Hyperammonemia syndrome due to Ureaplasma urealyticum in a kidney transplant recipient: A case of disseminated disease from a fluoroquinolone-resistant isolate.
Ureaplasma
hyperammonemia
kidney transplantation
Journal
Transplant infectious disease : an official journal of the Transplantation Society
ISSN: 1399-3062
Titre abrégé: Transpl Infect Dis
Pays: Denmark
ID NLM: 100883688
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
received:
27
04
2020
accepted:
02
05
2020
pubmed:
18
5
2020
medline:
4
8
2021
entrez:
17
5
2020
Statut:
ppublish
Résumé
Ureaplasma species (spp.) are common colonizers of the urogenital tract but may cause systemic infection in immunocompromised patients. They release significant amounts of ammonia via urea hydrolysis and have been recently implicated in the pathogenesis of hyperammonemia syndrome after organ transplantation. We describe a unique case of hyperammonemia syndrome after kidney transplant caused by U urealyticum infection, and the first, to our knowledge, case of a fluoroquinolone-resistant Ureaplasma strain causing hyperammonemia syndrome. A 17-year-old female developed intermittent fevers, rising creatinine, sterile pyuria and debilitating polyarthritis approximately 1 year after kidney transplant. Serum ammonia level was elevated, and urine PCR was positive for U urealyticum. Near the end of treatment with levofloxacin, she had rebound hyperammonemia, which preceded clinical relapse of polyarthritis and encephalopathy. Blood and urine PCR and synovial fluid culture were positive for U urealyticum. Susceptibility testing showed fluoroquinolone resistance, but she responded well to azithromycin and doxycycline. The frequency of Ureaplasma spp. infection in immunocompromised patients is probably underestimated due to diagnostic challenges. Ammonia levels were helpful biomarkers of response to antimicrobial therapy in our case. Susceptibility testing of clinical isolates should be pursued. In serious Ureaplasma spp. infections, particularly in immunocompromised patients, two empiric antibiotics may be indicated given the potential for antimicrobial resistance.
Substances chimiques
Anti-Bacterial Agents
0
Fluoroquinolones
0
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13328Subventions
Organisme : Brown Physicians Inc.
ID : Academic Assessment Grant
Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
Cordtz J, Jensen JS. Disseminated Ureaplasma urealyticum infection in a hypo-gammaglobulinaemic renal transplant patient. Scand J Infect Dis. 2006;38(11-12):1114-1117.
Geissdorfer W, Sandner G, John S, et al. Ureaplasma urealyticum meningitis in an adult patient. J Clin Microbiol. 2008;46(3):1141-1143.
Ekiel AM, Pietrzak B, Kamiński P, et al. Prevalence of urogenital Mycoplasmas and Ureaplasmas in women after kidney transplantation. Transplantation. 2009;87(6):848-851.
Gerber L, Gaspert A, Braghetti A, et al. Ureaplasma and Mycoplasma in kidney allograft recipients-A case series and review of the literature. Transpl Infect Dis. 2018;20(5):e12937.
Jhaveri VV, Lasalvia MT. Invasive Ureaplasma infection in patients receiving rituximab and other humoral immunodeficiencies-A case report and review of the literature. Open Forum. Infect Dis. 2019;6(10):ofz399.
Bharat A, Cunningham SA, Budinger GRS, et al. Disseminated Ureaplasma infection as a cause of fatal hyperammonemia in humans. Sci Transl Med. 2015;7(284):284re3.
Bharat A, Budinger GRS, Ison MG. Donor-derived Ureaplasma is a potentially lethal infection in lung allograft recipients. J Heart Lung Transplant. 2017;36(8):917-918.
Fernandez R, Ratliff A, Crabb D, et al. Ureaplasma transmitted from donor lungs Is pathogenic after lung transplantation. Ann Thorac Surg. 2017;103(2):670-671.
Li GZ, Tio MC, Pak LM, et al. Noncirrhotic hyperammonemia after deceased donor kidney transplantation: a case report. Am J Transplant. 2019;19(11):3197-3201.
Seethapathy H, Fenves AZ. Pathophysiology and management of hyperammonemia in organ transplant patients. Am J Kidney Dis. 2019;74(3):390-398.
Cannon CA, Corcorran MA, Shaw KW, et al. Hyperammonemia syndrome due to Ureaplasma infection after liver-kidney transplant. Transpl Infect Dis. 2020;e13298.
Fernández J, Karau MJ, Cunningham SA, et al. Antimicrobial susceptibility and clonality of clinical Ureaplasma isolates in the United States. Antimicrob Agents Chemother. 2016;60(8):4793-4798.
Meygret A, Le Roy C, Renaudin H, et al. Tetracycline and fluoroquinolone resistance in clinical Ureaplasma spp. and Mycoplasma hominis isolates in France between 2010 and 2015. J Antimicrob Chemother. 2018;73(10):2696-2703.
Sayer JA, Bhatti AA, Jaques B, et al. Hyperammonaemic coma post-renal transplantation. Clin Intens Care. 2003;14(1-2):37-40.
Nurmohamed S, Weenink A, Moeniralam H, et al. Hyperammonemia in generalized Mycobacterium genavense infection after renal transplantation. Am J Transplant. 2007;7(3):722-723.
Bezinover D, Douthitt L, McQuillan PM, et al. Fatal hyperammonemia after renal transplant due to late-onset urea cycle deficiency: a case report. Transplant Proc. 2010;42(5):1982-1985.
Kiberenge RK, Lam H. Fatal hyperammonemia after repeat renal transplantation. J Clin Anesth. 2015;27(2):164-167.
Nowbakht C, Edwards AR, Rodriguez-Buritica DF, et al. Two cases of fatal hyperammonemia syndrome due to Mycoplasma hominis and Ureaplasma urealyticum in immunocompromised patients outside lung transplant recipients. Open Forum Infect Dis. 2019;6(3):ofz033.
Legouy C, Hu A, Mochel F, et al. Ureaplasma parvum causes hyperammonemiapresenting as refractory status epilepticus after kidney transplant. J Crit Care. 2020;57:79-83.
Clinical and Laboratory Standards Institute. Methods for antimicrobial susceptibility testing of human Mycoplasmas. Approved guideline. CLSI Document M43-A. Clinical Laboratory Standards Institute, Wayne. PA, 2011.
Waites KB, Duffy LB, Xiao L.Detection of human mycoplasmas and ureaplasmas from clinical specimens by culture and PCR. Clinical Microbiology Procedure Handbook, Laber A, Editor. 2016, ASM Press. Chapter 3.15, 2016.
Schwartz DJ, Elward A, Storch GA, et al. Ureaplasma urealyticum pyelonephritis presenting with progressive dysuria, renal failure, and neurologic symptoms in an immunocompromised patient. Transpl Infect Dis. 2019;21(2):e13032.
Furr PM, Taylor-Robinson D, Webster AD Mycoplasmas and ureaplasmas in patients with hypogammaglobulinaemia and their role in arthritis: microbiological observations over twenty years. Ann Rheum Dis. 1994;53(3):183-187.
Xiao L, Crabb DM, Duffy LB, et al. Chromosomal Mutations Responsible for Fluoroquinolone Resistance in Ureaplasma Species in the United States. Antimicrob Agents Chemother. 2012;56(5):2780-2783.
Baker AW, Messina JA, Maziarz EK, et al. Epidemiology of invasive Mycoplasma and Ureaplasma infections early after lung transplantation. Open Forum Infect Dis. 2019;6(suppl 2):S646.