Hyperammonemic Encephalopathy due to <i>Ureaplasma parvum</i> Infection in an Immunocompromised Child

Smith, Mallory B; Crews, Jonathan D.; Cheek, Nadia; Srivastava, R. N.; Appachi, Elumalai

doi:10.1542/peds.2019-0601

Cited by 18 publications

(18 citation statements)

References 21 publications

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“…Cerebral edema may develop, leading to death in some cases 8‐10 . Previous studies have demonstrated a relationship between Ureaplasma urealyticum , Ureaplasma parvum , and Mycoplasma hominis identification, mostly but not limited to airway specimens, and the development of HS 4‐6,8,11,12,13 . An immunocompromised murine model also demonstrated a relationship specifically between Ureaplasma urealyticum infection and HS 14 …”

Section: Introductionmentioning

confidence: 95%

Association between Mycoplasma and Ureaplasma airway positivity, ammonia levels, and outcomes post–lung transplantation: A prospective surveillance study

Buzo

Preiksaitis

Halloran

et al. 2021

American Journal of Transplantation

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Hyperammonemia syndrome (HS) is a rare complication with high mortality described after lung transplantation. Its pathophysiology is still unclear, but previous studies, including murine models, have linked the identification of Mycoplasmataceae in airway specimens with HS occurrence. This study explores the association between Mycoplasmataceae polymerase chain reaction (PCR) positivity, ammonia levels, HS, and mortality post–lung transplant. Adults who underwent lung transplantation between July 2017 and August 2019 had prospective surveillance testing for Mycoplasma and Ureaplasma using PCR on post‐operative bronchoscopy samples. One hundred and fifty‐nine patients underwent lung transplantation during the study period. Mean age was 54 (±13) years; baseline diseases were predominantly pulmonary fibrosis (37.7%) and chronic obstructive pulmonary disease (35.8%). Mycoplasma and/or Ureaplasma airway positivity was found in 42 (26.4%) of tested patients, represented mostly by M. salivarium (26/43; 60.4%), U. parvum (7/43; 16.2%), and U. urealyticum (5/43; 11.6%). Median peak ammonia levels were higher in those with Ureaplasma colonization compared to uncolonized patients (p = .04), however, only three patients developed HS. Recipient airway Ureaplasma positivity was independently associated with younger (aOR 0.94, 95% CI 0.88–0.99, p = .04) and female donors (aOR 4.29; 95% CI 1.01–18.2, p = .05).

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Section: Introductionmentioning

confidence: 95%

Association between Mycoplasma and Ureaplasma airway positivity, ammonia levels, and outcomes post–lung transplantation: A prospective surveillance study

Buzo

Preiksaitis

Halloran

et al. 2021

American Journal of Transplantation

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“…Está considerado como flora genital humana. Sin embargo, se ha aislado en pacientes inmunodeprimidos [ 226 - 228 ]. También se ha asociado con corioamnionitis [ 229 - 231 ]; vaginosis bacteriana [ 232 ]; coinfección con papiloma-virus e infertilidad [ 233 ]; neumonía y sepsis en recién nacido [ 234 ]; infección de herida esternal [ 235 ]; orquitis, artritis séptica y endocarditis en pacientes con linfoma [ 236 ]; y uretritis no gonocócica [ 237 ].…”

Section: Especies Implicadas En Patología Humanaunclassified

Clinical implications of the genus Mycoplasma

Rufo¹,

Sánchez²,

Sánchez³

et al. 2021

Rev Esp Quimioter

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Within Mycoplasma genus, M. pneumoniae, M. genitalium, M. hominis or U. urealyticum are the main species that have been traditionally linked to infectious processes. However, there are many other species involved in these conditions and that are, frequently, unfamiliar to healthcare professionals. The aim of this review is to identify all Mycoplasma genus species that have been isolated in human beings and to determine their involvement in infectious pathology.

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“…31 PCR was also successfully used to identify Ureaplasma parvum by Smith et al in a pediatric, hyperammonemic patient, whose infection had become disseminated. 36 Somerville et al similarly implemented a real-time PCR screening program to test fluid from bronchioalveolar lavage of recently transplanted lungs. Their results support the association between Mollicute infection and hyperammonemia syndrome.…”

Section: Diagnosticsmentioning

confidence: 99%

“…The first case of Ureaplasma -induced hyperammonemia in an immunosuppressed pediatric patient with acute myelogenous leukemia was recently published. 35 Subsequent case reports have evinced further incidences of hyperammonemia secondary to disseminated Ureaplasma in other children with hematologic malignancies and impaired immunologic function, 36 which notably resolved with antibiotic treatment of the infection. Systemic Ureaplasma infections have similarly been observed in patients experiencing hyperammonemia following hematopoietic cell transplantation 37 and undergoing immunosuppression for cancer treatment.…”

Section: Pathophysiologymentioning

confidence: 99%

“…The first case of Ureaplasmainduced hyperammonemia in an immunosuppressed pediatric patient with acute myelogenous leukemia was recently published. 35 Subsequent case reports have evinced further incidences of hyperammonemia secondary to disseminated Ureaplasma in other children with hematologic malignancies and impaired immunologic function, 36 which notably resolved Figure 1. The urea cycle.…”

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confidence: 99%

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Hyperammonemia Post Lung Transplantation: A Review

Leger

Silverman

Hauck

et al. 2020

Clin Med Insights Circ Respir Pulm Med

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Hyperammonemia is the pathological accumulation of ammonia in the blood, which can occur in many different clinical settings. Most commonly in adults, hyperammonemia occurs secondary to hepatic dysfunction; however, it is also known to be associated with other pathologies, surgeries, and medications. Although less common, hyperammonemia has been described as a rare, but consistent complication of solid organ transplantation. Lung transplantation is increasingly recognized as a unique risk factor for the development of this condition, which can pose grave health risks—including long-term neurological sequelae and even death. Recent clinical findings have suggested that patients receiving lung transplantations may experience postoperative hyperammonemia at rates as high as 4.1%. A wide array of etiologies has been attributed to this condition. A growing number of case studies and investigations suggest disseminated opportunistic infection with Ureaplasma or Mycoplasma species may drive this metabolic disturbance in lung transplant recipients. Regardless of the etiology, hyperammonemia presents a severe clinical problem with reported mortality rates as high as 75%. Typical treatment regimens are multimodal and focus on 3 main avenues of management: (1) the reduction of impact on the brain through the use of neuroprotective medications and decreasing cerebral edema, (2) augmentation of mechanisms for the elimination of ammonia from the blood via hemodialysis, and (3) the diminishment of processes producing predominantly using antibiotics. The aim of this review is to detail the pathophysiology of hyperammonemia in the setting of orthotopic lung transplantation and discuss methods of identifying and managing patients with this condition.

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Hyperammonemic Encephalopathy due to Ureaplasma parvum Infection in an Immunocompromised Child

Cited by 18 publications

References 21 publications

Association between Mycoplasma and Ureaplasma airway positivity, ammonia levels, and outcomes post–lung transplantation: A prospective surveillance study

Association between Mycoplasma and Ureaplasma airway positivity, ammonia levels, and outcomes post–lung transplantation: A prospective surveillance study

Clinical implications of the genus Mycoplasma

Hyperammonemia Post Lung Transplantation: A Review

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