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“Genital Mikoplazma” sıklığının multipleks gerçek zamanlı polimeraz zincir reaksiyonu ile saptanması: Klinikte önemli olabilir mi?

Amaç: Genital mikoplazma etkenleri, erişkinve infantlarda birçok enfeksiyon ile ilişkilidir. Bunedenle etkenlerin doğru ve hızlı tanısı önemlidir.Kültür yöntemlerinde karşılaşılan sorunlar vemikoplazmaların fastidiyöz özellik taşıması nedeniyle,günümüzde enfeksiyöz ajanların tanısında yaygın olarakkullanılan moleküler yöntemler genital mikoplazmaenfeksiyonlarının tanısında da kullanılabilmektedir. Buçalışmada merkezimize rutin tanı amacıyla gönderilensemptomatik hastalarda Multipleks Gerçek ZamanlıPolimeraz Zincir Reaksiyonu ile genital mikoplazmasıklığının araştırılması amaçlanmıştır.Yöntem: Ocak 2016-Aralık 2017 tarihleri arasındaHalk Sağlığı Genel Müdürlüğü, Cinsel Yolla BulaşanHastalıklar Referans Laboratuvarı’na tanı amacıylagönderilen, 0-72 yaş olguları içeren 359 semptomatikhastaya (179 kadın, 180 erkek) ait ürogenital örnekçalışmaya dahil edilmiştir. Toplam 359 hastaya aitakıntı veya idrar örneğinden Mycoplasma hominis,Mycoplasma genitalium, Ureaplasma urealyticum,Ureaplasma parvum ticari Gerçek Zamanlı PZR testi ileçalışılmıştır.Bulgular: Toplam 359 hastanın %25,62’sinin(92/359) tek ve çoklu etken ile kolonize olduğu tespitedilmiştir. Çoklu etken pozitifliği 18 (%5) hastadasaptanmıştır. Ureaplazma pozitif örneklerin %52,70(39/74)’i U. parvum, %47,3 (35/74)’i U. urealyticum;Mikoplazma pozitif hastaların ise %81,08 (30/37)’i M.hominis ve %18,92 (7/37)’si M. genitalium olaraktespit edilmiştir. Kadınlarda U. parvum ve erkeklerdeU. urealyticum sıklığının diğer etkenlere göre dahayüksek olduğu tespit edilmiştir. M. hominis, M.genitalium ve U. parvum en fazla 30-34 yaş grubundagörülürken, U. urealyticum 18-24 yaş grubundagörülmüştür..Sonuç: Genital mikoplazmaların patojenik rolününgittikçe arttığı kabul edildiğinden, semptomatikolgularda enfeksiyon etkenleri araştırılırkengenital mikoplazmaların akılda tutulmasıgerektiği düşünülmüştür. Ayrıca, erken tedavi vekomplikasyonların zamanında önlenebilmesi içinduyarlılık ve özgüllüğü yüksek olan tanı metodlarınınkullanılarak etkenlerin ayırımının yapılması gerektiğidüşüncesine varılmıştır.

Detection of “Genital Mycoplasma” incidence by multiplex real-time polymerase chain reaction: Could it be clinically important?

Objective: Genital mycoplasma agents are associated with many infections in adults and infants. Therefore rapid and accurate diagnosis of the agents is important. Molecular methods commonly used in the diagnosis of infectious agents can also be used to diagnose genital mycoplasma infections because of the problems encountered in culture methods and the fastidious characteristic of mycoplasmas. In this study, it was aimed to investigate the frequency of genital mycoplasma with multiplex Real Time Polymerase Chain Reaction in symptomatic patients sent to our center for routine diagnosis. Methods: Urogenital samples of 359 symptomatic patients (179 women, 180 men) aged 0-72 years, sent to the Public Health General Directorate, Sexually Transmitted Diseases Reference Laboratories for diagnosis between January 2016 and December 2017 were included in the study. Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma urealyticum, Ureaplasma parvum were investigated by commercially available Real-Time PCR test from urine or discharge samples of 359 patients. Results: It was determined that 25.62% (92/359) of 359 patients were colonized with single and multiple agents. Multiple agents positivity was detected in 18 patients (5%). Among Ureaplasma positive patients 52.70% (39/74) of them were detected as U. Parvum and % 47, 3 (35/74) of them as U. urealyticum. Among mycoplasma positive patients 81.08% (30/37) of them were detected as M. hominis and 18.92% (7/37) of them were detected as M. genitalium. U. parvum and U. urealyticum were found to be the most frequent agents in females and males respectively. M. hominis, M. genitalium and U. parvum were most commonly present in the 30-34 ages group, while U. urealyticum was mostly detected in the 18-24 ages group. Conclusion: In conclusion, since the pathogenic role of genital mycoplasma agents is increasingly accepted, it is considered that genital mycoplasmas should be kept in mind while investigating the infection agents during symptomatic cases. It has been thought that for early treatment and for the prevention of complications in a timely manner, it is necessary to differentiate the agents by using highly sensitive and specific methods.

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1. D’Inzeo T, Angelis GD, Fiori B, Menchinelli G, Liotti FM, Morandotti GA, et al. Comparison of Mycoplasma IES, Mycofast Revolution and Mycoplasma IST2 to detect genital mycoplasmas in clinical samples. J Infect Dev Ctries, 2017; 11(1): 98-101.
2. Bayraktar MR, Ozerol IH, Gucluer N, Celik O. Prevalence and antibiotic susceptibility of Mycoplasma hominis and Ureaplasma urealyticum in pregnant women. J Int Dis, 2010; 14: 90-5.
3. Stellrecht KA, Woron AM, Mishrik NG, Venezia RA. Comparison of multiplex PCR assay with culture for detection of genital mycoplasmas. J Clin Microbiol, 2004; 42(4): 1528–33.
4. Redelinghuys MJ, Ehlers MM, Dreyer AW, Lombaard HA, Kock MM. Antimicrobial susceptibility patterns of Ureaplasma species and Mycoplasma hominis in pregnant women. BMC Infect Dis, 2014; 14: 171.
5. Strauss M, Colodner R, Sagas D, Adawi A, Edelstein H, Chazan B. Detection of Ureaplasma Species by a Semi-Quantitative PCR Test in Urine Samples: Can It Predict Clinical Significance? Isr Med Assoc J, 2018; 1(20): 9-13.
6. Vica ML, Junie LM, Tataru A, Grad AI, Matei HV. Simultaneous PCR-based detection of six pathogens inducing sexually transmitted diseases. J Clin Lab Invest, 2015; 3: 11-6.
7. Foschi C, Salvo M, Galli S, Moroni A, Cevenini R, Marangoni A. Prevalence and antimicrobial resistance of genital mollicutes in Italy over a two-year period. New Microbiol 2018; 41(1) (Basım aşamasında).
8. VGovender S, Theron GB, Odendaal HJ, Chalkley LJ. Prevalence of genital mycoplasmas, ureaplasmas and chlamydia in pregnancy. J Obstet Gynaecol, 2009; 29: 698–701.
9. Taylor-Robinson D, Jensen JS. Mycoplasma genitalium from Chrysalis to multicolored butterfly. Clin Microbiol Rev, 2011; 24: 498–514.
10. Leli C, Mencacci A, Bombaci JC, D’Alò F, Farinelli S, Vitali M et al. Prevalence and antimicrobial susceptibility of Ureaplasma urealyticum and Mycoplasma hominis in a population of Italian and immigrant outpatients. Infez Med, 2012; 20: 82- 7.
11. De Francesco MA, Caracciolo S, Bonfanti C, Manca N. Incidence and antibiotic susceptibility of Mycoplasma hominis and Ureaplasma urealyticum isolated in Brescia, Italy, over 7 years. J Infect Chemother, 2013; 19: 621–7.
12. Ito S, Tsuchiya T, Yasuda M, Yokoi S, Nakano M, Deguchi T. Prevalence of genital mycoplasmas and ureaplasmas in men younger than 40 years-of-age with acute epididymitis. Int J Urol, 2012; 19: 234-8.
13. Saigal K, Dhawan B, Rawre J, Khanna N, Chaudhry R.. Genital Mycoplasma and Chlamydia trachomatis infections in patients with genital tract infections attending a tertiary care hospital of North India. Indian J Pathol Microbiol, 2016; 59(2): 194-6.
14. Ishihara S, Yasuda M, Ito S, Maeda S, Deguchi T. Mycoplasma genitalium urethritis in men. Int J Antimicrob Agents, 2004; 24 (1): 23-7.
15. McIver CJ, Rismanto N, Smith C, Naing ZW, Rayner B, Lusk MJ et al. Multiplex PCR testing detection of higher-than-expected rates of cervical mycoplasma, ureaplasma, and trichomonas and viral agent infections in sexually active australian women. J Clin Microbiol, 2009; 47(5): 1358-63.
16. Kataoka S, Yamada T, Chou K, Nishida R, Morikawa M, Minami M et al. Association between preterm birth and vaginal colonization by mycoplasmas in early pregnancy. J Clin Microbiol, 2006; 44: 51–5.
17. Schlicht MJ, Lovrich SD, Sartin JS, Karpinsky P, Callister SM, Agger WA. High prevalence of genital mycoplasmas among sexually active young adults with urethritis or cervicitis symptoms in La Crosse, Wisconsin. J Clin Microbiol, 2004; 42: 4636–40.
18. Jensen JS, Uldum SA, Søndergård-Andersen J, Vuust J, Lind K. Polymerase chain reaction for detection of Mycoplasma genitalium in clinical samples. J Clin Microbiol, 1991; 29: 46-50.
19. Maleki S , Motamedi H, Moosavian SM, Shahbaziyan N. Frequency of Mycoplasma hominis and Ureaplasma urealyticum in females with urogenital infections and habitual abortion history in Ahvaz Iran: Using Multiplex PCR. Jundishapur J Microbiol, 2013; 6(6): e10088.
20. Yeganeh O, Jeddi-Tehrani M, Yaghmaie F, Kamali K, Heidari-Vala H, Zeraati H et al. Genitalium infections in symptomatic and asymptomatic men referring to Urology Clinic of Labbafinejad Hospital, Tehran, Iran. Iran Red Crescent Med J, 2013; 15(4): 340–4.
21. Kotrotsiou T, Exindari M, Diza E, Gioula G, Melidou A, Kaplanis K et al. Prevalence and antimicrobial susceptibility of Ureaplasma urealyticum in asymptomatic women in Northern Greece. Hippokratia, 2013; 17: 319-21.
22. Esen B, Gozalan A, Sevindi DF, Demirbas A, Onde U, Erkayran U et al. Ureaplasma urealyticum: Presence among Sexually Transmitted Diseases. Jpn J Infect Dis, 2017; 70: 75–9.
23. Patel MA, Nyirjesy P: Role of Mycoplasma and Ureaplasma species in female lower genital tract infections. Curr Infect Dis Rep, 2010; 12(6): 417-22.
24. Choe HS, Lee DS, Lee SJ, Hong SH, Park DC, Lee MK et al. Performance of Anyplex™ II multiplex real-time PCR for the diagnosis of seven sexually transmitted infections: comparison with currently available methods. Int J Infect Dis, 2013; 17(12): e1134-40.