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Published on: March 2, 2020
Pelvic abscess due to Mycoplasma hominis following caesarean section
Nobuaki Mori1, Aya Takigawa2, Narito Kagawa3
1Department of General Internal Medicine, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo 152-8902, Japan.
Introduction:
Mycoplasma hominis is associated with genito-urinary tract infection and adverse pregnancy outcomes. However, whether the species is a true pathogen or part of the genito-urinary tracts natural flora remains unclear.
Case Presentation:
A 41-year-old pregnant woman was admitted to our hospital at 38 weeks and 5 days of gestation owing to premature rupture of the membranes. The patient delivered by caesarean section. Subsequently, the patient complained of lower abdominal pain and had persistent fever. Enhanced computed tomography revealed pelvic abscesses. Gram staining of pus from the abscess and vaginal secretions indicated presence of polymorphonuclear leucocytes but no pathogens. Cultures on blood agar showed growth of pinpoint-sized colonies in an anaerobic environment within 48 h. Although administration of carbapenem and metronidazole was ineffective and we could not fully drain the abscess, administration of clindamycin led to clinical improvement. The isolates 16S rRNA gene and yidC gene sequences exhibited identity with those of M. hominis.
Conclusion:
Physicians should consider M. hominis in cases of pelvic abscesses where Gram staining yields negative results, small colonies are isolated from the abscess and treatment with β-lactam antibiotics is ineffective.
Insights
Mycoplasma hominis, often found in the genito-urinary tract, can cause pelvic abscesses in pregnant women. Early diagnosis and clindamycin treatment are crucial for effective management of these infections.
Area of Science:
- Microbiology
- Infectious Diseases
Background:
- Mycoplasma hominis is implicated in genito-urinary infections and adverse pregnancy outcomes.
- Its role as a pathogen versus commensal in the genito-urinary tract remains debated.
Observation:
- A pregnant patient developed pelvic abscesses post-cesarean section with persistent fever and abdominal pain.
- Initial Gram staining was negative; however, cultures revealed small colonies consistent with Mycoplasma hominis.
- Abscesses did not respond to carbapenem and metronidazole but improved with clindamycin.
Findings:
- 16S rRNA and yidC gene sequencing confirmed the isolates as Mycoplasma hominis.
- This case highlights Mycoplasma hominis as a causative agent of pelvic abscesses.
Implications:
- Clinicians should consider Mycoplasma hominis in pelvic abscess cases with negative Gram stains and resistance to beta-lactam antibiotics.
- Prompt identification and appropriate antibiotic selection, such as clindamycin, are vital for successful treatment.
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