A Case Report of Mycoplasma hominis Subdural Empyema Following Decompressive Craniotomy, and a Review of Central Nervous System Mycoplasma hominis Infections

Frontiers in Medicine

article

Assaf Potruch¹  Guy Rosenthal²  Ayelet Michael-Gayego⁴  Violeta Temper⁴  Mohanad Abdelrahman²  Oshrat Ayalon²  Ran Nir-Paz²  Yonatan Oster² 

[1] Department of Internal Medicine, Hadassah Hebrew University Medical Center;Faculty of Medicine, Hebrew University of Jerusalem;Department of Neurosurgery, Hadassah Hebrew University Medical Center;Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center

关键词: Mycoplasma hominis;    CNS infection;    subdural empyema;    multi-trauma;    MALDI TOF;   

DOI  :  10.3389/fmed.2022.792323

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background Mycoplasma hominis is a small cell-wall-free organism, part of the normal microbiota of the genitourinary tract. It is rarely involved in extragenital infections, mainly joint, surgical-site, and respiratory infections. Methods We describe a case of M. hominis subdural empyema and lower limb surgical site infections, following decompressive craniotomy, after traumatic brain and extremities injury. In addition, a literature review of 34 cases M. hominis CNS infections was done. Results Our case depicts a 25-years old patient who developed subdural empyema and surgical site infections in his cranium and fibula. Both sites were cultured, and small pinpoint colonies grew on blood agar. MALDI-TOF MS identified M. hominis . Simultaneously 16S-rDNA PCR from CSF detected M. hominis . Antimicrobial treatment was switched to doxycycline with improvement. Literature review revealed 21 adults and 13 pediatric cases of M. hominis CNS infection. Risk factors in adults were head trauma, neurosurgery, or post-partum period. Conclusions Based upon the literature reviewed, we postulate that adult patients with head trauma or neurosurgical procedure, rarely are infected either through direct contamination during the trauma, or by undergoing urgent, urinary catheterization, and may experience distant infection due to translocation of M. hominis into the bloodstream. In such cases diagnosis is delayed due to difficulties in growing and identifying the bacteria. Empiric antimicrobials are usually not effective against mycoplasmas. These factors contributed to the mortality in adult cases (15%). Our rare case highlights the necessity of combining classical microbiology routines with advanced molecular techniques to establish a diagnosis in complicated cases.

【 授权许可】

CC BY