MYCOPLASMA AND UREAPLASMA:

- The order Mycoplasmatales is subdivided into 4 genera:

 Eperythrozoon
 Haemobartonella
 Mycoplasma
 Ureaplasma

MYCOPLASMA:

 The most clinically significant genus is Mycoplasma (127 species)

 The most important species is M.pneumoniae (also called Eaton agent after the investigator
who originally isolated it).
 M. pneumoniae causes respiratory tract diseases such as tracheobronchitis and pneumonia.
 Other commonly isolated pathogens includes:
M. genitalium
M. hominis

STRUCTURE:

 Smallest free-living organisms

 No cell wall
 Cell membrane contains sterols

**In contrast, other cell wall deficient bacteria = L-forms, don’t have sterols in their cell membrane
and can form cell walls under appropriate growth conditions

 Absence of cell wall renders mycoplasmas resistnt to:

Renicillin
Cephalosporins
Vancomycin
Other antibiotics that interfere with synthesis of cell wall
 Mycoplasmas form pleiomorphic shapes varying from coccoid forms to rods
 Many can pass through the 0.45-μm filters used to remove bacteria from solutions= thus, the
mycoplasmas were originally thought to be viruses (previously called as eaton agent)
 However:
the organisms divide by binary fission (typical of all bacteria),
Grow on artificial cell-free media,
Contain both ribonucleic acid (RNA) and deoxyribonucleic acid (DNA)
 Mycoplasmas are facultatively anaerobic = EXCEPT M.Pneumonia – strict aerobe
 Require exogenous sterols supplied by animal serum added to growth medium
 Slow growth – 1 to every 16 hours
 Small colonies that are difficult detect without extended incubation
 VIRULENCE FACTORS:

1. M.Genitalium:
 Attachment organelle
 Intracellular growth

2. M.pneumonia:
 Extracellular obligate human pathogen
 Contains complex adhesion proteins
 Most important adhesion protein= P1 adhesine
 Phase and antigenic changes cause ciliostasis
 Exotoxin = pertussis tx like toxin which causes vacuolisation
 Polyclonal T and B cell stimulation = cytocine = auto antibody

PATHOGENESIS:

1. M.Pneumonia:
 Extracellular pathogen
 Adheres to respiratory epithelium
 Attachment structure forms at one end of the cell
 Attachment structure: adhesion proteins+P1 adhesin
 Adhesions interact specifically with sialated glycoprotein receptors:
at the base of the cilia on epithelial surface
on the surface of erythrocytes
 Cilia and ciliated epithelial cells are destroyed – ciliostasis
 Loss of these ciliated epithelial cells:
interferes with normal clearance of upper airways
permit the bacteria to spread to lower respiratory tract
 Cilia and epithelial cell loss and interaction with sialated glycorpoteins result in persistant cough
**Ciliostasis test – evaluates ciliary activity of trachea
 M.pneumonia functions as super antigen – stimulates inflammatory cells to migrate to site of
infection = release of cytokines:
Initially TNF-alpha+IL-1
Later IL-6
 Formation of these inflammatory cytokines contributes to clearance of bacteria and observed
disease
 Mycoplasma species can change expression of surface lipoproteins rapidly:
important for evading host immune responses
establishing persistent or chronic infections
BRIEF:

1. Destroys ciliated epithelial cells

2. Acts as super-antigen
3. Changes expression of surface lipoproteins

EPIDEMIOLOGY: RESPIRATORY DISEASE:

 M.pneumonia is strict human pathogen

 Causes respiratory disease worldwidethroughout the year with no consistent increase in
seasonal activity
 Epidemic disease occurs
 Most common in school-age children and young adults (5-15 years)
 Colonizes nose, throat, trachea, lower airways of infected humans
 Spread by respiratory dropkets during coughing episodes

EPIDEMIOLOGY: GENITOURINARY:

 M.Hominis and M.Genitalium

 Increases after puberty, corresponding to sexual activity
 Sexually active humans are colonized with mainly = M.Genitalium; small proportion with:
M.Hominis
 The incidence of carriage in adults who are sexually inactive is no greater than that in pre
pubertal children.

CLINICAL: RESPIRATORY:

 Exposure to M.Pneumonia results in asymptomatic carriage

 Most common clinical presentation of M.pneumonia = tracheobronchitis
 Low-grade fever, non-productive cough is present, acute pharyngitis
 Symptoms gradually worsen over the next few days and can persist for 2 weeks or longer
 The bronchial passages primarily become infiltrated with lymphocytes and plasma cells.
 Atypical pneumonia = walking pneumonia – also develops:
Patchy bronchopneumonia seen on chest radiographs is more impressive than physical findings
 Myalgias and gastrointestinal tract symptoms are uncommon.
 2nd complications = neurologic abnormalities, pericarditis etc
CLINICAL: GENITOURINARY:

 Genitourinary tract is colonized with other mycoplasma species, it is difficult to determine role
of these organisms in disease
 M.genitalium cause nongonococcal urethritis, cervicitis, pelvic inflammatory disease
 M.hominis cause pyelonephritis, postpartum fevers, and systemic infections in
immunocompromised patients.

LAB: MYCOPLASMA

 Microscopy has no diagnostic value (mycoplasmas stain poorly with gram stain)
 Antigen tests have poor sensitivity and specificity = not recommended
 NUCLEIC ACID AMPLIFICATION TESTs = most sensitive diagnostic tests
 CULTURE – M.pneumonia – can be isolated in cultre from throat washings, bronchial washings,
sputum;
 BUT organisms grow slowly and require special media supplemented with:
Serum (provides sterols)
Yeast extract (for nucleic acid precursors)
Glucose
Ph indicator
Penicillin (to inhibit other bact)
 Serology tests are available for M.pneumonia – enzyme immunoassays for detection of IgM and
IgG
 Serology tests are more sensitive than culture
 Disadvantage with serologic tests is that they have to be collected early in the course of disease
and then after 3 to 4 weeks to demonstrate a rise in antibody levels
MYCOFAST:

 Rapid detection of M. hominis and U. urealyticum

 Rapid detection of antibiotic susceptiblilties
 Commarcially avaliable diagnostic reactive

TREATMENT:M.PNEUMONIA:

 Macrolides (azithromycin)
Tetracyclines (doxycycline)
Fluoroquinoles are effective in M.pneumonia
 although the tetracyclines and fluoroquinolones are reserved for use in adults.
 Azithromycin is widely used for treating M. pneumoniae

TREATMENT: SEXUALLY

 M.genitalium is resistant to macrolides and fluoroquinolones=problematic treatment

 M.hominis is resistant to macrolides
 Azithromycin is widely used for treating M. pneumoniae
GENITAL MYCOPLASMAS:

Ureaplasma urealyticum

Mycoplasma genitalium

Mycoplasma hominis
 UREALYTICUM:

 Urease(+)
 differentiated from mycoplasmas wirh urease positivity
 rapid growth in culture
 colonized at genitourinary system in adults
 diseases:
nongonococcal urethritis
low weight birth
Chorioamnionitis
Urinary infection (urolithiasis)
 Transmitted with sexually and vertical route

**M.Hominis and U.Urealyticum – cause male infertility – 7%