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Texto Completo ISSN: 0214-3429 / ©The Author 2021. Published by Sociedad Española de Quimioterapia. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)(https://creativecommons.org/licenses/by-nc/4.0/). Revisión Revista Española de Quimioterapia doi:10.37201/req/014.2021 David Gómez Rufo Enrique García Sánchez Implicaciones clínicas de las especies del género José Elías García Sánchez María García Moro Mycoplasma Departamento de Ciencias Biomédicas. Facultad de Medicina. Universidad de Salamanca. Article history Received: 18 January 2021; Revision Requested: 4 February 2021; Revision Received: 9 February 2021; Accepted: 17 February 2021; Published: 18 March 2021 RESUMEN INTRODUCCIÓN Dentro del género Mycoplasma, las especies que tradicio- El término micoplasma es la forma genérica de referirse a nalmente se han relacionado con cuadros infecciosos han sido los miembros de la clase Mollicutes, que se caracterizan por la principalmente M. pneumoniae, M. genitalium, M. hominis o U. ausencia de pared celular. Estas bacterias poseen un genoma urealyticum. Sin embargo, existen otras muchas que están im- extremadamente reducido, que limita su capacidad de biosín- plicadas y, que muchas veces, son desconocidas para los pro- tesis, lo que les obliga a llevar un estilo de vida parásita [1]. En fesionales sanitarios. El objetivo de esta revisión es identificar la familia Mycoplasmataceae se sitúan micoplasmas con im- todas las especies del género Mycoplasma que se han aislado plicaciones clínicas en el ser humano pertenecientes al género en el hombre y determinar su participación en la patología in- Mycoplasma y Ureaplasma [2]. fecciosa humana. La primera especie que se demostró que estaba implicada Palabras clave: Mycoplasma spp., Ureaplasma spp., implicaciones clínicas, en un brote de pleuroneumonía en ganado vacuno fue aislada nuevas especies, mecanismos de patogenicidad, diagnóstico, tratamiento. en 1898. Por este motivo, la comunidad científica empezó a re- ferirse a ellas como pleuropneumonia-like-organisms (PPLO). Clinical implications of the genus Mycoplasma Fueron considerados virus hasta 1931, cuando se demostró que formaban pequeñas colonias en las placas de agar. Al mi- ABSTRACT croscopio, se observó que presentaban una zona densa de cre- cimiento central rodeada de una zona periférica más clara, en Within Mycoplasma genus, M. pneumoniae, M. genitalium, forma de “huevo frito” [3]. M. hominis or M. urealyticum are the main species that have En el año 1937 Dienes y Edsall [4] describen el primer ais- been traditionally linked to infectious processes. However, lamiento en el ser humano, Mycoplasma hominis. Más tarde, there are many other species involved in these conditions and en 1954, Shepard [5] aisló un microorganismo que recordaba that are, frequently, unfamiliar to healthcare professionals.The a los PPLO, pero las colonias eran de menor tamaño, pues ca- aim of this review is to identify all Mycoplasma genus species recen de la zona de crecimiento periférica. Por esta razón, se that have been isolated in human beings and to determine denominan cepas-T, del inglés “tiny”, actualmente conocidas their involvement in infectious pathology. como Ureaplasma spp. Key words: Mycoplasma spp., Ureaplasma spp., clinical implications, novel En años sucesivos comenzaron a conocerse cada vez más species, mechanisms of pathogenicity, diagnosis, treatment. casos de micoplasmas que se aislaban en el ser humano, casi siempre a partir de muestras del tracto respiratorio y genital. El papel patogénico de algunos se refleja rápidamente en espe- cies como Ureaplasma urealyticum, Mycoplasma pneumoniae Correspondencia: o Mycoplasma genitalium [6]; mientras en otros, como Myco- Enrique García Sánchez plasma fermentans o M. hominis, no se evidencia su patogeni- Departamento de Ciencias Biomédicas. Facultad de Medicina. Universidad de Salamanca. E-mail: [email protected] cidad hasta varios años después [2]. El diagnóstico microbiológico mediante técnicas de culti- vo tradicionales es complicado, ya que requieren condiciones Rev Esp Quimioter 2021;34(3): 169-184 169 D. Gómez Rufo, et al. Implicaciones clínicas de las especies del género Mycoplasma especiales para su crecimiento, tienen un crecimiento lento o más efectiva frente a los linfocitos de ratones que frente a los no son cultivables in vitro [7-9]. En la actualidad, estas difi- humanos, esto explicaría su baja incidencia en el ser humano cultades se han solventado con la introducción de las técnicas [31]. El diagnóstico microbiológico se realizó por PCR y culti- moleculares para el diagnóstico microbiológico. Su aplicación vo. No existen evidencias sobre el patrón de sensibilidad de M. ha sido determinante para que cada día se documenten nue- arthritidis. vas implicaciones de estas bacterias en patología infecciosa. M. bovis. Un único caso documentado en humanos se La experiencia clínica demuestra que el diagnóstico de comunicó en 1979 [32] en una mujer que previamente había infección por micoplasmas es, con mucha frecuencia, por estado en contacto con un fertilizante elaborado con estiércol exclusión [10] ya que, durante mucho tiempo se pensó que de vaca. No obstante, esta tenía títulos altos de anticuerpos eran oportunistas que afectaban casi siempre a personas in- para M. pneumoniae, que acabaron bajando, sugiriendo que M. munocomprometidas. Actualmente, las evidencias indican bovis no causó realmente la infección, sino que la colonizó de que muchas infecciones graves ocurren también en personas forma oportunista; una característica típica de su patogenici- inmunocompetentes [11, 12]. Los avances en el conocimiento dad ya descrita anteriormente en ganado bovino [33]. El diag- científico que se han producido en los últimos años han venido nóstico microbiológico se realizó mediante cultivo; la PCR sería a aclarar aspectos relevantes de sus mecanismos patogénicos una alternativa. Las tetraciclinas fueron eficaces clínicamente [13-15]. [33]. En la revisión se han incluido exclusivamente las especies M. buccale. En su día fue descrito como M. orale tipo de Mycoplasma en las que existen casos documentados de ais- 2 [34, 35]. Forma parte de la microbiota de la boca [36] y no lamientos en humanos. existen evidencias que indiquen que tiene significación clíni- ca en humanos. El diagnóstico microbiológico se lleva a cabo ESPECIES IMPLICADAS EN PATOLOGÍA HUMANA mediante cultivo o PCR. No se han establecido tratamientos específicos [37]. M. amphoriforme. Se aisló por primera vez en 1999, en M. canis. El único aislamiento documentado data de un paciente con inmunodepresión y bronquitis crónica [16]. 2018, tras mordedura de perro. El diagnostico se realizó en Está relacionado filogenéticamente conM. pneumonie [17], cultivo enriquecido en ambiente microaerófilo, y confirmado siendo muy común la coinfección por ambos. Está considerado por PCR. El paciente no desarrolló un cuadro infeccioso y no se un patógeno oportunista [18, 19]. El diagnóstico microbioló- han descrito alternativas terapéuticas [38]. gico se realiza por PCR ya que el cultivo es lento y laborioso M. edwardii. Es un microorganismo antropozoonótico [20]. El tratamiento es similar al utilizado para M. pneumoniae que se encuentra en el tracto respiratorio superior y urogenital (macrólidos, tetraciclinas y fluoroquinolonas) [21]. de los perros. En el año 2015 se aisló M. edwardii en un niño M. arginini. Fue descubierto en 1968. Es un microorga- con peritonitis polimicrobiana en la que se aislaron M. edwar- nismo asociado tradicionalmente con el mundo animal [22]. dii, Kingella denitrificans, Actinomyces spp.y Capnocytopha- Hasta la fecha, se han comunicado 4 casos de infección por M. ga cynodegmi. Este paciente tenía un perro como mascota. El arginini en humanos: un trabajador de un matadero con infec- diagnóstico microbiológico se llevó a cabo mediante cultivo y ción diseminada mortal en un cuadro de linfoma no Hodgkin PCR [39]. avanzado [23], una infección tras un ataque de un león [24], M. faucium. Fue descrito originalmente como M. orale un cuadro de fascitis eosinofílica en un usuario de esteroides tipo 3 [34], para pasar posteriormente a denominarse M. fau- y suplementos derivados de origen animal [25] y un paciente cium [35]. Coloniza la orofaringe, siendo más común en perso- inmunodeprimido con linfoma no Hodgkin avanzado que con- nas con defectos sinusales o dentales. También se ha aislado en vivía con gatos. Estos animales son el reservorio habitual de M. abscesos cerebrales [40, 41], procesos de gastritis crónica [42] arginini. Las evidencias analizadas indican que es una enfer- y en abscesos diseminados en paciente con inmunodeficiencia medad zoonótica [26, 27] y que afecta con mayor probabilidad primaria [43]. De las especies del género Mycoplasma, sólo se a pacientes inmunocomprometidos [28]. La presencia de fiebre, han aislado M. salivarium y M. faucium en abscesos cerebrales, leucopenia, celulitis e infección posquirúrgica han sido los da- lo que sugiere que puedan tener un papel patógeno específico tos más relevantes en los pacientes infectados. El diagnóstico [44]. Pertenecen al grupo de micoplasmas hidrolizantes de la microbiológico se realizó por PCR y cultivo. Los hemocultivos arginina que, al producir amoníaco, logran neutralizar el ácido no demostraron sensibilidad [26, 29]. Las tetraciclinas, macróli- gástrico causando daño tisular [45]. El diagnóstico microbioló- dos y quinolonas se consideran los antimicrobianos de elección gico se lleva a cabo mediante
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