Roles of Ureaplasma Species in Idiopathic Chronic Prostatitis: A Case-Control Study

PURPOSE: Because of the inconsistent symptoms associated with Ureaplasma infections, their clinical significances in genitourinary tracts are under debate. Therefore, we evaluated the presence of Ureaplasma urealyticum (UU) and Ureaplasma parvum (UP) in urine samples and examined their associations with chronic prostatitis (CP) through a case and control study. MATERIALS AND METHODS: We included 696 nonchlamydial nongonococcal (NCNG) urine samples from men; 350 were categorized into non-inflammatory CP, 88 in inflammatory CP, and 258 in non-CP group. We amplified a region in the Ureaplasma urease areas from these samples and determined their biovars using the Sanger method. RESULTS: Among the NCNG population, the rates of UU, UP, and non-UU/UP were 3.88%, 6.46%, and 89.66%, respectively. The overall infection rates of non-CP, inflammatory CP, and non-inflammatory CP groups were 4.15%, 6.10%, and 3.65% in UU (p=0.612) and 6.85%, 7.22%, and 6.50% in UP (p=0.968), respectively. UU infection increased the risk of white blood cell (WBC) counts (≥5) in urine (p=0.005). In contrast, UP infections did not increase the risks of urethritis. Re-analysis from the 633 men who were excluded from urethritis effects did not reveal the associations between UU infection and the clinical characteristics of CP. Furthermore, the profiles from the National Institutes of Health-Chronic Prostatitis Symptom Index questionnaire and WBC counts in expressed prostatic secretion were similar among the non-CP and the two CP groups in each Ureaplasma infection. CONCLUSIONS: We found that UU may induce male urethritis. However, Ureapalsma species in urine were not definitively associated with the occurrence of CP.

An analysis on biovars and antimicrobial susceptibility of 78 Ureaplasma strains isolated from respiratory tract of hospitalized infants / 预防医学

Objective To learn the biovars,antimicmbial susceptibility in Ureaplasma species isolated from respiratory tracts of infants hospitalized in tertiary children's hospital,and to provide evidences and clinical basis for the prevention and treatment of Ureaplasma infection in infants.Methods Ureaplasma species cultivation,identification and antibiotic susceptibility testing were performed using Mycoplasma IST2.The primers according to the conservative MB-Ag gene were designed to identify Ureaplasma biovars.Erythmmcin resistant genes (ermA,ermB and ermC) and active effiux transporter genes (mefA/E,msrA/B and mreA) were amplified using PCRs.Results A total of 78 Ureaplasma positive cases,of them,48 Ureaplasma strains were isolated from premature neonates.Biovar 1 was present in 51 (65.38％) strains,and biovar 2 was present in 27 (34.62％) strains.There were no significant differences among sex,premature infant,age,gestational age,birth weight,length of stay (P ＞ 0.05).The drug resistance rates to ciprofloxacin and ofloxacin were 80.77％,and to tetracycline was 1.28％.All strains were sensitive to doxycycline,josamycin and pristinomycin.The drug resistance rates to the macrolide antibiotics (erythromycin,azithromycinand and clarithromycin) were ＜ 12％.There was no statistically significant difference among the drug resistance rates of different biovars and these antibiotics (P ＞ 0.05).Only the methylated enzyme gene (ermB) and the active efilux pump gene (msrA/B) were detected,and the detection rate was 39.74％ and 12.82％ respectively.The ermB gene mainly exists in biovar 2,and the detection rate is 55.56％ (P ＜ 0.05).The msrA/B was balanced distributed between biovar 1 and 2 (P ＞ 0.05).A total of 78 Ureaplasma strains were isolated from 24 cases of neonatal septicemia,30 cases of congenital infection pneumonia,9 cases of retinopathy of prematurity,9 cases of neonatal intracranial hemorrhage,and 15 cases of bronchopulmonmT dysplasia.Conclusion Biovar 1 is more prevalent in Ureaplasma species isolated from infant respiratory tract,and higher detection rate of Ureaplasma is found in the preterm infants.All Ureaplasma strains have high drug resistance to both ciprofloxacin and ofloxacin,but low drug resistance to the macrolide antibiotics (erythromycin,azithromycin and clarithromyc),that could be used as a first choice for the treatment of Ureaplasma infection.Erythromycin resistance gene ermB,mainly exists in biovar 2.

Prevalence and Antimicrobial Susceptibility of Genital Mycoplasmataceae in Korean Women: Correlation between Phenotypic Test and Resistance Genes / 대한임상미생물학회지

BACKGROUND: While 7.6% of cultured genital Mycoplasmataceae was identified as Ureaplasma urealyticum, most of them were Ureaplasma parvum (80.3%). This is the first study differentiating between these two species. We investigated the prevalence and antimicrobial resistance of genital Mycoplasmataceae in Korean women. METHODS: A total of 150 specimens submitted to the laboratory for culture of M. hominis and Ureaplasma spp. were included. Detection and antimicrobial susceptibility tests were performed with the Mycoplasma IST2 kit (bioMérieux, France). The identification of Ureaplasma spp. was performed by PCR, and mutations in drug resistance genes were investigated by PCR and sequencing. RESULTS: In total, 66 specimens (44.0%) were positive for genital Mycoplasmatacea: U. parvum, 53 (80.3%); U. urealyticum, 5 (7.6%); M. hominis, 2 (3.0%); mixed infection, 6 (9.1%). Susceptibilities of Ureaplasma spp. to erythromycin, azithromycin, clarithromycin, and doxycycline were 86.0%, 80.7%, 98.2%, and 94.7%, respectively. The susceptibility of Ureaplasma spp. to ofloxacin and ciprofloxacin was 47.4% and 17.5%, respectively. The S83L mutation was found in the ParC subunit of the ofloxacin-resistant (5/7, 71.4%) and the ciprofloxacin-resistant isolates (7/14, 50.0%). One M. hominis isolate showed resistance to erythromycin, azithromycin, and clarithromycin but susceptibility to josamycin, pristinamycin, fluoroquinolones, and tetracyclines. CONCLUSION: The prevalence of genital Mycoplasmataceae in Korean women was 44.0%; most of them were identified as U. parvum. As more than 10% of Ureaplasma spp. showed non-susceptibility to erythromycin and azithromycin (15.5%, 20.7%), a susceptibility test is needed prior to use of these antibiotics. Further study is needed about the clinical features of infections caused by U. urealyticum vs. U. parvum and their associated resistance mechanisms.

Prevalence and Antimicrobial Susceptibility of Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum in Individuals With or Without Symptoms of Genitourinary Infections

BACKGROUND: The aim of this study was to determine the prevalence and antimicrobial susceptibility of Mycoplasma hominis, Ureaplasma urealyticum, and Ureaplasma parvum among patients displaying symptoms of genitourinary infections and asymptomatic volunteers. METHODS: Genitourinary samples were collected from 897 participants (365 symptomatic patients and 532 asymptomatic volunteers). The samples were analyzed using multiplex real-time PCR (Anyplex™ II, Seegene, Korea), multiplex PCR (Seeplex®, Seegene), and Mycoplasma IST 2 Kit (bioMerieux, France). RESULTS: The prevalence of M. hominis, U. urealyticum, and U. parvum in the genitourinary samples of symptomatic patients compared with asymptomatic volunteers was 9.9% vs. 5.5%, 12.3% vs. 9.0%, and 36.4% vs. 30.8%, respectively. After eliminating cases of co-infections with other pathogens, there was a significant difference in the prevalence of M. hominis between symptomatic patients and asymptomatic volunteers (9.1% vs. 5.2%, P<0.05), but not in the prevalence of U. urealyticum and U. parvum organisms. When tested for antimicrobial susceptibility, more than 95.5% of each species were susceptible to tetracycline, doxycycline, josamycin, and pristamycin. More than 78.9% of Ureaplasma spp. were susceptible to azithromycin, erythromycin, and clarithromycin; however less than 4.2% of M. hominis were susceptible to these antibiotics. When tested with ofloxacin and ciprofloxacin, 40.9-58.9% and 9.1-25.0% of the three species were susceptible to these drugs, respectively. CONCLUSIONS: M. hominis is the leading causative pathogen for genitourinary infection; however the involvement of Ureaplasma spp. is debatable. For optimal antimicrobial therapy, the accurate detection of these organisms and determination of antimicrobial susceptibility is crucial considering their diverse antimicrobial susceptibility patterns.

Ureaplasma: Current perspectives.

Ureaplasma species are the most prevalent genital Mycoplasma isolated from the urogenital tract of both men and women. Ureaplasma has 14 known serotypes and is divided into two biovars‑ Ureaplasma parvum and Ureaplasma urealyticum. The organism has several genes coding for surface proteins, the most important being the gene encoding the Multiple Banded Antigen (MBA). The C‑terminal domain of MBA is antigenic and elicits a host antibody response. Other virulence factors include phospholipases A and C, IgA protease and urease. Besides genital tract infections and infertility, Ureaplasma is also associated with adverse pregnancy outcomes and diseases in the newborn (chronic lung disease and retinopathy of prematurity). Infection produces cytokines in the amniotic fluid which initiates preterm labour. They have also been reported from renal stone and suppurative arthritis. Genital infections have also been reported with an increasing frequency in HIV‑infected patients. Ureaplasma may be a candidate ‘co factor’ in the pathogenesis of AIDS. Culture and polymerase chain reaction (PCR) are the mainstay of diagnosis. Commercial assays are available with improved turnaround time. Micro broth dilution is routinely used to test antimicrobial susceptibility of isolates. The organisms are tested against azithromycin, josamycin, ofloxacin and doxycycline. Resistance to macrolides, tetracyclines and fluoroquinolones have been reported. The susceptibility pattern also varies among the biovars with biovar 2 maintaining higher sensitivity rates. Prompt diagnosis and initiation of appropriate antibiotic therapy is essential to prevent long term complications of Ureaplasma infections. After surveying PubMed literature using the terms ‘Ureaplasma’, ‘Ureaplasma urealyticum’ and ‘Ureaplasma parvum’, relevant literature were selected to provide a concise review on the recent developments.

Genetic Classification and Antimicrobial Resistance of Ureaplasma urealyticum Isolated from Urine

Recently, polymerase chain reaction (PCR)-based methods have been used to reclassify Ureaplasma urealyticum into two independent species (spp.), designating U. parvum and U. urealyticum. In the current study, we aim to reclassify U. urealyticum and to analyze the correlation between the presence of a genetic marker and an antibiotic resistance of U. urealyticum. Susceptibility test against tetracycline, levofloxain or moxifloxacin was performed by broth microdilution method. The presence of tet(M) gene and the mutations of quinolone resistance-determining regions (QRDRs) were analyzed by PCR and sequencing. Among fourteen Ureaplasma isolates, three were identified as U. parvum and eleven were identified as U. urealyticum, and this is first report showing that two independent spp. of U. urealyticum isolated from Korean are present. The minimum inhibitory concentration (MIC) ranges for Ureaplasma isolates were as follows: tetracycline 0.25~128 microg/ml, levofloxacin 1~8 microg/ml, and moxifloxacin 0.5~4 microg/ml. The tet(M) determinant was found in 3 among 14 Ureaplasma isolates with tetracycline MIC of >16 microg/ml, suggesting that the presence of the tet(M) determinant is associated with tetracycline resistance. Mutations of gyrA, gyrB, parC, and parE genes in the QRDRs were found in 3 among 14 Ureaplasma isolates, exhibiting only parE gene mutation is associated with fluoroquinolone resistance.

Ureaplasma infections in pre-term infants: Recent information regarding the role of Ureaplasma species as neonatal pathogens / 소아과

Although numerous clinical observational studies have been conducted over a period of over 30 years, the clinical significance of Ureaplasma infection is still under debate. The Ureaplasma speices. is a commensal in the female genital tract and considered to have of low virulence; however, Ureaplasma colonization has been associated with infertility, stillbirth, preterm delivery, histologic chorioamnionitis, and neonatal morbidities, including congenital pneumonia, meningitis, bronchopulmonary dysplasia, and perinatal death. Recently, Ureaplasma was subdivided into 2 separate species and 14 serovars. Ureaplasma parvum is known as biovar 1 and contains serovars 1, 3, 6, and 14, and Ureaplasma urealyticum (biovar 2) contains the remaining serovars (2, 4, 5, and 7-13). The existence of differences in pathogenicities of these 14 serovars and 2 biovars is controversial. Although macrolides are the only antimicrobial agents currently available for use in neonatal ureaplasmal infections, in the current clinical field, it is difficult to make decisions regarding which antibiotics should be used. Future investigations involving large, multicenter, randomized, controlled studies are needed before proper recommendations can be made for clinical practice.