Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

$Ureaplasma$ infections in pre-term infants: Recent information regarding the role of $Ureaplasma$ species as neonatal pathogens

  • Sung, Tae-Jung (Department of Pediatrics, School of Medicine, Hallym University)
  • Received : 2010.11.02
  • Accepted : 2010.11.30
  • Published : 2010.12.15
Download PDF
⟨ Previous Next ⟩

Abstract

Although numerous clinical observational studies have been conducted over a period of over 30 years, the clinical significance of $Ureaplasma$ infection is still under debate. The $Ureaplasma$ speices. is a commensal in the female genital tract and considered to have of low virulence; however, $Ureaplasma$ colonization has been associated with infertility, stillbirth, preterm delivery, histologic chorioamnionitis, and neonatal morbidities, including congenital pneumonia, meningitis, bronchopulmonary dysplasia, and perinatal death. Recently, $Ureaplasma$ was subdivided into 2 separate species and 14 serovars. $Ureaplasma$ $parvum$ is known as biovar 1 and contains serovars 1, 3, 6, and 14, and $Ureaplasma$ $urealyticum$ (biovar 2) contains the remaining serovars (2, 4, 5, and 7-13). The existence of differences in pathogenicities of these 14 serovars and 2 biovars is controversial. Although macrolides are the only antimicrobial agents currently available for use in neonatal ureaplasmal infections, in the current clinical field, it is difficult to make decisions regarding which antibiotics should be used. Future investigations involving large, multicenter, randomized, controlled studies are needed before proper recommendations can be made for clinical practice.

Keywords

References

  1. Waites KB, Katz B, Schelonka RL. Mycoplasmas and Ureaplasmas as neonatal pathogens. Clin Microbiol Rev 2005;18:757-89. https://doi.org/10.1128/CMR.18.4.757-789.2005
  2. Volgmann T, Ohlinger R, Panzig B. Ureaplasma urealyticum-harmless commensal or underestimated enemy of human reproductions? A review. Arch Gynecol Obstet 2005;273:133-9. https://doi.org/10.1007/s00404-005-0030-1
  3. Viscardi RM. Ureaplasma species: Role in diseases of prematurity. Clin Perinatol 2010;37:393-409. https://doi.org/10.1016/j.clp.2009.12.003
  4. Waites KB, Schelonka RL, Xiao L, Grigsby PL, Novy M. Congenital and opportunistic infections: Ureaplasma species and Mycoplasma hominis. Semin Fetal Neonatal Med 2009;14:190-9. https://doi.org/10.1016/j.siny.2008.11.009
  5. Gupta A, Gupta S, Mittal A, Chandral P, Gill AK. Correlation of mycoplasma with unexplained infertility. Arch Gynecol Obstet 2009;280:981-5. https://doi.org/10.1007/s00404-009-1042-z
  6. Gibbs RS. The origins of stillbirth: infectious diseases. Semin Perinatol 2002;26:75-8. https://doi.org/10.1053/sper.2002.29839
  7. Yoon BH, Romero R, Park JS, Chang JW, Kim YA, Kim JC, et al. Microbial invasion of the amniotic cavity with Ureaplasma urealyticum is associated with a robust host response in fetal, amniotic, and maternal compartments. Am J Obstet Gynecol 1998;179:1254-60. https://doi.org/10.1016/S0002-9378(98)70142-5
  8. Perni SC, Vardhana S, Korneeva I, Tuttle SL, Paraskevas LR, Chasen ST, et al. Mycoplasma hominis and Ureaplasma urealyticum in midtrimester amniotic fluid: association with amniotic fluid cytokine levels and pregnancy outcome. Am J Obstet Gynecol 2004;191:1382-6. https://doi.org/10.1016/j.ajog.2004.05.070
  9. Hillier SL, Martius J, Krohn M, Kiviat N, Holmes KK, Eschenabach DA. A case-control study pf chorioamnionic infection and histologic chorioamnionitis in prematurity. N Engl J Med 1988;319:972-8. https://doi.org/10.1056/NEJM198810133191503
  10. Viscardi RM, Hashmi N, Gross GW, Sun CC, Rodriguez A, Fairchild KD. Incidence of invasive Ureaplasma in VLBW infants: relationship to severe intraventricular hemorrhage. J Perinatol 2008;28:759-65. https://doi.org/10.1038/jp.2008.98
  11. Shepard MC. The recovery of pleuropneumonia-like organisms from Negro men with and without nongonococcal urethritis. Am J Syph Gonorrhea Vener Dis 1954;38:113-124
  12. Robertson JA, Stemke GW, Davis JW Jr, Harasawa R, Thirkell D, Kong F, et al. Proposal of Ureaplasma parvum sp. Nov. and emended description of Ureaplasma urealyticum (Shepard et al. 1974). Int J Syst Evol Microbiol 2002;52:587-97. https://doi.org/10.1099/00207713-52-2-587
  13. Glass JI, Lefkowitz EJ, Glass JS, Heiner CR, Chen EY, Cassell GH. The complete sequence of the mucosal pathogen. Nature 2000;407:757-62. https://doi.org/10.1038/35037619
  14. Colaizy TT, Kuforiji T, Sklar RS, Pillers DA. PCR methods in clinical investigations of human ureaplasmas: a minireview. Mol Genet Metab 2003;80:389-97. https://doi.org/10.1016/j.ymgme.2003.08.024
  15. Cordero L, Coley BD, Miller RL, Mueller CF. Bacterial and Ureaplasma colonization of the airway: radiologic findings in infants with bronchopulmonary dysplasia. J Perinatol 1997;17:428-33.
  16. Kelly VN, Garlnad SM, Gilbert GL. Isolation of genital mycoplasmas from the blood of neonate and women with pelvic infection using conventional SPS-free blood culture media. Pathology 1987;19:277-280. https://doi.org/10.3109/00313028709066563
  17. Kundsin RB, Leviton A, Allred EN, Poulin SA. Ureaplasma Urealyticum infection of the placenta in pregnancies that ended prematurely. Obstet Gynecol 1996;87:122-7. https://doi.org/10.1016/0029-7844(95)00376-2
  18. Sanchez PJ, Regan JA. Vertical transmission of Ureaplasma urealyticum from mothers to preterm infants. Pediatr Infect Dis J 1990;9:398-401. https://doi.org/10.1097/00006454-199006000-00006
  19. Waites KB, Crouse DT, Philips JB 3rd, Canupp KC, Cassell GH. Ureaplasmal pneumonia and sepsis associated with persistent pulmonary hypertension of the newborn. Pediatrics 1989;83:79-85.
  20. Schelonka RL, Waites KB. Ureaplasma infection and neonatal lung disease. Semin Perinatol 2007;31:2-9. https://doi.org/10.1053/j.semperi.2007.01.001
  21. Goldenberg RL, Hauth JC, Andrews WW. Intrauterine infection and preterm delivery. N Engl J Med 2000;342:1500-7. https://doi.org/10.1056/NEJM200005183422007
  22. Cassell GH, Waites KB, Watson HL, Crouse DT, Harasawa R. Ureaplasma ureaplyticum intrauterine infection: role in prematurity and disease in newborns. Clin Microbiol Rev 1993;6:69-87. https://doi.org/10.1128/CMR.6.1.69
  23. Normann E, Lacaze-Masmonteil T, Eaton F, Schwendimann L, Gressens P, Thebaud B. A novel mouse model of Ureaplasma-induced perinatal inflammation: effects on lung and brain injury. Pediatr Res 2009;65:430-6. https://doi.org/10.1203/PDR.0b013e31819984ce
  24. Moss TJ, Nitsos I, Ikegami M, Jobe AH, Newnham JP. experimental intrauterine Ureaplasma infection in sheep. Am J Obstet Gynecol 2005;192:1179-86. https://doi.org/10.1016/j.ajog.2004.11.063
  25. Novy MJ, Duffy L, Axthelm MK, Sadowsky DW, Witkin SS, Gravett MG, et al. Ureaplasma partum or Mycoplasma hominis as sole pathogens cause chorioamnionitis, preterm delivery, and fetal pneumonia in rhesus macaques. Reprod Sci 2009;16:56-70. https://doi.org/10.1177/1933719108325508
  26. Tafari N, Ross S, Naeye RL, Judge DM, Marboe C. Mycoplasma T strains and perinatal death. Lancet 1976;1:108-9.
  27. Quinn PA, Gillan JE, Markestad T, St John MA, Daneman A, Lie KI, et al. Intrauterine infection with Ureaplasma urealyticum as a cause of fatal neonatal pneumonia. Pediatr Infect Dis 1985;4:538-43. https://doi.org/10.1097/00006454-198509000-00020
  28. Crouse DT, Odrezin GT, Cutter GR, Reese JM, Hamrick WB, Waites KB, et al. Radiographic changes associated with tracheal isolation of Ureaplasma urealyticum from neonates. Clin Infect Dis 1993;17 Suppl 1:S122-30. https://doi.org/10.1093/clinids/17.Supplement_1.S122
  29. Panero A, Pacifico L, Rossi N, Roggini M, Chiesa C. Ureaplasma urealyticum as a cause of pneumonia in preterm infants: analysis of the white cell response. Arch Dis Child Fetal Neonatal Ed 1995;73:F37-40. https://doi.org/10.1136/fn.73.1.F37
  30. Klein JO, Buckland D, Finland M. Colonization of newborn infants by mycoplasmas. N Engl J Med 1969;280:1025-30. https://doi.org/10.1056/NEJM196905082801901
  31. Goldenberg RL, Andrews WW, Goepfert AR, Faye-Petersen O, Cliver SP, Carlo WA, et al. The Alabama Preterm Birth Study: umbilical cord blood Ureaplasma urealyticum and Mycoplasma homminis cultures in very preterm newborn infants. Am J Obstet Gynecol 2008;198:43.e1-5. https://doi.org/10.1016/j.ajog.2007.07.033
  32. Cassell GH, Waites KB, Crouse DT, Rudd PT, Canupp KC, Stagno S, et al. Association of Ureaplasma urealyticum infection of the lower respiratory tract with chronic lung disease and death in very-low-birth-weight infants. Lancet 1988;2:240-5.
  33. Viscardi RM, Manimtim W, He JR, Hasday JD, Sun CC, Joyce B, et al. Disordered pulmonary myofibroblast distribution and elastin expression in preterm infants with Ureaplasma urealyticum pneumonitis. Pediatr Dev Pathol 2006;9:143-51. https://doi.org/10.2350/10-05-0112.1
  34. Li YH, Brauner A, Jensen JS, Tullus K. Induction of human macrophage vascular endothelial growth factor and intercellular adhesion molecule-1 by Ureaplasma urealyticum and downregulation by steroids. Biol Neonate 2002;82:22-8. https://doi.org/10.1159/000064148
  35. Viscardi RM, Atamas SP, Luzina IG, Hasday JD, He JR, Sime PJ, et al. Antenatal ureaplasma urealyticum respiratroty tract infection stimulates proinflammatory, profibrotic responses in the preterm baboon lung. Pediatr Res 2006;60:141-6. https://doi.org/10.1203/01.pdr.0000228322.73777.05
  36. Viscardi RM, Kaplan J, Lovchik JC, He JR, Hester L, Rao S, et al. Characterization of a murine model of Ureaplasma urealyticum pneumonia. Infect Immun 2002;70:5721-9. https://doi.org/10.1128/IAI.70.10.5721-5729.2002
  37. Bancalari E, Claure N, Sosenko IR. Bronchopulmonary dysplasia: changes in pathogenesis, epidemiology and definition. Semin Neonatol 2003;8:63-71. https://doi.org/10.1016/S1084-2756(02)00192-6
  38. Wang EE, Frayha H, Watts J, Hammerberg O, Chernesky MA, Mahony JB, et al. Role of Ureaplasma urealyticum and other pathogens in the development of chronic lung disease of prematurity. Pediatr Infect Dis J 1988;7:547-51.
  39. Schelonka RL, Katz B, waites KB, Benjamin DK. Critical appraisal of the role of Ureaplsma in the development of bronchopulmonary dysplasia with metaanalytic techniques. Pediatr Infect Dis J 2005;24:1033-9. https://doi.org/10.1097/01.inf.0000190632.31565.83
  40. Castro-Alcaraz S, Greenberg EM, Bateman DA, Regan JA. Patterns of colonization with Ureaplsma urealyticum during neonatal intensive care unit hospitalizations of very low birth weight infants and the development of chronic lung disease. Pediatrics 2002;110:e45. https://doi.org/10.1542/peds.110.4.e45
  41. Viscardi RM, Hasday JD. Role of Ureaplasma species in neonatal chronic lung disease: epidemiologic and experimental evidence. Pediatr Res 2009;65:84R-90R. https://doi.org/10.1203/PDR.0b013e31819dc2f9
  42. Novy MJ, Sadowsky DW, Grigsby PL, Sparks KE, Duffy LB, Wautes KB. Maternal azithromycin therapy for Ureaplasma intraamniotic infection prevents advanced fetal lung lesions in rhesus monkey. Paper presented at: 55th SGI. Annual Scientific Meeting; 2008 March 26-29; San Diego, CA.
  43. Walls SA, Kong L, Leeming HA, Placencia FX, Popek EJ, Weisman LE. Antiniotic prophylaxis improves Ureaplasma-associated lung disease in suckling mice. Pediatr Res 2009;66:197-202. https://doi.org/10.1203/PDR.0b013e3181aabd34

Cited by

  1. Host Genetic Background Impacts Disease Outcome During Intrauterine Infection with Ureaplasma parvum vol.7, pp.8, 2012, https://doi.org/10.1371/journal.pone.0044047
  2. Recent Advances between Prenatal Inflammatory Response and Prematurity Associated Complications vol.24, pp.3, 2010, https://doi.org/10.14734/kjp.2013.24.3.127
  3. Clinical Effect ofUreaplasma UrealyticumColonization of Maternal Low Genital Tract and Premature Respiratory Tract on Neonatal Adverse Outcome vol.20, pp.4, 2010, https://doi.org/10.5385/nm.2013.20.4.447
  4. Ureaplasma urealyticum or Ureaplasma parvum: what's the difference? vol.56, pp.11, 2010, https://doi.org/10.3345/kjp.2013.56.11.474
  5. Serological investigation of Ureaplasma urealyticum in Korean preterm infants vol.56, pp.11, 2010, https://doi.org/10.3345/kjp.2013.56.11.477
  6. Immune Profiling of BALB/C and C57BL/6 Mice Reveals a Correlation Between Ureaplasma parvum‐Induced Fetal Inflammatory Response Syndrome‐Like Pathology and Increased Placental Expression o vol.71, pp.3, 2010, https://doi.org/10.1111/aji.12192
  7. Maternal influences on fetal microbial colonization and immune development vol.77, pp.1, 2015, https://doi.org/10.1038/pr.2014.163
  8. Ureaplasma urealyticumandU. parvumin sexually active women attending public health clinics in Brazil vol.145, pp.11, 2010, https://doi.org/10.1017/s0950268817001145
  9. Surveillance for incidence and etiology of early-onset neonatal sepsis in Soweto, South Africa vol.14, pp.4, 2019, https://doi.org/10.1371/journal.pone.0214077
  10. Bronchopulmonary dysplasia: how can we improve its outcomes? vol.62, pp.10, 2010, https://doi.org/10.3345/kjp.2019.00178
  11. Colorimetric‐based detection of Ureaplasma urealyticum using gold nanoparticles vol.14, pp.1, 2010, https://doi.org/10.1049/iet-nbt.2019.0088
  12. Ureaplasma species and preterm birth: current perspectives vol.46, pp.2, 2010, https://doi.org/10.1080/1040841x.2020.1736986