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Experimental infection of the genital tract of female grivet monkeys by Mycoplasma hominis.

Mycoplasma hominis, a common inhabitant of the mucosae of the genitourinary tract of human and nonhuman primates, was inoculated directly into the uterine tubes of five laparotomized grivet monkeys. A self-limiting acute salpingitis and parametritis developed within a few days in all animals. Although there were no clinical signs of overt disease, the gross pathology was characterized by pronounced oedematous swelling and hyperaemia of the tubes and parametria. Microscopically, cellular infiltrations of lymphocytes and some polymorphonuclear leukocytes were found in the acute phase in the subserosa and muscularis of the tubes and in the parametria. Granulation tissue and fat necrosis appeared at a later stage in the parametria. The infection was associated with a marked antibody response and a moderate rise of the erythrocyte sedimentation rate and leukocyte counts. The capability of M. hominis to produce salpingitis and parametritis in a nonhuman primate would seem to add rather significantly to the available evidence suggesting an etiological role of this organism in inflammatory diseases of the internal female genitals of humans.

Acute Disease

Detection of Mycoplasma hominis and Mycoplasma orale in cell cultures by immunofluorescence.

Mycoplasma contaminants of animal and human cell cultures were rapidly detected and identified by an indirect immunofluorescent technique. Cells suspected of being contaminated by mycoplasmas were grown as monolayers on chamber slides in a culture medium selected to promote mycoplasmal growth. Before fixation by acetone, the monolayers were subjected to a hypotonic treatment to cause swelling of the mycoplasmas. Detection and identification were then performed by indirect immunofluorescence using rabbit antisera to various mycoplasma species. The correlation between results obtained by the standard isolation procedure and those obtained by this method was very close.

Animals

Preparation of competent single-cell suspensions of Mycoplasma hominis tets and Mycoplasma salivarium tets for genetic transformation to tetracycline resistance by DNA extracted from Mycoplamsa hominis tetr.

DNA extracted from Mycomplasma hominis (Sprott strain), resistant to 100 micrograms of tetracycline/ml transformed M. hominis strain H29 and Mycoplasma salivarium strain S9, which are sensitive to 2.5 and 5.0 micrograms of tetracycline/ml, respectively, to resistance. The transformants were selected on agar medium containing 10 micrograms of tetracycline/ml. Some transformants were resistant also to 20 micrograms of tetracycline/ml, a finding confirming that transformation occurred between homologous and heterologous species and that resistance is stepwise and controlled by several genetic loci. Medium containing 10 micrograms of tetracycline/ml was bacteriostatic. Prototype experiments employing mixtures of strains that were tetr and tets (tetracycline-resistant and tetracycline-sensitive, respectively) demonstrated that tetr mutants and transformants formed typical fried-egg colonies when mixtures containing not more than 10(9) mycoplasmas were spread on tetracycline agar plates. No mutants to tetracycline resistance were detected. Both M. hominis and M. salivarium were competent after treatment with MgCl2 and CaCl2, while Mycoplasma orale type 2 was inactivated. During DNA extraction different quantities of DNA formed insoluble precipitates with protein, thus preventing quantitative experiments.

Calcium Chloride

Early phases of degeneration of mycoplasma-like bodies in plant tissue cultures infected with aster yellows: morphological analogies with Mycoplasma hominis.

Several forms of mycoplasma-like bodies (MLBs) were observed in electron micrographs of phloem cells from explants infected with aster yellows disease. The structures were found only in explants 11--25 days old, when the degenerating MLBs were first observed. They resembled those described by Anderson and Barile in 1965 for Mycoplasma hominis. A sequence of events in the degeneration of MLBs is postulated and morphological analogies with degenerating M. hominis are discussed.

Culture Techniques

Changes in composition, biosynthesis, and physical state of membrane lipids occurring upon aging of Mycoplasma hominis cultures.

During the progression of Mycoplasma hominis cultures from the early logarithmic phase to the stationary phase of growth, the total phospholipid content of the cell membranes decreased. Measurement of the amount of the various phospholipids during the growth cycle showed that a decrease in the phosphatidylglycerol (PG) content, accompanied by an increase in the phosphatidic acid content, occurred upon aging of the culture. Pulse labeling experiments revealed that the PG, once formed, is relatively stable, undergoing no detectable turnover in growing cultures of M. hominis. No changes in the fatty acid composition of the membrane phospholipids were observed on aging of the culture, with palmitic acid predominating throughout the growth cycle. The preferential incorporation of palmitate into the phospholipid fraction is apparently caused by the higher activity of the membrane-bound acyl-coenzyme A (CoA):alpha-glycerophosphate transacylase with palmityl-CoA rather than with oleyl-CoA as substrate. The activity of the soluble acyl-CoA synthetase was the same whether palmitate or oleate served as substate. M. hominis membrane preparations contained a PG-synthetase system catalyzing the incorporation of L-alpha-glycerol-3-phosphate into PG. The activity of the PG synthetase system was markedly dependent on the age of the culture, being highest in cells from the early exponential phase of growth while declining sharply thereafter, and thus probably responsible, in part, for the decrease in PG content upon aging of the cells. Electron paramagnetic resonance spectra of a spin-labeled fatty acid incorporated in M. hominis membranes revealed a marked decrease in the freedom of motion of the spin label on aging of the culture. It is proposed that this decrease is due primarily to the decrease in the lipid-to-protein ratio of the membranes and has a marked effect on the activity of membrane-associated enzymes and transport systems.

Acetyltransferases

Effect of preparatory techniques on the gross morphology of Mycoplasma hominis.

A method is presented whereby cells of Mycoplasma hominis can be prepared with minimal distortion for electron microscopy. After the addition of glutaraldehyde to broth cultures, incubation is continued for 1 h. The cells are then collected by centrifugation, washed in distilled water, and used for negative-contrast preparations.

Bacteriological Techniques

Serologic studies of human genital mycoplasmas: distribution of titers of mycoplasmacidal antibody to Ureaplasma urealyticum and Mycoplasma hominis in pregnant women.

Titers of mycoplasmacidal antibody to the human genital mycoplasmas Ureaplasma urealyticum and Mycoplasma hominis were determined using genital isolates from pregnant patients as antigens and comparing these isolates with the 11 prototypic reference strains for U. urealyticum and the seven reference strains for M. hominis. Virtually all titers that were detected with use of the patient's own isolates were detected by the 11 reference strains of U. urealyticum and by the seven reference strains of M. hominis. Serologic surveys of pregnant women who harbored either or both mycoplasmas in vaginal cultures indicated that antibody to M. hominis was found more commonly than antibody to U. urealyticum. It was demonstrated that significant postpartum rises in titers of antibody to M. hominis were correlated with the presence of these mycoplasmas in genital cultures. Postpartum rises in titer of antibody were particularly likely to occur in women with low titers of mycoplasmacidal antibody in serum at the time of delivery. Approximately 88% of the women who were colonized with M. hominis showed significant changes in titer of antibody to M. hominis throughout an apparently normal pregnancy; only 40% of the women who were colonized with U. urealyticum showed such changes in titers to U. urealyticum. Statistical analysis showed that mean log titers of antibody to both mycoplasmas at the first prenatal visit were significantly associated with the number of pregnancies experienced by these women.

Antibodies, Bacterial

Mycoplasma hominis. A cause of neonatal meningitis.

Two cases of Mycoplasma hominis meningitis in the newborn are described. These infants demonstrate the need to consider M. hominis as a cause of neonatal meningitis, especially if the Gram stain is negative, conventional cultures yield no growth, and there is a history of maternal infection. CSF cultures on appropriate medium can quickly confirm the diagnosis.

Adult

A Strain of Mycoplasma hominis Causing Pleuropneumonia Infection in an Immunocompetent Patient and Recent Epidemiological Trends: Implications for Clinical Management.

Mycoplasma hominis (M. hominis) is an opportunistic pathogen linked to urogenital and neonatal infections; however, limited genetic and epidemiological data are available. Extragenital infections in healthy adults are rare, and effective antibiotics are species-specific, complicating diagnosis and treatment. Hence, this study aimed to elucidate the clinical process, update the epidemiological characteristics, and investigate the genomic features of a fluoroquinolone-resistant M. hominis isolate from an immunocompetent patient with pleuropneumonia in China. The M. hominis isolate ZY_MH01 was recovered from pleural fluid and was identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and Whole Genome Sequencing (WGS). The completed genome was annotated using the NCBI Prokaryotic Genome Annotation Pipeline (PGAP). Snippy v4.4.5 was utilized to conduct a core genome single nucleotide polymorphism (cgSNP) analysis between ZY_MH01 and 144 M. hominis strains from the NCBI GenBank database. Subsequently, phylogenies were constructed using IQ-TREE v3.1.2 and visualized by iTOL. Antimicrobial resistance determinants were identified using strict criteria of Comprehensive Antibiotic Resistance Database (CARD) RGI 6.0.5 (Web portal) and broth microdilution test. Virulence genes were screened using Abricate v1.0.1 against the Virulence Factor Database (VFDB). A total of 42 strains (including ZY_MH01) from Genbank with an assembly level of Complete or Chromosome were re-annotated using Prokka v1.2.0 and pangenome analysis was performed using the Roary. The core genome constitutes only 17.1%, which may contribute to the unusually high level of polymorphism observed among M. hominis strains. No antibiotic resistance genes or virulence genes were detected in the genome of ZY_MH01. However, some resistance-associated mutations of gene parC and gyrA in the Quinolone Resistance Determining Region (QRDR) were identified. Phylogenetic analysis indicates that strains originating from the same geographic region typically exhibit reduced genetic distances; this trend is especially pronounced in regions with a higher number of publicly available strain sequences. In specific circumstances, when conventional broad-spectrum antibiotics are ineffective, even immunocompetent patients should consider the possibility of M. hominis infection. This study presents a detailed account of the diagnostic and therapeutic course of a pleuropneumonia infection caused by M. hominis in an immunocompetent patient, and performs an epidemiological analysis of all M. hominis sequences that have been recently made publicly available.

Humans

Adaptation of Mycoplasma hominis to an obligate parasitic existence in monkey kidney cell culture (BSC-1).

During attempts to eliminate Mycoplasma hominis from a monkey kidney BSC-1 cell line with antibiotics, the mycoplasmas were isolated repeatedly. However, the organisms ultimately failed to grow on medium although electron microscopy confirmed that the cell culture still contained mycoplasmas. Thus, the mycoplasma had adapted to an environment in which viable cells were required for growth. Budding mycoplasmas which are indicative of replication were seen associated with viable cells extracellularly. Moreover, structures resembling cycoplasmas were observed budding from the cells which suggests that the mycoplasmas replicate within the cells and are similar to many viruses in their manner of release from the cells.

Adaptation, Biological

Isolation of Mycoplasma hominis from blood cultures in patients with postpartum fever.

Eight women with postpartum fever are presented in whom Mycoplasma hominis was isolated from cultures of their blood. Clinical disease consisted of a mild although often prolonged febrile illness, and all but one recovered without appropriate antimicrobial therapy. Five patients demonstrated elevated convalescent titers of mycoplasmacidal antibodies. The isolates of M. hominis were recovered from routine blood cultures in the diagnostic bacteriology laboratory using blind subcultures to blood agar plates. These cases lend support to the concept that endometritis with M. hominis is a cause of postpartum fever and suggest that these organisms may be recovered with increased frequency if minor changes in standard bacteriologic technique are introduced.

Bacteriological Techniques

Prevalence of Mycoplasma hominis in patients with gynecologic diseases and abortion in the 2nd--3rd month of pregnancy.

The presence of Mycoplasma hominis was investigated in 100 patients with gynecologic diseases, 20 infertility cases and 50 cases of abortion in the 2nd--3rd month of pregnancy. M. hominis could be isolated from the vaginal secretions of 20 patients with gynecologic diseases and of 3 infertility cases. Eighteen M. hominis isolates were recovered from 13 patients with abortion (8 strains from the placenta and 10 from vaginal secretions). High titers (1/64--1/512) of complement fixing antibodies to M. hominis were found in 16 patients with gynecologic diseases, 12 infertility and 17 abortion cases.

Abortion, Spontaneous

Impact of pH and Mycoplasma hominis endosymbiosis on Trichomonas vaginalis pathogenesis.

The parasite Trichomonas vaginalis colonizes the human vaginal tract and adheres to and lyses epithelial cells causing an inflammatory infection. The vaginal tract is typically acidic, ranging from pH 3.8 to 5.1; however, pathogenesis studies have previously been conducted on parasites grown at pH 5.9 to 6.2. Here we compared the adherence and cytotoxicity of T. vaginalis grown at pH 5.1 and pH 5.9, identifying changes in the surface proteome that contribute to increased pathogenesis of the parasite at pH 5.1. We show that growth of the parasite at pH 5.1 significantly enhances adherence to and lysis of host cells and that this is strongly amplified by the presence of a common bacterial endosymbiont, Mycoplasma hominis. Quantitative proteomics revealed the upregulation of putative surface proteins, three of which were found to be involved in increased parasite adherence and host cell killing. Mechanistic assays demonstrated that a Ricin B-like protein mediates parasite adherence dependent on host glycosaminoglycans via its carbohydrate-recognition domain, while an EF-hand-like protein is shown to promote Ca2+dependent adherence. Ricin B overexpression was found to reprogram host metabolism, activating ERK1/2 and HIF-1α and driving a Warburg-like glycolytic shift with greatly increased lactate release, which may create a nutrient-rich niche that supports parasite persistence and host cell cytotoxicity. These studies demonstrate a coordinated upregulation of multiple adhesins rather than a single factor at pH 5.1 in the presence of M. hominis and explore the mechanisms underlying the interaction of parasite surface proteins with the host cell.

Trichomonas vaginalis

Diagnosis of Mycoplasma hominis pyelonephritis by demonstration of antibodies in urine.

To evaluate the diagnostic significance of the demonstration in urine of antibodies to Mycoplasma hominis, 1,000 samples of urine with more than 5 leukocytes per high-power field were serologically investigated by indirect hemagglutination, using glutaraldehyde-fixed erythrocytes coated with M. hominis antigen. The samples were collected from 702 patients. Antibodies were demonstrated in the urine of nine patients, all of whom had signs of acute attack of pyelonephritis. In seven of these patients, characterized by mild or moderate clinical signs and absence of lower urinary tract symptoms, bacterial causes were not observed, whereas M. hominis organisms were isolated from the upper urinary tract in most cases and from the bladder urine in all cases. In two patients, characterized by severe clinical signs and presence of lower urinary tract symptoms, both M. hominis and bacteria were isolated from the upper urinary tract and ballder urine. The demonstration of antibodies to M. hominis in urine is of high diagnostic value as they were only observed in patients in whom M. hominis infection in the upper urinary tract was evident or likely and only in the presence of clinical signs of acute attacks of pyelonephritis.

Adolescent

Experimental animal infections with Mycoplasma hominis and Ureaplasma urealyticum.

Subcutaneous tissue cavities in mice and guinea pigs were infected with human isolates of Ureaplasma urealyticum and Mycoplasma hominis. The minimal infective dose for M. hominis was as low as less than 10 color-changing units (CCU) for mice and 10(2) CCU for guinea pigs. The minimal infective dose for U. urealyticum was as low as less than 10 CCU for mice and 10(4) CCU for guinea pigs. Mouse infections with either U. urealyticum or M. hominis persisted for 1 day to greater than 4 months. Guinea pigs remained infected for up to 4 weeks. Two M. hominis isolates were similar in their ability to infect subcutaneous tissue cavities but two U. urealyticum isolates varied in their ability to infect the cavities. The histopathology of the M. hominis and U. urealyticum infections was similar: an initial intense polymorphonuclear response with giant cells, followed in 4 weeks by histiocytes and giant cells with some plasma cells and lymphocytes.

Animals

Experimental infection of the genital tract of female grivet monkeys by Mycoplasma hominis: effects of different routes of infection.

In a previous study we produced acute salpingitis and parametritis in grivet monkeys by inoculation of Mycoplasma hominis directly into the uterine tubes. With the purpose of examining in the same animal model the effect of more natural routes of infection, six female grivet monkeys were inoculated, two by two, with M. hominis by the following methods: (experiment A) into the uterine cavity through the cervical canal; (experiment B) into the uterine cavity by the same route, but after ligature of the isthmus of the uterine tubes had been performed and followed by curettage of the endometrium; and (experiment C) into the cervical epithelium. Whereas the animals in experiment A developed no or only very slight signs of infection, all monkeys in experiments B and C developed pronounced gross and microscopic inflammatory lesions of the uterine tubes and parametria, together with a significant antibody response. It is concluded that ascending M. hominis infection of the genital tract must be preceded by mechanical injury of the epithelial barrier, and that subsequent spread of the infection occurs via blood and lymph vessels rather than by the canalicular route. The inflammatory genital tract disease produced experimentally with M. hominis in grivet monkeys is very similar in its pathogenesis and pathology to the type of salpingitis caused in humans by microorganisms other than Neisseria gonorrhoeae and Chlamydia trachomatis.

Animals

Ureaplasma urealyticum and Mycoplasma hominis in chlamydial and non-chlamydial nongonococcal urethritis.

Urethral specimens from 726 patients with nongonococcal urethritis (NGU) were examined for Chlamydia trachomatis, Ureaplasma urealyticum, and Mycoplasma hominis. Chlamydiae were isolated from 35.9% of ureaplasma-positive patients and from 36.5% of ureaplasma-negative patients. Ureaplasmas were isolated from 52.5% of chlamydia-positive patients and from 53.1% of chlamydia-negative patients, an observation which contrasts with that of some workers who have suggested that ureaplasmas are significantly associated with chlamydia-negative NGU. Furthermore, the numbers of ureaplasmas isolated from patients who did or did not harbour chlamydiae were not significantly different nor was there a particular association of ureaplasmas with chlamydia-negative NGU in patients experiencing their first episode of disease. In addition, M. hominis was not isolated more frequently from those from whom chlamydiae were or were not isolated. The only significant associations were the isolation of M. hominis from patients who were ureaplasma-positive and of ureaplasmas from those who were M. hominis-positive. These findings do not necessarily mitigate against ureaplasmas being responsible for some cases of chlamydia-negative NGU.

Chlamydia trachomatis