Ureaplasma urealyticum
| Ureaplasma urealyticum | ||||||||||||||
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| Scientific classification | ||||||||||||||
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| Binomial name | ||||||||||||||
| Ureaplasma urealyticum Shepard et al., 1974 |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Fatimo Biobaku M.B.B.S [2]
Synonyms and Keywords: Ureaplasma parvum, U. urealyticum biovar 1, U. urealyticum biovar 2, T-strain Mycoplasma
Overview
Ureaplasma species (U. urealyticum and U. parvum) are commensal organisms commonly found in the urogenital tract of sexually active men and women.[1] 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.[2][3][4][5] Some studies also show an association between urogenital colonization by U. urealyticum and nongonococcal urethritis in men.[6][7][8] However, the pathogenic role of Ureaplasma urealyticum in nongonococcal urethritis is still not clear.[9][10][11] 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.[5] 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 PCR-based techniques, and antibiotics are the drug of choice for eradication of infection.[12][4][13]
Historical Perspective
T-strain mycoplasma (now known as Ureaplasma urealyticum) was first discovered in the human urogenital tract in 1954 by Shepard et al.[7][10] In 1974, this tiny (T)-strain mycoplasma was renamed Ureaplasma urealyticum.[10][7] 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.[7] 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.[14] 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.[15] 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.[14]
Pathophysiology
Pathogenesis
The role of Ureaplasma infection in preterm delivery
- 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 genital tract.[4][16][14][17]
- Controversial evidence exists supporting the association between genital colonization by Ureaplasma species and complications of pregnancy such as preterm delivery.[5]
- 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.[5]
- 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.[1][5] Uterine stimulation by prostaglandins result in preterm delivery.[5][1]
- Ureaplasmal lipoprotein also induce apoptosis, and it is possible that the apoptotic cells sustain genital tract inflammation which promote preterm delivery.[5]
- Studies have also shown a higher rate of vaginal colonization by Ureaplasma species in women with preterm deliveries compared to those with full-term deliveries.[5]
Neonatal infection and the role of Ureaplasma species
- 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.[18][16][14][17]
- The infection is commonly acquired via vertical transmission by three main mechanisms:[14]
- 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.[17][14]
- Preterm neonates are most commonly affected, and very low birth weight (VLBW) infants have been noted to have invasive Ureaplasma infection.[17] 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.[17]
- There may also be an association between necrotising enterocolitis and Ureaplasma colonization in preterm neonates.[16]
Colonization by Ureaplasma species and its association with urogenital infections in adults
- There is no significant association between Ureaplasma colonization of the lower genital tract and symptomatic urogenital infection in females.[19]
- 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 genital tract can occur in women following direct ascent of these organisms from the cervix and vagina to the sterile upper reproductive tract.[20]
- Ureaplasma colonization of the genital tract is common following puberty and it is directly related to sexual activity.[1]
- Ureaplasma urealyticum has been detected in men with nongonococcal urethritis, and also in those without nongonococcal urethritis.[6] Some studies conducted in men show there is an association between urogenital colonization by Ureaplasma urealyticum and nongonococcal urethritis.[6][7][8] However, the pathogenic role of Ureaplasma urealyticum in nongonococcal urethritis is still not clear.[9][10][11]
- Men with higher bacterial load of U. urealyticum (≥5 x 103) 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.[10]
Epidemiology and Demographics
Prevalence
Ureaplasma species are commensal organisms in the female genital tract, colonizing 40-80% of the genital tract of healthy women.[14] [4][16][17] The prevalence of vaginal colonization with U. urealyticum in pregnant women is 29-42%.[21] Ureaplasma species are the most common pathogen identified in VLBW infants.[17] Ureaplasma colonization of the respiratory tract is more common in preterm VLBW infants compared to term infants.[22][23] 20-45% of VLBW infants have Ureaplasma colonization of the respiratory tract.[4] The incidence of Ureaplasma species in cord blood cultures of VLBW neonates was found to be 17%.[18] Ureaplasma species have also been shown to invade the bloodstream and cross the blood–brain barrier in 23% of VLBW infants in another study.[17] The prevalence of Ureaplasma positive CSF culture from preterm infants investigated for suspected meningitis was 8%.[24]
Age
Colonization by Ureaplasma species can be seen in both the pediatric and adult population. Genital tract of adult men and women are the main reservoirs of Ureaplasma species.[4][7] However, symptomatic Ureaplasma infection is seen more often in preterm neonates.[17] Colonization of neonates by U. urealyticum increases with decreasing gestational age and birth weight.[25]
Gender
There is no known gender predilection for Ureaplasma infection.
Race
There is no racial predilection for Ureaplasma colonization.[26] 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 [27]
Risk Factors
Risk factors for Ureaplasma infection in infants include the following:[14][4][17][5][28][29]
Neonatal factors
- Prematurity
- Low birth weight
- Perinatal asphyxia (Apgar score less than 6 at 5min)
- Mechanical ventilation of the infant
- 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.
- Congenital anomalies such as meningomyelocele
Maternal factors
- Prolonged or preterm rupture of membranes
- Chorioamnionitis
- Heavy vaginal colonization by Ureaplasma species
- Low socioeconomic status
Risk factors for Ureaplasma colonization/infection in adult men and women:[19][6][8][9][30][31]
- Multiple sexual partners
- Younger age
- Urogenital colonization/infection with other microorganisms
- Low socioeconomic status
- Immunosuppresion such as congenital immunodeficiency disorders like hypogammaglobulinemia.
Screening
There are no screening guidelines for Ureaplasma infection.
Natural History, Complications, and Prognosis
Natural History
The genital tract of adult men and women serve as the main reservoirs for Ureaplasma species.[7][4] Colonization by Ureaplasma species has been documented in sick as well as healthy infants.[14]
Complications
Infection with Ureaplasma species has been associated with the following complications:
Pregnancy complications[5][21][28][32][29]
- Histologic chorioamnionitis
- Preterm labor
- Preterm rupture of membranes
- Pregnancy loss
- Postpartum endometritis
Fetal/neonatal complications[14][15][4][16][17][23][24][25][33][34][35]
Common
- Umbilical cord vasculitis
- Prematurity
- Pneumonia
- Pneumonitis
- Bronchopulmonary dysplasia
- Hyaline membrane disease (respiratory distress syndrome of the newborn)
- Sepsis
Uncommon
- Persistent pulmonary hypertension of the newborn
- Meningitis
- Periventricular hemorrhage
- Intraventricular hemorrhage
- Necrotizing enterocolitis
- Stillbirth
Complications in adult men and women[7][10][20][6][8][9][31][36][37][11][38]
- Urogenital tract infections such as nongonococcal urethritis and prostatitis in men
- Infertility
- Pelvic inflammatory disease in females
- Septic arthritis
- Prosthetic joint infection
- Post-operative mediastinitis with persistent pleural and pericardial effusion
- Possible association with dry eye disease
Prognosis
Polymicrobial infection of the amniotic fluid with Ureaplasma species and other bacteria is associated with poor perinatal prognosis in preterm labor.[39] Despite macrolide antibiotic treatment, there is a significant association between U. urealyticum infection and pulmonary morbidity and mild cerebral impairment in preterm infants.[4]
Diagnosis
History and Symptoms[14][15][5][6]
- 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:
- 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:[40]
Vital signs
- Temperature instability
- Hypothermia
- Fever
HEENT
- Jaundice
- Anemia
Respiratory system
- Increased apnea
- Increased need for respiratory support and oxygen
Cardiovascular system
- Bradycardia
- Tachycardia
- Hypotension
Gastrointestinal system
- Abdominal distension
- Feeding intolerance
- Guaiac-positive stools
Musculoskeletal system
- Lethargy
- Hypotonia
Laboratory findings[14][15][4][16][39][41][42]
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.
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.
Recommended antibiotics[12][4][13]
- This is the drug of first choice.
- It is the most active tetracycline for Mycoplasma and Ureaplasma infection.
- It should be avoided in pregnant women and young children.
- 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.
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.[43] 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 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.[43]
- Prolonged vaginal progesterone administration in selected pregnant women with risk factors for preterm birth reduced cervicovaginal colonization by U. urealyticum.[29]
References
- ↑ 1.0 1.1 1.2 1.3 Waites KB, Schelonka RL, Xiao L, Grigsby PL, Novy MJ (2009). "Congenital and opportunistic infections: Ureaplasma species and Mycoplasma hominis". Semin Fetal Neonatal Med. 14 (4): 190–9. doi:10.1016/j.siny.2008.11.009. PMID 19109084.
- ↑ Waites KB, Crouse DT, Cassell GH (1993). "Systemic neonatal infection due to Ureaplasma urealyticum". Clin Infect Dis. 17 Suppl 1: S131–5. PMID 8399903 8399903 Check
|pmid=value (help). - ↑ Waites KB, Crouse DT, Philips JB, Canupp KC, Cassell GH (1989). "Ureaplasmal pneumonia and sepsis associated with persistent pulmonary hypertension of the newborn". Pediatrics. 83 (1): 79–85. PMID 2909979 2909979 Check
|pmid=value (help). - ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 Resch B, Gutmann C, Reiterer F, Luxner J, Urlesberger B (2016). "Neonatal Ureaplasma urealyticum colonization increases pulmonary and cerebral morbidity despite treatment with macrolide antibiotics". Infection. 44 (3): 323–7. doi:10.1007/s15010-015-0858-7. PMID 26518581.
- ↑ 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 Harada K, Tanaka H, Komori S, Tsuji Y, Nagata K, Tsutsui H; et al. (2008). "Vaginal infection with Ureaplasma urealyticum accounts for preterm delivery via induction of inflammatory responses". Microbiol Immunol. 52 (6): 297–304. doi:10.1111/j.1348-0421.2008.00039.x. PMID 18577163.
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 Povlsen K, Bjørnelius E, Lidbrink P, Lind I (2002). "Relationship of Ureaplasma urealyticum biovar 2 to nongonococcal urethritis". Eur J Clin Microbiol Infect Dis. 21 (2): 97–101. PMID 11939406.
- ↑ 7.0 7.1 7.2 7.3 7.4 7.5 7.6 7.7 Deguchi T, Yoshida T, Miyazawa T, Yasuda M, Tamaki M, Ishiko H; et al. (2004). "Association of Ureaplasma urealyticum (biovar 2) with nongonococcal urethritis". Sex Transm Dis. 31 (3): 192–5. PMID 15076934.
- ↑ 8.0 8.1 8.2 8.3 Maeda S, Deguchi T, Ishiko H, Matsumoto T, Naito S, Kumon H; et al. (2004). "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". Int J Urol. 11 (9): 750–4. doi:10.1111/j.1442-2042.2004.00887.x. PMID 15379939.
- ↑ 9.0 9.1 9.2 9.3 Couldwell DL, Gidding HF, Freedman EV, McKechnie ML, Biggs K, Sintchenko V; et al. (2010). "Ureaplasma urealyticum is significantly associated with non-gonococcal urethritis in heterosexual Sydney men". Int J STD AIDS. 21 (5): 337–41. doi:10.1258/ijsa.2009.009499. PMID 20498103.
- ↑ 10.0 10.1 10.2 10.3 10.4 10.5 Shimada Y, Ito S, Mizutani K, Sugawara T, Seike K, Tsuchiya T; et al. (2014). "Bacterial loads of Ureaplasma urealyticum contribute to development of urethritis in men". Int J STD AIDS. 25 (4): 294–8. doi:10.1177/0956462413504556. PMID 24047884.
- ↑ 11.0 11.1 11.2 Esen B, Gozalan A, Sevindi DF, Demirbas A, Onde U, Erkayran U; et al. (2017). "Ureaplasma urealyticum: Presence among Sexually Transmitted Diseases". Jpn J Infect Dis. 70 (1): 75–79. doi:10.7883/yoken.JJID.2015.258. PMID 27000449.
- ↑ 12.0 12.1 De Francesco MA, Caracciolo S, Bonfanti C, Manca N (2013). "Incidence and antibiotic susceptibility of Mycoplasma hominis and Ureaplasma urealyticum isolated in Brescia, Italy, over 7 years". J Infect Chemother. 19 (4): 621–7. doi:10.1007/s10156-012-0527-z. PMID 23192735.
- ↑ 13.0 13.1 Lee MY, Kim MH, Lee WI, Kang SY, Jeon YL (2016). "Prevalence and Antibiotic Susceptibility of Mycoplasma hominis and Ureaplasma urealyticum in Pregnant Women". Yonsei Med J. 57 (5): 1271–5. doi:10.3349/ymj.2016.57.5.1271. PMC 4960396. PMID 27401661.
- ↑ 14.00 14.01 14.02 14.03 14.04 14.05 14.06 14.07 14.08 14.09 14.10 14.11 Waites KB, Crouse DT, Cassell GH (1993). "Systemic neonatal infection due to Ureaplasma urealyticum". Clin Infect Dis. 17 Suppl 1: S131–5. PMID 8399903.
- ↑ 15.0 15.1 15.2 15.3 Waites KB, Crouse DT, Philips JB, Canupp KC, Cassell GH (1989). "Ureaplasmal pneumonia and sepsis associated with persistent pulmonary hypertension of the newborn". Pediatrics. 83 (1): 79–85. PMID 2909979.
- ↑ 16.0 16.1 16.2 16.3 16.4 16.5 Okogbule-Wonodi AC, Gross GW, Sun CC, Agthe AG, Xiao L, Waites KB; et al. (2011). "Necrotizing enterocolitis is associated with ureaplasma colonization in preterm infants". Pediatr Res. 69 (5 Pt 1): 442–7. doi:10.1203/PDR.0b013e3182111827. PMC 3968774. PMID 21258263.
- ↑ 17.00 17.01 17.02 17.03 17.04 17.05 17.06 17.07 17.08 17.09 17.10 Viscardi RM, Hashmi N, Gross GW, Sun CC, Rodriguez A, Fairchild KD (2008). "Incidence of invasive ureaplasma in VLBW infants: relationship to severe intraventricular hemorrhage". J Perinatol. 28 (11): 759–65. doi:10.1038/jp.2008.98. PMC 5334544. PMID 18596706.
- ↑ 18.0 18.1 Goldenberg RL, Andrews WW, Goepfert AR, Faye-Petersen O, Cliver SP, Carlo WA; et al. (2008). "The Alabama Preterm Birth Study: umbilical cord blood Ureaplasma urealyticum and Mycoplasma hominis cultures in very preterm newborn infants". Am J Obstet Gynecol. 198 (1): 43.e1–5. doi:10.1016/j.ajog.2007.07.033. PMC 2278008. PMID 18166302.
- ↑ 19.0 19.1 Marovt M, Keše D, Kotar T, Kmet N, Miljković J, Šoba B; et al. (2015). "Ureaplasma parvum and Ureaplasma urealyticum detected with the same frequency among women with and without symptoms of urogenital tract infection". Eur J Clin Microbiol Infect Dis. 34 (6): 1237–45. doi:10.1007/s10096-015-2351-8. PMID 25717022.
- ↑ 20.0 20.1 Kasprzykowska U, Elias J, Elias M, Mączyńska B, Sobieszczańska BM (2014). "Colonization of the lower urogenital tract with Ureaplasma parvum can cause asymptomatic infection of the upper reproductive system in women: a preliminary study". Arch Gynecol Obstet. 289 (5): 1129–34. doi:10.1007/s00404-013-3102-7. PMC 3984420. PMID 24318169.
- ↑ 21.0 21.1 Vogel I, Thorsen P, Hogan VK, Schieve LA, Jacobsson B, Ferre CD (2006). "The joint effect of vaginal Ureaplasma urealyticum and bacterial vaginosis on adverse pregnancy outcomes". Acta Obstet Gynecol Scand. 85 (7): 778–85. doi:10.1080/00016340500442423. PMID 16817073.
- ↑ Waites KB, Katz B, Schelonka RL (2005). "Mycoplasmas and ureaplasmas as neonatal pathogens". Clin Microbiol Rev. 18 (4): 757–89. doi:10.1128/CMR.18.4.757-789.2005. PMC 1265909. PMID 16223956.
- ↑ 23.0 23.1 Patterson AM, Taciak V, Lovchik J, Fox RE, Campbell AB, Viscardi RM (1998). "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". Pediatr Infect Dis J. 17 (4): 321–8. PMID 9576388.
- ↑ 24.0 24.1 Waites KB, Rudd PT, Crouse DT, Canupp KC, Nelson KG, Ramsey C; et al. (1988). "Chronic Ureaplasma urealyticum and Mycoplasma hominis infections of central nervous system in preterm infants". Lancet. 1 (8575–6): 17–21. PMID 2891889.
- ↑ 25.0 25.1 Agarwal P, Rajadurai VS, Pradeepkumar VK, Tan KW (2000). "Ureaplasma urealyticum and its association with chronic lung disease in Asian neonates". J Paediatr Child Health. 36 (5): 487–90. PMID 11036807.
- ↑ Doh K, Barton PT, Korneeva I, Perni SC, Bongiovanni AM, Tuttle SL; et al. (2004). "Differential vaginal expression of interleukin-1 system cytokines in the presence of Mycoplasma hominis and Ureaplasma urealyticum in pregnant women". Infect Dis Obstet Gynecol. 12 (2): 79–85. doi:10.1080/10647440400003667. PMC 1784593. PMID 15739821.
- ↑ Goldenberg RL, Klebanoff MA, Nugent R, Krohn MA, Hillier S, Andrews WW; et al. (1996). "Bacterial colonization of the vagina during pregnancy in four ethnic groups". Am J Obstet Gynecol. 174 (5): 1618–1621. doi:10.1016/S0002-9378(96)70617-8. PMID 28140029.
- ↑ 28.0 28.1 Kikhney J, von Schöning D, Steding I, Schulze J, Petrich A, Hiergeist A; et al. (2017). "Is Ureaplasma spp. the leading causative agent of acute chorioamnionitis in women with preterm birth?". Clin Microbiol Infect. 23 (2): 119.e1–119.e7. doi:10.1016/j.cmi.2016.10.010. PMID 27756710.
- ↑ 29.0 29.1 29.2 Koucký M, Malíčková K, Cindrová-Davies T, Smíšek J, Vráblíková H, Černý A; et al. (2016). "Prolonged progesterone administration is associated with less frequent cervicovaginal colonization by Ureaplasma urealyticum during pregnancy - Results of a pilot study". J Reprod Immunol. 116: 35–41. doi:10.1016/j.jri.2016.04.285. PMID 27172838.
- ↑ Benedetto C, Tibaldi C, Marozio L, Marini S, Masuelli G, Pelissetto S; et al. (2004). "Cervicovaginal infections during pregnancy: epidemiological and microbiological aspects". J Matern Fetal Neonatal Med. 16 Suppl 2: 9–12. doi:10.1080/14767050410001727107. PMID 15590426.
- ↑ 31.0 31.1 George MD, Cardenas AM, Birnbaum BK, Gluckman SJ (2015). "Ureaplasma septic arthritis in an immunosuppressed patient with juvenile idiopathic arthritis". J Clin Rheumatol. 21 (4): 221–4. doi:10.1097/RHU.0000000000000248. PMID 26010188.
- ↑ Joste NE, Kundsin RB, Genest DR (1994). "Histology and Ureaplasma urealyticum culture in 63 cases of first trimester abortion". Am J Clin Pathol. 102 (6): 729–32. PMID 7801884.
- ↑ Abele-Horn M, Peters J, Genzel-Boroviczény O, Wolff C, Zimmermann A, Gottschling W (1997). "Vaginal Ureaplasma urealyticum colonization: influence on pregnancy outcome and neonatal morbidity". Infection. 25 (5): 286–91. PMID 9334863.
- ↑ Schelonka RL, Katz B, Waites KB, Benjamin DK (2005). "Critical appraisal of the role of Ureaplasma in the development of bronchopulmonary dysplasia with metaanalytic techniques". Pediatr Infect Dis J. 24 (12): 1033–9. PMID 16371861.
- ↑ Wang EE, Ohlsson A, Kellner JD (1995). "Association of Ureaplasma urealyticum colonization with chronic lung disease of prematurity: results of a metaanalysis". J Pediatr. 127 (4): 640–4. PMID 7562292.
- ↑ Farrell JJ, Larson JA, Akeson JW, Lowery KS, Rounds MA, Sampath R; et al. (2014). "Ureaplasma parvum prosthetic joint infection detected by PCR". J Clin Microbiol. 52 (6): 2248–50. doi:10.1128/JCM.00432-14. PMC 4042745. PMID 24671783.
- ↑ Abdelfattah MM, Khattab RA, Mahran MH, Elborgy ES (2016). "Evaluation of patients with dry eye disease for conjunctival Chlamydia trachomatis and Ureaplasma urealyticum". Int J Ophthalmol. 9 (10): 1457–1465. doi:10.18240/ijo.2016.10.15. PMC 5075662. PMID 27803864.
- ↑ García-de-la-Fuente C, Miñambres E, Ugalde E, Sáez A, Martinez-Martinez L, Fariñas MC (2008). "Post-operative mediastinitis, pleuritis and pericarditis due to Mycoplasma hominis and Ureaplasma urealyticum with a fatal outcome". J Med Microbiol. 57 (Pt 5): 656–7. doi:10.1099/jmm.0.47632-0. PMID 18436601.
- ↑ 39.0 39.1 Yoneda N, Yoneda S, Niimi H, Ueno T, Hayashi S, Ito M; et al. (2016). "Polymicrobial Amniotic Fluid Infection with Mycoplasma/Ureaplasma and Other Bacteria Induces Severe Intra-Amniotic Inflammation Associated with Poor Perinatal Prognosis in Preterm Labor". Am J Reprod Immunol. 75 (2): 112–25. doi:10.1111/aji.12456. PMID 26668114.
- ↑ Fanaroff AA, Korones SB, Wright LL, Verter J, Poland RL, Bauer CR; et al. (1998). "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". Pediatr Infect Dis J. 17 (7): 593–8. PMID 9686724.
- ↑ Ollikainen J, Hiekkaniemi H, Korppi M, Katila ML, Heinonen K (1993). "Ureaplasma urealyticum cultured from brain tissue of preterm twins who died of intraventricular hemorrhage". Scand J Infect Dis. 25 (4): 529–31. PMID 8248756.
- ↑ Ollikainen J, Hiekkaniemi H, Korppi M, Sarkkinen H, Heinonen K (1993). "Ureaplasma urealyticum infection associated with acute respiratory insufficiency and death in premature infants". J Pediatr. 122 (5 Pt 1): 756–60. PMID 8496757.
- ↑ 43.0 43.1 Vouga M, Greub G, Prod'hom G, Durussel C, Roth-Kleiner M, Vasilevsky S; et al. (2014). "Treatment of genital mycoplasma in colonized pregnant women in late pregnancy is associated with a lower rate of premature labour and neonatal complications". Clin Microbiol Infect. 20 (10): 1074–9. doi:10.1111/1469-0691.12686. PMID 24849820.