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      Mycoplasma hominis empyema following caesarean section

      case-report

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          Abstract

          Mycoplasma hominis as a cause of empyema is rare. We report a case of empyema caused by M. hominis following a caesarean section. A 28‐year‐old woman at 39 weeks and one day of pregnancy was admitted to our hospital and underwent an emergency caesarean section because of premature rupture of membranes. On postoperative day 2, she developed a fever, and flomoxef was administered. A pleural effusion developed on the right side. A diagnosis of empyema was made, and sulbactam/ampicillin was administered. However, the patient’s clinical condition did not improve. Numerous small pinpoint colonies, which did not yield visible bacteria on a Gram stain, were observed on a plate of pleural fluid culture, and M. hominis empyema was suspected. Based on this result, antibiotic therapy was switched to clindamycin, and the patient’s clinical condition improved rapidly. M. hominis was detected in the pleural fluid by polymerase chain reaction (PCR) assay. M. hominis should be considered a causative pathogen for empyema following a caesarean section.

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          Mycoplasmas and ureaplasmas as neonatal pathogens.

          The genital mycoplasmas represent a complex and unique group of microorganisms that have been associated with a wide array of infectious diseases in adults and infants. The lack of conclusive knowledge regarding the pathogenic potential of Mycoplasma and Ureaplasma spp. in many conditions is due to a general unfamiliarity of physicians and microbiology laboratories with their fastidious growth requirements, leading to difficulty in their detection; their high prevalence in healthy persons; the poor design of research studies attempting to base association with disease on the mere presence of the organisms in the lower urogenital tract; the failure to consider multifactorial aspects of diseases; and considering these genital mycoplasmas only as a last resort. The situation is now changing because of a greater appreciation of the genital mycoplasmas as perinatal pathogens and improvements in laboratory detection, particularly with regard to the development of powerful molecular nucleic acid amplification tests. This review summarizes the epidemiology of genital mycoplasmas as causes of neonatal infections and premature birth; evidence linking ureaplasmas with bronchopulmonary dysplasia; recent changes in the taxonomy of the genus Ureaplasma; the neonatal host response to mycoplasma and ureaplasma infections; advances in laboratory detection, including molecular methods; and therapeutic considerations for treatment of systemic diseases.
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            Hematoma and abscess formation caused by Mycoplasma hominis following cesarean section

            Mycoplasma species cannot be identified by routine bacteriological culture methods and are resistant to common antimicrobial agents. Mycoplasma hominis usually colonizes the lower urogenital tract and causes pyelonephritis, pelvic inflammatory disease, chorioamnionitis, rupture of fetal membranes, preterm labor, postpartum fever, postabortal fever, and neonatal infection. This organism is highly prevalent in cervicovaginal cultures of sexually active women. M. hominis, M. genitalis, Ureaplasma urealyticum, and U. parvum may invade and infect placental and fetal tissues, leading to adverse pregnancy outcomes. M. hominis occasionally causes nongenitourinary infection of the blood, wounds, central nervous system, joints, or respiratory tract. We present a case of a 27-year-old woman who developed abdominal wound hematoma and abscess after cesarean section. The wound was drained, but her high fever persisted, in spite of antibiotic treatment using flomoxef sodium and imipenem·cilastatin sodium. Because the exudate exhibited M. hominis growth in an anaerobic environment, we administered the quinolone ciprofloxacin. This therapy resolved her fever, and her white blood cell count and C-reactive protein level diminished to the normal ranges. To our knowledge, there are four published articles regarding the isolation of M. hominis from postcesarean incisions. Based on the current study and the literature, infection by this pathogen may cause hematoma formation with or without abscess after cesarean section or in immunosuppressed postoperative patients. In such cases, physicians may need to suspect Mycoplasma infection and initiate appropriate antibacterial treatment as soon as possible in order to avoid persistent fever.
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              Mycoplasma hominis pneumonia complicating bilateral lung transplantation: case report and review of the literature.

              Mycoplasma hominis is a commensal of humans. The organism has been predominantly associated with infections of the genitourinary tract. Extragenital infections have been described in neonates, in women during the postpartum period, and in immunocompromised patients. Pneumonia caused by M. hominis is very rare. This report describes the development of M. hominis pneumonia in a lung transplantation recipient and underscores the difficulty in establishing the correct diagnosis and the need for early and aggressive treatment with appropriate antimicrobial agents to insure a good outcome.
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                Author and article information

                Contributors
                yamazoe@kcho.jp
                Journal
                Respirol Case Rep
                Respirol Case Rep
                10.1002/(ISSN)2051-3380
                RCR2
                Respirology Case Reports
                John Wiley & Sons, Ltd (Chichester, UK )
                2051-3380
                14 September 2018
                November 2018
                : 6
                : 8 ( doiID: 10.1002/rcr2.v6.8 )
                : e00367
                Affiliations
                [ 1 ] Department of Respiratory Medicine Kobe City Medical Center West Hospital Kobe Japan
                [ 2 ] Department of Bacteriological Examination Kobe City Medical Center West Hospital Kobe Japan
                [ 3 ] Department of General Internal Medicine Kobe City Medical Center West Hospital Kobe Japan
                Author notes
                [*] [* ] Correspondence

                Masatoshi Yamazoe, 4, 2‐chome, Ichibancho, Nagata‐ku, Kobe 653‐0013, Japan. E‐mail: yamazoe@ 123456kcho.jp

                Author information
                http://orcid.org/0000-0003-4088-5432
                Article
                RCR2367 RCR-18-071.R1
                10.1002/rcr2.367
                6138538
                43831e68-061f-475b-aa21-17de5eefa063
                © 2018 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 31 July 2018
                : 20 August 2018
                : 24 August 2018
                Page count
                Figures: 3, Tables: 0, Pages: 3, Words: 1451
                Categories
                Case Report
                Case Reports
                Custom metadata
                2.0
                rcr2367
                November 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.4.7.1 mode:remove_FC converted:14.09.2018

                bloodstream infection,caesarean section,empyema,mycoplasma hominis,pregnancy

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