Rheumatoid Arthritis (RA) may be related to lower urinary tract symptoms (LUTS)

July 13, 2006

Recommendations for PCR tests and/or culture for the following

pathogens found in patients with lower urinary tract symptoms (LUTS)

and Rheumatoid Arthritis (RA), systemic lupus erythematosus (SLE),

Sjögren's syndrome (SS), Graves disease, autoimmune diseases as well

as Chronic Fatigue Syndrome/Gulf War Syndrome:

Mycoplasma hominis

Mycoplasma genitalium

Ureaplasma urealyticum

Escherichia coli

Gardnerella vaginalis

Streptococcus agalactiae

Chlamydia trachomatis

* * * * * * * * * * * * * * * * * * * * * * * * * * *

MYCOPLASMA REGISTRY REPORTS

for gulf war syndrome & chronic fatigue syndrome

<MycoplasmaRegistry-subscribe >

* * * * * * * * * * * * * * * * * * * * * * * * * * *

Rheumatoid Arthritis May Be Related To Lower Urinary Tract Symptoms

(LUTS)

By Philip M. Hanno MD, MPH

Medical News Today (press release) - UK - July 10,2006

http://www.medicalnewstoday.com/medicalnews.php?newsid=46693

Patients with systemic lupus erythematosus (SLE), Sjögren's syndrome

(SS), and Graves disease

are reported to be associated with an increased severity of LUTS

compared with control populations. Peeler's recent report that in a

survey of 222 patients with interstitial cystitis, RA was the second

most common IC-associated disease, occurring in more than 13% of his

patients (Scand J Urol Nephrol 37:60-63, 2003), stimulated Lee and

colleagues to look for a relationship between RA and LUTS.

Urinary symptoms, including IC-like symptoms, were investigated in a

cohort of patients with RA. Results were compared with a group of age-

matched controls. Patients with urinary tract infection and those on

medications that could induce oral or ocular dryness were excluded

from the analysis. One hundred eighty-nine patients were compared

with 679 controls. AUA symptom scores and percentage of individuals

reporting severe LUTS (AUA score >20) were similar in both groups.

Likewise, there was no significant difference in patients reporting

IC-like symptoms as per the O'Leary Sant Interstitial Cystitis

Symptom Index. Multivariate regression analysis did reveal that SS

was significantly correlated with severe LUTS as per the AUA Symptom

Index. There was a trend toward a higher score on the O'Leary Sant

Symptom Index in patients with SS, but this did not reach statistical

significance.

The authors conclude that RA does not by itself predispose to

increased severity of LUTS. Patients with secondary SS do have more

severe LUTS. This is an excellent study. One wonders whether some

symptoms suggestive of PBS/IC may have been masked by treatment for

RA that was ongoing in these patients.

Reference: Scand J Rheumatol 35:96-101, 2006

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?

db=pubmed & cmd=Retrieve & dopt=Abstract & list_uids=16641041 & query_hl=4 & ito

ol=pubmed_DocSum

UroToday - the only urology website with original content written by

global urology key opinion leaders actively engaged in clinical

practice. To access the latest urology news releases from UroToday,

go to: http://www.urotoday.com

* * * * * * * * * * * * * * * * * * * * * * * * * * *

Lower urinary tract symptoms in female patients with rheumatoid

arthritis.

Lee KL, Chen MY, Yeh JH, Huang SW, Tai HC, Yu HJ.

Department of Internal Medicine, National Taiwan University Hospital

and College of Medicine, Taipei, Taiwan.

Scand J Rheumatol. 2006 Mar-Apr;35(2):96-101.

OBJECTIVE: Patients with autoimmune diseases such as systemic lupus

erythematosus (SLE) and Sjogren's syndrome (SS) are associated with

an increased severity of lower urinary tract symptoms (LUTS).

Recent surveys also reveal that rheumatoid arthritis (RA) is

prevalent in patients with interstitial cystitis (IC). Therefore, we

have investigated LUTS in patients with RA.

METHODS: A total of 198 female patients with RA, aged 40 years or

older, from the rheumatology outpatient clinic completed this

prospective study. The American Urological Association Symptom

Index (AUASI) score was used to assess the severity of LUTS and the

O'Leary-Sant Symptom Index (ICSI) was used to evaluate IC-like

urinary symptoms in these patients, which were compared to those of

679 age-matched controls. The possible associations of clinical

parameters with LUTS were also explored.

RESULTS: The Mean AUASI score and the percentage of individuals

reporting severe LUTS (AUASI score > or = 20) or IC-like urinary

symptoms (ICSI score > or = 12) showed no significant differences

between the RA and control groups. However, in the RA group

multivariate regression analyses identified patients with secondary

SS (n = 21) to be associated with a significantly higher AUASI score

(p = 0.007) and a higher percentage of severe LUTS (p = 0.02); these

were also significantly higher than those of the control group (p =

0.02 and p = 0.01, respectively).

CONCLUSION: Patients with RA have similar urinary complaints when

compared to controls. However, those with secondary SS have a greater

severity of LUTS, a finding similar to that observed in patients with

primary SS.

PMID: 16641041 [PubMed - indexed for MEDLINE]

* * * * * * * * * * * * * * * * * * * * * * * * * * *

[Role of bacteria associated with sexually transmitted infections in

the etiology of lower urinary tract infection in primary care]

[Article in Spanish]

-Pedraza A, Ortiz C, Mota R, Davila R, Dickinson E.

Centro de Salud Dr. Castro Villagrana. Tlalpan. Mexico.

silviala@...

Enferm Infecc Microbiol Clin. 2003 Feb;21(2):89-92.

INTRODUCTION: Urinary tract infections (UTI) are the second most

frequent type of infectious pathology treated in primary care

clinics. The participation of microorganisms associated with sexually

transmitted infection has been reported as a cause of UTI;

nevertheless this concept is still controversial. To gather data on

this subject, we carried out a search for Gardnerella vaginalis,

Ureaplasma urealyticum, Mycoplasma hominis and Streptococcus

agalactiae besides the common microorganisms involved in

UTI. METHODS: A total of 1507 urine cultures from patients with a

clinical diagnosis of low UTI were analyzed. Samples were inoculated

onto 5% sheep blood agar and McConkey agar, as well as HBT medium for

G. vaginalis, and U9B broth and agar E broth for M. hominis and U.

urealyticum.The following parameters were analyzed as possible risk

factors: age, sex, pregnancy and diabetes status.

RESULTS. There were 436 (28.9%) positive urine cultures. Escherichia

coli was isolated in 44.34% of cases. Microorganisms associated with

sexually transmitted disease were found in 162 (37%): G. vaginalis

(25.7%), U. urealyticum (5.9%), S. agalactiae (3.4%) and M. hominis

(2%). UTI were more frequent among the 20 to 40 year-old age group,

in women and in diabetic patients.

CONCLUSIONS: Microorganisms associated with sexually transmitted

disease were found in a large percentage of cultures, indicating the

need for studies to clarify their role in the etiology of UTI.

PMID: 12586032 [PubMed - indexed for MEDLINE]

* * * * * * * * * * * * * * * * * * * * * * * * * * *

[Mepartricine and prostatitis. Clinical experience and rationale for

use][Article in Italian]

Minerva Urol Nefrol. 2001 Sep;53(3):129-33.

Saita A, Morgia G, Branchina A, Giammusso B, Iurato C, Malacasa E,

Motta M.

Divisione Clinicizzata di Nefrologia Chirurgica-Urologia, Universita

degli Studi, Catania, Italy.

BACKGROUND: The purpose of this study was to report our experience on

the use of Mepartricine in the treatment of chronic and sub-acute

prostatitis and to analyse, on the basis of the literature, the role

of estrogens, the target of Mepartricine in the development and

maintenance of prostatic inflammatory reactions.

METHODS: In a retrospective study the data of 110 patients who

presented with lower urinary tract symptoms suggestive of

prostatitis, from January 1994 to February 1999 have been evaluated:

65 of this patients had an abacterial prostatitis, and 45 a bacterial

prostatitis. The Mearers-Stamey test was used to localize

inflammation and pathogens to prostate. The clinical symptoms

presented were essentially pelvic and perineal pain and irritative

and obstructive voiding symptoms. The treatment was based on

antibiotic therapy indicated by the sensitivity to antibiotic assay.

In abacterial prostatitis, in cases of Chlamidia, Mycoplasma and

Ureaplasma positivity, the treatment was based on macrolides and

tetracycline use. All the patients received Mepartricine by oral

supply, 1 daily tablet (40 mg) for 60 days.

RESULTS: After two months of treatment remarkable improvements in

symptoms were obtained despite the persistent bacteriological

positivity in the prostatic secretion in 68% of cases. Therefore

antinflammatory antiedemic and decongestant effects of Mepartricine

on prostatic inflammation, are observed. CONCLUSIONS: The data of the

literature show data estrogens modulate inflammatory reactions: it is

possible that their decrease can produce, at prostatic level,

antinflammatory effects improving urethro-prostatic bladder

functions. Personal experience seems to confirm this supposition and

so we think that Mepartri-cine can be considered and excellent

coadjuvant in the treatment of prostate inflammation, independent of

etiology.

PMID: 11723437 [PubMed - indexed for MEDLINE]

* * * * * * * * * * * * * * * * * * * * * * * * * * *

Cytokine concentrations in seminal plasma from subfertile men are not

indicative of the presence of Ureaplasma urealyticum or Mycoplasma

hominis in the lower genital tract.

Pannekoek Y, Trum JW, Bleker OP, van der Veen F, Spanjaard L, Dankert

J.

Department of Medical Microbiology, Academic Medical Center,

Amsterdam, The Netherlands. y.pannekoek@...

J Med Microbiol. 2000 Aug;49(8):697-700.

The inflammatory response to the presence of Ureaplasma urealyticum

or Mycoplasma hominis in the lower genital tract of subfertile men

without any signs or symptoms of infection was investigated by

measuring the concentrations of interleukin (IL)-6, IL-8, tumour

necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma) in

seminal plasma. Semen samples were collected from 30 culture-positive

subfertile males and 23 culture-negative subfertile males. Enzyme-

linked immunosorbent assays showed that IL-8 was present in

relatively high concentrations (0.12-4.8 ng/ml) in all semen samples

investigated. In contrast, the other cytokines were only detectable

in 72% (IFN-gamma), 44% (IL-6) and 19% (TNF-gamma) of the samples and

were present in relatively low concentrations (1-410 pg/ml). Seminal

plasma cytokine concentrations were similar in samples from culture-

positive and culture-negative males. These data strongly indicate

that the presence of U. urealyticum or M. hominis in the lower

genital tract of subfertile males reflects a silent colonisation

rather than infection.

PMID: 10933253 [PubMed - indexed for MEDLINE]

* * * * * * * * * * * * * * * * * * * * * * * * * * *

Association of ureaplasma urealyticum with abnormal reactive oxygen

species levels and absence of leukocytospermia.

Potts JM, Sharma R, Pasqualotto F, D, Hall G, Agarwal A.

Department of Urology, The Cleveland Clinic Foundation, Cleveland,

Ohio, USA.

J Urol. 2000 Jun;163(6):1775-8.

PURPOSE: Ureaplasma urealyticum is a commensal of the lower

genitourinary tract of many sexually active adults. The organism is

more common in partners of infertile than fertile marriages. We

conducted a prospective study at our tertiary care center to confirm

a possible association between U. urealyticum and abnormal sperm

function parameters.

MATERIALS AND METHODS: A total of 50 consecutive male patients

seeking general urology consultation for lower urinary tract symptoms

characteristic of chronic prostatitis were evaluated. Urine and semen

localization cultures were performed with additional semen cultures

for U. urealyticum, Chlamydia trachomatis and Mycoplasma hominis.

Specimens from 21 healthy men were used as controls. Specimens were

analyzed by a computer assisted semen analyzer, and verified manually

for concentration, percent motility and morphology. Leukocytospermia

was measured by the Endtz test. Semen specimens were also analyzed

for reactive oxygen species (ROS), acrosome reaction and mannose

binding assay. RESULTS: Of the patients 17 had positive U.

urealyticum cultures and the other cultures were negative. Patients

with U. urealyticum had significantly higher ROS levels (log [ROS +

1] = 2.52 +/- 0.25) than those without U. urealyticum (1.49 +/- 0.20,

p = 0.002) or controls (1.31 +/- 0.19, p = 0.002). Leukocytospermia

was detected in only 1 of the 17 (6%) positive specimens and 4 (12%)

negative specimens.

CONCLUSIONS: Seminal ROS levels are elevated among patients with U.

urealyticum. ROS induces lipid peroxidation, which reduces membrane

fluidity and sperm fertilization capability, and may be the mechanism

by which U. urealyticum impairs sperm function. Absence of

leukocytospermia does not exclude U. urealyticum.

PMID: 10799180 [PubMed - indexed for MEDLINE]

* * * * * * * * * * * * * * * * * * * * * * * * * * *

A double-blind, randomized, controlled multicentre study to compare

the efficacy of ciprofloxacin with pivampicillin as oral therapy for

epididymitis in men over 40 years of age.

Eickhoff JH, Frimodt-Moller N, Walter S, Frimodt-Moller C.

Glostrup Hospital, Denmark.

BJU Int. 1999 Nov;84(7):827-34.

OBJECTIVE: To compare the efficacy and safety of ciprofloxacin 500 mg

orally twice daily with pivampicillin 700 mg orally twice daily for

10 days in men with acute epididymitis and over 40 years of age.

PATIENTS AND METHODS: The study comprised 172 men who entered a

prospective, controlled, randomized, double-blind, trial of

pivampicillin and ciprofloxacin. The median (range) age of the 158

patients eligible for the efficacy analysis was 58 (41-85) years; 41%

had previously had a urinary tract infection and 27% had previously

had epididymitis. Only one patient had a urethral catheter and 38%

were sexually active. About half of the patients were admitted to

hospital.

RESULTS: No bacteria could be cultured from samples in 53% of the

patients; Escherichia coli could be cultured from 35% and the

remaining isolates were the expected urinary pathogens. None of the

patients had Gonococci and only one in each group had Chlamydia.

Mycoplasma hominis was detected in three patients only and M.

genitalium was detected in three, while Ureaplasma was detected in 24

(15%). The treatment failed in 48 patients; in 15 of 76 (20%)

receiving ciprofloxacin and in 33 of 82 (40%) receiving

pivampicillin. This corresponds to a reduction in the risk of failure

of 20.5% (95% confidence limits 6.6-40.2%, P=0. 006). The principal

cause of failure was an unsatisfactory clinical response requiring

changed antibiotic treatment in 27 patients; adverse events were

responsible for failure in 14. The in vitro resistance of cultured

bacteria was low in both groups, at approximately 4%. Adverse events,

mainly gastro-intestinal, occurred in 17 of 83 (21%) patients

starting on ciprofloxacin and in 33 of 89 (37%) receiving

pivampicillin (P=0.04).

CONCLUSION: For epididymitis in men over the age of 40 years

ciprofloxacin 500 mg orally twice daily is more effective than

pivampicillin 700 mg orally twice daily. Furthermore, ciprofloxacin

has a lower incidence of adverse events.

PMID: 10532980 [PubMed - indexed for MEDLINE]

* * * * * * * * * * * * * * * * * * * * * * * * * * *

Levofloxacin and sparfloxacin: new quinolone antibiotics.

SJ, Meyer JM, Chuck SK, Jung R, Messick CR, Pendland SL.

Department of Pharmacy Practice, College of Pharmacy, University of

Toledo, OH 43606, USA. smartin2@...

Ann Pharmacother. 1998 Mar;32(3):320-36.

OBJECTIVE: To discuss the pharmacology, pharmacokinetics, spectrum of

activity, clinical trials, and adverse effects of levofloxacin and

sparfloxacin, two new fluoroquinolone antibiotics.

DATA SOURCES: Literature was identified by a MEDLINE search from

January 1985 to September 1997. Abstracts and presentations were

identified by review of program abstracts from the Interscience

Conference on Antimicrobial Agents and Chemotherapy from 1988 to

1996.

STUDY SELECTION: Randomized, controlled clinical studies were

selected for evaluation; however, uncontrolled studies were included

when data were limited for indications approved by the Food and Drug

Administration (FDA). In vitro data were selected from comparison

trials whenever available. Only in vitro trials that provided data on

the minimum inhibitory concentrations required to inhibit 90% of

isolates were used. Data from North American studies were selected

whenever available.

DATA EXTRACTION: Data were evaluated with respect to in vitro

activity, study design, clinical and microbiologic outcomes, and

adverse drug reactions.

DATA SYNTHESIS: Levofloxacin and sparfloxacin are active against

pathogens frequently involved in community-acquired upper and lower

respiratory tract infections, including Streptococcus pneumoniae,

Haemophilus influenzae, Moraxella catarrhalis, Mycoplasma pneumoniae,

Legionella pneumophila, and Chlamydia pneumoniae. Both compounds have

enhanced activity compared with ciprofloxacin against most gram-

positive bacteria, including enterococci, streptococci, and

staphylococci, and retain good activity against most

Enterobacteriaceae and Pseudomonas aeruginosa. Sparfloxacin has

greater anaerobic activity than levofloxacin, which is more active

than ciprofloxacin or ofloxacin. Although many clinical studies are

available only in abstract form, the clinical data demonstrate that

these new quinolones are effective for most community-acquired upper

and lower respiratory tract infections, urinary tract infections,

gonococcal and nongonococcal urethritis, and skin and skin structure

infections. FDA-approved indications are limited for both compounds

to date.

CONCLUSIONS: Levofloxacin and sparfloxacin have improved gram-

positive activity compared with that of older fluoroquinolones, and

are administered once daily. Sparfloxacin-associated photosensitivity

may limit its therapeutic usefulness. Clinical trials confirm that

these agents are as effective as traditional therapies for the

management of community-acquired pneumonia, acute exacerbations of

chronic bronchitis, sinusitis, urinary tract infections, acute

gonococcal and nongonococcal urethritis, and skin and skin structure

infections.

PMID: 9533064 [PubMed - indexed for MEDLINE]

* * * * * * * * * * * * * * * * * * * * * * * * * * *

In vitro and in vivo antibacterial activities of AM-1155, a new 6-

fluoro-8-methoxy quinolone.

Hosaka M, Yasue T, Fukuda H, Tomizawa H, Aoyama H, Hirai K.

Central Research Laboratories, Kyorin Pharmaceutical Co., Ltd.,

Tochigi, Japan.

Antimicrob Agents Chemother. 1992 Oct;36(10):2108-17.

AM-1155 is a new quinolone with a wide spectrum of antibacterial

activity against various bacteria including anaerobes and Mycoplasma

pneumoniae. AM-1155 was 2- to 16-fold more active than ciprofloxacin

and ofloxacin against Staphylococcus aureus including methicillin-

resistant strains, Staphylococcus epidermidis, Streptococcus

pneumoniae, and Enterococcus faecalis; its MICs for 90% of strains

tested were 0.10 to 0.78 micrograms/ml. The activity of AM-1155 was

comparable to that of ciprofloxacin against members of the family

Enterobacteriaceae, Branhamella catarrhalis, Haemophilus influenzae,

and Neisseria gonorrhoeae, but was fourfold less than that of

ciprofloxacin against Pseudomonas aeruginosa. Against Xanthomonas

maltophilia, Acinetobacter calcoaceticus, and Campylobacter jejuni,

AM-1155 was two- to fourfold more active than ciprofloxacin. At a

concentration of 1.56 micrograms/ml, AM-1155 inhibited 90% of

Bacteroides fragilis strains tested; its activity was 8- to 10-fold

higher than those of ofloxacin and ciprofloxacin. Development of

resistance to AM-1155 in S. aureus and S. epidermidis occurred at a

lower frequency than did that to ciprofloxacin after eight transfers

in the presence of drug. In the oral treatment of mouse systemic

infections, AM-1155 was four- to eightfold more effective than

ciprofloxacin against gram-positive cocci and was as active as

ciprofloxacin against gram-negative rods. The efficacy of an oral or

a subcutaneous dose of AM-1155 was two- to fivefold greater than that

of ofloxacin. Against experimental pneumonia with Klebsiella

pneumoniae and P. aeruginosa, AM-1155 was two- to fourfold more

active than ciprofloxacin and ofloxacin. AM-1155 also had good

efficacy against mouse ascending urinary tract infections with

Escherichia coli and P. aeruginosa. These results suggest that AM-

1155 may be a potent antibacterial agent applicable to various

infections.

PMID: 1332587 [PubMed - indexed for MEDLINE]

* * * * * * * * * * * * * * * * * * * * * * * * * * *

Temafloxacin: an overview.

Pankey GA.

Ochsner Clinic, New Orleans, Louisiana 70121.

Am J Med. 1991 Dec 30;91(6A):166S-172S

Temafloxacin (6-fluoro-7-piperazino-4-quinolone) is a new

fluoroquinolone with a 7-8 hour half-life and rapid gastrointestinal

absorption. These characteristics make it an ideal antimicrobial for

once- or twice-daily oral dosing. With the exception of the central

nervous system (CNS), temafloxacin has excellent tissue and body

fluid penetration and concentration. Temafloxacin has broad

antimicrobial activity against gram-positive and gram-negative

bacteria, including improved in vitro activity against Streptococcus

pneumoniae, Mycoplasma hominis, and anaerobic bacteria, including

Bacteroides fragilis. Temafloxacin is as effective as beta-lactam

therapy and superior to ciprofloxacin in the treatment of S.

pneumoniae lower respiratory infections. It has been clinically

effective when given in a short 3-day regimen for the treatment of

uncomplicated urinary tract infections. Multiple clinical trials

indicate that temafloxacin is also clinically effective, well

tolerated, and safe for use in adult patients for the treatment of

other lower respiratory tract, genitourinary tract, and skin and skin-

structure infections.

PMID: 1662889 [PubMed - indexed for MEDLINE]

* * * * * * * * * * * * * * * * * * * * * * * * * * *

Antenatal microbiologic and maternal risk factors associated with

prematurity.

Comment in: Am J Obstet Gynecol. 1991 Aug;165(2):485-6.

McGregor JA, French JI, Richter R, Franco-Buff A, A, Hillier

S, Judson FN, Todd JK.

Department of Obstetrics and Gynecology, University of Colorado

Health Sciences Center, Denver 80262.

Am J Obstet Gynecol. 1990 Nov;163(5 Pt 1):1465-73.

In a prospective study of 202 women (gestational age 24 +/- 4 weeks),

we evaluated possible influences of lower genital tract infection or

bacterial conditions on obstetric outcomes, including preterm labor,

preterm premature rupture of membranes, and preterm birth. The

presence of bacterial vaginosis (18.7%) was associated with an

increased risk of preterm labor (relative risk, 2.6; 95% confidence

interval, 1.08 to 6.46). For women with bacterial vaginosis who also

had Mobiluncus species morphotypes identified on Gram stain, the

relative risk of preterm labor was 3.8 (95% confidence interval, 1.32

to 11.5). Presence of vaginal Mycoplasma hominis (10.8% of patients)

was associated with both preterm labor (relative risk, 1.8; 95%

confidence interval, 0.77 to 4.4) and preterm birth (relative risk,

5.1; 95% confidence interval, 1.45 to 17.9). Recovery of

Staphylococcus aureus (3.0%) was associated with preterm labor

(relative risk, 3.1; 95% confidence interval 1.12 to 8.7).

Identification of two or more bacterial-linked abnormalities was also

associated with preterm labor (relative risk, 3.3; 95% confidence

interval, 1.44 to 7.58). An increased level of vaginal wash protease

(greater than or equal to 10 trypsin units) (16%) was associated with

preterm labor and was noted in 50% of women with preterm premature

rupture of membranes. A history of prior preterm birth was the single

best historical predictor of both preterm labor (relative risk, 3.6;

95% confidence interval, 1.92 to 6.83) and preterm birth (relative

risk, 6.7; 95% confidence interval, 2.2 to 20.4). History of three or

more abortions, antenatal urinary tract infection, and occurrence of

medical complications during pregnancy also correlated with increased

risk of preterm labor. These findings affirm and refine associations

of various maternal reproductive tract infections with preterm labor,

premature rupture of membranes, and birth, allowing for controlled

treatment trials aimed at prevention of preterm birth.

PMID: 2240089 [PubMed - indexed for MEDLINE]

* * * * * * * * * * * * * * * * * * * * * * * * * * *

Ureaplasmas and mycoplasmas in chimpanzees of various breeding

capacities.

- D, Barile MF, Furr PM, Graham CE.

Division of Sexually Transmitted Diseases, Clinical Research Centre,

Harrow, Middlesex, U.K.

J Reprod Fertil. 1987 Sep;81(1):169-73.

Adult chimpanzees (24 male, 76 female) with low and high rates of

conception were examined for ureaplasmas, arginine-metabolizing

mycoplasmas and chlamydiae. Ureaplasmas were isolated from the throat

of only 1 male and 1 female animal, but from the urethra of 29% of

the males and from the vagina of 95% of the females. Mycoplasmas were

isolated from the throat more often than were ureaplasmas, but from

the genital tract with about the same frequency as ureaplasmas. The

numbers of organisms, of either type, isolated from the vagina were

larger than the numbers isolated from the male urethra. Chlamydiae

were not isolated from any animal. The occurrence of ureaplasmas and

mycoplasmas and the numbers of these organisms isolated were similar

in animals with low or high rates of conception. Furthermore, no

association was noted between the organisms in the lower genital

tract and the occurrence of abortion and/or stillbirth.

PMID: 3668947 [PubMed - indexed for MEDLINE]

* * * * * * * * * * * * * * * * * * * * * * * * * * *

Pathogenesis and significance of urogenital mycoplasmal infections.

Cassell GH, JK, Waites KB, Rudd PT, Talkington D, Crouse D,

Horowitz SA.

Department of Microbiology, University of Alabama School of Medicine,

Birmingham, Alabama 35294.

Adv Exp Med Biol. 1987;224:93-115.

U. urealyticum and M. hominis can no longer be considered as harmless

commensals of the lower genitourinary tract. Both can produce disease

in humans. Diagnosis and management of infections due to these

organisms must be based upon isolation of the organisms from the

affected site and preferably the number of organisms present. Due to

the frequent resistance of both organisms to tetracycline, treatment

must be based upon appropriate antibiotic sensitivities. For a more

detailed description of the basic biology of these organisms and

isolation and identification and treatment, the reader is referred to

several recent reviews.

Publication Types: Review

PMID: 3329816 [PubMed - indexed for MEDLINE]

* * * * * * * * * * * * * * * * * * * * * * * * * * *

Leukocyte esterase activity in the rapid detection of urinary tract

and lower genital tract infections in obstetric patients.

Abbasi IA, Hess LW, TR, McFadden E, Chernow B.

Am J Perinatol. 1985 Oct;2(4):311-3.

Infections of the vagina and urinary tract are important problems for

the obstetrician. Examination of the vaginal discharge and urine for

the presence of leukocytes is an important part of the evaluation for

vaginitis and urinary tract infections. Neutrophils contain several

esterases that are not present in serum, urine, or vaginal

secretions. These esterases are not influenced by bacteria, commonly

used drugs, or variable compositions of urine or vaginal secretions.

A prospective study was performed to assess the sensitivity and

specificity of leukocyte esterase activity as measured by dipstick

(Chemstrip 9, Biodynamics) for the prediction of vaginitis and

urinary tract infections during pregnancy. Results were compared with

those obtained from potassium hydroxide smears, wet preps, and urine

cultures. The vaginal discharge and urine of 65 patients was tested

for leukocyte esterase activity on their initial OB visit. Leukocyte

esterase was 100% sensitive and 100% specific for detecting urinary

tract infections. It was 100% sensitive and 90% specific for

predicting vaginal infections. Trichomonas infections accounted for

the positive leukocyte esterase results when the urine culture was

negative. On the basis of this study we believe that leukocyte

esterase activity is sufficiently sensitive and specific to permit

use of this test as a rapid and inexpensive screening procedure for

vaginitis and urinary tract infections.

PMID: 4052183 [PubMed - indexed for MEDLINE]

* * * * * * * * * * * * * * * * * * * * * * * * * * *

Chlamydia, mycoplasmas, ureaplasmas, and yeasts in the lower genital

tract of females. Comparison between a group attending a venereal

disease clinic and a control group.

Moller BR, Sparre nsen A, From E, Stenderup A.

Acta Obstet Gynecol Scand. 1985;64(2):145-9.

162 women were investigated. Group I consisted of 85 women, who were

partners to men with non-gonococcal urethritis (NGU) or presented

macroscopic signs of cervicitis; patients who had harbored Neisseria

gonorrhoeae were excluded from the study. Group II was a control

group of 77 women without any complaints from the urogenital tract

and with normal findings at pelvic examination.

All the women were tested for infection with Chlamydia trachomatis,

Mycoplasma hominis, Ureaplasma urealyticum, and Candida albicans.

In group I, chlamydiae and mycoplasmas were recovered in 44% and 36%,

respectively, the corresponding figures for the control group (group

II) being 5% and 19%. The difference is highly significant. No such

difference between the two groups was found for ureaplasmas. Sixteen

percent of the patients in group I were positive for C. albicans; 12%

were positive in group II. Fifty per cent of asymptomatic NGU-

partners were chlamydia-positive, and about one-third of patients

with either dysuria or vaginal discharge harbored the organism. No

difference in the isolation frequency of mycoplasmas was observed

between asymptomatic partners to male NGU carriers and women with

increased vaginal discharge, whereas the organism was isolated more

frequently from patients with dysuria. Fifty-nine per cent of

patients with cervicitis were chlamydia-positive, compared with 30%

of patients with normal cervical appearance and normal vaginal

discharge.

Samples obtained from the cervix were more often positive than

samples from the urethra. In conclusion, if samples can be taken from

only one of the two sites in patients with lower genital tract

infection, the cervix is the optimal sampling site.

PMID: 3885669 [PubMed - indexed for MEDLINE]

* * * * * * * * * * * * * * * * * * * * * * * * * * *

Occurrence and pathogenicity of Mycoplasma hominis in the upper

urinary tract: a review.

Thomsen AC.

Sex Transm Dis. 1983 Oct-Dec;10(4 Suppl):323-6.

In two studies Mycoplasma hominis was isolated from the upper urinary

tracts of seven of 80 patients with symptoms of acute pyelonephritis

(is a bacterial infection of the kidney) and three of 18 patients

with signs of acute exacerbation of chronic pyelonephritis. M.

hominis was not recovered from the upper urinary tract of 22 patients

with chronic pyelonephritis without acute exacerbation or from 60

patients with noninfectious urinary tract disease. In an additional

study, specimens were cultured from patients with antibodies to M.

hominis in urine. All of these patients had acute pyelonephritis; M.

hominis was isolated from the upper urinary tract of seven patients.

Thus, M. hominis was cultured from the upper urinary tract of a total

of 17 patients. No other microorganisms were recovered from 12 of

these patients. The titer of antibody to M. hominis significantly

increased or decreased in the serum of 13 patients, and antibodies

were demonstrated in the urine of nine. These results suggest that M.

hominis may be a cause of acute pyelonephritis in humans; the

organism is estimated to account for approximately 5% of such cases.

The clinical signs of infection in the patients studied were subtle,

and the symptoms did not involve the lower urinary tract. The

diagnosis of acute pyelonephritis due to M. hominis can be

established by culture of the organism from the upper urinary tract

and its likely if antibodies are present in urine; in contrast,

culture of M. hominis from catheter-collected urine or detection of a

serum antibody response is not sufficient evidence for this diagnosis.

Publication Types: Review

PMID

* * * * * * * * * * * * * * * * * * * * * * * * * * *

Association of genital mycoplasmas with exudative vaginitis in a 10

year old (who had been sexually molested) : a case of misdiagnosis.

Waites KB, Brown MB, Stagno S, Schachter J, Greenberg S, Hemstreet

GP, Cassell GH.

Pediatrics. 1983 Feb;71(2):250-2.

A 10-year-old girl with a 1-year history of lower genitourinary tract

symptoms suggestive of bacterial infection but with numerous negative

urine cultures was referred to the University of Alabama urology

clinic after empirical treatment with multiple antibiotics failed to

resolve her symptoms. An extensive urologic evaluation revealed no

structural or physiologic abnormalities, but an exudative vaginitis

was noted and large numbers of Ureaplasma urealyticum and Mycoplasma

hominis were isolated from the lower genital tract. Cultures for

Chlamydia, viruses, and routine bacterial pathogens were negative.

After initiation of tetracycline therapy, symptoms resolved and

subsequent cultures for mycoplasmas were negative. In addition, a

seroconversion was noted for M hominis but not for U urealyticum.

Chlamydia serology was negative.

It was later learned that the patient had been sexually molested just

prior to the onset of symptoms. This case illustrates the necessity

of early consideration of a mycoplasmal etiology in the patient with

persistent genitourinary symptoms and no obvious bacterial pathogen,

or in the patient whose condition is refractory to routine antibiotic

therapy.

Publication Types: Case Reports

PMID: 6823429 [PubMed - indexed for MEDLINE]

* * * * * * * * * * * * * * * * * * * * * * * * * * *

Chronic cystitis and urethritis associated with ureaplasmal and

mycoplasmal infection in primary hypogammaglobulinaemia.

Webster AD, - D, Furr PM, Asherson GL.

Br J Urol. 1982 Jun;54(3):287-91.

Six of 58 patients with primary hypogammaglobulinaemia developed

chronic urethritis and/or cystitis. We have some evidence that this

complication may be caused by infection with strains R of Ureaplasma

urealyticum. This is important because ureaplasmas are usually

resistant to most antibiotics routinely used to treat lower urinary

tract infections. It appears that hypogammaglobulinaemic patients

develop less localised and more severe ureaplasmal infections than

immunocompetent subjects, which indicates that antibodies are

important in controlling the growth of these organisms in the bladder

and urethra.

Publication Types: Case Reports

PMID: 7104592 [PubMed - indexed for MEDLINE]

* * * * * * * * * * * * * * * * * * * * * * * * * * *

Diagnosis of Mycoplasma hominis pyelonephritis by demonstration of

antibodies in urine.

Thomsen AC, Lindskov HO.

J Clin Microbiol. 1979 Jun;9(6):681-7.

To evaluate the diagnostic significance of the demonstration in urine

of antibodies to Mycoplasma hominis, 1,000 samples of urine with more

than 5 leukocytes per high-power field were serologically

investigated by indirect hemagglutination, using glutaraldehyde-fixed

erythrocytes coated with M. hominis antigen. The samples were

collected from 702 patients. Antibodies were demonstrated in the

urine of nine patients, all of whom had signs of acute attack of

pyelonephritis. In seven of these patients, characterized by mild or

moderate clinical signs and absence of lower urinary tract symptoms,

bacterial causes were not observed, whereas M. hominis organisms were

isolated from the upper urinary tract in most cases and from the

bladder urine in all cases. In two patients, characterized by severe

clinical signs and presence of lower urinary tract symptoms, both M.

hominis and bacteria were isolated from the upper urinary tract and

ballder urine. The demonstration of antibodies to M. hominis in urine

is of high diagnostic value as they were only observed in patients in

whom M. hominis infection in the upper urinary tract was evident or

likely and only in the presence of clinical signs of acute attacks of

pyelonephritis.

PMID: 500801 [PubMed - indexed for MEDLINE]

* * * * * * * * * * * * * * * * * * * * * * * * * * *

Microbial flora of the lower genital tract during pregnancy:

relationship to morbidity.

de Louvois J, Hurley R, Stanley VC.

J Clin Pathol. 1975 Sep;28(9):731-5.

Nineteen genera and groups of micro-organisms were isolated from the

lower genital tract of 280 women at their first antenatal visit.

Chlamydia, viruses, and T-strain mycoplasmas were not sought, and

only routine methods of anaerobic culture were used. Growth was

recorded as scanty, moderate or heavy. The population studied was

grouped according to age, parity, gestational stage at booking,

presence and degree of severity of lower genital tract morbidity,

past history of vulvovaginitis, and suspicion of lower genital tract

morbidity as evidenced by a request for a report on the

microbiological findings. The frequency of isolation of the various

microbes in health and in disease is given. The grading of Gram-

stained smears bore no relation to the isolation rates of

lactobacilli, but there was a significant increase (p less than 0-

001) in the isolation rates of each of the following: Mycoplasma

hominis, Bacteroides spp., Trichomonas vaginalis, Gram-variable cocco-

bacilli, and anaerobic streptococci in those patients with smears in

which lactobacilli were adjudged to be absent. The isolation of

faecal streptococci was increased (p less than 0-001) in women aged

more than 34 years. Escherichia coli (p less than 0-05) and anaerobic

and microaerophilic streptococci (p less than 0-02) were isolated

more frequently from those booking after the 25th week of pregnancy.

The incidence of M. hominis (p less than 0-02) and of anaerobic

streptococci (p less than 0-05) increased between the first and third

trimesters. No significance positive correlations were established

between the isolation rates of the various microbes and objective

assessment of lower genital tract morbidity or the demonstration of

pus cells, but lactobacilli were isolated less frequently (p less

than 0-01) from those with morbidity. The isolation of Candida

albicans (p less than 0-02), T. vaginalis (p less than 0-05), and M.

hominis (p less than 0.05) was increased in patients in whom

vulvovaginitis was suspected, and that of T. vaginalis (p less than 0-

05) was increased in those with a past history of vulvovaginitis. The

study indicates that, other than the pathogens T. vaginalis and C.

albicans, only M. Hominis could be suspected, on statistical grounds,

of being associated with disease of the lower genital tract during

early pregnancy.

PMID: 1100681 [PubMed - indexed for MEDLINE]

* * * * * * * * * * * * * * * * * * * * * * * * * * *

FREE BROCHURE: " How to Get an Accurate Polymerase Chain Reaction (PRC)

Blood Test for Mycoplasmal and Other Infections-with a List of

is sent automatically and immediately to all new subscribers. It is

updated with current information and the new version is posted to the

Mycoplasma Registry Reports & News list each month.

<MycoplasmaRegistry-subscribe >

<MycoplasmaRegistry-owner >

FAIR USE: In accordance with Title 17 U.S.C. Section 107, this

material is distributed without profit to those who have expressed a

prior interest in receiving the included information for research and

educational purposes. The Mycoplasma Registry has no affiliation with

the originator of this article nor is the Mycoplasma Registry

endorsed or sponsored by the originator. If you wish to use

copyrighted material from this site for purposes of your own that go

beyond 'fair use', you must obtain permission from the copyright

owner.

* * * * * * * * * * * * * * * * * * * * * * * * * * *

July 13, 2006

This is interesting, and I don't know whether it belongs in this posting, but

I have AS that is caused by a different bacterium than any mentioned here--and a

different focus of infection.

Professor (emeritus) Alan Ebringer, Kings College devised a test to

differentiate RA from AS and found that every subject with RA had a pathogen not

mentioned here. Later, he studied BSE and this may have led to a breakthrough

in MS research; Mad Cow is apparently an autoimmune disease, and not caused by

prions. The professor has suggested that he will eat any steak (best cuts,

please) from any certified Mad Cow.

These diseases may be due to a molecular mimicry reaction that causes the

autoimmune response:

RA: Usually after a UTI due to Proteus mirabilis (majority of UTIs are E.

coli) and elevated IgG-Pm can be measured; focus of infection is urinary tract

and most common in tissue types HLA DR 1/DR4.

AS/ReA/CD: Due to LGS and reaction to Klebsiella pneumoniae--elevated IgA-Kp

focus of infection is entire digestive system, but typical lesions are at the

ileocecal junction (higher for Crohn's and lower for Reiter's).

MS/BSE/kuru/vCJD: Acinetobacter calcoaceticus may infect the sinus cavities

and cause an immunoglobulin response that results in systemic neurological

damage. In aggressive forms of MS, such as vCJD there may be other bacteria

involved or a more susceptible genetic component. Other pathogens have been

suspected in MS, and treated, in certain individuals, with some success using

powerful broad-spectrum antibiotics.

I am glad that some of this information is being studied, but just wondering

about the germ connection with RA, and I don't want to discount Dr. Brown's

discoveries or the work of those physicians following his successes. I have

only proven the AS-Kp connection for myself, although others have done Giraud

's regimen for 'arthritis' and have had success with this type of

anti-inflammatory diet. Certainly, diet and lifestyle are major components in

many or most chronic diseases.

Best Regards,

Mycoplasma Registry GWI & CFS <mycoreg@...> wrote: