Epidemiología y prevalencia de Mycoplasma genitalium y resistencia a azitromicina en el Área Norte de Tenerife, Islas Canarias

Introducción: La infección y resistencia antimicrobiana de Mycoplasma genitalium está infradiagnósticada en nuestra comunidad ya que no es una Enfermedad de Declaración Obligatoria y requiere técnicas de biología molecular, no siempre disponibles. Objetivo: Estudiar la epidemiología y prevalencia de M. genitalium y la tasa de resistencia frente a azitromicina en nuestra Área de Salud. Métodos: Estudio retrospectivo, desde abril de 2019 a julio de 2020, realizado en el Área de Salud del Norte de Tenerife, la cual atiende el Hospital Universitario Canarias. Para el diagnóstico de las infecciones de transmisión sexual (ITS) se utilizó la RT-PCR Allplex™ STI Essential Assay (Seegene, South Korea). Las muestras en las que se detectó M. genitalium fueron congeladas a −80°C para posteriormente realizar estudio de resistencia a azitromicina con la RT-PCR Allplex™ MG y AziR Assay (Seegene, South Korea). Resultados: Se identificaron 111/3.849 (prevalencia de 2,8%) pacientes con M. genitalium, de los cuales la mayoría, 59(53,1%) eran hombres con una mediana de 32 años (15-74) y cuyas muestras procedían principalmente de Atención Primaria: 55 (49,5%). Para la detección de resistencia a azitromicina, de los 111 pacientes solo se pudo analizar las muestras de 79, detectándose resistencia in vitro en 15(18,3%): 10 con A2059G, 4 con A2058G y 1 con ambas. La resistencia a azitromicina fue más frecuente en hombres 12 (15,8%). Discusión y Conclusiones: Con este estudio se pone de manifiesto la importancia de la prevalencia de M. genitalium en nuestro entorno, así como su alta tasa de resistencia a azitromicina por lo que se hace necesario vigilar dicha resistencia en nuestro Área de Salud para su adecuado tratamiento.

Background: Infection and antimicrobial resistance of Mycoplasma genitalium is under-diagnosed in our community as it is not a Notifiable Infectious Disease and requires for its detection molecular biology techniques, which are not always available. Aim: To study the epidemiology and prevalence of M. genitalium and the rate of resistance to azithromycin in our Health Care Area. Methods: We conducted a retrospective study from April 2019 to July 2020 in the Northern Health Care Area of Tenerife, which is attended to the Universitary Hospital Complex of the Canary Islands. The RT-PCR Allplex™ STI Essential Assay (Seegene, South Korea) to diagnose Sexually Transmitted Infections (STI) was used. Samples in which M. genitalium was detected were stored at −80°C for subsequent diagnosis of resistance to azithromycin with the RT-PCR Allplex™ MG and AziR Assay (Seegene, South Korea). Results: Of a total of 111/3,849 (2.8% prevalence) patients diagnosed with M. genitalium, 59 (53.1%) were male with a mean age of 30 (19-61) years and mainly from Primary Care 55 (49.5%). Only 79 samples of the 111 patients could be tested to detect azithromycin resistance, of which 15 (18.3%) were resistant in vitro: 10 with A2059G, 4 with A2058G and 1 with both. Azithromycin resistance was more frequent in men 12 (15.8%) and detected mainly in urine samples 6 (60%). Discussion and Conclusions: This study highlights the prevalence of M. genitalium in our setting as well as the high rate of resistance to azithromycin, making it necessary to detect resistance to azithromycin in M. genitalium for its appropriate treatment in our Health Care Area.

Mycoplasma Genitalium and Chlamydia Trachomatis Prevalence, Co-Infection and Relevant Factors in An Epidemiology Study (2016 - 2019) In Ho Chi Minh, Vietnam

Chlamydia trachomatis and Mycoplasma genitalium are two common types of sexually transmitted infections. However, currently in Vietnam, there is no report on the rate of patients infected by the two types of bacteria. In this study, there were 6194 patients visiting the STI clinic of the HCMC Hospital of Dermato-Venereology, Vietnam, from 2016 to 2019. The results show that the proportion of patients positive with CT and MG is in-dependent on time. The infection rate is mainly at the age of 21 - 30 (53.4%). The CT infection rate in female and male is equal (17.3% vs 17.4%) while the rate of MG in female is lower (5.1% vs 7, 8%). The rate of pa-tients co-infected with either CT or MG is 4.5%, 17% and 5.7% respectively, time independence. This study may give better understandings of the epidemiological characteristics of MG and CT in Vietnam.

Cervicitis necrótica por co-infección de virus herpes simplex 2 y Mycoplasma genitalium / Necrotic cervicitis for co-infection of herpes simplex virus 2 and Mycoplasma genitalium

Resumen Las cervicitis es una condición frecuente causada principalmente por agentes de transmisión sexual. Su presentación clínica varía desde cuadros asintomáticos hasta procesos inflamatorios extensos, que incluso asemejan un tumor maligno. Presentamos el caso de una adolescente que presentó úlceras genitales, síntomas generales y cérvix necrótico con aspecto tumoral. Los estudios de laboratorio confirmaron una co-infección por virus herpes simplex 2 (HSV-2) y Mycoplasma genitalium. El estudio histológico descartó una neo- plasia. Evolucionó favorablemente al tratamiento antimicrobiano, con recuperación progresiva del aspecto del cérvix. La cervicitis en raras ocasiones se presenta con compromiso necrótico. La co-infección por HSV-2 y M. genitalium, en este caso, pudo ser el determinante del daño cervical y la necrosis. Una evaluación acuciosa y estudio con exámenes diagnósticos de alta sensibilidad y especificidad permitieron hacer un diagnóstico y tratamiento adecuado.

Abstract Cervicitis is a frequent condition caused mainly by sexually trans- mitted agents. The clinical spectrum varies from absence of symptoms to extensive inflammatory processes that may simulate a malignant neoplasm. We present a clinical case of an adolescent with genital ulcers and systemic disease. Speculoscopy revealed a tumoral-looking cervix. Laboratory studies confirm infection with herpes simplex virus 2 (HSV-2) and Mycoplasma genitalium, together with a histological study that ruled out neoplasia. It progresses favorably to antimicrobial treatment, with recovery of the appearance of the cervix. Cervicitis rarely presents with necrotic involvement. Co-infection with HSV-2 and M. genitalium infection may have been the determinant of cervical damage and the necrotic appearance. A thorough evaluation and study with highly sensitive and specific diagnostic tests allowed an adequate diagnosis and treatment.

Doxycycline-moxifloxacin sequential therapy for Mycoplasma genitalium urethritis/cervicitis: a clinical observation / 中华皮肤科杂志

Objective:To investigate outcomes and safety of doxycycline-moxifloxacin sequential regimen in the treatment of Mycoplasma genitalium urethritis/cervicitis. Methods:From June 2019 to December 2020, patients with Mycoplasma genitalium urethritis/cervicitis confirmed by nucleic acid amplification testing were successively recruited at Department of Sexually Transmitted Diseases, Hospital of Dermatology, Chinese Academy of Medical Sciences, and received sequential therapy with oral doxycycline for 7 days followed by oral moxifloxacin for 7 days. Clinical and/or etiological assessment was conducted 2 to 3 weeks after the end of treatment. Fisher′s exact test was used to analyze factors influencing the treatment outcome. Results:Totally, 36 eligible subjects were enrolled, including 30 males and 6 females. Among them, 18 (50%) patients completed post-treatment etiological assessment, which showed that 12 achieved microbiological cure, and treatment failures occurred in 6; another 18 patients achieved clinical cure. The overall response rate to doxycycline-moxifloacin sequential therapy was 83.3% (30/36, 95% confidence interval[ CI]: 70.5%, 96.1%) . The treatment outcome showed no significant association with the patients′ age, gender, marital status, number of sexual partners in the past 1 month, history of sexually transmitted diseases, history of antibiotic use in the past 1 month, or co-infections (all P > 0.05) . Conclusion:The efficacy of doxycycline-moxifloacin sequential regimen is limited in the treatment of Mycoplasma genitalium infections in Nanjing area, and clinicians should be alerted to the possibility of treatment failure in clinical practice.

Main etiological agents identified in 170 men with urethritis attended at the Fundação Alfredo da Matta, Manaus, Amazonas, Brazil,

Abstract Background: Sexually transmitted infections (STI) are a global public health problem. Urethritis are among the most common STIs, and can cause several complications and facilitate the transmission of the HIV virus. Objectives: To investigate the main etiologic agents of urethritis in 170 men treated at Fundação Alfredo da Matta. Methods: To identify the agents, urethral exudate and urine were collected. Gram and culture tests were performed in Thayer-Martin medium for Neisseria gonorrhoeae and polymerase chain reaction for Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Ureaplasma urealyticum, Ureaplasma parvum, Mycoplasma hominis, Mycoplasma genitalium, and herpes simplex types 1 and 2. Results: N. gonorrhoeae were identified in 102 (60.0%) patients, C. trachomatis in 50 (29.4%), U. urealyticum in 29 (17.0%), M. genitalium in 11 (6.5 %), U. parvum in ten (5.9%), and M. hominis in seven (4.1%). Herpes simplex type 2 was diagnosed in 24 (21.6%) of the 111 patients who underwent PCR for this pathogen. In 69 cases there was co-infection; the most frequent were: N. gonorrhoeae and C. trachomatis in 21 (14.7%) patients; N. gonorrhoeae and C. trachomatis in 21 (12.4%) patients; N. gonorrhoeae and herpes simplex type 2 in 11 (6.5%), and N. gonorrhoeae and U. urealyticum in nine (5.3%). Study limitations: Not relevant. Conclusion: N. gonorrhoeae, C. trachomatis, U. urealyticum, and herpes simplex type 2 were the pathogens most frequently identified in the present study. The main coinfection found was N. gonorrhoeae and C. trachomatis. T. vaginalis and herpes simplex type 1 were not identified in any of the patients.

Prevalencia de la infección por Mycoplasma genitalium en mujeres embarazadas / Prevalence of Mycoplasma genitalium infection in pregnant women / Prevalência da infecção por Mycoplasma genitalium em gestantes

Resumen Durante los últimos 5-10 años se ha considerado a Mycoplasma genitalium como un agente emergente de infecciones de transmisión sexual. Su papel en el embarazo ha sido poco estudiado. La prevalencia en la Argentina es desconocida. El objetivo del trabajo fue determinar la prevalencia de M. genitalium en muestras endocervicales de mujeres embarazadas que concurrieron a un control ginecológico. La metodología utilizada para la detección fue una PCR de punto final que amplifica una secuencia específica del gen mgpB. Se estudiaron 270 mujeres embarazadas entre 15 y 42 años. La prevalencia global de M. genitalium fue de 5,2% (14/270). De las sintomáticas el 10% eran positivas (9/90) y de las pacientes asintomáticas 2,8% eran positivas (5/180). El 1,5% (4/270) presentó coinfección con Chlamydia trachomatis. Todas cursaban un embarazo de más de 12 semanas. Este es el primer trabajo de prevalencia de M. genitalium realizado en mujeres embarazadas en la Argentina. Se necesitan más estudios de asociación entre este microorganismo y las complicaciones en el embarazo para avanzar hacia la prevención y el control de esta infección.

Abstract Mycoplasma genitalium has been considered an emerging agent of sexually transmitted infections for the past 5-10 years. Its association with agent of non-gonococcal urethritis in men is well recognized. In women it has been linked to cervicitis, endometritis and pelvic inflammatory disease. Its role in pregnancy has been poorly studied. In Argentina, the prevalence is unknown. The objective of this work was to determine the prevalence of M. genitalium in endocervical samples of pregnant women who attended a gynecological control. An end-point PCR was used to amplify a specific sequence of the mgpB gene. A group of 270 pregnant women between 15 and 42 years were studied. The overall prevalence of M. genitalium was 5.2% (14/270). Among the symptomatic patients, 10% were positive (9/90), whereas among the asymptomatic patients, 2.8% were positive (5/180). Only 1.5% (4/270) presented co-infection with Chlamydia trachomatis. This is the first prevalence study on M. genitalium performed on pregnant women in Argentina. More studies are needed to understand the relationship between this microorganism and complications during pregnancy, in order to prevent and control this infection in women.

Resumo O Mycoplasma genitalium tem sido considerado um agente de infecções sexualmente transmissível emergente nos últimos 5 a 10 anos. Seu papel na gravidez tem sido pouco estudado. Na Argentina, a prevalência é desconhecida. O objetivo deste trabalho foi determinar a prevalência de M. genitalium em amostras endocervicais de gestantes que realizaram controle ginecológico. Uma PCR de ponto final foi utilizada como metodologia para a detecção, que amplifica uma sequência específica do gene mgpB. Um grupo de 270 gestantes entre 15 e 42 anos foi estudado. A prevalência geral de M. genitalium foi de 5,2% (14/270). Entre as pacientes sintomáticas, 10% foram positivas (9/90), ao passo que entre as assintomáticas, 2,8% foram positivas (5/180). Apenas 1,5% (4/270) apresentou coinfecção por Chlamydia trachomatis. Todas as mulheres estudadas estavam grávidas fazia mais de 12 semanas. Este é o primeiro estudo de prevalência sobre M. genitalium realizado em mulheres grávidas na Argentina. Mais estudos de associação entre esse microorganismo e as complicações na gravidez são necessários, a fim de avançar na prevenção e no controle desta infecção.

Correlation of Mycoplasma genitalium infection with semen parameters and sperm DNA integrity in male infertility patients / 中华男科学杂志

Objective@#To analyze the relationship of Mycoplasma genitalium (MG) infection with routine semen parameters and sperm DNA integrity in male infertility patients.@*METHODS@#Totally, 114 semen samples, 34 MG-positive and 80 MG-negative, were collected from male infertility patients and subjected to routine semen analysis with the computer-assisted sperm analysis system, Papanicolaou staining for observation of sperm morphology, and sperm chromatin diffusion (SCD) test for detection of sperm DNA integrity. Semen parameters and DNA integrity were compared between the MG-positive and MG-negative groups with SPSS 21.0 statistical software and the relationship between the semen parameters and DNA integrity analyzed by Pearson correlation analysis.@*RESULTS@#The MG-positive samples, compared with the MG-negative ones, showed significantly decreased semen volume (［2.87 ± 0.37］ vs ［3.86 ± 0.43］ ml, P 0.05).@*CONCLUSIONS@#MG infection may be an important factor affecting sperm quality in male infertility patients. Active prevention and treatment of MG infection can help prevent male infertility.

Are vaginal swabs comparable to cervical smears for human papillomavirus DNA testing? / 부인종양

OBJECTIVE: Human papillomavirus (HPV) testing is widely incorporated into cervical cancer screening strategies. Current screening requires pelvic examination for cervical sampling, which may compromise participation. The acceptance could be raised by introducing testing on vaginal swabs. We explored the interchangeability of vaginal swabs and cervical smears for HPV testing, by means of a prospective study conducted in female sex workers (FSWs). Besides, we report on the occurrence of 32 different HPV genotypes in FSW with low-grade squamous intraepithelial lesion (LSIL) or high-grade squamous intraepithelial lesion (HSIL). METHODS: Paired physician-collected vaginal swabs and cervical smears from 303 FSW were tested for HPV using the Abbott RealTime High-Risk HPV assay. Cervical cytology was examined on cervical smears. In case of HSIL/LSIL cytological classification (n=52), both samples were genotyped using INNO-LiPa HPV Genotyping Extra II. RESULTS: The overall prevalence of high-risk (HR)-HPV was 51%. In FSW with HSIL/LSIL cervical cytology, the sensitivity and specificity of vaginal samples for the detection of HR-HPV was 100% and 70% and for probable HR-HPV 100% and 91%. The mean number of genotypes identified in vaginal samples (mean=3.5; 95% confidence interval [CI]=2.8–4.2) was significantly higher than in cervical smear samples (mean=2.6; 95% CI=2.1–3.0) (p=0.001). The most frequently encountered HR-HPV genotypes were HPV16, 31, 51, and 52. CONCLUSION: As our study shows that vaginal swabs are equivalent to cervical smears for the detection of (probable) HR-HPV, vaginal swabs can be used for HPV testing in cervical cancer screening strategies. Given the acceptance of vaginal sampling, this finding offers an opportunity to boost screening coverage.

Progress of Mycoplasma genitalium infection / 中华检验医学杂志

This paper highlights the current research and knowledge, and reviews the incidence, pathogenesis, laboratory diagnosis andantibiotic therapy.M.genitalium is one of the major causes of nongonococcal urethritis worldwide.Its pathogenesis is not fully clear,which may be associated with toxin, immune response and persistent infection.Diagnosis is achievable only through nucleic acid amplification testing(NAAT).Azithromycin, moxifloxacin and doxycycline have been the treatments of choice for M. genitalium infections.Rapid spread of macrolide resistance as well as emergence of quinolone resistance has occurred.Increasing rates of treatment failure have resulted in an urgent need for new therapies.(Chin J Lab Med,2018,41:328-332)

Identification of protein that interacts with adhesion protein of Mycoplasma genitalium from T7-phage display cDNA library / 中国免疫学杂志

Objective:To screen and identify the protein that interacts with the adhesion protein of Mycoplasma genitalium (MgPa)from T7-phage display cDNA library of human uroepithelial cells(SV-HUC-1).Methods:Recombinant adhesion protein of My-coplasma genitalium(rMgPa)was used as target molecule to biopan the T7 phage display cDNA library of SV-HUC-1 cell,the selected positive clones were analysed using DNA sequencing and BLAST analysis and identified by means of indirect ELISA,Dot immunoblot and Far-western blot.Results:After four rounds of biopanning,positive phages were obviously enriched.According to the results of DNA sequencing and BLAST analysis,the selected randomly 32 positive clones included 7 kinds different sequences,of which the number of RPL35 repeats was the most.The results of indirect ELISA,Dot immunoblot and Far-western blot showed that 7 representative phages could bind specifically with rMgPa.Conclusion:60S ribosomal protein L35(RPL35) may be the interacting protein of MgPa,which lays the experimental foundation for understanding the function of MgPa and the pathogenesis of Mycoplasma genitalium.

Impact of Mycoplasma genitalium infection on the semen quality of infertile males / 中华男科学杂志

<p><b>Objective</b>To explore Mycoplasma genitalium (MG) infection in the urogenital tract of infertile men and its influence on semen quality.</p><p><b>METHODS</b>Semen samples were collected from 352 infertile males in the Center of Reproductive Medicine of Nanjing General Hospital from March to July 2015. MG infection was detected by real-time fluorescence simultaneous amplification and testing and semen analyses were conducted according to the WHO Laboratory Manual for the Examination and Processing of Human Semen (5th Ed) on the semen pH value, semen volume, total sperm count, sperm concentration, total sperm motility, percentages of progressively motile sperm (PMS) and immotile sperm (IMS), and sperm DNA fragmentation index (DFI). The data obtained were subjected to statistical analysis by t-test and non-parametric test (Wilcoxon test).</p><p><b>RESULTS</b>MG infection was found in 3.4% (12/352) of the infertile patients. Compared with the MG-positive cases, the MG-negative ones showed a significantly higher semen volume (［2.85 ± 0.14］ vs ［3.84 ± 0.12］ ml, P = 0.008) and percentage of PMS (［15.86±1.72］ vs ［60.95 ± 5.63］ %, P = 0.032) but a lower DFI (［30.73 ±2.24］ vs ［20.71 ± 1.55］%, P = 0.014). However, no statistically significant differences were observed between the two groups in the semen pH value (7.38 ±0.02 vs 7.39 ± 0.01, P = 0.774), sperm concentration (［52.96 ± 15.78］ vs ［60.05 ± 4.29］×10⁶/ml, P = 0.683), sperm count (［154.15 ± 46.37］ vs ［221.56 ± 15.43］×106, P = 0.236), total sperm motility (［29.04 ± 3.11］ vs ［33.52 ± 1.51］ %, P = 0.626), or percentage of IMS (［23.57 ± 0.99］ vs ［62.34 ± 1.69］ %, P = 0.691).</p><p><b>CONCLUSIONS</b>Urogenital MG infection is common in infertile males and potentially affects the semen quality, especially sperm vitality of the patient.</p>

Mycoplasma genitalium and male urogenital diseases: An update / 中华男科学杂志

Mycoplasma genitalium (MG) was first isolated by Tully from the urinary tract of the male patient with non-gonococcal urethritis (NGU) in 1981. MG is extremely difficult to be cultured and was rarely studied until the development and application of molecular biology technology. The research on MG in China is still in the primary stage. However, relevant studies abroad have found that it is an important pathogen causing human genitourinary tract infection and spreading worldwide. Male MG infection is reportedly related to NGU, prostatitis, epididymitis, balanoposthitis, male HIV infection, and male infertility. This review outlines the advances in the studies of MG in male urogenital diseases.

Effects of infections with five sexually transmitted pathogens on sperm quality / 대한생식의학회지

OBJECTIVE: This study investigated the prevalence of infections with human papillomavirus, Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, and Mycoplasma genitalium in the semen of Korean infertile couples and their associations with sperm quality. METHODS: Semen specimens were collected from 400 men who underwent a fertility evaluation. Infection with above five pathogens was assessed in each specimen. Sperm quality was compared in the pathogen-infected group and the non-infected group. RESULTS: The infection rates of human papillomavirus, C. trachomatis, U. urealyticum, M. hominis, and M. genitalium in the study subjects were 1.57%, 0.79%, 16.80%, 4.46%, and 1.31%, respectively. The rate of morphological normality in the U. urealyticum-infected group was significantly lower than in those not infected with U. urealyticum. In a subgroup analysis of normozoospermic samples, the semen volume and the total sperm count in the pathogen-infected group were significantly lower than in the non-infected group. CONCLUSION: Our results suggest that infection with U. urealyticum alone and any of the five sexually transmitted infections are likely to affect sperm morphology and semen volume, respectively.

Screening and identification of the polypeptides specifically binding to the adhesion protein of Myco-plasma genitalium / 中华微生物学和免疫学杂志

Objective To screen and identify the polypeptides specifically binding to the adhesion protein of Mycoplasma genitalium(MgPa) by using the Ph. D.-12TM phage display peptide library for further understanding the biological function and the possible pathogenic mechanism of the MgPa. Methods The Ph. D.-12TM phage display peptide library was used for 3 rounds of biopanning with the purified recombinant MgPa ( rMgPa) as the given target. The phages were collected for amplification after biopanning. The single strand DNA of phage clones were extracted and purified by using the sodium iodide method for further se-quencing. ELISA, competitive binding assay and dot immunobinding assay were performed to analyze the specific binding of positive phages to rMgPa. Results A significant enrichment of phages was achieved after 3 rounds of biopanning. Eleven different phage exogenous sequences (P1-P11) were detected among the 38 phages randomly selected from the agar. Two core sequences were deduced according to the repeating times of amino acids among the 11 polypeptide sequences, which were V-H-W-D-F-R-Q-W-W-Q-P-S and D-W-S-S-W-V-H/Y-R-D-P-Q-T/S. Ten out of the 11 representative phages ( P1-P10 ) specifically combined with the rMgPa. Conclusion Two polypeptides specifically binding to rMgPa were successfully screened out, which provided the tool for further investigation on the biological function of MgPa and the pathogenic mecha-nism of Mycoplasma genitalium.

Effect of CD14 on lipid-associated membrane proteins of Mycoplasma genitalium activate NF-kappaB / 中国人兽共患病学报

To investigate the effects of CD14 on nuclear transcription factorκB (NF-κB) was activated by lipid-associated membrane proteins (LAMPs) of Mycoplasma genitalium (Mg) ,THP-1 cells were pretreated with serum human or CD14 neu-tralizing antibody ,and then were stimulated by LAMPs .The activation of NF-κBp65 was detected by ELISA .After LAMPs was pretreated with sCD14 stimulated Hela cells with the co-transfection ,the activity of NF-κB luciferase were detected by the dual-luciferase reporter gene to analyze the role of CD14-mediated NF-κB activation by LAMPs .The activation of NF-κBp65 was significantly up-regulated in LAMPs activated THP-1 cells by human serum .It’s suggested that CD14 neutralizing anti-body could inhibit the activation of NF-κBp65 in LAMPs stimulated THP-1 .The activation of NF-κB was significantly up-regu-lated in LAMPs activated Hela cells by mCD14 or sCD14 .CD14 could augment the activation of NF-κB by Mg LAMPs .

0.5% Proparacain hydrochloride for clear corneal phacoemulsification in patients with co-morbid conditions.

Genital tuberculosis is a common cause of female infertility in India. But, it is important to screen for other agents like Chlamydia trachomatis and genital Mycoplasmas as well to avoid persistence of infection and its long-term sequelae. Timely diagnosis of these infections using nucleic acid amplifi cation tests and institution of appropriate therapy will improve the conception rates in infertile women. We report a case of co-infection of Mycoplasma genitalium and Chlamydia trachomatis in an infertile female patient with genital tuberculosis. The infections were diagnosed using polymerase chain reaction, and the patient responded to a combination of antituberculosis therapy and 1 g single-dose Azithromycin.

Micoplasmas genitais e seu papel em infecções respiratórias em recém-nascidos / Genital Mycoplasmas and their Role in Respiratory Tract Infections in Newborn Infants

Os micoplasmas e os ureaplasmas são bactérias cuja maioria das espécies é considerada apenas comensal para o ser humano. Entretanto, o Ureaplasma urealyticum, o Ureaplasma parvum, o Mycoplasma genitaliume o Mycoplasma hominis, conceituados como micoplasmas genitais, são comprovadamente patogênicos para o homem. Essas bactérias podem ser causa de infecções respiratórias ou sistêmicas graves em neonatos. Existe pouco conhecimento sobre a infecção neonatal por estes germes pelos pediatras. A ocorrência dos micoplasmas genitais na flora vaginal de grávidas possibilita a disseminação da infecção para o feto e/ou recém-nascido, associando-se a diversas complicações perinatais como natimortalidade, pneumonia congênita, meningoencefalite, bacteremia e abscessos subcutâneos em neonatos. A literatura é controversa sobre a associação da colonização do trato respiratório de recém-nascidos por ureaplasmas e o desenvolvimento de displasia broncopulmonar. O diagnóstico da infecção por estes microrganismos é obtido, principalmente, através de cultura. A terapêutica antibiótica deve ser introduzida quando ocorre o isolamento dessas bactérias no líquor ou no sangue de neonatos, bem como napneumonia congênita por micoplasmas genitais. Existem limitações para o uso de antimicrobianos nessa faixa etária, particularmente, entre os prematuros, além de número restrito de antibióticos com atividade contra esses microorganismos.

Most of the species of mycoplasmas and ureaplasmas are only human commensal. However, Ureaplasma urealyticum,Urea-plasma parvum, Mycoplasma genitalium and Mycoplasma hominisare considered genital mycoplasmas, because the infection occurs through sexual contact and they are proven pathogenic. These bacteria can cause severe respiratory and sys-temic diseases in newborn infants. The pediatric knowledge about these infections is scarce.The occurrence of genital mycoplasmas in vaginal flora of pregnant women enables the spread of infection to fetus and/ornewborn, being associated with adverse perinatal outcomes as fetal death, congenital pneumonia, meningo encephalitis, bacteremia and subcutaneous abscesses in neonates. There is a controversy if colonization with Ureaplasma spp results inbronchopulmonary dysplasia in neonates. Cultures remain the gold standard for the diagnosis of these infections. The antibiotic treatment must be introduced if there is bacteria isolation in cerebrospinal fluid or blood as well as in congenital pneumonia. The treatment of these infectionsin neonates is challenging, particularly in preterm infants. Furthermore, there is a limited number of antibiotics that have activity against these microorganisms.

Observation on the immunological competence of multiple antigen peptides based on the mimic epitope of the adhesion protein of Mycoplasma genitalium / 中华微生物学和免疫学杂志

Objective To provide experimental evidence for the development of multi-epitope-baseded marker vaccines through investigating the humoral and cellular immune responses in BALB/c mice induced by the multiple antigen peptides (MAPs) with the mimic epitope.Methods Three types of MAPs in eight branched forms containing the mimic epitope of Mycoplasma genitalium adhesion protein (MgPa) were prepared using poly-lysine as the core matrix.The purity of MAPs was analyzed by reverse phase high performance liquid chromatography (RP-HPLC).The molecular weights of MAPs were characterized by Mass Spectrometry.The BALB/c mice were immunized intramuscularly for four times with single or mixed MAPs.The specific IgG antibody and the subtype of IgG antibody in serum of the immunized mice were detected by indirect ELISA.The proliferative responses of the spleen lymphocytes were detected using MTT assay.The ELISA were used to detect IFN-γ and IL-4 levels in the cultured supematant of spleen lymphocytes.Results The three types of MAPs containing the mimic epitopes were successfully prepared with high purity.They,could stimulate mice to produce specific IgG antibodies,of which,the major antibody isotype was Th1 immune response-associated IgG2a.Compared with the single MAP immunization group,the mixed-MAPs immunized mice produced more IgG,IgG1 and IgG2a antibody (P＜0.05).Furthermore,these MAPs could enhance the specific proliferation of spleen lymphocytes in immunized mice and induce the production of IFN-γ and IL-4.The levels of IFN-γand IL-4 in mixed-MAPs group were significantly higher than those of the single MAPs group (P＜0.01).Conclusion The three types of MAPs could induce strong specific cellular and humoral immune responses.The immunological competence of the mixed-MAPs was stronger than those of the single MAP.

Mycoplasma genitalium: An emerging sexually transmitted pathogen.

Mycoplasma genitalium is a member of genital mycoplasmas, which is emerging as an important causative agent of sexually transmitted infections both in males and females. The advent of polymerase chain reaction and other molecular methods have made studies on M. genitalium more feasible, which is otherwise a difficult organism to isolate. Besides Chlamydia trachomatis, M. genitalium is now an important and established cause of non gonococcal urethritis (NGU) in men, more so in persistent and recurrent NGU. Multiple studies have also shown a positive association of M. genitalium with mucopurulent cervicitis and vaginal discharge in females as well. The evidences for M. genitalium pelvic inflammatory diseases and infertility are quite convincing and indicate that this organism has potential to cause ascending infection. Lack of clear association with M. genitalium has been reported for bacterial vaginosis and adverse pregnancy outcomes. Diagnosis of M. genitalium infections is performed exclusively using nucleic acid amplification tests (NAATs), owing to poor or slow growth of bacterium in culture. Although there are no guidelines available regarding treatment, macrolide group of antimicrobials appear to be more effective than tetracyclines. The present review provides an overview of the epidemiology, pathogenesis, clinical presentation and management of sexually transmitted infections due to M. genitalium.

Screening and identification of antigenic mimics of the adhesion protein of Mycoplasma genitalium by phage display peptide library / 中华微生物学和免疫学杂志

ObjectiveTo screen a 12-mer phage display peptide library by the polyclonal antibody (pAb) against the recombinant adhesion protein of Mycoplasma genitalium (rMgPa) in order to obtain the antigenic mimic epitopes of MgPa.MethodsThe purified pAb was used to screen the immunodominant mimic epitopes of MgPa by a random 12-peptide phage display library.Seventy-four recombinant phage clones were randomly selected,and then DNA sequence analysis and computer-based bioinformatics analysis were performed to define the consensus amino acid residues of the mimotopes by MIMOX.The binding specificities of the selected phage-displayed peptides to the purified pAb were confirmed by ELISA,competitive ELISA and Western blot analysis.Results After four rounds of biopanning,a significant enrichment of phages was achieved,the inserts from 74 phage clones distinguished 45 peptides based on the different amino acids sequences.Amongst 45 peptides,36 peptides were ELISA positive and 23 peptides that absorbance values were higher than 1.5 showed high reactivities with pAb and effectively inhibited the binding of pAb to rMgPa.Immunoscreening via phage display peptide library revealed three different mimptopes of adhesion protein of M.genitalium,P-S-A-A/V-X-R-F/W-E/S-L-S-P,A-K-I/L-T/Q-X-T-L-X-L and K-S-L-S-R-X-D-X-I.Results of bioinformatics analysis by MIMOX demonstrated that S,A,F for cluster 1,A,K,I,T and L for cluster 2,K,S,L,R,D and I for cluster 3,may be the key consensus amino acid residues in the aligned mimotopes,respectively.ConclusionAntigenic mimics on MgPa were successfully identified and the motif P-S-A-A/V-X-R-F/W-E/S-L-S-P,A-K-I/L-T/Q-X-T-L-X-L and K-S-L-S-R-X-D-X-I may represent the immunodominant mimic epitopes of MgPa.And S,A,F K,I,T,L,R and D may be the key amino acid residues for the epitopes of MgPa.