.2009.009499 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20498103 }} </ref><ref name="pmid24047884">{{cite journal| author=Shimada Y, Ito S, Mizutani K, Sugawara T, Seike K, Tsuchiya T et al.| title=Bacterial loads of Ureaplasma urealyticum contribute to development of urethritis in men. | journal=Int J STD AIDS | year= 2014 | volume= 25 | issue= 4 | pages= 294-8 | pmid=24047884 | doi=10.1177/0956462413504556 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24047884 }} </ref><ref name="pmid27000449">{{cite journal| author=Esen B, Gozalan A, Sevindi DF, Demirbas A, Onde U, Erkayran U et al.| title=Ureaplasma urealyticum: Presence among Sexually Transmitted Diseases. | journal=Jpn J Infect Dis | year= 2017 | volume= 70 | issue= 1 | pages= 75-79 | pmid=27000449 | doi=10.7883/yoken.JJID.2015.258 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27000449 }} </ref> Colonization with Ureaplasma species occur in asymptomatic and symptomatic infants and adults, and further investigations to determine the exact pathogenic role of Ureaplasma is required.<ref name="pmid18577163">{{cite journal| author=Harada K, Tanaka H, Komori S, Tsuji Y, Nagata K, Tsutsui H et al.| title=Vaginal infection with Ureaplasma urealyticum accounts for preterm delivery via induction of inflammatory responses. | journal=Microbiol Immunol | year= 2008 | volume= 52 | issue= 6 | pages= 297-304 | pmid=18577163 | doi=10.1111/j.1348-0421.2008.00039.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18577163 }} </ref> There is often a medical dilemma as to whether an isolation of Ureaplasma represent a 'true' infection or 'mere' colonization. Hence, the challenge in making a decision whether medical treatment is necessary. The diagnosis of Ureaplasma colonization/infection is done via culture and/or [[Polymerase chain reaction|PCR]]-based techniques, and antibiotics are the drug of choice for eradication of infection.<ref name="pmid23192735">{{cite journal| author=De Francesco MA, Caracciolo S, Bonfanti C, Manca N| title=Incidence and antibiotic susceptibility of Mycoplasma hominis and Ureaplasma urealyticum isolated in Brescia, Italy, over 7 years. | journal=J Infect Chemother | year= 2013 | volume= 19 | issue= 4 | pages= 621-7 | pmid=23192735 | doi=10.1007/s10156-012-0527-z | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23192735 }} </ref><ref name="pmid26518581"/><ref name="pmid27401661">{{cite journal| author=Lee MY, Kim MH, Lee WI, Kang SY, Jeon YL| title=Prevalence and Antibiotic Susceptibility of Mycoplasma hominis and Ureaplasma urealyticum in Pregnant Women. | journal=Yonsei Med J | year= 2016 | volume= 57 | issue= 5 | pages= 1271-5 | pmid=27401661 | doi=10.3349/ymj.2016.57.5.1271 | pmc=4960396 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27401661 }} </ref>
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| ==Historical Perspective== | | ==[[Ureaplasma urealyticum classification|Classification]]== |
| T-strain [[mycoplasma]] (now known as ''Ureaplasma urealyticum'') was first discovered in the human urogenital tract in 1954 by Shepard et al.<ref name="pmid15076934">{{cite journal| author=Deguchi T, Yoshida T, Miyazawa T, Yasuda M, Tamaki M, Ishiko H et al.| title=Association of Ureaplasma urealyticum (biovar 2) with nongonococcal urethritis. | journal=Sex Transm Dis | year= 2004 | volume= 31 | issue= 3 | pages= 192-5 | pmid=15076934 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15076934 }} </ref><ref name="pmid24047884">{{cite journal| author=Shimada Y, Ito S, Mizutani K, Sugawara T, Seike K, Tsuchiya T et al.| title=Bacterial loads of Ureaplasma urealyticum contribute to development of urethritis in men. | journal=Int J STD AIDS | year= 2014 | volume= 25 | issue= 4 | pages= 294-8 | pmid=24047884 | doi=10.1177/0956462413504556 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24047884 }} </ref> In 1974, this tiny (T)-strain [[mycoplasma]] was renamed ''Ureaplasma urealyticum''.<ref name="pmid24047884">{{cite journal| author=Shimada Y, Ito S, Mizutani K, Sugawara T, Seike K, Tsuchiya T et al.| title=Bacterial loads of Ureaplasma urealyticum contribute to development of urethritis in men. | journal=Int J STD AIDS | year= 2014 | volume= 25 | issue= 4 | pages= 294-8 | pmid=24047884 | doi=10.1177/0956462413504556 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24047884 }} </ref><ref name="pmid15076934">{{cite journal| author=Deguchi T, Yoshida T, Miyazawa T, Yasuda M, Tamaki M, Ishiko H et al.| title=Association of Ureaplasma urealyticum (biovar 2) with nongonococcal urethritis. | journal=Sex Transm Dis | year= 2004 | volume= 31 | issue= 3 | pages= 192-5 | pmid=15076934 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15076934 }} </ref> ''U. urealyticum'' was further subdivided into two biotypes; biovar 1 ( parvo biovar) and biovar 2 (T960 biovar). ''Ureaplasma urealyticum'' biovar 1 was later designated as a separate specie called ''U. parvum'' following phylogenetic analysis done in 1999, but the biovar 2 strain retained its designation as ''U. urealyticum''.<ref name="pmid15076934">{{cite journal| author=Deguchi T, Yoshida T, Miyazawa T, Yasuda M, Tamaki M, Ishiko H et al.| title=Association of Ureaplasma urealyticum (biovar 2) with nongonococcal urethritis. | journal=Sex Transm Dis | year= 2004 | volume= 31 | issue= 3 | pages= 192-5 | pmid=15076934 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15076934 }} </ref> Investigations carried out in the mid 1970's by Tafari et al. described the isolation of ''Ureaplasma urealyticum'' from the lungs of stillborn infants with [[pneumonitis]], and it is one of the earliest investigations that suggested the possible pathogenic role of ''U. urealyticum'' in neonatal disease.<ref name="pmid8399903">{{cite journal| author=Waites KB, Crouse DT, Cassell GH| title=Systemic neonatal infection due to ''Ureaplasma urealyticum''. | journal=Clin Infect Dis | year= 1993 | volume= 17 Suppl 1 | issue= | pages= S131-5 | pmid=8399903 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8399903 }} </ref> Waites et al. reported the first case of suspected neonatal ureaplasmal [[pneumonia]] with [[sepsis]] and persistent [[pulmonary hypertension]] of the newborn in the 1980's.<ref name="pmid2909979">{{cite journal| author=Waites KB, Crouse DT, Philips JB, Canupp KC, Cassell GH| title=Ureaplasmal pneumonia and sepsis associated with persistent pulmonary hypertension of the newborn. | journal=Pediatrics | year= 1989 | volume= 83 | issue= 1 | pages= 79-85 | pmid=2909979 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2909979 }} </ref> Several case reports are now available in the literature documenting the isolation of ''Ureaplasma urealyticum'' and ''Ureaplasma parvum'' in fetal lung tissue, [[cord blood]], pulmonary secretions, [[pleural fluid]], lung tissue, and blood stream of neonates with [[pneumonia]].<ref name="pmid8399903">{{cite journal| author=Waites KB, Crouse DT, Cassell GH| title=Systemic neonatal infection due to ''Ureaplasma urealyticum''. | journal=Clin Infect Dis | year= 1993 | volume= 17 Suppl 1 | issue= | pages= S131-5 | pmid=8399903 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8399903 }} </ref>
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| ==Pathophysiology== | | ==[[Ureaplasma urealyticum pathophysiology|Pathophysiology]]== |
| ===Pathogenesis===
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| ====The role of Ureaplasma infection in preterm delivery====
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| * Ureaplasma species are considered to be of low virulence, and 40-80% of healthy women have Ureaplasma species (''U. urealyticum'' and ''U. parvum'') in their [[Urogenital tract|genital tract]].<ref name="pmid26518581">{{cite journal| author=Resch B, Gutmann C, Reiterer F, Luxner J, Urlesberger B| title=Neonatal Ureaplasma urealyticum colonization increases pulmonary and cerebral morbidity despite treatment with macrolide antibiotics. | journal=Infection | year= 2016 | volume= 44 | issue= 3 | pages= 323-7 | pmid=26518581 | doi=10.1007/s15010-015-0858-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26518581 }} </ref><ref name="pmid21258263">{{cite journal| author=Okogbule-Wonodi AC, Gross GW, Sun CC, Agthe AG, Xiao L, Waites KB et al.| title=Necrotizing enterocolitis is associated with ureaplasma colonization in preterm infants. | journal=Pediatr Res | year= 2011 | volume= 69 | issue= 5 Pt 1 | pages= 442-7 | pmid=21258263 | doi=10.1203/PDR.0b013e3182111827 | pmc=3968774 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21258263 }} </ref><ref name="pmid8399903">{{cite journal| author=Waites KB, Crouse DT, Cassell GH| title=Systemic neonatal infection due to Ureaplasma urealyticum. | journal=Clin Infect Dis | year= 1993 | volume= 17 Suppl 1 | issue= | pages= S131-5 | pmid=8399903 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8399903 }} </ref><ref name="pmid18596706">{{cite journal| author=Viscardi RM, Hashmi N, Gross GW, Sun CC, Rodriguez A, Fairchild KD| title=Incidence of invasive ureaplasma in VLBW infants: relationship to severe intraventricular hemorrhage. | journal=J Perinatol | year= 2008 | volume= 28 | issue= 11 | pages= 759-65 | pmid=18596706 | doi=10.1038/jp.2008.98 | pmc=5334544 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18596706 }} </ref>
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| * Controversial evidence exists supporting the association between genital colonization by Ureaplasma species and complications of pregnancy such as [[Preterm birth|preterm delivery]].<ref name="pmid18577163">{{cite journal| author=Harada K, Tanaka H, Komori S, Tsuji Y, Nagata K, Tsutsui H et al.| title=Vaginal infection with Ureaplasma urealyticum accounts for preterm delivery via induction of inflammatory responses. | journal=Microbiol Immunol | year= 2008 | volume= 52 | issue= 6 | pages= 297-304 | pmid=18577163 | doi=10.1111/j.1348-0421.2008.00039.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18577163 }} </ref>
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| * [[Lactobacilli]] help maintain the vaginal acidity, preventing the invasion of [[bacteria]]. However, the [[urease]] activity of Ureaplasma species such as ''U. urealyticum'' increases the pH of the vagina via the hydrolysis of urea into carbon dioxide and ammonia. This increases the susceptibility to mixed infection with other [[pathogenic bacteria]].<ref name="pmid18577163">{{cite journal| author=Harada K, Tanaka H, Komori S, Tsuji Y, Nagata K, Tsutsui H et al.| title=Vaginal infection with Ureaplasma urealyticum accounts for preterm delivery via induction of inflammatory responses. | journal=Microbiol Immunol | year= 2008 | volume= 52 | issue= 6 | pages= 297-304 | pmid=18577163 | doi=10.1111/j.1348-0421.2008.00039.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18577163 }} </ref>
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| * Ureaplasma and other [[pathogenic bacteria]] induce the secretion of pro-inflammatory [[cytokines]] such as [[IL-1]], [[TNF-α]], [[IL-6]], and [[chemokines]] such as [[IL-8]], leading to the recruitment of [[leukocytes]] and production of [[prostaglandins]].<ref name="pmid19109084">{{cite journal| author=Waites KB, Schelonka RL, Xiao L, Grigsby PL, Novy MJ| title=Congenital and opportunistic infections: Ureaplasma species and Mycoplasma hominis. | journal=Semin Fetal Neonatal Med | year= 2009 | volume= 14 | issue= 4 | pages= 190-9 | pmid=19109084 | doi=10.1016/j.siny.2008.11.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19109084 }} </ref><ref name="pmid18577163"/> Uterine stimulation by [[prostaglandins]] result in [[Preterm birth|preterm delivery]].<ref name="pmid18577163">{{cite journal| author=Harada K, Tanaka H, Komori S, Tsuji Y, Nagata K, Tsutsui H et al.| title=Vaginal infection with Ureaplasma urealyticum accounts for preterm delivery via induction of inflammatory responses. | journal=Microbiol Immunol | year= 2008 | volume= 52 | issue= 6 | pages= 297-304 | pmid=18577163 | doi=10.1111/j.1348-0421.2008.00039.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18577163 }} </ref><ref name="pmid19109084"/>
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| * Ureaplasmal lipoprotein also induce [[apoptosis]], and it is possible that the apoptotic cells sustain [[Urogenital tract|genital tract]] [[inflammation]] which promote [[Preterm birth|preterm delivery]].<ref name="pmid18577163">{{cite journal| author=Harada K, Tanaka H, Komori S, Tsuji Y, Nagata K, Tsutsui H et al.| title=Vaginal infection with Ureaplasma urealyticum accounts for preterm delivery via induction of inflammatory responses. | journal=Microbiol Immunol | year= 2008 | volume= 52 | issue= 6 | pages= 297-304 | pmid=18577163 | doi=10.1111/j.1348-0421.2008.00039.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18577163 }} </ref>
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| * Studies have also shown a higher rate of vaginal colonization by Ureaplasma species in women with [[Preterm birth|preterm deliveries]] compared to those with full-term deliveries.<ref name="pmid18577163">{{cite journal| author=Harada K, Tanaka H, Komori S, Tsuji Y, Nagata K, Tsutsui H et al.| title=Vaginal infection with Ureaplasma urealyticum accounts for preterm delivery via induction of inflammatory responses. | journal=Microbiol Immunol | year= 2008 | volume= 52 | issue= 6 | pages= 297-304 | pmid=18577163 | doi=10.1111/j.1348-0421.2008.00039.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18577163 }} </ref>
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| ====Neonatal infection and the role of Ureaplasma species==== | | ==[[Ureaplasma urealyticum causes|Causes]]== |
| * ''Ureaplasma urealyticum'' and ''U. parvum'' are the most common organisms isolated from infected [[amniotic fluid]] and [[placenta]], suggesting the potential role of Ureaplasma species in the development of disseminated neonatal infection.<ref name="pmid18166302">{{cite journal| author=Goldenberg RL, Andrews WW, Goepfert AR, Faye-Petersen O, Cliver SP, Carlo WA et al.| title=The Alabama Preterm Birth Study: umbilical cord blood Ureaplasma urealyticum and Mycoplasma hominis cultures in very preterm newborn infants. | journal=Am J Obstet Gynecol | year= 2008 | volume= 198 | issue= 1 | pages= 43.e1-5 | pmid=18166302 | doi=10.1016/j.ajog.2007.07.033 | pmc=2278008 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18166302 }} </ref><ref name="pmid21258263">{{cite journal| author=Okogbule-Wonodi AC, Gross GW, Sun CC, Agthe AG, Xiao L, Waites KB et al.| title=Necrotizing enterocolitis is associated with ureaplasma colonization in preterm infants. | journal=Pediatr Res | year= 2011 | volume= 69 | issue= 5 Pt 1 | pages= 442-7 | pmid=21258263 | doi=10.1203/PDR.0b013e3182111827 | pmc=3968774 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21258263 }} </ref><ref name="pmid8399903">{{cite journal| author=Waites KB, Crouse DT, Cassell GH| title=Systemic neonatal infection due to Ureaplasma urealyticum. | journal=Clin Infect Dis | year= 1993 | volume= 17 Suppl 1 | issue= | pages= S131-5 | pmid=8399903 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8399903 }} </ref><ref name="pmid18596706">{{cite journal| author=Viscardi RM, Hashmi N, Gross GW, Sun CC, Rodriguez A, Fairchild KD| title=Incidence of invasive ureaplasma in VLBW infants: relationship to severe intraventricular hemorrhage. | journal=J Perinatol | year= 2008 | volume= 28 | issue= 11 | pages= 759-65 | pmid=18596706 | doi=10.1038/jp.2008.98 | pmc=5334544 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18596706 }} </ref>
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| * The infection is commonly acquired via [[vertical transmission]] by three main mechanisms:<ref name="pmid8399903">{{cite journal| author=Waites KB, Crouse DT, Cassell GH| title=Systemic neonatal infection due to Ureaplasma urealyticum. | journal=Clin Infect Dis | year= 1993 | volume= 17 Suppl 1 | issue= | pages= S131-5 | pmid=8399903 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8399903 }} </ref>
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| # Maternal placental infection with [[umbilical vessels]] involvement result in the hematogenous dissemination of infection in the neonate.
| |
| # Passage of the organism into the fetal lung via an infected [[amniotic fluid]].
| |
| # Perinatal acquisition of infection following passage of the baby through an infected maternal [[birth canal]].
| |
| * [[Pneumonitis]], [[bacteremia]], or [[meningitis]] can occur following stimulation of host [[inflammatory responses]] by the organism.<ref name="pmid18596706" /><ref name="pmid8399903" />
| |
| * Preterm neonates are most commonly affected, and very low birth weight (VLBW) infants have been noted to have invasive Ureaplasma infection.<ref name="pmid18596706">{{cite journal| author=Viscardi RM, Hashmi N, Gross GW, Sun CC, Rodriguez A, Fairchild KD| title=Incidence of invasive ureaplasma in VLBW infants: relationship to severe intraventricular hemorrhage. | journal=J Perinatol | year= 2008 | volume= 28 | issue= 11 | pages= 759-65 | pmid=18596706 | doi=10.1038/jp.2008.98 | pmc=5334544 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18596706 }} </ref> Preterm infants weighing <5.5 pounds are nearly four times more likely to develop systemic infection compared to full term infants weighing above 5.5 pounds.
| |
| * It has been suggested that severe Ureaplasma infection in VLBW infants may contribute to the development of severe [[intraventricular hemorrhage]].<ref name="pmid18596706"/>
| |
| * There may also be an association between [[necrotising enterocolitis]] and Ureaplasma colonization in preterm neonates.<ref name="pmid21258263" />
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|
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|
| ====Colonization by Ureaplasma species and its association with urogenital infections in adults==== | | ==[[Ureaplasma urealyticum differential diagnosis|Differentiating Ureaplasma urealyticum from other Diseases]]== |
| * There is no significant association between Ureaplasma colonization of the lower [[Urogenital tract|genital tract]] and symptomatic urogenital infection in females.<ref name="pmid25717022">{{cite journal| author=Marovt M, Keše D, Kotar T, Kmet N, Miljković J, Šoba B et al.| title=Ureaplasma parvum and Ureaplasma urealyticum detected with the same frequency among women with and without symptoms of urogenital tract infection. | journal=Eur J Clin Microbiol Infect Dis | year= 2015 | volume= 34 | issue= 6 | pages= 1237-45 | pmid=25717022 | doi=10.1007/s10096-015-2351-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25717022 }} </ref>
| |
| * The detection of ''Ureaplasma urealyticum'' and ''U. parvum'' in fluid samples obtained from the [[pouch of Douglas]] in 60% of women with lower [[urogenital tract]] Ureaplasma colonization confirms the fact that asymptomatic infection of the upper [[Urogenital tract|genital tract]] can occur in women following direct ascent of these organisms from the [[cervix]] and [[vagina]] to the sterile upper reproductive tract.<ref name="pmid24318169">{{cite journal| author=Kasprzykowska U, Elias J, Elias M, Mączyńska B, Sobieszczańska BM| title=Colonization of the lower urogenital tract with Ureaplasma parvum can cause asymptomatic infection of the upper reproductive system in women: a preliminary study. | journal=Arch Gynecol Obstet | year= 2014 | volume= 289 | issue= 5 | pages= 1129-34 | pmid=24318169 | doi=10.1007/s00404-013-3102-7 | pmc=3984420 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24318169 }} </ref>
| |
| * Ureaplasma colonization of the [[Urogenital tract|genital tract]] is common following puberty and it is directly related to sexual activity.<ref name="pmid19109084">{{cite journal| author=Waites KB, Schelonka RL, Xiao L, Grigsby PL, Novy MJ| title=Congenital and opportunistic infections: Ureaplasma species and Mycoplasma hominis. | journal=Semin Fetal Neonatal Med | year= 2009 | volume= 14 | issue= 4 | pages= 190-9 | pmid=19109084 | doi=10.1016/j.siny.2008.11.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19109084 }} </ref>
| |
| * ''Ureaplasma urealyticum'' has been detected in men with [[nongonococcal urethritis]], and also in those without [[nongonococcal urethritis]].<ref name="pmid11939406">{{cite journal| author=Povlsen K, Bjørnelius E, Lidbrink P, Lind I| title=Relationship of Ureaplasma urealyticum biovar 2 to nongonococcal urethritis. | journal=Eur J Clin Microbiol Infect Dis | year= 2002 | volume= 21 | issue= 2 | pages= 97-101 | pmid=11939406 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11939406 }} </ref> Some studies conducted in men show there is an association between urogenital colonization by ''Ureaplasma urealyticum'' and [[nongonococcal urethritis]].<ref name="pmid11939406">{{cite journal| author=Povlsen K, Bjørnelius E, Lidbrink P, Lind I| title=Relationship of Ureaplasma urealyticum biovar 2 to nongonococcal urethritis. | journal=Eur J Clin Microbiol Infect Dis | year= 2002 | volume= 21 | issue= 2 | pages= 97-101 | pmid=11939406 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11939406 }} </ref><ref name="pmid15076934">{{cite journal| author=Deguchi T, Yoshida T, Miyazawa T, Yasuda M, Tamaki M, Ishiko H et al.| title=Association of Ureaplasma urealyticum (biovar 2) with nongonococcal urethritis. | journal=Sex Transm Dis | year= 2004 | volume= 31 | issue= 3 | pages= 192-5 | pmid=15076934 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15076934 }} </ref><ref name="pmid15379939">{{cite journal| author=Maeda S, Deguchi T, Ishiko H, Matsumoto T, Naito S, Kumon H et al.| title=Detection of Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma parvum (biovar 1) and Ureaplasma urealyticum (biovar 2) in patients with non-gonococcal urethritis using polymerase chain reaction-microtiter plate hybridization. | journal=Int J Urol | year= 2004 | volume= 11 | issue= 9 | pages= 750-4 | pmid=15379939 | doi=10.1111/j.1442-2042.2004.00887.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15379939 }} </ref> However, the pathogenic role of ''Ureaplasma urealyticum'' in [[nongonococcal urethritis]] is still not clear.<ref name="pmid20498103">{{cite journal| author=Couldwell DL, Gidding HF, Freedman EV, McKechnie ML, Biggs K, Sintchenko V et al.| title=Ureaplasma urealyticum is significantly associated with non-gonococcal urethritis in heterosexual Sydney men. | journal=Int J STD AIDS | year= 2010 | volume= 21 | issue= 5 | pages= 337-41 | pmid=20498103 | doi=10.1258/ijsa.2009.009499 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20498103 }} </ref><ref name="pmid24047884">{{cite journal| author=Shimada Y, Ito S, Mizutani K, Sugawara T, Seike K, Tsuchiya T et al.| title=Bacterial loads of Ureaplasma urealyticum contribute to development of urethritis in men. | journal=Int J STD AIDS | year= 2014 | volume= 25 | issue= 4 | pages= 294-8 | pmid=24047884 | doi=10.1177/0956462413504556 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24047884 }} </ref><ref name="pmid27000449">{{cite journal| author=Esen B, Gozalan A, Sevindi DF, Demirbas A, Onde U, Erkayran U et al.| title=Ureaplasma urealyticum: Presence among Sexually Transmitted Diseases. | journal=Jpn J Infect Dis | year= 2017 | volume= 70 | issue= 1 | pages= 75-79 | pmid=27000449 | doi=10.7883/yoken.JJID.2015.258 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27000449 }} </ref>
| |
| * Men with higher bacterial load of ''U. urealyticum'' (≥5 x 10<sup>3</sup>) in first-void urine were found to have higher [[leukocyte]] counts (in their first-void urine sample) and symptomatic [[urethritis]], suggesting there could be a positive correlation between the bacteria load of ''U. urealyticum'' and the development of inflammatory responses to the organism.<ref name="pmid24047884">{{cite journal| author=Shimada Y, Ito S, Mizutani K, Sugawara T, Seike K, Tsuchiya T et al.| title=Bacterial loads of Ureaplasma urealyticum contribute to development of urethritis in men. | journal=Int J STD AIDS | year= 2014 | volume= 25 | issue= 4 | pages= 294-8 | pmid=24047884 | doi=10.1177/0956462413504556 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24047884 }} </ref>
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|
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|
| ==Epidemiology and Demographics== | | ==[[Ureaplasma urealyticum epidemiology and demographics|Epidemiology and Demographics]]== |
| ===Prevalence===
| |
| Ureaplasma species are commensal organisms in the female [[Urogenital tract|genital tract]], colonizing 40-80% of the [[Urogenital tract|genital tract]] of healthy women.<ref name="pmid8399903" /> <ref name="pmid26518581" /><ref name="pmid21258263" /><ref name="pmid18596706" /> The prevalence of vaginal colonization with ''U. urealyticum'' in pregnant women is 29-42%.<ref name="pmid16817073">{{cite journal| author=Vogel I, Thorsen P, Hogan VK, Schieve LA, Jacobsson B, Ferre CD| title=The joint effect of vaginal Ureaplasma urealyticum and bacterial vaginosis on adverse pregnancy outcomes. | journal=Acta Obstet Gynecol Scand | year= 2006 | volume= 85 | issue= 7 | pages= 778-85 | pmid=16817073 | doi=10.1080/00016340500442423 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16817073 }} </ref> Ureaplasma species are the most common pathogen identified in VLBW infants.<ref name="pmid18596706" /> Ureaplasma colonization of the [[respiratory tract]] is more common in preterm VLBW infants compared to term infants.<ref name="pmid16223956">{{cite journal| author=Waites KB, Katz B, Schelonka RL| title=Mycoplasmas and ureaplasmas as neonatal pathogens. | journal=Clin Microbiol Rev | year= 2005 | volume= 18 | issue= 4 | pages= 757-89 | pmid=16223956 | doi=10.1128/CMR.18.4.757-789.2005 | pmc=1265909 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16223956 }} </ref><ref name="pmid9576388">{{cite journal| author=Patterson AM, Taciak V, Lovchik J, Fox RE, Campbell AB, Viscardi RM| title=Ureaplasma urealyticum respiratory tract colonization is associated with an increase in interleukin 1-beta and tumor necrosis factor alpha relative to interleukin 6 in tracheal aspirates of preterm infants. | journal=Pediatr Infect Dis J | year= 1998 | volume= 17 | issue= 4 | pages= 321-8 | pmid=9576388 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9576388 }} </ref> 20-45% of VLBW infants have Ureaplasma colonization of the [[respiratory tract]].<ref name="pmid26518581">{{cite journal| author=Resch B, Gutmann C, Reiterer F, Luxner J, Urlesberger B| title=Neonatal Ureaplasma urealyticum colonization increases pulmonary and cerebral morbidity despite treatment with macrolide antibiotics. | journal=Infection | year= 2016 | volume= 44 | issue= 3 | pages= 323-7 | pmid=26518581 | doi=10.1007/s15010-015-0858-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26518581 }} </ref> The incidence of Ureaplasma species in [[cord blood]] cultures of VLBW neonates was found to be 17%.<ref name="pmid18166302"/> Ureaplasma species have also been shown to invade the [[bloodstream]] and cross the [[blood–brain barrier]] in 23% of VLBW infants in another study.<ref name="pmid18596706" /> The prevalence of Ureaplasma positive [[CSF]] culture from preterm infants investigated for suspected [[meningitis]] was 8%.<ref name="pmid2891889">{{cite journal| author=Waites KB, Rudd PT, Crouse DT, Canupp KC, Nelson KG, Ramsey C et al.| title=Chronic Ureaplasma urealyticum and Mycoplasma hominis infections of central nervous system in preterm infants. | journal=Lancet | year= 1988 | volume= 1 | issue= 8575-6 | pages= 17-21 | pmid=2891889 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2891889 }} </ref>
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|
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|
| ===Age=== | | ==[[Ureaplasma urealyticum risk factors|Risk Factors]]== |
| Colonization by Ureaplasma species can be seen in both the pediatric and adult population. [[Urogenital tract|Genital tract]] of adult men and women are the main reservoirs of Ureaplasma species.<ref name="pmid26518581" /><ref name="pmid15076934" /> However, symptomatic Ureaplasma infection is seen more often in preterm neonates.<ref name="pmid18596706" /> Colonization of neonates by ''U. urealyticum'' increases with decreasing gestational age and birth weight.<ref name="pmid11036807">{{cite journal| author=Agarwal P, Rajadurai VS, Pradeepkumar VK, Tan KW| title=Ureaplasma urealyticum and its association with chronic lung disease in Asian neonates. | journal=J Paediatr Child Health | year= 2000 | volume= 36 | issue= 5 | pages= 487-90 | pmid=11036807 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11036807 }} </ref>
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|
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| ===Gender=== | | ==[[Ureaplasma urealyticum natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| There is no known gender predilection for Ureaplasma infection.
| |
| ===Race===
| |
| There is no racial predilection for Ureaplasma colonization.<ref name="pmid15739821">{{cite journal| author=Doh K, Barton PT, Korneeva I, Perni SC, Bongiovanni AM, Tuttle SL et al.| title=Differential vaginal expression of interleukin-1 system cytokines in the presence of Mycoplasma hominis and Ureaplasma urealyticum in pregnant women. | journal=Infect Dis Obstet Gynecol | year= 2004 | volume= 12 | issue= 2 | pages= 79-85 | pmid=15739821 | doi=10.1080/10647440400003667 | pmc=1784593 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15739821 }} </ref> A previous study conducted in the United States in the 1980's in 13,747 women of low socioeconomic status from four different ethnic groups revealed that women of black ethnicity were more likely to have genital tract colonization with potentially pathogenic organisms such as ''U. urealyticum ''<ref name="pmid28140029">{{cite journal| author=Goldenberg RL, Klebanoff MA, Nugent R, Krohn MA, Hillier S, Andrews WW et al.| title=Bacterial colonization of the vagina during pregnancy in four ethnic groups. | journal=Am J Obstet Gynecol | year= 1996 | volume= 174 | issue= 5 | pages= 1618-1621 | pmid=28140029 | doi=10.1016/S0002-9378(96)70617-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28140029 }} </ref>
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| ==Risk Factors==
| |
| Risk factors for Ureaplasma infection in infants include the following:<ref name="pmid8399903" /><ref name="pmid26518581"/><ref name="pmid18596706" /><ref name="pmid18577163" /><ref name="pmid27756710">{{cite journal| author=Kikhney J, von Schöning D, Steding I, Schulze J, Petrich A, Hiergeist A et al.| title=Is Ureaplasma spp. the leading causative agent of acute chorioamnionitis in women with preterm birth? | journal=Clin Microbiol Infect | year= 2017 | volume= 23 | issue= 2 | pages= 119.e1-119.e7 | pmid=27756710 | doi=10.1016/j.cmi.2016.10.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27756710 }} </ref><ref name="pmid27172838">{{cite journal| author=Koucký M, Malíčková K, Cindrová-Davies T, Smíšek J, Vráblíková H, Černý A et al.| title=Prolonged progesterone administration is associated with less frequent cervicovaginal colonization by Ureaplasma urealyticum during pregnancy - Results of a pilot study. | journal=J Reprod Immunol | year= 2016 | volume= 116 | issue= | pages= 35-41 | pmid=27172838 | doi=10.1016/j.jri.2016.04.285 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27172838 }} </ref>
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| Neonatal factors
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| * [[Prematurity]]
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| * [[Low birth weight]]
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| * [[Perinatal asphyxia]] (Apgar score less than 6 at 5min)
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| * [[Mechanical ventilation]] of the infant
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| * Tracheal colonization of the infant by Ureaplasma species: The risk of developing moderate-severe [[bronchopulmonary dysplasia]] is increased by 7-9 folds in mechanically ventilated infants with Ureaplasma positive tracheal aspirate compared to mechanically ventilated infants with Ureaplasma positive nasopharyngeal sample.
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| * [[Congenital anomalies]] such as [[meningomyelocele]]
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| Maternal factors
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| * Prolonged or [[Premature rupture of membranes|preterm rupture of membranes]]
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| * [[Chorioamnionitis]]
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| * Heavy vaginal colonization by Ureaplasma species
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| * Low socioeconomic status
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| Risk factors for Ureaplasma colonization/infection in adult men and women:<ref name="pmid25717022" /><ref name="pmid11939406" /><ref name="pmid15379939" /><ref name="pmid20498103" /><ref name="pmid15590426">{{cite journal| author=Benedetto C, Tibaldi C, Marozio L, Marini S, Masuelli G, Pelissetto S et al.| title=Cervicovaginal infections during pregnancy: epidemiological and microbiological aspects. | journal=J Matern Fetal Neonatal Med | year= 2004 | volume= 16 Suppl 2 | issue= | pages= 9-12 | pmid=15590426 | doi=10.1080/14767050410001727107 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15590426 }} </ref><ref name="pmid26010188">{{cite journal| author=George MD, Cardenas AM, Birnbaum BK, Gluckman SJ| title=Ureaplasma septic arthritis in an immunosuppressed patient with juvenile idiopathic arthritis. | journal=J Clin Rheumatol | year= 2015 | volume= 21 | issue= 4 | pages= 221-4 | pmid=26010188 | doi=10.1097/RHU.0000000000000248 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26010188 }} </ref>
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| * Multiple sexual partners
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| * Younger age
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| * Urogenital colonization/infection with other microorganisms
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| *Low socioeconomic status
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| * [[Immunosuppressive disorder|Immunosuppresion]] such as [[congenital immunodeficiency disorders]] like [[hypogammaglobulinemia]].
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| ==Screening==
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| There are no screening guidelines for Ureaplasma infection.
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| ==Natural History, Complications, and Prognosis==
| |
| ===Natural History===
| |
| The [[Urogenital tract|genital tract]] of adult men and women serve as the main reservoirs for Ureaplasma species.<ref name="pmid15076934" /><ref name="pmid26518581" /> Colonization by Ureaplasma species has been documented in sick as well as healthy infants.<ref name="pmid8399903" />
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| ===Complications===
| |
| Infection with Ureaplasma species has been associated with the following complications:
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| '''Pregnancy complications'''<ref name="pmid18577163" /><ref name="pmid16817073" /><ref name="pmid27756710" /><ref name="pmid7801884">{{cite journal| author=Joste NE, Kundsin RB, Genest DR| title=Histology and Ureaplasma urealyticum culture in 63 cases of first trimester abortion. | journal=Am J Clin Pathol | year= 1994 | volume= 102 | issue= 6 | pages= 729-32 | pmid=7801884 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7801884 }} </ref><ref name="pmid27172838">{{cite journal| author=Koucký M, Malíčková K, Cindrová-Davies T, Smíšek J, Vráblíková H, Černý A et al.| title=Prolonged progesterone administration is associated with less frequent cervicovaginal colonization by Ureaplasma urealyticum during pregnancy - Results of a pilot study. | journal=J Reprod Immunol | year= 2016 | volume= 116 | issue= | pages= 35-41 | pmid=27172838 | doi=10.1016/j.jri.2016.04.285 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27172838 }} </ref>
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| * [[Chorioamnionitis|Histologic chorioamnionitis]]
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| * [[Preterm labor]]
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| * [[Premature rupture of membranes|Preterm rupture of membranes]]
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| * [[Pregnancy loss]]
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| * Postpartum [[endometritis]]
| |
| '''Fetal/neonatal complications'''<ref name="pmid8399903" /><ref name="pmid2909979" /><ref name="pmid26518581"/><ref name="pmid21258263" /><ref name="pmid18596706" /><ref name="pmid9576388" /><ref name="pmid2891889" /><ref name="pmid11036807" /><ref name="pmid9334863">{{cite journal| author=Abele-Horn M, Peters J, Genzel-Boroviczény O, Wolff C, Zimmermann A, Gottschling W| title=Vaginal Ureaplasma urealyticum colonization: influence on pregnancy outcome and neonatal morbidity. | journal=Infection | year= 1997 | volume= 25 | issue= 5 | pages= 286-91 | pmid=9334863 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9334863 }} </ref><ref name="pmid16371861">{{cite journal| author=Schelonka RL, Katz B, Waites KB, Benjamin DK| title=Critical appraisal of the role of Ureaplasma in the development of bronchopulmonary dysplasia with metaanalytic techniques. | journal=Pediatr Infect Dis J | year= 2005 | volume= 24 | issue= 12 | pages= 1033-9 | pmid=16371861 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16371861 }} </ref><ref name="pmid7562292">{{cite journal| author=Wang EE, Ohlsson A, Kellner JD| title=Association of Ureaplasma urealyticum colonization with chronic lung disease of prematurity: results of a metaanalysis. | journal=J Pediatr | year= 1995 | volume= 127 | issue= 4 | pages= 640-4 | pmid=7562292 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7562292 }} </ref>
| |
| | |
| Common
| |
| * Umbilical cord [[vasculitis]]
| |
| | |
| * [[Prematurity]]
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| * [[Pneumonia]]
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| * [[Pneumonitis]]
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| * [[Bronchopulmonary dysplasia]]
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| * [[Hyaline membrane disease]] ([[Neonatal respiratory distress syndrome|respiratory distress syndrome of the newborn]])
| |
| * [[Sepsis]]
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| Uncommon
| |
| * Persistent [[pulmonary hypertension]] of the newborn
| |
| * [[Meningitis]]
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| * Periventricular hemorrhage
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| * [[Intraventricular hemorrhage]]
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| * [[Necrotizing enterocolitis]]
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| * [[Stillbirth]]
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| '''Complications in adult men and women'''<ref name="pmid15076934" /><ref name="pmid24047884" /><ref name="pmid24318169" /><ref name="pmid11939406" /><ref name="pmid15379939" /><ref name="pmid20498103" /><ref name="pmid26010188" /><ref name="pmid24671783">{{cite journal| author=Farrell JJ, Larson JA, Akeson JW, Lowery KS, Rounds MA, Sampath R et al.| title=Ureaplasma parvum prosthetic joint infection detected by PCR. | journal=J Clin Microbiol | year= 2014 | volume= 52 | issue= 6 | pages= 2248-50 | pmid=24671783 | doi=10.1128/JCM.00432-14 | pmc=4042745 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24671783 }} </ref><ref name="pmid27803864">{{cite journal| author=Abdelfattah MM, Khattab RA, Mahran MH, Elborgy ES| title=Evaluation of patients with dry eye disease for conjunctival Chlamydia trachomatis and Ureaplasma urealyticum. | journal=Int J Ophthalmol | year= 2016 | volume= 9 | issue= 10 | pages= 1457-1465 | pmid=27803864 | doi=10.18240/ijo.2016.10.15 | pmc=5075662 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27803864 }} </ref><ref name="pmid27000449">{{cite journal| author=Esen B, Gozalan A, Sevindi DF, Demirbas A, Onde U, Erkayran U et al.| title=Ureaplasma urealyticum: Presence among Sexually Transmitted Diseases. | journal=Jpn J Infect Dis | year= 2017 | volume= 70 | issue= 1 | pages= 75-79 | pmid=27000449 | doi=10.7883/yoken.JJID.2015.258 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27000449 }} </ref><ref name="pmid18436601">{{cite journal| author=García-de-la-Fuente C, Miñambres E, Ugalde E, Sáez A, Martinez-Martinez L, Fariñas MC| title=Post-operative mediastinitis, pleuritis and pericarditis due to Mycoplasma hominis and Ureaplasma urealyticum with a fatal outcome. | journal=J Med Microbiol | year= 2008 | volume= 57 | issue= Pt 5 | pages= 656-7 | pmid=18436601 | doi=10.1099/jmm.0.47632-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18436601 }} </ref>
| |
| * [[Urogenital tract]] infections such as [[nongonococcal urethritis]] and [[prostatitis]] in men
| |
| * [[Infertility]]
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| * [[Pelvic inflammatory disease]] in females
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| * [[Septic arthritis]]
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| * Prosthetic [[Joint infections|joint infection]]
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| * Post-operative [[mediastinitis]] with persistent pleural and [[pericardial effusion]]
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| * Possible association with [[Dry eyes|dry eye disease]]
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| | |
| ===Prognosis===
| |
| Polymicrobial infection of the [[amniotic fluid]] with Ureaplasma species and other bacteria is associated with poor perinatal prognosis in [[preterm labor]].<ref name="pmid26668114">{{cite journal| author=Yoneda N, Yoneda S, Niimi H, Ueno T, Hayashi S, Ito M et al.| title=Polymicrobial Amniotic Fluid Infection with Mycoplasma/Ureaplasma and Other Bacteria Induces Severe Intra-Amniotic Inflammation Associated with Poor Perinatal Prognosis in Preterm Labor. | journal=Am J Reprod Immunol | year= 2016 | volume= 75 | issue= 2 | pages= 112-25 | pmid=26668114 | doi=10.1111/aji.12456 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26668114 }} </ref> Despite [[Macrolide antibiotics|macrolide antibiotic]] treatment, there is a significant association between ''U. urealyticum'' infection and pulmonary morbidity and mild cerebral impairment in preterm infants.<ref name="pmid26518581" />
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|
| |
|
| ==Diagnosis== | | ==Diagnosis== |
| ===History and Symptoms<ref name="pmid8399903" /><ref name="pmid2909979" /><ref name="pmid18577163" /><ref name="pmid11939406" />===
| | [[Ureaplasma urealyticum history and symptoms|History and Symptoms]] | [[Ureaplasma urealyticum physical examination|Physical Examination]] | [[Ureaplasma urealyticum laboratory findings|Laboratory Findings]] | [[Ureaplasma urealyticum chest x ray|Chest X Ray]] | [[Ureaplasma urealyticum CT|CT]] | [[Ureaplasma urealyticum other diagnostic studies|Other Diagnostic Studies]] |
| * It is important to take a history of the underlying risk factors for Ureaplasma colonization/infection.
| |
| * The site of the body affected by Ureaplasma infection determines the presenting symptom:
| |
| # [[Non-gonococcal urethritis|Nongonococcal urethritis]] can present with [[dysuria]] and [[urethral discharge]]. It can also be asymptomatic.
| |
| # Ureaplasma pneumonia presents with symptoms similar to other [[bacterial pneumonia]] such as [[fever]], [[labored breathing]], etc.
| |
| | |
| ===Physical Examination===
| |
| There is no physical examination finding that is specific or pathognomonic for Ureaplasma infection, and a laboratory diagnosis is required. The signs of neonatal infections associated with Ureaplasma species are similar to those caused by other microorganisms, and it can include some of the following nonspecific signs:<ref name="pmid9686724">{{cite journal| author=Fanaroff AA, Korones SB, Wright LL, Verter J, Poland RL, Bauer CR et al.| title=Incidence, presenting features, risk factors and significance of late onset septicemia in very low birth weight infants. The National Institute of Child Health and Human Development Neonatal Research Network. | journal=Pediatr Infect Dis J | year= 1998 | volume= 17 | issue= 7 | pages= 593-8 | pmid=9686724 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9686724 }} </ref>
| |
| | |
| ====Vital signs====
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| * Temperature instability
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| * Hypothermia
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| * Fever
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| | |
| ====HEENT====
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| * Jaundice
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| * Anemia
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| ====Respiratory system====
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| * Increased apnea
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| * Increased need for respiratory support and oxygen
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| | |
| ====Cardiovascular system====
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| * Bradycardia
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| * Tachycardia
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| * Hypotension
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| | |
| ====Gastrointestinal system====
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| * Abdominal distension
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| * Feeding intolerance
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| * Guaiac-positive stools
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| | |
| ====Musculoskeletal system====
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| * Lethargy
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| * Hypotonia
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| | |
| ===Laboratory findings<ref name="pmid8399903" /><ref name="pmid2909979" /><ref name="pmid26518581" /><ref name="pmid21258263" /><ref name="pmid26668114">{{cite journal| author=Yoneda N, Yoneda S, Niimi H, Ueno T, Hayashi S, Ito M et al.| title=Polymicrobial Amniotic Fluid Infection with Mycoplasma/Ureaplasma and Other Bacteria Induces Severe Intra-Amniotic Inflammation Associated with Poor Perinatal Prognosis in Preterm Labor. | journal=Am J Reprod Immunol | year= 2016 | volume= 75 | issue= 2 | pages= 112-25 | pmid=26668114 | doi=10.1111/aji.12456 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26668114 }} </ref><ref name="pmid8248756">{{cite journal| author=Ollikainen J, Hiekkaniemi H, Korppi M, Katila ML, Heinonen K| title=Ureaplasma urealyticum cultured from brain tissue of preterm twins who died of intraventricular hemorrhage. | journal=Scand J Infect Dis | year= 1993 | volume= 25 | issue= 4 | pages= 529-31 | pmid=8248756 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8248756 }} </ref><ref name="pmid8496757">{{cite journal| author=Ollikainen J, Hiekkaniemi H, Korppi M, Sarkkinen H, Heinonen K| title=Ureaplasma urealyticum infection associated with acute respiratory insufficiency and death in premature infants. | journal=J Pediatr | year= 1993 | volume= 122 | issue= 5 Pt 1 | pages= 756-60 | pmid=8496757 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8496757 }} </ref>===
| |
| Colonization and infection with Ureaplasma species are diagnosed based on culture results and/or PCR.
| |
| ====Microscopy====
| |
| Culture method: Ureaplasma species have been cultured from different sites of the body of infants such as the blood, [[CSF]], [[nasopharynx]], endotracheal secretions, gastric aspirates, [[pleural fluid]], [[lung]] and [[brain tissue]]. Ureaplasma species are also the most common organism isolated from infected [[amniotic fluid]] and [[placenta]]. Culture from sites such as the [[urogenital tract]], [[rectum]], and joint aspirate, has been documented. Conventional bacteriologic culture methods cannot identify these species and special culture for [[Mycoplasma]] is often used.
| |
| | |
| ====Molecular-based test====
| |
| [[PCR]]-based method: This is a rapid and more sensitive technique for detection of Ureaplasma species compared to microbial culture method.
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|
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|
| ==Treatment== | | ==Treatment== |
| Antibiotics are the mainstay of treatment for Ureaplasma infection. Antibiotic susceptibility testing should be done to avoid treatment failure because of the geographical differences in antibiotic resistance.
| | [[Ureaplasma urealyticum medical therapy|Medical therapy]] | [[Ureaplasma urealyticum prevention|Prevention]] | |
| | |
| '''Recommended antibiotics'''<ref name="pmid23192735">{{cite journal| author=De Francesco MA, Caracciolo S, Bonfanti C, Manca N| title=Incidence and antibiotic susceptibility of Mycoplasma hominis and Ureaplasma urealyticum isolated in Brescia, Italy, over 7 years. | journal=J Infect Chemother | year= 2013 | volume= 19 | issue= 4 | pages= 621-7 | pmid=23192735 | doi=10.1007/s10156-012-0527-z | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23192735 }} </ref><ref name="pmid26518581"/><ref name="pmid27401661">{{cite journal| author=Lee MY, Kim MH, Lee WI, Kang SY, Jeon YL| title=Prevalence and Antibiotic Susceptibility of Mycoplasma hominis and Ureaplasma urealyticum in Pregnant Women. | journal=Yonsei Med J | year= 2016 | volume= 57 | issue= 5 | pages= 1271-5 | pmid=27401661 | doi=10.3349/ymj.2016.57.5.1271 | pmc=4960396 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27401661 }} </ref>
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|
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| * [[Doxycycline]]
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| # This is the drug of first choice.
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| # It is the most active [[tetracycline]] for [[Mycoplasma]] and Ureaplasma infection.
| |
| # It should be avoided in pregnant women and young children.
| |
| | |
| * [[Macrolides]]
| |
| # [[Josamycin]] and [[clarithromycin]] are the most effective macrolides against Ureaplasma infection.
| |
| # [[Josamycin]] is often recommended for neonates and pregnant women, especially when mixed infection is present.
| |
| # [[Pristinamycin]] can be used as an alternative to [[Josamycin]] in pregnant women.
| |
| # [[Erythromycin]] has a low efficacy against ''Ureaplasma urealyticum''.
| |
| | |
| * [[Fluoroquinolones]]: They have a low efficacy against urogenital [[Mycoplasma]] and Ureaplasma infection.
| |
| * [[Clindamycin]]: This has also been demonstrated to have a low efficacy against Ureaplasma species.
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|
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|
| ==Prevention==
| |
| There are no guidelines for the prevention of Ureaplasma colonization or infection. There is controversial benefit for screening of pregnant women for urogenital colonization with Ureaplasma species.<ref name="pmid24849820">{{cite journal| author=Vouga M, Greub G, Prod'hom G, Durussel C, Roth-Kleiner M, Vasilevsky S et al.| title=Treatment of genital mycoplasma in colonized pregnant women in late pregnancy is associated with a lower rate of premature labour and neonatal complications. | journal=Clin Microbiol Infect | year= 2014 | volume= 20 | issue= 10 | pages= 1074-9 | pmid=24849820 | doi=10.1111/1469-0691.12686 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24849820 }} </ref> A reduction in adverse pregnancy outcomes has been documented in some studies following medical intervention before delivery in pregnant women with Ureaplasma colonization of the [[Urogenital tract|genital tract]]. Some of the studies demonstrated the following findings:
| |
| * A lower rate of preterm birth and improved neonatal outcomes in pregnant women who received antibiotics in late pregnancy for the treatment of genital ''[[Mycoplasma hominis]]'' and/or Ureaplasma species colonization.<ref name="pmid24849820">{{cite journal| author=Vouga M, Greub G, Prod'hom G, Durussel C, Roth-Kleiner M, Vasilevsky S et al.| title=Treatment of genital mycoplasma in colonized pregnant women in late pregnancy is associated with a lower rate of premature labour and neonatal complications. | journal=Clin Microbiol Infect | year= 2014 | volume= 20 | issue= 10 | pages= 1074-9 | pmid=24849820 | doi=10.1111/1469-0691.12686 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24849820 }} </ref>
| |
| * Prolonged [[Progesterone (vaginal)|vaginal progesterone]] administration in selected pregnant women with risk factors for preterm birth reduced cervicovaginal colonization by ''U. urealyticum''.<ref name="pmid27172838"/>
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|
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| == References ==
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| {{reflist|2}}
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