Mycoplasma hominis, Ureaplasma parvum, and Ureaplasma urealyticum: hidden pathogens in peritoneal dialysis-associated...

Area of Science:

• Infectious Diseases
• Nephrology
• Microbiology

Background:

• Mycoplasma hominis, Ureaplasma parvum, and Ureaplasma urealyticum are common urogenital colonizers but rarely cause peritoneal dialysis (PD)-associated peritonitis.
• Recurrent culture-negative PD-associated peritonitis, particularly in women and associated with menstruation, presents a diagnostic challenge.

Approach:

• This study reports four cases of PD-associated peritonitis caused by M. hominis, U. parvum, or U. urealyticum in female patients.
• Metagenomic next-generation sequencing (mNGS) was employed to detect these pathogens in PD fluid, overcoming limitations of conventional cultures.
• A literature review was conducted to contextualize these findings within existing knowledge.

Key Points:

• Four female patients with recurrent culture-negative PD-associated peritonitis, linked to menstruation, were successfully diagnosed using mNGS.
• M. hominis, U. parvum, and U. urealyticum were identified as the causative agents in these challenging cases.
• Effective treatment involved intraperitoneal tigecycline combined with oral azithromycin or minocycline.

Conclusions:

• M. hominis, U. parvum, and U. urealyticum should be considered in female PD patients with recurrent culture-negative peritonitis, especially if related to menstruation or urogenital procedures.
• Metagenomic next-generation sequencing is a valuable tool for identifying pathogens in culture-negative PD-associated peritonitis.
• Prompt and targeted antimicrobial therapy can lead to successful outcomes in these infections.