Mycoplasma infection

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Mycoplasma infection

  1. 1. By Dr.Sujith S
  2. 2. Species Mycoplasma pneumoniae Mycoplasma hominis Mycoplasma genitalium Ureaplasma urealyticum
  3. 3. Pathogenesis Pathogenic organisms for humans and animals possess specialized tip organelles that mediate their interactions with host cells. This host-adapted survival is achieved by i)surface parasitism of target cells ii) the acquisition of essential biosynthetic precursors iii) cell entry and intracellular survival.
  4. 4. Toll-like receptor 2 for binding of Mycoplasma and activation of inflammatory mediators, including cytokines. M. pneumoniae grows under both aerobic and anaerobic conditions ,isolated on media supplemented with serum. The organism most commonly exists in a filamentous form and has adherence proteins that attach to epithelial membranes with particular affinity for respiratory tract epithelium
  5. 5. An immune-mediated mechanism in infants and young children developing pneumonia. In addition, the antibodies produced against the glycolipid antigens of M. pneumoniae may act as autoantibodies, since they crossreact with human red cells and brain cells.
  6. 6. Epidemiology M. pneumoniae is transmitted from person-to-person by infected respiratory droplets during close contact. The incubation period after exposure averages three weeks . Infection occurs most frequently during the fall and winter but may develop year-round
  7. 7. Mycoplasma pneumoniaeone of the most common causes of atypical pneumonia Atypical pneumonia  account for 7 to 20% of community-acquired pneumonia The incidence may be higher in patients with milder disease that can be managed without hospitalization
  8. 8. Many infections due to M. pneumoniae are asymptomatic. The signs and symptoms vary according to the stage of illness Headache, malaise, and low grade fever. Chills are frequent.
  9. 9. Cough due to M. pneumoniae infection ranges from nonproductive to mildly productive, with sputum discoloration occurring late in the disease. Wheezing may occur Pharyngitis Rhinorrhea and Ear pain
  10. 10. Extrapulmonary manifestations These manifestations include Hemolysis Skin rash Joint involvement Symptoms and signs indicative of gastrointestinal tract, central nervous system, and heart disease..
  11. 11. Haemolysis Antibodies (IgM)  I antigen on erythrocyte membranes appear during the course ; produce a cold agglutinin response in about 60 % of patients .
  12. 12. Skin Disease Dermatologic manifestations a mild erythematous maculopapular / vesicular rash to the Stevens- Johnson syndrome. 16 % patients with Stevens-Johnson syndrome had evidence of mycoplasma infection.
  13. 13. Central Nervous System CNS involvement occurs most frequently in children, with encephalitis as the most frequent manifestation. Other manifestations include aseptic meningitis, peripheral neuropathy, transverse myelitis, cranial nerve palsies and cerebellar ataxia . Acute transverse myelitis (ATM) and acute disseminated encephalomyelitis (ADEM) most severe complications . 59 percent of patients presenting with spinal cord involvement suffered permanent neurologic sequelae .
  14. 14. Other Systems Rheumatologic symptoms including tender joints and muscles and polyarthritis. Arthritis is believed to result from immune-mediated mechanisms M. pneumoniae has been isolated from synovial fluid in some patients with polyarthritis.
  15. 15. Cardiac or renal involvement -unusual . Rhythm disturbances, congestive heart failure, chest pain, and conduction abnormalities on the electrocardiogram. Clinically significant glomerulonephritis is a rare complication that is presumed to be secondary to immune complex deposition
  16. 16. Chest X-Ray Bronchopneumonia Plate-like atelectasis Nodular infiltration Hilar adenopathy The most common radiographic finding is the peribronchial pneumonia pattern, which consists of a thickened bronchial shadow, streaks of interstitial infiltration, and areas of atelectasis; these changes have a predilection for the lower lobes. Nodular infiltrates and hilar adenopathy  less common, and result in a broader differential diagnosis, including tuberculosis, mycotic infections, and sarcoidosis
  17. 17. Lab Diagnosis Subclinical evidence of hemolytic anemia is present in the majority of patients with pneumonia positive Coombs' test and elevated reticulocyte count. Cold agglutinin titers are elevated in 50 percent of patients with mycoplasma disease, and the titer usually exceeds 1:128 in patients with pneumonia With overt hemolysis, titers may be as high as 1:50,000.
  18. 18. Elevated Cold Agglutinin Titres Infectious Mononucleosis secondary to Epstein Barr virus Cytomegalovirus Adenovirus pneumonia Viral illness Lymphoma and Collagen vascular disorders
  19. 19. The white blood cell count (WBC) normal  75 to 90 percent of cases. Thrombocytosis can occur acute phase response.
  20. 20. CSF-Lymphocytic pleocytosis, elevated protein, and normal glucose. Isolation of M. pneumoniae in CSF - possible. A culture is more likely to be positive in encephalitis rather than myelitis. PCR testing for Mycoplasma in the CSF can also be performed.
  21. 21. Treatment Treatment options for outpatient community- acquired pneumonia are presented in the 2007 consensus IDSA/ATS guideline: Macrolide antibiotics (azithromycin, clarithromycinor erythromycin) first line treatment . Azithromycin (500 mg orally once daily, initially followed by 250 mg orally for 4 days) has become the most commonly used drug regimen.
  22. 22. Adjunctive Therapy For hemolytic anemia, case reports indicate some patients respond to warming, steroid therapy, possibly plasmapheresis. For CNS disease, therapy with steroids, antiinflammatory drugs, diuretics, and plasma exchange ,used in addition to antibiotics.
  23. 23. M.Hominis Epidemiology:M. hominis is part of the normal genital flora of many sexually experienced men and women Infants & childrren:Newborns are likely to become colonized during passage through the birth canal..
  24. 24. The organism Mycoplasma are the smallest free-living bacteria. M. hominis cannot be visualized by Gram stain. M. Hominisproduces nonhemolytic colonies on sheep blood agar after three to five days of incubation. M. hominis does not alter the appearance of blood culture media; therefore,routine blind subculturing onto blood is required for detection.
  25. 25. For optimizing the recovery of M. hominis, clinical specimens should be immediately inoculated onto culture media and not allowed to dry. After plating, cultures should be promptly incubated or kept at 4ºC. The best laboratory culture media is beef heart infusion broth (also known as pleuropneumonia-like organism) (PPLO) broth with fresh yeast extract and horse serum.
  26. 26. PCR is superior to traditional culture methods for detecting M. hominis in genital secretions.
  27. 27. Genitourinary infection Pyelonephritis Pelvic inflammatory disease Chorioamnionitis Postpartum and postabortal fever Nongenitourinary infections that have been linked to M. hominis include: Septicemia Wound infections Central nervous infections Joint infections Lower respiratory tract infections Endocarditis
  28. 28. Post partum & post abortal fever M. hominis causes approximately 10 percent of all cases of postpartum and postabortal fever. There was a fourfold rise in antibody titers in one-half of all women who had postabortal fever compared to only 2 of 53 controls who had abortion without fever.
  29. 29. PID M. hominis was isolated from 4 of 50 fluid samples taken directly from the fallopian tubes of women with salpingitis. Significant rises in antibody titers to M. hominis occurred in 9 of 16 women with salpingitis who had positive lower genital tract cultures for M. hominis .
  30. 30. UTI M. hominis can frequently be recovered from the lower genitourinary tract in men and women.
  31. 31. Chorioamnionitis M. hominis, along with Ureaplasma urealyticum, is frequently found in the amniotic fluid of women with i)preterm labor, ii) preterm premature rupture of membranes iii) spontaneous labor at term iv) premature rupture of membranes at term v) chorioamnionitis
  32. 32. CNS M. hominis infection has been associated with non- functioning CNS shunts , brain abscess , subdural empyema, and meningitis. M. hominis arthritis can occur in women after childbirth, in conjunction with congenital immune defects, such as hypogammaglobulinemia , in association with immunosuppression (eg, in solid organ transplant patients) or lymphoma , or following joint replacement surgery or trauma. M. hominis arthritis is usually characterized by fever, leukocytosis, and a purulent joint effusion with large numbers of polymorphonuclear cells but a negative Gram stain.
  33. 33. Wound infections M. hominis has been associated with infected pelvic hematoma , infected cesarean wounds, and sternal wound infections
  34. 34. Treatment Tetracycline is the treatment of choice
  35. 35. Thank you

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