Peritonitis due to post-myomectomy Mycoplasma hominis infection

A 36-year-old woman undergoing a myomectomy developed postoperative surgical-saite peritonitis and hematoma. Eight days postoperatively, she developed a 38 degrees C-plus fever and accumulated ascites, with fever unchanged despite antimicrobial beta-lactams therapy. Following transvaginal ascitic drainage, her fever disappeared. Recurrent 38 degrees C fever and inflammation were cured by clindamycin of 1.2 g/day. M. hominis detected from ascites drainage was considered the primary causative organism. Nongenito-urinary M. hominis infection is often difficult to detect, as in our case. Gram staining, for example, is not useful in ascertaining small organisms such as Mycoplasma spp. having no cell walls to stain. M. hominis grows slowly, requiring over three days to form colonies on blood agar plates, requiring time to identify pathogens. We report case showing the importance of suspecting M. hominis of causing gynecological surgical-site infection. When common bacterial pathogen cultures remain negative and when empiric beta-lactam antibiotic treatment is ineffective, M. hominis should be suspected. In conclusion, M. hominis should be considered a causative following myomectomy resection.     

Neonatal dengue infection: report of dengue fever in a 1-day-old infant

A male infant was admitted because of fever. He was born at 37-weeks' gestation. His mother had experienced acute febrile illness with headache and myalgia. Her illness persisted with onset of active labor pain on day 5, which prompted cesarean section; postoperatively, the hematocrit decreased, requiring transfusion. The infant was well until fever developed at 16 hours after birth. There were petichiae on his face and trunk and the liver was enlarged. Fever subsided on day 5 without evidence of plasma leakage or severe hemorrhage. He made an uneventful recovery after 8 days of illness. Leukopenia and thrombocytopenia were present in the mother and infant. Both were diagnosed as dengue fever. Dengue type 1 was recovered from the infant by polymerase chain reaction. The dengue enzyme-linked immunoassay showed secondary infection in the mother and primary infection in the infant. In dengue-endemic areas, clinicians should be alert to dengue fever/dengue hemorrhagic fever in pregnant women presenting with acute febrile illness, and be prepared for proper management.     

Neonatal mycoplasmaemia: Mycoplasma hominis as a significant cause of disease?

A full-term baby boy had respiratory distress, fever and pneumonia within 20 h of birth. Isolation of Mycoplasma hominis from blood taken after 20 h and 11 days was accompanied by an antibody response. Although chlamydial IgM antibody was detected, chlamydial infection probably did not cause the pneumonia. Penicillin was ineffective but treatment with gentamicin, and particularly tetracycline, was associated with slow improvement. Mycoplasma hominis should be considered as a cause of respiratory disease and fever in neonates.     

Fever, leucocytosis and infection after open heart surgery. A log-linear regression analysis of 115 cases

A prospective investigation was undertaken in adults to assess the specificity and sensitivity of fever (greater than 38 degrees C) and leucocytosis (greater than 10 000/microliters) for the diagnosis of infection after operations with cardiopulmonary bypass. A log-linear model analysis of a multiway frequency table was used for statistical evaluation. The model parameters were separately evaluated for 2 periods: the early one until the 6th day, the late period from the 7th postoperative day until discharge. Seven out of 115 patients suffered infections during their hospital stay: Bacteremia occurred in 3, pneumonia in 2, and deep sternal wound infection in 2 patients, and a superficial wound infection in one. No significant interactions between fever, leucocytosis and/or infection were found in the first period, except an inverse relation between fever and elevated WBC (p = 0.0197). After the 6th postoperative day the model parameters did show significant interactions, fever and leucocytosis being more frequent in infected patients. However, the specificity was low: only 15% of the patients with fever or elevated WBC had an infection. The risk of in-hospital infection was significantly higher after a long duration of cardiopulmonary bypass (p = 0.009), and after transfusion of more than 2500 ml of blood on the day of operation (p = 0.001).     

Mycoplasma hominis wound infection after a vascular allograft

Cases of Mycoplasma hominis infections after allograft are rare. We report a case of M. hominis wound infection after a vascular allograft. The allograft was positive before having any contact with the recipient, and our investigation suggests that M. hominis may have been transmitted from the donor to the recipient. It is not clear, however, whether specific diagnosis of M. hominis should be performed on tissue before grafting in order to prevent such donor-to-host transmission.     

Case of pulmonary tuberculosis in late stage of pregnancy

A 28-year-old woman who was a nurse was admitted to our hospital because her sputum was positive for M. tuberculosis. She was pregnancy of 35 weeks. First, she was administered INH, RFP, PZA and was treated with cesarean section on the 21st day after starting tuberculosis chemotherapy. The operation was done in operating room of negative pressure ventilation. The patient returned to the tuberculosis ward, and the newborn infant entered to a newborn nursery room after confirming negative tubercle bacilli in amnionic fluid by PCR examination. EB was added to the regimen of chemotherapy after childbirth. In general hospitals, infection control is an important issue as seen in this case.     

Cardiac rupture and tamponade in a pregnant woman with acute myocardial infarction]

A case is described of a 35-year old pregnant woman (38-th week, tertigravida) with an acute myocardial infarction (AMI). The diagnosis of anterolateral myocardial infarction was based on the clinical, biochemical, ecg and echocardiographical findings. Ventricular premature beats were observed in the tenth day of AMI: Delivery was accomplished by cesarean section without complications. In the second day after the cesarean section the patient died. On autopsy cardiac rupture, tamponade and fresh necrosis of the lateral wall was found.     

Spontaneous splenic rupture complicating acute Q fever.

Q fever is usually a self-limited febrile illness that involves the lungs and the liver. Acute complications are rare. We present the case of a 30-yr-old patient with spontaneous splenic rupture during the course of acute Q fever infection. He was admitted to the hospital with high temperature and the radiological signs of an atypical pneumonia. Forty-eight hours after admission, he developed shock. Because of free intraabdominal liquid, a laparatomy was performed that revealed a tear in the enlarged spleen. A splenectomy was performed. The diagnosis of Q fever was established by a significant titer increase in complement fixation test and IgM-ELISA. Serological investigations into the patient's surroundings revealed evidence of Q fever infection in 10 additional persons. Q fever should be taken into account as a possible differential diagnosis in patients with unexplained febrile illness and symptoms of pneumonia. The acute course of Q fever infection can be complicated by splenic rupture. The diagnosis of an acute infection with Coxiella burnetii often requires serologic testing of a second serum sample obtained at least 10 days after the onset of symptoms. Q fever should be ruled out in cases of unexplained splenic rupture particularly in Q fever endemic areas.     

Successful management of Mycoplasma hominis septic arthritis involving a cementless prosthesis

Prompt identification of the infectious agent and antibiotic treatment are essential to the prevention of mortality or serious morbidity in patients with septic arthritis. Of concern is the increasing incidence of Mycoplasma hominis saprophytes as a cause of joint infections given the problems in isolating these microbes. The case of a 32-year-old black woman with a 9-year history of systemic lupus erythematous who presented with an M hominis-related septic arthritis involving hip and knee joint protheses offers guidelines on the predisposing factors and characteristic clinical and laboratory findings in such cases. The literature indicates that hypogammaglobulinemia, immunocompromise, postpartum or postabortion fever, and urinary tract manipulation are the risk factors most commonly associated with mycoplasmal septic arthritis. Typical laboratory results include a synovial fluid white blood cell count exceeding 80,000/mm3, a synovial fluid smear greater than 95% neutrophils, negative Gram's stain of synovial fluid smear, positive acridine-orange stain, and slow or absent growth in standard culture media. M hominis infections respond to tetracyclines, lincomycin, and clindamycin, but are resistant to erythromycin. Risk factors in the patient described here included longterm corticosteroid treatment, prior urinary tract infection, and an abortion 2 months prior to presentation for which antibiotic prophylaxis was not administered. The results of synovial tissue, bone, and irrigation fluid cultures were initially negative, but more sophisticated testing ("fried egg" morphology) isolated M hominis. This microorganism was also isolated in endometrial tissue cultures, and retained products of conception are considered the most likely source of the patient's joint infection. A 10-week course of tetracycline eliminated the infection.     

Clinicobacteriological studies on the nine cases with upper genital tract Mycoplasma hominis infection]

Clinicobacteriological characteristics of nine cases isolated Mycoplasma hominis from the genital tract were studied, and the following results were obtained: elevation of IgG antibodies to M. hominis was measured by ELISA in all cases, but in the MI method only one case showed an elevation of metabolic inhibitory antibody. Convalescent sera from seven patients showed additional and high density bands which were not recognized by acute phase sera in immunoblotting. It was thought that in two patients M. hominis was a causal bacteria for pelvic inflammatory disease (PID). In three cases, it was suggested that M. hominis was related to a premature delivery and idiopathic labor. As infectious symptoms, two patients had body temperatures of more than 38 degrees C but other cases showed 37-37.8 degrees C. Though all cases showed an elevation of CRP, six elevations were slight. As a medication beta-lactam agents were administrated, but their efficacy was not recognized. Furthermore, two patients showed spontaneous recovery in spite of improper antimicrobial agents administration or drainage combined with antimicrobial agents. From the above results. It was thought that M. hominis played a causative role in upper genital tract infection.     

妊娠合并子宫肌瘤行剖宫产术中切除的临床研究

目的 探讨对妊娠合并子宫肌瘤患者在剖宫产术中同时行肌瘤剔除术的可行性和安全性,并探讨缩宫素联合米索前列醇、葡萄糖酸钙及子宫下段环扎术在剖宫产术中同时行子宫肌瘤剔除术的作用.方法 回顾性分析我院2007年1月-2011年4月对妊娠合并子宫肌瘤在剖宫产术中同时行肌瘤剔除术患者40例的临床资料,选择同期无任何并发症的正常剖宫产患者50例为对照组,统计两组在平均术后产褥病率、恶露、子宫复旧、远期随访等方面的差异.结果 研究组与对照组平均术中输血率、术后24h出血量、恶露,手术前后HGB差值、子宫复旧情况比较均有显著性差异(P＜0.05);但在产后发热率、手术时间和产后住院时间方面无显著性差异(P＞0.05).结论 在病例选择合适、手术方法得当的情况下,产妇在剖宫产术中同时行子宫肌瘤剔除术是安全可行的,是一种安全的手术方法,值得临床推广.     

Septicemia due to Mycoplasma hominis

Mycoplasma hominis was recovered from the blood of 7 patients with various underlying disorders. One patient had a legal abortion, another a Caesarian section, both followed by septicemia. Three patients had genital infections in pregnancy, followed by septicemia and spontaneous abortion. M. hominis was also recovered from cervix and urethra in 2 of these women. High serum antibody levels against M. hominis were demonstrated in 3 women. One female developed septicemia after cancer surgery, one male after heart surgery. In the first 6 patients described the septicemia was of short duration and self-limiting, in the 7th patient it was of long duration and appropriate antimicrobial treatment was required. From this patient M. hominis was also isolated from infected operation wounds.     

Multiple hepatosplenic abscesses: successful treatment by continuous intraportal administration of amphotericin B in a case with acute promyelocytic leukemia]

A 40-year-old female was admitted in August 1989 with a diagnosis of acute promyelocytic leukemia (AML; M3). One course of modified-DCMP regimen induced complete remission in September, but she developed spiking fever at a nadir period of WBC after induction chemotherapy. CT revealed multiple hepato-splenic abscesses presumably due to candida infection. She was treated with intravenous administration of amphotericin B (AMPH-B) and other antifungal agents. Despite the hematological remission and prolonged use of these antifungal agents, high fever persisted. A catheter was inserted into the portal vein under ultrasonic-guidance. AMPH-B was administered through the catheter: the initial dose was 3 mg/day and was soon increased to 20 mg/day. Her fever subsided in 1 week, and the sizes of liver abscesses on CT reduced markedly. Chill and hypokalemia were observed during this therapy. The catheter was removed from the portal vein after 29 days. Partial portal vein thrombosis was noted around the catheter tip. This case suggests the usefulness of intraportal administration of AMPH-B in patients with hematological malignancy developing multiple liver abscesses.     

HLA antibodies and neonatal alloimmune thrombocytopenia

A female baby with a severe thrombocytopenia at 18 x 10(9)/l was born to a 29-year-old (gestation 2/partum 2) mother. Scattered petechiae were present on her legs, arms, chest and face, but there was no bleeding, infection, fever or hepatosplenomegaly. A platelet antibody screening immunocapture test was positive, which was performed on the mother's serum 3, 12 and 38 days after delivery, but no platelet-specific antibodies were found by the monoclonal-antibody-specific immobilization of platelet antigen assay. The baby's platelets and lymphocytes and the father's platelets reacted strongly with the HLA antibodies present in the mother's serum. The neonate was treated with intravenous human immunoglobulin (Tegeline), 1 g/kg per day) 1, 2 and 3 days after delivery. The platelet count rose from 18 x 10(9)/l on day 0 to 37 x 10(9)/l on day 3 and to 227 x 10(9)/l on day 12. No platelet transfusion was needed. Several factors which developed hereafter lead us to think that this neonatal alloimmune thrombocytopenia is due to the transplacental passage of maternal HLA antibodies to the baby.     

Sternotomy infections with Mycoplasma hominis

Mycoplasma hominis caused sternal wound infections with mediastinitis in three patients. One infection occurred in a nonimmunocompromised man after coronary artery bypass grafting. The wound did not heal after repeated debridement, closed irrigation of the mediastinum with povidone-iodine solution, and antimycoplasmal chemotherapy; muscle flap grafting was eventually required. Two infections occurred in recipients of heart-lung transplants after the isolation of mycoplasma from bronchial secretions. Although no Mycoplasma species were isolated after specific antimycoplasmal therapy was begun, the wounds still did not heal. Both patients died of other complications. Infection of wounds after sternotomy is another of an increasing number of infections caused by M. hominis in the normal and immunocompromised host. Familiarity with the morphologic characteristics of M. hominis on bacteriologic culture media may increase the recognition of this pathogen in atypical clinical settings.     

Effect of treatment with exogenous interferon, polyriboinosinic-polyribocytidylic acid, or polyriboinosinic-polyribocytidylic acid-poly-L-lysine complex on Herpesvirus hominis infections in mice.

The effect of treatment with exogenous interferon was compared with those of two interferon inducers, polyriboinosinic-polyribocytidylic acid [poly(I) . poly(C)] and poly(I) . poly(C)-poly-L-lysine complex [poly(ICLC)], in three model Herpesvirus hominis type 2 infections of mice. After intraperitoneal inoculation of H. hominis type 2, all drugs significantly protected animals against death and increased the mean day of death when administered as late as 48 hr after viral inoculation. With intranasal inoculation of H. hominis type 2, pretreatment with poly (I) . poly (C) and poly (ICLC) increased the mean day of death; however, no drug prevented death. In mice inoculated intravaginally, local treatment with exogenous interferon or poly(I) . poly(C) appeared to reduce the mean titers of virus in genital secretions and resulted in earlier clearance of infection in some animals. Systemic treatment of genital H. hominis type 2 infections with all drugs resulted in significant numbers of infected animals surviving the infection, although the mean titers of virus in genital secretions were unchanged. Therapeutic efficacy varied depending on the route of viral inoculation.     

Infective endocarditis of aortic valve during pregnancy: a case report

Infective endocarditis during pregnancy is uncommon but very serious. A 31-year-old woman in the 36th week of second pregnancy was admitted to a hospital because of fever, weakness, chest pain, painful skin over her right leg and dyspnea. Transthoracic echocardiography showed aortic valve vegetation and severe aortic regurgitation. Transesophageal echocardiography revealed a 18 mmx6 mm mobile vegetation, attached to the right coronary cusp. Emergency cesarean section followed with a delivery of a healthy baby. Cardiopulmonary bypass with subsequent aortic replacement with bioprosthesis was initiated immediately after cesarean section. Early echocardiographic examination and 6 months after surgery revealed normal function of aortic valve bioprosthesis and normal LV function. Clinical recognition and early echocardiographic diagnosis followed urgent simultaneous cesarean section and aortic valve replacement was lifesaving for both mother and fetus.     

瘢痕子宫再次妊娠分娩方式选择的效果观察

目的探讨瘢痕子宫再次妊娠的合理分娩方式,减少母婴近期和远期并发症。方法对该院近3年来收治的168例剖宫产术后再次足月妊娠孕妇按分娩方式分为阴道试产组（观察组）48例和择期剖宫产术组（对照组）120例。对比分析两种分娩方式术中及术后并发症、产后出血、新生儿并发症等发生情况。结果观察组48例阴道试产成功42例,成功率为87.5%,未发现子宫破裂现象;术中及术后并发症、产后出血发生率低于对照组（P均〈0.05）;住院时间短于对照组（P〈0.01）;住院费用也少于对照组（P〈0.01）。结论阴道分娩具有无术后并发症、产后出血发生率低、住院时间短、住院费用少等优点,瘢痕子宫再次妊娠在符合试产条件下实施阴道分娩是可行和安全的。     

Postdischarge surveillance of surgical site infections: a multi-method approach to data collection

BACKGROUND: Surveillance of surgical site infections (SSIs) is an important clinical indicator of quality patient care, yet an increasing number of SSIs manifest after discharge and are not detected through standard surveillance methods. AIM: This study evaluated a multimethod approach to postdischarge surveillance of SSIs with use of a cesarean section procedure as a case study. METHOD: A postdischarge questionnaire was sent on day 30 to women (n = 277) who had undergone cesarean section. A follow-up telephone interview was conducted if the questionnaire had not been returned within 2 weeks, a diagnosis of infection could not be clearly determined from the responses given, or to confirm the diagnosis of infection. If follow-up could not be made, a chart audit was undertaken. RESULTS: A total response rate of 89% (247/277) was obtained. Twenty-one women with SSI were identified through questionnaire responses. Additional strategies of telephone follow-up and chart review of patients with possible infection and of nonresponders identified more postdischarge infections (33%, 14/42). The overall infection rate was 17% (42/247) compared with 2.8% (7/247) at discharge. CONCLUSION: Postdischarge surveillance approaches need to achieve the best possible response rate, reflect follow-up health care delivery patterns, be cost-effective, gather data from both patients and treating physicians, and use standard definitions to facilitate benchmarking with other health care facilities and surveillance systems. The inclusion of contacting nonresponders in any method of postdischarge surveillance is recommended to determine the most accurate infection rate.     

Life-threatening Mycoplasma hominis mediastinitis.

Mycoplasma hominis infections are easily missed because conventional methods for bacterial detection may fail. Here, 8 cases of septic mediastinitis due to M. hominis are reported and reviewed in the context of previously reported cases of mediastinitis, sternum wound infection, pleuritis, or pericarditis caused by M. hominis. All 8 patients had a predisposing initial condition related to poor cardiorespiratory function, aspiration, or complications related to coronary artery surgery or other thoracic surgeries. Mediastinitis was associated with purulent pleural effusion and acute septic symptoms requiring inotropic medication and ventilatory support. Later, the patients had a tendency for indolent chronic courses with pleuritis, pericarditis, or open sternal wounds that lasted for several months. M. hominis infections may also present as mild sternum wound infection or as chronic local pericarditis or pleuritis without septic mediastinitis. Treatment includes surgical drainage and debridement. Antibiotics effective against M. hominis should be considered when treating mediastinitis of unknown etiology.