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Background To investigate the epidemiological profile and antimicrobial resistance patterns of genital mycoplasma in Eastern China and provide evidence-based guidance for clinical management. Methods A retrospective analysis was conducted on clinical records, mycoplasma culture results, and antimicrobial susceptibility testing data from patients with suspected urogenital tract infections between 2018 and 2023. Results Among 47,619 suspected infected patients, 20,830 cases tested positive for genital mycoplasma infection, with an overall infection rate of 43.74%. The infection rate of pure Ureaplasma spp. was 37.00%, for pure Mycoplasma hominis (Mh) was 0.66%, and for the co-infections with Ureaplasma spp. and Mh was 6.08%. The infection rate in females (44.00%) was significantly higher than that in males (20.12%), with a statistically significant difference ( P  < 0.001). The observed changes in each age group showed statistically significant differences ( P  < 0.001). Seasonally, the infection rate of mycoplasma in spring was slightly higher than that in winter. Regarding drug resistance, genital mycoplasmas generally exhibited a higher resistance rate to fluoroquinolone drugs, while the resistance rates to tetracycline, doxycycline, pristinamycin, and josamycin were relatively low. The average resistance rates to ciprofloxacin and ofloxacin in patients with pure Ureaplasma spp. infections were relatively high, at 83.39% and 66.34%, respectively. And the resistance rates showed an increasing trend year by year ( P  < 0.001). Patients with pure Mh infections had the highest resistance rate to ofloxacin (80.32%), followed by ciprofloxacin (69.21%), with no significant differences in resistance rates across the years. Patients co-infected with Ureaplasma spp. and Mh had the highest average resistance rates to both ofloxacin and ciprofloxacin, exceeding 90.00%. Conclusion The infection rate of genital mycoplasma in Eastern China is relatively high, predominantly Ureaplasma spp., with significant resistance to fluoroquinolone drugs. It is necessary for the hospital to enhance monitoring for the genital mycoplasma infections and to conduct drug resistance analysis to guide rational medication use and infection control measures. Clinical trial number Not applicable.

spp. are frequently isolated from the genital tract of women of reproductive age. To date, it remains unclear whether they are commensal or pathogenic. In our study, we assessed the prevalence of spp. in a group of 1,155 women of childbearing age. In addition, we assessed how often women with positive spp. develop genital tract co-infections and how the vaginal pH changes. This study showed a relationship between colonization by spp. and presenting symptoms. In fact, we showed that colonization of the genital tract by spp. can affect the occurrence of co-infections such as . We also observed a relationship between increased pH values and the presence of spp.

Background Detection of Ureaplasma , Mycoplasma and Candida spp. in the vagina during pregnancy has previously been associated with preterm birth (PTB). However, the prevalence of these microorganisms and the associated obstetric risks (likely to be population-specific) have not been determined in Australian women; furthermore, in the case of Ureaplasma spp., very few studies have attempted characterisation at the species level and none have examined genotype/serovar status to further refine risk assessment. Methods In order to address these issues we sampled the vaginal fluid of 191 pregnant Australian women at three time points in pregnancy. Culture methods were used for detection of Ureaplasma spp. and Candida spp., and real-time PCR was used for speciation of U. parvum and U. urealyticum , non-albicans Candida spp., Mycoplasma hominis and Mycoplasma genitalium . High-resolution melt PCR was used to genotype U. parvum . Data on various lifestyle factors (including sex during pregnancy and smoking), antimicrobial use and pregnancy outcome were collected on all participants. Chi-square tests were used to assess the association of vaginal microorganisms with PTB. Results Detection of Ureaplasma spp. was higher among spontaneous PTB cases, specifically in the presence of U. parvum [77 % preterm (95 % confidence interval (CI) 50–100 %) vs. 36 % term (CI: 29–43 %), p  = 0.004], but not U. urealyticum . The association with PTB strengthened when U. parvum genotype SV6 was detected (54 % preterm (CI: 22–85 %) vs. 15 % term (CI: 10–20 %), p  = 0.002); this genotype was also present in 80 % (4/5) of cases of PTB <34 weeks gestation. When present with Candida albicans in the same sample, the association with PTB remained strong for both U. parvum [46 % preterm (CI: 15–78 %) vs. 13 % term (CI: 8–18 %), p  = 0.005] and U. parvum genotype SV6 [39 % preterm (CI: 8–69 %) vs. 7 % term (CI: 3–11 %), p  = 0.003]. With the exception of Candida glabrata , vaginal colonisation status for all organisms was stable throughout pregnancy. Smoking significantly increased the likelihood of detection of all target organisms. Conclusions These data suggest that the presence of different species and serovars of Ureaplasma spp. in the vagina confers an increased risk of spontaneous PTB, findings which may be useful in risk assessment for identifying women who would benefit from antimicrobial treatment.

Alert intensivists about the diagnostic pitfalls arising from hyperammonemia due to Ureaplasma infections in post-transplant patients. Clinical observation of one patient. A 65-year-old female with a medical history of semi-recent kidney transplant was admitted to the Intensive Care Unit for refractory status epilepticus. There were no lesions on brain imaging. Bacterial cultures and viral PCR of cerebrospinal fluid were negative. The first blood ammonia level measured on day 2 was 13 times the normal level, but biological liver tests were normal. The persistence of elevated ammonia levels led to the initiation of symptomatic ammonia lowering-treatments and continuous renal replacement therapy, which led to its decrease without normalization. An Ureaplasma spp infection was then diagnosed. Levofloxacin and doxycyline were administered resulting in normalization of ammonia levels within 48 h. However repeat MRI showed diffuse cortical cytotoxic edema and the patient remained in a minimally conscious state. She eventually died 4 months later from a recurrent infection. Ureaplasma infection must be suspected in cases of neurological symptoms associated with hyperammonemia without liver failure, following an organ transplant. Only urgent treatment could improve the prognosis and prevent severe neurological damage or death. •Intensivits should be aware of the possibility of hyperammonemia due to Ureaplasma infections in immunosuppressed patients.•The diagnosis should be evoked in the presence of a severe neurological symptom, in a post-transplant context, including remotely.•Early MRI and CSF examination are often normal. The diagnosis of hyperammonemia is based on EEG, and serum ammonia dosage.•Ureaplasma infection is suspected in cases of absence of liver disorder associated with hyperammonemia.•Diagnostic of Ureaplasma infection is based on PCR technique on serum and urine samples in a specialized laboratory.•Treatment of hyperammonemia is urgent. It relies on ammonemia lowering agents (sodium benzoate, sodium phenylbutyrate).•Treatment of Ureaplasma infection relies on antibiotics active on intracellular germs.•Because of the risk of irreversible neural damage, the prognosis is poor.

Background Genital mycoplasmas colonise up to 80% of sexually mature women and may invade the amniotic cavity during pregnancy and cause complications. Tetracyclines and fluoroquinolones are contraindicated in pregnancy and erythromycin is often used to treat patients. However, increasing resistance to common antimicrobial agents is widely reported. The purpose of this study was to investigate antimicrobial susceptibility patterns of genital mycoplasmas in pregnant women. Methods Self-collected vaginal swabs were obtained from 96 pregnant women attending an antenatal clinic in Gauteng, South Africa. Specimens were screened with the Mycofast Revolution assay for the presence of Ureaplasma species and Mycoplasma hominis . The antimicrobial susceptibility to levofloxacin, moxifloxacin, erythromycin, clindamycin and tetracycline were determined at various breakpoints. A multiplex polymerase chain reaction assay was used to speciate Ureaplasma positive specimens as either U. parvum or U. urealyticum . Results Seventy-six percent (73/96) of specimens contained Ureaplasma spp., while 39.7% (29/73) of Ureaplasma positive specimens were also positive for M. hominis . Susceptibilities of Ureaplasma spp. to levofloxacin and moxifloxacin were 59% (26/44) and 98% (43/44) respectively. Mixed isolates ( Ureaplasma species and M. hominis ) were highly resistant to erythromycin and tetracycline (both 97% resistance). Resistance of Ureaplasma spp. to erythromycin was 80% (35/44) and tetracycline resistance was detected in 73% (32/44) of Ureaplasma spp. Speciation indicated that U. parvum was the predominant Ureaplasma spp. conferring antimicrobial resistance. Conclusions Treatment options for genital mycoplasma infections are becoming limited. More elaborative studies are needed to elucidate the diverse antimicrobial susceptibility patterns found in this study when compared to similar studies. To prevent complications in pregnant women, the foetus and the neonate, routine screening for the presence of genital mycoplasmas is recommended. In addition, it is recommended that antimicrobial susceptibility patterns are determined.

Whether Ureaplasma spp. are a causative agent of male infertility remains controversial. Previous studies concerning Ureaplasma spp. and male infertility have been confined to the species level of Ureaplasma. Currently, an expanded multilocus sequence typing (eMLST) scheme has been established with high discriminatory power. The aim of this study was to use eMLST to explore the distribution of Ureaplasma spp. and to analyze its role in oligozoospermia and semen quality. A total of 480 semen samples were obtained from Chinese infertile males. The associations between Ureaplasma spp. with oligozoospermia and semen characteristics were further evaluated. Phylogenetic analysis revealed that 102 Ureaplasma spp. could be separated into two clusters and seven sub-groups. Within cluster I (U. parvum), eST16 and eST41 were the most frequent clones. For cluster II (U. urealyticum), eST82 and eST147 were the most prevalent clones. Sub-groups A and C belonging to cluster I and sub-group 1 belonging to cluster II showed an association with oligozoospermia, in contrast with the Ureaplasma spp. negative group (P < 0.05). Compared with the negative group, semen motility decreased in sub-group 2, especially for non-progressive motility (P < 0.05). These results indicated that sub-groups A and C belonging to cluster I (U. parvum) and sub-group 1 belonging to cluster II (U. urealyticum) were shown to be associated with oligozoospermia. Sub-group 2 belonging to cluster II may have the ability to impair semen motility, especially for non-progressive motility.

This study investigated the prevalence and antibiotic resistance of Ureaplasma spp. and Mycoplasma hominis isolated from asymptomatic individuals in Korea. Endocervical swabs from women and urine from men, from a total of 5,781 asymptomatic individuals, were analyzed using a Mycoplasma IST2 Kit. Of the 4,825 specimens tested from females, 486 (10.1%) were positive culture. In these positive specimens, 437 (9.1%) were positive only for Ureaplasma spp., 17 (0.4%) were positive only for M. hominis , and 32 (0.7%) were positive for both Ureaplasma spp. and M. hominis . In males, of the 956 tested specimens, only 4 (0.42%) were positive for Ureaplasma spp. and no M. hominis colonization was identified. In antimicrobial susceptibility tests, more than 93.2% of both M. hominis and Ureaplasma spp. was susceptible to tetracycline, doxycycline, josamycin, and pristinamycin. However, M. hominis isolates were found to be highly resistant to erythromycin, azithromycin, and clarithromycin (82.4%, 70.6%, and 76.5%, respectively). Ofloxacin and ciprofloxacin, which have recently exhibited increasing resistance rates, showed rates of 17.7% and 35.3%, respectively, in M. hominis , and 50.6% and 27.4%, respectively, in Ureaplasma spp. In conclusion, accurate antimicrobial susceptibility tests of the genital mycoplasmas should be conducted for each case to select the appropriate antibiotics. Fluoroquinolone-based drugs should be avoided in the initial treatment of urogenital mycoplasmas because of the increasing rate of resistance to quinolones, although the susceptibility to tetracycline remains high in Korea.

To compare the genome sequences among clinical and American-Type Culture Collection strains and to reveal the potential molecular mechanisms of multiple banded antigen (MBA) variation. Two strains of 132 and 315 and one strain of 106 isolated from infertile males were sequenced using Illumina and Nanopore technologies. Comparative genomic analysis was performed of the three strains and two American-Type Culture Collection strains. The species shared a core genome. Strains 132 and 315 shared a distant relationship with previously sequenced spp. The MBA locus is more informative for studying MBA mutations than is the gene alone. The mechanisms of MBA variation are more flexible and complex than previously reported. The variation in MBA is not limited to the gene but occurs in other genes within the MBA locus.

Background/Objectives: Polycystic ovary syndrome (PCOS) is one of the most frequently diagnosed endocrine and metabolic disorders in women of reproductive age before menopause. It is associated with excess androgens and ovarian dysfunction, reduced fertility, the presence of obstetric disorders, but also metabolic disorders, and, among others, insulin resistance, obesity and type II diabetes. Its close relationship with changes in the diversity of the vaginal microbiome, vaginal inflammation and changes in the vaginal microenvironment, which can pave the way for pathogenic microorganisms, is emphasized. Methods: The research in the presented paper focuses on a group of women with PCOS (n = 490) of reproductive age (26–43 years), in whom the frequency of infections of the reproductive system caused by atypical pathogens, Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma spp., were analyzed, and then the immune system response was assessed in terms of the level of serum proinflammatory cytokines, IL-1β, IL-6 and TNF-α. Results: Our results showed a 40% infection rate in the studied group of patients with PCOS, with C. trachomatis being the most common pathogen (17.7%), followed by Ureaplasma spp. (10%) and M. hominis (4.9%). In some cases, co-infections such as Mycoplasma and Ureaplasma were also observed in 3.1% or all three atypical bacteria, M. hominis, Ureaplasma spp. and C. trachomatis, in 4.3% of patients with PCOS. In our study, in women with PCOS and confirmed infection with any atypical pathogen (n = 196), we analyzed the levels of proinflammatory cytokines, IL-1 β a, IL-6 and TNF-α. The results were compared with a control group (control group A) consisting of patients with the same underlying disease, i.e., PCOS (n = 39), who did not experience infection with atypical pathogens or symptoms of gynecological infection. Additionally, a control group B (n = 28) consisting of healthy women (without PCOS and without infection) was introduced. The results regarding the levels of cytokines studied in this work (IL-1β, IL-6, TNF-α) may suggest that the presence of intracellular C. trachomatis in the infection will play a dominant role in the immune system response. In the infections with atypical pathogens analyzed in this study in patients with PCOS, no characteristic clinical features were observed, apart from indications in the form of an increase in the number of leukocytes in the assessment of the vaginal biocenosis, suggesting cervicitis and reported reproductive failure or lower abdominal pain. An additional problem is the inability to detect the presence of atypical pathogens in routine microbiological tests; therefore, confirmation of such etiology requires referral of the patient for targeted tests. Conclusions: Invasion of host cells by atypical pathogens such as C. trachomatis and infections with “genital mycoplasmas” can disrupt the function of these cells and lead to many complications, including infertility. The immune response with the production of proinflammatory cytokines such as TNF-α, IL-1β, and IL-6, observed in response to infection with C. trachomatis, M. hominis, and Ureaplasma spp., induces or amplifies inflammation by activating immune cells or controlling infection, but may lead to the facilitation of the survival of pathogenic microorganisms and irreversible damage to fallopian tube tissues. Especially in the case of the proinflammatory cytosine TNF-α, there seems to be a close correlation with infections with atypical pathogens and a marked immune response, as well as with increased IL-1β and IL-6 values compared with the absence of infection (both in the presence and absence of PCOS). The presented study may suggest the importance of extended diagnostics to include atypical pathogens in the case of PCOS and the importance of research in this area also from the point of view of the immune response.

Background Ureaplasma spp. have been implicated in a variety of clinical conditions and certain serovars are likely to be disease-associated. Hence, the ascending trend of Ureaplasma spp. resistance to antimicrobials should deserve more attention. Here we assessed the extent of antimicrobial resistance of Ureaplasma serovars in Tunisia, and investigated the underlying molecular basis. Methods This study included 101 molecularly typed Ureaplasma spp. clinical strains isolated over a 12-year time period (2005–2017). The antimicrobial susceptibility was tested against nine antibacterial agents using the broth microdilution method. Neighbor-joining tree was constructed to establish the phylogenetic relationships among isolates. Results We found that all ureaplasma isolates were resistant to ciprofloxacin and erythromycin, intermediately resistant to azithromycin, and susceptible to doxycycline, moxifloxacin and josamycin. Ofloxacin and levofloxacin resistance was found in 73.27 and 17.82%, respectively, while 37.62% of isolates proved resistant to tetracycline. Consequently, we detected an elevated multidrug resistance rate among ureaplasma isolates (37.62%), particularly among serovars 2, 5, 8, and 9 (77.77% overall), as well as serovars 4, 10, 12, and 13 (52.63% overall). In most cases, drug resistance was found to be associated with known molecular mechanisms, yet we have identified two novel mutations in the L22 protein, which might be associated with macrolide-resistance. Conclusion To our knowledge, this is the first study that reports the widespread expansion of multidrug resistance among Ureaplasma serovars, a finding of importance in terms of both surveillance and antimicrobial usage.