Post-operative mediastinitis, pleuritis and pericarditis due to Mycoplasma hominis and Ureaplasma urealyticum with a fatal outcome

García-de-la-Fuente, Celia; Miñambres, Eduardo; Ugalde, Estibaliz; Sáez, Ana; Martı́nez-Martı́nez, Luis; Fariñas, María Carmen

doi:10.1099/jmm.0.47632-0

Cited by 33 publications

(26 citation statements)

References 9 publications

(6 reference statements)

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“…In half of the cases, IE appeared in the first year following cardiac surgery, as reported in our case, suggesting possible nosocomial infection. Despite the fact that M. hominis nosocomial IE was never previously reported, M. hominis wound infections have been described after a caesarian procedure (15,16) and sternotomy and may be responsible for mediastinitis (17)(18)(19)(20)(21)(22). Eight cases of M. hominis mediastinitis (6 occurring after coronary artery bypass) were reported previously (21).…”

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confidence: 99%

Mycoplasma hominis, a Rare but True Cause of Infective Endocarditis

et al. 2015

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e Mycoplasma spp. are rarely recognized agents of infective endocarditis. We report a case of Mycoplasma hominis prosthetic valve endocarditis diagnosed by 16S ribosomal DNA (rDNA) PCR and culture of valves in a 74-year-old man. We reviewed the literature and found only 8 other cases reported. CASE REPORTA 74-year-old man, with a history of hypertension and mitral and aortic biological prosthetic valve replacement since June 2013 and stroke in August 2013, was admitted in December 2013 to the intensive care unit of the University Hospital of Saint Etienne, Saint-Etienne, France, for dizziness and cardiac and kidney failure. Physical examination revealed a low-grade fever (38.2°C) and an aortic murmur. A first transthoracic echocardiography procedure showed a decrease in the left ventricular ejection function fraction (LVEF) to 35% compared to anterior data (LVEF, 45% to 50% in June 2013), whereas the prosthetic valves appeared functional. The results of a second transthoracic echocardiography procedure, performed only 2 days later, were consistent with aortic prosthetic endocarditis associated with grade IV aortic insufficiency, a decrease in the LVEF to 25%, and an abscess of mitroaortic intervalvular fibrosa. Four days later, 2 of 6 blood cultures grew with the same strain of Staphylococcus epidermidis after 19 and 23 h, respectively (blood culture system, Bactec FX40; Becton Dickinson). Both positive blood cultures were obtained through an arterial catheter. The results of peripheral blood cultures obtained through vein and central venous catheters remained negative. Diagnosis of infective endocarditis (IE) was based on Duke's criteria (1 major criterion [valvular abscess] and 3 minor criteria [fever over 38°C, blood culture positive for S. epidermidis, and predisposing heart condition, i.e., history of valvular replacement]). The initial antibiotic regimen included vancomycin (20 mg/kg of body weight/day) and linezolid (600 mg twice a day).Cardiac surgery was performed 24 h after the diagnosis of infective endocarditis. Cardiac surgeons observed destruction of the mitroaortic intervalvular fibrosa, with dehiscence of the aortic prosthesis, and multiple abscesses. Aortic valve replacement with a biologic prosthesis associated with a reconstruction of the mitroaortic fibrosa was performed. After surgery, linezolid was replaced by daptomycin (8 mg/kg every 48 h) due to acute kidney injury. Serological testing for Bartonella spp. and Coxiella burnetii was negative. Broad-range 16S ribosomal DNA (rDNA) PCR was performed on the cardiac valve, using the primers described by Harris and Hartley (1), followed by sequencing; the results were positive for Mycoplasma hominis. Initially, routine cultures of the cardiac valve performed on standard media, including blood agar and chocolate agar for 48 h and Schaedler broth for 15 days, remained sterile. After the results of the PCR were seen, a culture of the valve was plated on chocolate agar for longer and led to the growth of translucent and tiny colonies after 5 days. A...

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Mycoplasma hominis, a Rare but True Cause of Infective Endocarditis

et al. 2015

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“…The patient responded to combination therapy with clindamycin, gentamicin, and doxycycline (10). García-de-la-Fuente et al published a case of a 77-year-old male who developed sternal wound dehiscence, mediastinitis, pleural effusion, and pericardial effusion following aortic valve replacement (5). Cultures demonstrated both M. hominis and Ureaplasma spp.…”

Section: Ureaplasma Parvum Belongs To the Class Mollicutesmentioning

confidence: 99%

Ureaplasma parvum as a Cause of Sternal Wound Infection

Walkty

Manickam

et al. 2009

J Clin Microbiol

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Few reports in the literature have documented the isolation of Ureaplasma species from sternal wounds. A case of sternal wound infection likely due to Ureaplasma parvum is described. When routine bacterial cultures from a sternal wound infection fail to yield a pathogen, diagnostic testing for mycoplasmas and ureaplasmas should be considered. CASE REPORTA 66-year-old Aboriginal male presented to a tertiary care hospital in Winnipeg, Manitoba, Canada, with an episode of chest pain that was unrelieved by nitroglycerin. His past medical history was significant for known ischemic heart disease, hyperlipidemia, hypertension, type 2 diabetes mellitus, remote tuberculosis, and bilateral knee arthroplasty. Laboratory investigations performed at the time of arrival (and repeated 18 h later) demonstrated a troponin T level of Ͻ0.01 g/liter. The patient was admitted under the cardiology service with a diagnosis of unstable angina. Therapy with heparin was initiated.A coronary angiogram performed 2 days postadmission demonstrated 70% stenosis of the left anterior descending coronary artery, complete occlusion of the right coronary artery, and an ejection fraction of 44%. Following consultation with a cardiac surgeon, the patient underwent three-vessel coronary artery bypass grafting. Cefazolin was administered before the procedure, and the treatment was continued for 5 days postoperatively. The patient was transferred out of the surgical intensive care unit to the general cardiac surgery ward on postoperative day 1. His postoperative course was complicated by ileus that spontaneously resolved over several days. On postoperative day 5, he developed a new onset fever of 38.6°C and increasing shortness of breath. He was also having runs of sustained ventricular tachycardia. On postoperative day 6, he was readmitted to the surgical intensive care unit with a diagnosis of possible pneumonia. Empirical antimicrobial therapy with piperacillin-tazobactam was initiated. His condition stabilized over the next few days. Blood cultures were negative.On postoperative day 10, purulent drainage from the sternal wound was observed. The sternum was also found to be unstable on clinical examination. A chest computed tomography scan demonstrated soft tissue stranding and fluid around the sternum, consistent with expected postoperative changes. No definite evidence of osteomyelitis was noted. A wound swab of the sternal drainage was sent to the microbiology laboratory on postoperative day 10. A Gram stain demonstrated at most one polymorphonuclear leukocyte per oil immersion field. No bacteria were isolated on culture. A second wound swab, submitted on postoperative day 11, also did not yield bacterial growth.On postoperative day 15, due to sternal instability and ongoing purulent drainage from the sternal wound, the patient was taken back to the operating room. The sternal incision was opened, and a substantial amount of pus was drained. The edges of the sternum were debrided, and the sternal wires were removed. The wound was closed again wit...

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“…Each of these patients had well-defined predisposing conditions and a plausible source of infectious inoculation (Table 1). Although several cases of postoperative mediastinitis with pericarditis and one case of posttransplant pericarditis have also been described (Table 1) (8,11,12,13), no cases of spontaneous pericarditis have been previously reported with this pathogen. Even though the patient reported herein has several immunosuppressing conditions that may have contributed to infection susceptibility, she had no recent history of surgery or instrumentation that would have introduced the pathogen into her thorax or vascular system.…”

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“…Infection with Ureaplasma spp. in anatomical sites outside the urogenital tract is extremely rare in the adult population (Table 1) (6,8,9,12,13). Notably, published cases include infection of the pleura and meninges.…”

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Spontaneous Bacterial Pericarditis with Tamponade Due to Ureaplasma spp

et al. 2009

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Infectious pericardial effusion with tamponade is an uncommon but life-threatening disease. We report an unusual case of spontaneous Ureaplasma pericardial effusion with tamponade associated with pneumonia, pleural effusion, and urinary tract infection. All published cases of clinically invasive Ureaplasma infections in the adult population are also reviewed.

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Post-operative mediastinitis, pleuritis and pericarditis due to Mycoplasma hominis and Ureaplasma urealyticum with a fatal outcome

Cited by 33 publications

References 9 publications

Mycoplasma hominis, a Rare but True Cause of Infective Endocarditis

Mycoplasma hominis, a Rare but True Cause of Infective Endocarditis

Ureaplasma parvum as a Cause of Sternal Wound Infection

Spontaneous Bacterial Pericarditis with Tamponade Due to Ureaplasma spp

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