Meningitis in a Chinese adult patient caused by Mycoplasma hominis: a rare infection and literature review

Abstract

Background: Mycoplasma hominis, a well known cause of neonatal infection, has been reported as a pathogen in urogenital infections in adults; however, central nervous system (CNS) infections are rare. We report here the first case of M. hominis meningitis in China, post neurosurgical treatment for an intracerebral haemorrhage in a 71-year-old male.

Case presentation: We describe a 71-year-old man who developed M. hominis meningitis after neurosurgical treatment and was successfully treated with combined azithromycin and minocycline therapy of 2 weeks duration, despite delayed treatment because the Gram stain of cerebrospinal fluid (CSF) yielded no visible organisms. The diagnosis required 16S rDNA sequencing analysis of the cultured isolate from CSF. Literature review of M. hominis CNS infections yielded 19 cases (13 instances of brain abscess, 3 of meningitis, 1 spinal cord abscess and 1 subdural empyema each). Delay in diagnosis and initial treatment failure was evident in all cases. With appropriate microbiological testing, antibiotic therapy (ranging from 5 days to 12 weeks) and often, multiple surgical interventions, almost all the patients improved immediately.

Conclusions: Both our patient findings and the literature review, highlighted the pathogenic potential of M. hominis together with the challenges prompted by rare infectious diseases in particular for developing countries laboratories with limited diagnostic resources.

Keywords: Case report; Hospital acquired pneumonia; Meningitis; Mycoplasma hominis; Post-operative infection.

Fig. 1

Computed tomography (CT) scans of the patient’s brain and lung during hospitalization. a. Cerebral CT scan revealed an extensive left hematoma in the temporal region of the hemispheres and moderate lateral ventricle enlargement with a drainage tube in it. The hematoma was surrounded by brain edema, narrowed gyri and the right–shifted cranial midline. b. Thoracic CT scan (lung windows) revealed a cavity with a wall of 7-mm thick surrounded by patchy shadowing in the right lower lobe. c. After 30 days of therapy, resolving brain swelling was seen in the CT scan with decreased edema. d. After 30 days of therapy, thoracic CT scan (lung window) revealed that the area of cavitation had decreased substantially

Fig. 2

The correlation between the change of body temperature and the use of antibiotics during hospitalization

Fig. 3

Non-hemolytic, semi-translucent pinpoint colonies of M. hominis were shown on 5 % blood sheep agar after 4 days of incubation