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Intraamniotic Infection and Inflammation (Triple I)
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Victoria Adewale, Cecily May Barber, Elizabeth Liveright
Triple I is largely considered to be an acute inflammation that is due to an ascending polymicrobial infection from the cervix after membrane rupture. Additional routes have been proposed, including hematologic dissemination from the gastrointestinal (GI) tract, retrograde spread from the peritoneal cavity via the fallopian tube, and iatrogenic spread through medical procedures [13]. In this setting, the most common bacteria implicated are Ureaplasma, Urealyticum, and Mycoplasma. Other bacteria often isolated in amniotic fluid cultures are Gardnerella, Bacteroides, group B streptococcus, and Escherichia coli [14]. Rarely, hematogenous spread is the source, as in the case of Listeria infection [15].
Urolithiasis
Published in Manit Arya, Taimur T. Shah, Jas S. Kalsi, Herman S. Fernando, Iqbal S. Shergill, Asif Muneer, Hashim U. Ahmed, MCQs for the FRCS(Urol) and Postgraduate Urology Examinations, 2020
Thomas Johnston, James Armitage, Oliver Wiseman
Urease is an enzyme that is produced by many Gram-negative, Gram-positive and Mycoplasma bacteria. Proteus species, Klebsiella species and Pseudomonas aeruginosa are examples of Gram-negative urease producing bacteria. However, Escherichia coli and Enterococci do not usually produce urease. Helicobacter pylori is present in the upper gastrointestinal tracts of more than 50% of the population and while associated with peptic ulcer disease is of no recognised importance with respect to the urinary tract. Ureaplasma urealyticum is a mycoplasma bacterium of low pathogenicity that comprises part of the normal genital flora of many men and women. Gram-positive Staphylococcus aureus and Staphylococcus epidermidis can produce urease.
Habitual Abortion
Published in E. Nigel Harris, Thomas Exner, Graham R. V. Hughes, Ronald A. Asherson, Phospholipid-Binding Antibodies, 2020
Dwight D. Pridham, Christine L. Cook
Ureaplasma urealyticum (T-mycoplasma) has been isolated with increased frequency among women with primary unexplained infertility by several authors.138,140 However, treatment of this microorganism has not always been associated with an improved pregnancy rate.141 In one large series (n = 114), no relationship between fertility and the presence of T-mycoplasma could be established.142
Evaluation of Ureaplasma urealyticum, Chlamydia trachomatis, Mycoplasma genitalium and Neisseria gonorrhoeae in infertile women compared to pregnant women
Published in Journal of Obstetrics and Gynaecology, 2022
Fatemeh Sameni, Shahrzad Zadehmodarres, Hossein Dabiri, Mansoor Khaledi, Fatemeh Nezamzadeh
Female reproductive system is a suitable environment for the growth of many pathogens and non-pathogenic microorganisms. Microorganisms may interact with various mechanisms, such as obstruction, lesions or inflammation in the reproductive system, which may disrupt any stage of foetal formation, implantation or growth, leading to primary infertility, the absence of an embryo, abortion and stillbirth. Chlamydia trachomatis (C. trachomatis), Neisseria gonorrhoeae (N. gonorrhoeae), Mycoplasma genitalium (M. genitalium) and Ureaplasma urealyticum (U. urealyticum) are the most important microorganisms that have been considered in the infertility (Sameni et al. 2017; Chemaitelly et al. 2019; Hoenderboom et al. 2019). Polymicrobial infection can passed from the vagina, through the cervix, to the upper genital tract, the endometrium, and finally to the fallopian tubes, which severe pelvic inflammatory disease (PID) may occur (Tsevat et al. 2017). Based on reports in developed countries, C. trachomatis accounts for approximately 50% of cases of acute PID (Haggerty et al. 2010). As in most women, C. trachomatis infections are asymptomatic, often undetected, untreated, and less reported (Tsevat et al. 2017; Balle et al. 2018; Chang et al. 2020).
Intrauterine bacterial growth in elective and non-elective caesarean sections
Published in Journal of Obstetrics and Gynaecology, 2021
Ido Solt, Maya Frank Wolf, Rosa Michlin, Yaniv Farajun, Ella Ophir, Jacob Bornstein
The large sample size is a main strength of this study. One of the study limitations is the incomplete data on the duration of membrane rupture and its possible association with the rate and type of positive intrauterine bacterial cultures and lack of information concerning the indications for CSs. However, among women who underwent non-elective CS, the duration of membrane rupture was relatively short. Another limitation is that we did not evaluate cultures for Mycoplasma, Ureaplasma, chlamydia or Neisseria gonorrhoeae. The clinical significance of these bacteria has been under debate in the literature: Although mycoplasmas are often isolated from the endometrial cavity, antibiotic therapy is not usually required for clinical cure in women who have Ureaplasma urealyticum only, without additional organisms (Harrison 1983; Watts et al. 1989; Patai et al. 2005). In addition, sexually transmitted infections, such as N. gonorrhoeae and C. trachomatis, are uncommon causes of postpartum endometritis and appear to be more prevalent in patients with late onset of symptoms (two or more weeks after delivery). Of note, women with late onset endometritis were not included in this study since we evaluated the immediate postoperative clinical course in the maternity ward (Ismail et al. 1987).
We have the technology, but should we build the test?
Published in Expert Review of Molecular Diagnostics, 2018
In a similar vein, there has been a proliferation of mycoplasma diagnostics targeting other species and some of these assays are being offered commercially in many parts of the world. Ureaplasma urealyticum and Ureaplasma parvum molecular diagnostics are excellent examples of laboratory tests with unproven clinical utility that are widely used [10]. The history of these two ureaplasma organisms is quite murky and not often fully taken into account in epidemiologic studies. U. parvum and U. urealyticum were members of a single species (U. urealyticum biovar 1 and biovar 2, respectively) until about 2 decades ago and thus the literature about associations with genital diseases such as cervicitis and urethritis is not straightforward. At this point, it seems clear that U. parvum is nearly ubiquitous while U. urealyticum is statistically associated with cervicitis and non-gonococcal urethritis. Further, we do not have evidence of efficacy of currently used treatment regimens. Many cases are asymptomatic and the need for treatment in these cases is unclear [8]. Why then are diagnostic assays available, and widely used in southern and eastern Europe, that test for both of these organisms and why are clinicians using these tests for screening of asymptomatic patients?