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Ureaplasma SPP and Mycoplasma Hominis in Women of Reproductive

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Ureaplasma SPP and Mycoplasma Hominis in Women of Reproductive ORIGINAL ARTICLE Nuradilova et al. / Gulhane Med J 2019;61: 1-5 1 Ureaplasma SPP and mycoplasma hominis in women of reproductive age with pelvic inflammatory disease Dina Nuradilova 1, Lira Kaliyeva 1, Daiva Vaitkiene 2, Saltanat Kalimoldayeva 3, Khasen Dasibekov 4, Zbigniew Omiotek 5, Teresa Małecka-Massalska 6 (1) Asfendiyarov Kazakh National Medical University, Department of obstetrics and gynecology No. 2, Almaty, Kazakhstan (2) Lithuanian University of Health Sciences, Department of obstetrics and gynecology, Kaunas, Lithuania (3) State-owned public enterprise with right of economic jurisdiction “Regional diagnostics center”, Clinical Diagnostics Laboratory, Almaty, Kazakhstan (4) Regional clinical hospital, Almaty, Kazakhstan (5) Lublin University of Technology, Faculty of Electrical Engineering and Computer Science, Lublin, Poland (6) Medical University of Lublin, Department of Human Physiology, Lublin, Poland Date submitted: ABSTRACT Oct 05, 2018 Aims:To determine the prevalence of infections with species Ureaplasma species (SPP) Date accepted: and Mycoplasma hominis and the antibiotic sensitivity in women of reproductive age with Oct 17, 2018 inflammatory diseases. Online publication date: Methods:2360 samples were investigated, obtained by urethral and cervical canal March 15, 2019 scrapings of reproductive age women with pelvic inflammatory disease in the clinical diagnostic laboratory of the Regional diagnostic center of Almaty. The cultivation, identification and susceptibility testing of urogenital mycoplasmas and ureaplasmas to 9 Corresponding Author: antibiotics were conducted with the use of commercial kits. Zbigniew Omiotek Results:Among 2360 tested samples total infection (isolated USPP, Mycoplasma hominis Lublin University of Technology, and mixed infection) was high (47.6%). The infection rate of Ureaplasma SPP was more Faculty of Electrical Engineering than 30 times higher than the prevalence of Mycoplasma hominis (23.0% and 0.7%, and Computer Science, Lublin, respectively). Mixed infection was found in 23.8% of cases. Total infection of Ureaplasma Poland SPP and Mycoplasma hominis was the highest in women aged 30-39 years (60.0%), less in women in the age group of 40-45 years (31.4%). Most active against Ureaplasma [email protected] SPP and Mycoplasma hominis were tetracyclines. Indeed 94.1% of the isolated strains of Ureaplasma SPP and 98.2% of Mycoplasma hominis were sensitive to tetracycline. The doxycycline susceptibility of Ureaplasma SPP and Mycoplasma hominis was the highest Keywords: Pelvic inflammatory (99.5% and 98.3%, respectively). disease, Ureaplasma SPP, A high level of pefloxacin sensitivity allows to recommend this antibiotic to Mycoplasma hominis, infertility, Conclusions: prescribe for women with pelvic inflammatory disease. In light of wide spread of strains of pregnancy pathology, antibiotic Ureaplasma SPP and Mycoplasma hominis, resistant to ofloxacin and macrolides, we do sensitivity. not suggest these antibiotics to treat the infections. Introduction action (PCR) method has enhanced the ability of most labo- ratories to diagnose of ureaplasmosis and mycoplasmosis in- Pelvic inflammatory disease (PID) does not only deterio- fections. But in some cases, when the infection continues to rate the quality of women’s life, but also reduces their fertility recur, despite the treatment, there is a need of determination of function. Currently many researchers believe the main etiolog- the sensitivity of microorganisms to antibiotics. Ureaplasma is ical factor of PID are the urogenital infections, among which extremely easily transmitted sexually and vertically from mother Ureaplasma SPP (USPP) and Mycoplasma hominis (MH) play to fetus. The probability of this transmission reaches 90% (11). a key role. According to many researchers, urogenital Myco- They are capable of adhesion to various cell types such as ure- plasma and Ureaplasma are associated with inflammatory dis- thral epithelial cells, spermatozoa and erythrocytes (2,12). My- eases of the genitourinary tract including pyelonephritis, cysti- coplasma is an atypical bacterium that does not have its own tis, urolithiasis, and the risk of miscarriage, chorioamnionitis, cell walls such as Ureaplasma. Mycoplasma hominis normally postpartum and abortion fever (1-3). colonises the urogenital tract asymptomatically but it can pro- Researchers have noted higher prevalence of Ureaplasma voke postpartum and postoperative infections of the genitouri- SPP than Mycoplasma hominis among the population (4-6). nary and respiratory systems (13). The role of Ureaplasma and Mycoplasma in the development Contamination during pregnancy may lead to chorioamni- of infertility is not fully understood. It is known that the USPP otic pregnancy complications and neonatal infection (14). In was detected more often than MH in the scrapings from the many cases USPP and MH are not diagnosed due to the lack cervix of infertile women (7-9). According to most researchers, of symptoms, the antibacterial effect of semen and cultivation two infections by Chlamydia trachomatis and Ureaplasma SPP difficulties (3,9). Urogenital mycoplasmas and ureaplasmas are directly associated with infertility (9,10). were isolated in a special class of Mollicutes due to their unique The widespread use in the practice of polymerase chain re- properties that distinguish them from most bacteria. These © Gülhane Faculty of Medicine 2019 / doi: 10.26657 / gulhane.00043 2 Nuradilova et al. / Gulhane Med J 2019;61: 1-5 properties are the following: very small sizes, close to the size from 102 to 104 CFU/ml); 2-GR++ (104<titre<105 CFU/ml); of viruses, lack of a rigid cell wall, polymorphism of cells (15). 3-GR+++ (titre>105 CFU/ml). The presence of Mycoplasma The most frequently USPP and MH are identified in genitalia hominis was confirmed using arginine test and the presence of and they grow well on nutrient medium. Therefore, in order to Ureaplasma SPP – with a urea test. Mycoplasma metabolises diagnose them, in most cases the culture method is used. It al- arginine from the culture medium during the growth. In these lows not only estimation of the number of microorganisms in the conditions, the colour of the 4-ADC well varies from yellow to material under study, but also their susceptibility to antibiotics. red. Ureaplasmas at cultivation consume urea, and colour of It is considered that concentration of 104 microbes in one gram the small 5-UR well turns red from yellow. of a sample has diagnostic value. Lower concentration can be Study of susceptibility to antibiotics. System of microorgan- defined in healthy people (16,17). Urogenital mycoplasmas and isms’ sensitivity determination to antibiotics consists of 9 an- ureaplasmas are passed by sexual contact and passage of the tibiotics in two concentrations (tetracycline 4 mg/l and 8 mg/l, fetus through the infected genital tract of the mother. The my- pefloxacin 8 mg/l and 16 mg/l, ofloxacin 1 mg/l and 4 mg/l, dox- coplasmas’ growth is suppressed by tetracyclines, fluoroquino- ycycline 4 mg/l and 8 mg/l, erythromycin 8 mg/l and 16 mg/l, lones and macrolides. Mycoplasmas and ureaplasmas are clarithromycin 8 mg/l and 16 mg/l, minocycline 4 mg/l and 8 resistant to antibiotics that suppress the synthesis of cell wall mg/l, clindamycin 4 mg/l and 8 mg/l; azithromycin 4 mg/l and components (penicillins, rifampicines) (16). In this regard, we 8 mg/l). Sensitivity and resistance of microorganisms were as- undertook testing with the use of commercial kits for the cultiva- sessed at three levels: S – sensitive (colour of the well is yel- tion, identification and susceptibility of urogenital mycoplasmas low); I – intermediate-sensitive (colour of the well – orange) and and ureaplasmas to antimicrobial agents. The aim of the study R-resistant (colour of the well – red). Before the procedure for was to determine the prevalence and antimicrobial sensitivity of taking the biomaterial, informed consent was obtained in ad- Ureaplasma SPP and Mycoplasma hominis in reproductive age vance from all the women surveyed. Statistical analyses were women with pelvic inflammatory disease. performed by using the statistical software package SPSS ver- Methods sion 15 for Windows (SPSS Inc., Chicago, IL, USA). P-value of less than 0,05 was considered to indicate a statistically sig- The research work has passed a local ethical examina- nificant difference. A P-value of less than 0.05 was considered tion at Asfendiyarov KazNMU, research protocols #179 from to indicate a statistically significant difference and all statistical 04/29/2015 and #345 of 04/05/2016, as the conclusion on ap- calculations and analyses were performed using the statistical proval by the local ethical commission is valid for one year. software package SPSS (version 15; Statistical Package for Under the conditions of diagnostic laboratory of the Regional the Social Sciences, Chicago, USA). Diagnostic Centre of Almaty, 2360 samples (one sample from Results each woman) of biological material were investigated, obtained by scraping from the cervical canal and urethra of reproduc- All the samples of biomaterial were examined for the pres- tive-aged women (from 17 to 45 years) with pelvic inflammatory ence of Ureaplasma SPP, Mycoplasma hominis and mixed in- disease. For clinical case of PID, isolated disease of the upper fection. In case of detection of these infections, the sensitivity sections of the reproductive tract (cervicitis, endometritis, sal- of microorganisms to antibiotics was conducted.
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