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This study was undertaken to test the effects of erythromycin as an adjunct to tocolysis for preterm labor in women with vaginal cultures positive for Ureaplasma urealyticum. The study group consisted of 18 women in active preterm labor with pregnancies between 26 and 34 weeks of gestation and intact membranes who received 500 mg erythromycin orally every 8 h for 10 days. Seventeen women with similar characteristics served as controls and received no antibiotics. In all women contractions were suppressed with ritodrine. Erythromycin treatment resulted in a statistically significant greater mean delay of delivery (36.4 days) than among the control group (23.1 days). Higher proportion of term pregnancies (7 versus 3 pregnancies), higher mean birth weight (2,745 versus 2,474 g), lower neonatal morbidity (22.2 versus 42.2%) and shorter mean neonatal hospitalization time (9.6 versus 12.1 days) were observed, although these differences were not statistically significant. Adjunctive erythromycin treatment given to women treated for preterm labor with intact membranes and positive vaginal cultures for U. urealyticum appears to prolong gestation and to improve perinatal outcome.

Chlamydia trachomatis is responsible for urogenital infections, often minimally symptomatic, revealed by their complications. Mycoplasmas, mainly Ureaplasma urealyticum and Mycoplasma hominis, are normal commensal organisms of the genital tract, which sometimes makes it difficult to determine their pathogenicity. However, they are responsible for urogenital infections, and U. urealyticum is a pathogen in male urethris. The laboratory diagnosis is based on specific techniques adapted to these microorganisms. In the case of C. trachomatis, it has benefited from the recent progress in molecular biology techniques. The therapeutic approach is common to both types of organisms: tetracyclines and macrolides are the major antibiotics used in the treatment of these urogenital infections.

Ureaplasma urealyticum is a fastidious organism which is not recovered by conventional bacterial cultures techniques, but special cultures are required for its isolation and identification. As it is a urease-producing organism, it is considered a risk factor for the formation of struvite calculi in the urinary tract. A total of 30 patients with urinary infection stones (19 of them with the 1st formation and 11 with recurrent stone formation) were included in the study. Both bladder urine specimen (cystoscopically obtained) and stones removed were subjected to conventional cultures and also to Ureaplasma specific cultures (A7 agar and U9 broth). The results of culture techniques revealed that 86.7% of patients had aerobic organisms (E. coli in 46.7%, Klebsiella in 30%, Proteus in 6.7% and Pseudomonas in 3.3%) and 26.7% showed U. urealyticum in mid stream urine. As regards stone cultures, they revealed aerobic organisms in 76.7%, and U. urealyticum in 20%. Sensitivity tests for U. urealyticum showed that minocycline was the most effective antimicrobial followed by tetracycline and ciprofloxacin. From these data, we conclude that U. urealyticum may be the causative organism for infection stone and should be searched for via its specific cultures, especially in patients with recurrent stones and with the so-called sterile pyuria.

Fourteen serotypes are currently recognized in the Ureaplasma urealyticum species. These serotypes have been divided into two genomic clusters or biovars by a large number of typing methods. The parvo-biovar includes strains of serotypes 1, 3, 6 and 14 and the T960-biovar, strains belonging to the ten other serotypes. In this study, arbitrarily primed polymerase chain reaction (AP-PCR) has been applied to the analysis of reference strains of the 14 U. urealyticum serotypes. By using two different sets of 10-mer oligonucleotide primers, the method allowed the clear differentiation between the two known biovars of the species. However, further differentiation within a same biovar was only achieved for a few standard strains of the T960-biovar analysed by using a pairwise combination of primers. The reproducibility of AP-PCR profiles was shown on strains tested after repeated subcultures and with different thermal cyclers. Additional experiments were performed on forty isolates of U. urealyticum recovered from subjects of various origins. They confirmed that AP-PCR was able to identify the strains at the biovar level. With reference to the other typing methods, AP-PCR is easy to perform and can be applied to large numbers of strains for epidemiological purposes.

Vaginal cultures for Ureaplasma urealyticum and confidential questionnaires were obtained from women with signs and symptoms of vaginitis who consulted a physician at a Primary Health Center, Tlalpan, D.F., México. In all 220 women were studied, 50 (22.7%) of whom were colonized with Ureaplasma urealyticum, statistical analysis (X2) showed there was no association between colonization with Ureaplasma urealyticum, and age, pregnancy, and other but there was association between colonization with Ureaplasma urealyticum and the number of pregnancies and no birth control method use.

Mycoplasma hominis was isolated in pure culture from septic synovial aspirates from an individual (patient A) during 16 different bouts of exacerbation over a 70-month period of observation. Two isolates, 10(7) and also 10(6) color-changing units (CCU) of the 1620 isolate and 5 x 10(4) CCU of the 1628 isolate, caused inflammation in chimpanzees inoculated intraarticularly. Inflammation was also induced with 10(7) CCU of the 2010B isolate, serovar VII of Ureaplasma urealyticum, recovered from an agammaglobulinemic individual (patient B) with septic polyarthritis and with 3 x 10(6) CCU of the PI-1428 isolate of Mycoplasma pneumoniae. Inflammation persisted for up to 36 days and was self-limiting. The aspirates contained up to 220,000 white blood cells/mm3 and up to 10(7) CCU/mL. There was good correlation between the severity of inflammation and the numbers of organisms, but antibody was not detected in aspirates during the peak severity of disease. As the numbers of organisms, decreased, detectable levels of antibody increased, thus suggesting that antibody may have been bound to antigen. Chimpanzees previously infected with either the 1628 isolate of M. hominis or the 2010B isolate of U. urealyticum were protected on challenge with > 100 times the minimal dose causing arthritis. Chimpanzees showed little or no inflammation when inoculated intraarticularly with 5 x 10(8) CCU of the type strain PG-21 of M. hominis or with the type strain CO of U. urealyticum or when inoculated intravenously with 3 x 10(8) CCU of the arthrogenic 1620 isolate of M. hominis.

On the ground of contemporary medical literature and our own observations, we have tried to estimate the participation of microorganism infection in preterm labor. In this article, we present mechanism, currently recognized as the most probable, that are leading to preterm labor under condition of perinatal infections. One of them seems to be the production of enzymes by pathological strains. Those enzymes are considered to stimulate decidual and amniotic cells to arachidonic acid metabolism and prostaglandins synthesis. Coexisted with chorionamnionitis the migration of leukocytes that are able to induce prostaglandins synthesis releasing interleukin, can also be an important factor of preterm labor.

The current concepts about sexually transmitted diseases (STD)--excluding syphilis and viral STD--are presented in a condensed form. The focus of attention is directed to complications or sequelae of these infections, and to the epidemiology of STD.

Cultures positive for Ureaplasma urealyticum in babies weighing < 1000 g have been associated with both chronic lung disease (CLD) and death, but no definite causality has been established. To further investigate the role of the organism in CLD, we colonized premature baboons with U. urealyticum and compared resulting pathology with that in uninoculated control animals. Using an established model of prematurity, the 140-day-gestation baboon, three animals were colonized with U. urealyticum via endotracheal tube. All had hyaline membrane disease, indistinguishable from disease in human infants, and U. urealyticum infection. Samples obtained from nasopharynx, trachea, pleural fluid, and, at necropsy, lung tissue produced positive cultures. Culture of blood from one animal yielded U. urealyticum. On pathologic examination, after 6 days of ventilation, all three of the infected animals had the specific pathologic finding of bronchiolitis with epithelial ulceration not seen in four uninfected control animals. Thus, U. urealyticum is capable of causing a pathologically recognizable pulmonary lesion in premature primates with hyaline membrane disease.

Recent studies show an association between the presence of Ureaplasma urealyticum in tracheal aspirates and bronchopulmonary dysplasia. We hypothesized that among infants with birth weights < or = 1,250 g and respiratory disease, those with U. urealyticum in their tracheal aspirates would have radiographic evidence of more-severe pulmonary disease more often than would those without this organism. A total of 292 low-birth-weight infants who had endotracheal aspirate cultured within 7 days of birth were enrolled. The radiographic outcome variables were pneumonia, early severe bronchopulmonary dysplasia (precocious), and chronic lung disease. Microorganisms were isolated from 128 infants (44%); U. urealyticum was isolated from 44 (15%). Pneumonia was significantly more common in infants with than without U. urealyticum (30% vs. 16%, P = .03). U. urealyticum also was associated with precocious bronchopulmonary dysplasia independent of prematurity, race, and sex (odds ratio, 2.2; P < .05). Tracheal isolation of U. urealyticum within 7 days of birth is associated with pneumonia and precocious bronchopulmonary dysplasia.

It is becoming apparent that a high rate of variability of surface structures is a ubiquitous property among mycoplasmas. The present study demonstrates how variations in the size of the V-1 antigen (a major surface antigen of Mycoplasma pulmonis thought to be associated with virulence) are reflected by phenotypic differences (cytadherence) that may play a role in virulence of the organism. Furthermore, a similar antigen is described for the human pathogen Urea-plasma urealyticum, and data are presented on the analysis of clinical isolates that demonstrate the potential for variation in the size of this antigen in vivo. Although no direct connection of antigen variation to natural disease has yet been presented, the data further document the tremendous potential for virulence-related diversity possessed by these organisms and emphasize the importance of a valid animal model for discerning the true relationship between variation and virulence.

This study examined the association between Ureaplasma urealyticum colonization and the development of chronic lung disease (CLD) in 93 premature infants who were treated with surfactant and who had birth weights < 1251 g. Nasopharyngeal and tracheal cultures for U. urealyticum were obtained at 2 +/- 1 and at 14 +/- 1 days after birth and were positive in 17 (18%) of 93 patients. Infants born vaginally were 4.5 times more likely to be colonized than were those born by cesarean section. Colonization with U. urealyticum was associated with 1.66 (95% confidence interval, 1.24-2.20, P = .024) times the risk of developing CLD and with a greater incidence of > or = 2+ polymorphonuclear leukocytes in the tracheal aspirate at 2 +/- 1 days of age compared with uncolonized infants (P = .025). We conclude that U. urealyticum colonization is associated with CLD even after surfactant treatment. The presence of U. urealyticum is also associated with inflammatory cells in the tracheal aspirate.

Evidence related to the association of Ureaplasma urealyticum with premature birth is reviewed. U. urealyticum is a common inhabitant in the vagina of pregnant women. It is recovered from the vaginas of approximately 70% of pregnant women. The presence of U. urealyticum in the vagina is not associated with premature birth. Therapy to eradicate U. urealyticum from the vagina during pregnancy does not reduce the incidence of premature birth. Recovery of U. urealyticum from the amniotic fluid has not been associated with prematurity. However, in three of six reports, the recovery of U. urealyticum from the chorioamnion has been associated with prematurity, and U. urealyticum is rather consistently associated with histological chorioamnionitis. This review suggests that U. urealyticum in the lower genital tract is not associated with premature birth but that its presence in the chorioamnion is weakly associated with prematurity and strongly associated with histological chorioamnionitis.

Multiple insults may induce bronchopulmonary dysplasia (BPD) in premature infants, including the recently reported association of BPD with neonatal Ureaplasma urealyticum colonization. One mechanism of damage could involve stimulation of proinflammatory cytokine release from pulmonary fibroblasts. We therefore compared the effects of U. urealyticum, oxygen, and lipopolysaccharide (LPS) on the release of interleukin (IL)-1 beta, IL-6, and IL-8 from neonatal fibroblasts. Fibroblasts were grown in multiwell plates and divided into the following experimental conditions: fibroblasts alone, fibroblasts plus U. urealyticum (10,000 cfu/mL), and fibroblasts plus LPS (2 micrograms/mL). Plates were then exposed to room air or hyperoxia for 48 h, and supernatants were assayed for IL. U. urealyticum-infected fibroblasts produced a significant increase in IL-6 (P < .05) and a dramatic increase in IL-8 (P < .05) that was independent of hyperoxic exposure and significantly increased over that produced by LPS or hyperoxia alone. U. urealyticum is a potent inducer of fibroblast cytokine release in vitro and may contribute to the development of BPD.

A critical appraisal of four cohort studies examining the relationship between Ureaplasma urealyticum and chronic lung disease (CLD) of prematurity is presented. Three studies were concurrently conducted, but the fourth was conducted 4 years later when surfactant replacement was a widespread practice. Although infants were enrolled in all studies soon after birth before they had developed CLD, there were differences in patients population, the definition of colonization with U. urealyticum, neonatal management, and the definition of CLD of prematurity. Despite the differences, all four studies found an association between colonization and development of CLD of prematurity. A combined estimate of relative risk for the four studies was 1.91 (95% confidence interval, 1.54-2.37). When infants were categorized into groups by birth weight, the association was not observed in infants who weighed > 1,250 g. The association was also not observed in infants who weighed < 750 g, but the risk of CLD of prematurity in the uncolonized control group was already 82%. Because the cohort study design allows for the possibility that one or more additional factors associated with U. urealyticum may be the true cause(s) of CLD of prematurity, there is strong but not definitive evidence that U. urealyticum causes CLD of prematurity.

The rate of genital Mycoplasma isolation from the uterine cavity was studied in 147 puerperae (80 ones with a normal course of the puerperium and 67 with acute postpartum endometritis). Mycoplasma were isolated from the metroaspirate in 11.3% of puerperae in whom the postpartum period ran a normal course; M. urealyticum were found in 8.8% and M. hominis in 2.5% of cases. In endometritis Mycoplasma were isolated from the infection focus 2.5 times more often, i.e. from 28.4% of patients with postpartum endometritis (M. urealyticum were detected in 9.0% and M. hominis in 19.4% of cases). Mycoplasma were the sole agents of endometritis in 9.0% of patients. Hysteroscopic and morphologic studies helped verify the contribution of genital Mycoplasma to the development of acute postpartum endometritis in 19.4% of the patients. Therefore, virtually every fifth patient with postpartum endometritis was in need of purposeful antimycoplasma therapy with tetracycline.

We present a case of premature twins, born at 24 weeks of gestation. Both infants died of intraventricular hemorrhage, aged 1 and 3 days, respectively. Ureaplasma urealyticum was isolated from brain tissue obtained at the autopsy of both infants. Our observations lend additional evidence of the role of U. urealyticum as a central nervous system pathogen in premature infants.

Ureaplasma urealyticum was investigated in urine from 765 outpatients who visited Jikei University Affiliated Hospital and Tokyo Metropolitan Taito Hospital from June, 1988 to December, 1989 in order to clarify the pathogenicity of U. urealyticum in human genitourinary tract. U. urealyticum in urine was detected by means of Taylor-Robinson's method. The positive rates of U. urealyticum were 31.5% in 146 patients with gonococcal urethritis, 33.8% in 334 patients with non-gonococcal urethritis, 17.5% in non-bacterial chronic prostatitis and 27.5% in the other patients without infectious diseases, respectively; no significant difference was seen among these groups. U. urealyticum was detected in the urine from 32.1% of the 28% patients who were younger than 12. However, U. urealyticum was detected in the urine from 5.6% of the 18 patients who were older than 70. Therefore, there was no relationship between the age and U. urealyticum-positive rate in urine. Furthermore, there was no relationship between the detection of U. urealyticum and the subjective and objective findings in the patients with urethritis before and after the treatment. From these results, it is presumed that U. urealyticum has no pathogenicity in human genitourinary tract.

In the experimental intraperitoneal infection of rabbits with U. urealyticum, serotype VIII, transitory polyarthritis with immunomorphological characteristics different from those of human rheumatoid arthritis has been shown to develop in the animals. The pathological process develops simultaneously with Ureaplasma infection. U. urealyticum persists in the body of infected rabbits during 12 weeks of observation. The mechanism of the resorption process in the bone tissue of joints, running similarly to periosteocytic osteolysis, is discussed.