CHAPTER 45

Cell Wall–Deficient Bacteria:

Mycoplasma and Ureaplasma

Copyright © 2014, by Mosby, an imprint of Elsevier Inc.

Objectives
• Describe the general characteristics of the Mycoplasmataceae, including
microscopic and macroscopic appearances.
• Identify key characteristic biochemical reactions for the differentiation of
pathogenic Mycoplasma spp.
• Explain the difficulties associated with the isolation of these fastidious
organisms, including required nutritional requirements, immune
responses, cellular locations, and incubation requirements (e.g., length of
time, temperature, oxygenation requirements).
• Compare the clinical presentation of M. pneumoniae to
S. pneumoniae.
• Describe the proper processing, collection, transport, and storage of
specimens for the isolation of the organism discussed in this chapter.
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Objectives (cont’d)
• State the site for colonization in the human host for Mycoplasma
genitalium, M. hominis, M. pneumoniae, and Ureaplasma urealyticum.
• Describe the clinical manifestations associated with each of the major
species considered in this chapter.
• Describe the complications of serologic diagnosis related to the
variations in antibody formation in infections with M. pneumoniae.
• Explain the current limitations and recommendations associated with
susceptibility testing related to the Mycoplasmataceae.
• Correlate signs and symptoms, and evaluate laboratory data
associated with the diagnosis of infections caused by the major
pathogens discussed in this chapter.
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Taxonomy

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General Characteristics
• Highly fastidious Require nucleic acid precursors, fatty
acids and cholesterol – growth
• Slow growing
• Facultative anaerobes
• Very small cell size (0.3 x 0.8 μm) Can a Gram stain be
used to report these
• No cell wall bacteria?

• Small genome

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 Mycoplasmas
• 2 Genera – Mycoplasma & Ureaplasma
• Size: 0.1 – 0.8µm in diameter (smallest free-living microbes)
• Lack:
Why does it
• cytochromes, enzymes of the Krebs cycle, and cell walls stain pink and
appear
• Stain pink (Gram stain) and have pleomorphic shapes. pleomorphic?
• Most have sterols in their cytoplasmic membranes
• Require various growth factors from a host or supplied in laboratory
media (cholestrol, Fatty Acids, Vitamins etc.)
• Some Mycoplasmas have colonies with ‘fried egg’ appearance
• Can colonize the mucous membranes of the respiratory and urinary tracts
Normal Flora Mycoplasmas

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Epidemiologic Factors
• Transmission – species:
• Direct sexual contact
• Transplants
• Mother to fetus
• Respiratory secretions (Mycoplasma pneumoniae)

• Important species isolated from humans:

• M. pneumoniae
• Causes community-acquired atypical pneumonia (walking pneumonia).
• Attaches strongly to mucosal cells.
• U. urealyticum from genitourinary tract
• M. hominis from genitourinary tract

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Pleomorphic forms of Mycoplasma

Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Figure 19.19
Mycoplasmas
 Mycoplasma pneumoniae
 Virulence – attaches to ciliated epithelial cells lining the respiratory
tracts of humans – interrupt mucous removal – mucous build up
 Causes primary atypical pneumonia (walking pneumonia):
 Early symptoms not typical of other types of pneumonia
 Not usually severe enough to require hospitalization
 Spread by nasal secretions among people in close contact
 Diagnosis difficult
 Mycoplasmas are small and difficult to detect, slow growth
 Lack ‘fried egg’ colony appearance, display grainy colonies
 Difficult to prevent
 Patients often infectious without signs or symptoms

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Mycoplasma pneumoniae

Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Figure 19.20
Mycoplasmas
 Other Mycoplasmas
 Three other mycoplasma associated with human diseases:
 M. hominis, M. genitalium, and Ureaplasma urealyticum
 Often colonize the urinary and genital tracts of newborn girls
 M. genitalium and U. urealyticum cause inflammation of the
urethra – Non gonococcal urethritis
 M. hominis can cause inflammation of the kidney & pelvic
inflammatory disease (PID) in women
 Abstinence and safe sex can help prevent the spread of these
organisms

Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings

Clinical Manifestations
• Mycoplasma pneumoniae
• Asymptomatic infection or
• Upper and lower respiratory tract infections

• Ureaplasma urealyticum and M. hominis

• Systemic infections in neonates
• Invasive disease in patients who are immunosuppressed
• Urogenital tract infections

• M. genitalium
• Nongonococcal urethritis in men
• Cervicitis and endometritis in women

• Ureaplasma spp.
• Has been isolated from tissue (e.g., chorioamnion) of neonates
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Diagnosis Why are direct
detection not
• Direct detection methods are not recommended. recommended?

• Molecular diagnostics
• Polymerase chain reaction (PCR) amplifies clinical relevant species.
• Very useful to confirm identification

• Cultivation and biochemistry

• Glucose is used to detect Mycoplasma pneumoniae.
• Urea and arginine media are used to isolate Ureaplasma urealyticum and
M. hominis, respectively.
• Identification
• M. pneumoniae appears spherical, grainy, and yellow.
• U. urealyticum appears as dark, brownish clumps.
• M. hominis has a “fried egg” appearance.
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Biochemical differentiation How will you differ M.
genitalium and M.
pneumoniae with the
same biochemical
profile?

Organism: Glucose Arginine Urease production

metabolism metabolism

Mycoplasma Positive Negative Negative

genitalium

Mycoplasma Negative Positive Negative

hominis

Mycoplasma Positive Negative Negative

pneumoniae

Ureaplasma Negative Negative Positive

urealyticum
Morphologic Characteristics

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 Susceptibility Testing and Therapy
• Most Mycoplasma pneumoniae infections are self-limited.
Can
• M. pneumoniae Cephalosporins be
used for treating
• Is resistant to beta-lactam antibiotics (no cell wall). Mycoplasma?
• Is usually susceptible to macrolides, tetracyclines, ketolides, and
fluoroquinolones.
• M. hominis and Ureaplasma urealyticum
• Are usually susceptible to tetracycline agents.
• Multidrug-resistant organisms have been identified in extragenital
infections in individuals who are immunocompromised.

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