K.W. Choi, MBChB, MRCP

Response from Shimon Kusne, MD
Division of Infectious Diseases, Mayo Clinic Hospital,Phoenix, AZ

Mycoplasma spp. can colonize the genital tract especially in women and in sexually active individuals. There have
been reports in the literature of patients developing peritonitis secondary to urinary leaks and spillage of urine into
the surrounding area, mostly with Mycoplasma hominis. There have also been reports of upper urinary tract
infections such as pyelonephritis and infections outside the urogenital area, including wound infection (ie, sternal
wound infection, mediastinitis, pleuritis, pericarditis, central nervous system infection, and arthritis). In many
occasions the Gram stain will show many white blood cells and no organisms. The agents active against Mycoplasma
hominis are doxycycline, clindamycin, and fluoroquinolones such as levofloxacin. There has been an increase in
resistance of genital Mycoplasma spp. to the tetracyclines. In summary, most likely the patient developed infection
with Mycoplasma hominis secondary to urinary spillage. I would consider combination therapy with doxycycline and
levofloxacin for 2-3 weeks.

Severe hemolytic anemia and excessive leukocytosis masking mycoplasma pneumonia

The formation of cold agglutinins is frequently observed during Mycoplasma pneumoniae infections. Nevertheless,
severe hemolysis is exceptional. We report a case of life-threatening hemolytic anemia caused by M. pneumoniae. As
the leucocyte count was excessively elevated, the differential diagnosis primarily comprised hematological
malignancies. The presence of cold agglutinins indicated the correct diagnosis, which was confirmed by highly
elevated levels of both IgG and IgM antibodies to M. pneumoniae and a chest X-ray suggestive of atypical
pneumonia. The patient was treated with roxithromycin and showed a favorable recovery within ten days after
admission. This case demonstrates that, even in patients with clinically mild pneumonia, M. pneumoniae may be the
cause of severe anemia.
Annals of Hematology, Volume 80, Number 3 / March, 2001

Relationship between Mycoplasma infection and newborn disease.

Specific nucleic acids in throat swab specimens from 156 cases of neonatal disease and 50 normal neonates were
investigated using nested polymerase chain reaction (nPCR) [Zhejiang, China]. The positive detection rates for
Mycoplasma hominis, Ureaplasma urealyticum, M. genitalium and M. fermentans were 84.6% (132 of 156), 46.8% (73
of 156), 1.9% (3 of 156) and 0% (0 of 156) in the neonatal disease group, respectively. The positive rates for double
infections (U. urealyticum and M. genitalium) and triple infections (U. urealyticum, M. hominis and M. genitalium) were
40.4% (63 of 156) and 1.9% (3 of 156), respectively. It is concluded that Mycoplasma infection is related to the
occurrence of neonatal diseases.
Chinese Journal of Zoonoses, 2005 (Vol. 21) (No. 1) 75-78

Anti-gal-C antibody in autoimmune neuropathies subsequent to mycoplasma infection   

Four of 82 patients with Guillain-Barré syndrome (GBS) and 1 of 12 with multifocal motor neuropathy (MMN), who
previously had had Mycoplasma pneumoniae infections, had serum antibody to galactocerebroside (Gal-C). Two
patients with GBS without mycoplasma infection also had anti-Gal-C antibody, whereas none of the normal or the
disease controls had it. As Gal-C is a major glycolipid antigen in myelin, anti-Gal-C antibody may function in the
pathogenesis of autoimmune demyelinative neuropathies. Mycoplasma pneumoniae appears to be an important
preceding infectious agent in autoimmune neuropathies with anti-Gal-C antibody. © 1995 John Wiley & Sons, Inc.  
Muscle & Nerve, Volume 18, Issue 4 , Pages 409 - 413