Fatal course of a mycoplasma hominis- and ureaplasma urealyticum-meningitis in a very low birth weight infant

Introduction: 53% of pregnant women are colonised with mycoplasma hominis, 80% with ureaplasma urealyticum. Neonatal transmission rate depends on birth weight and is up to 88% for preterm infants <1000g birth weight. We present a newborn of 27 gestational weeks with meningitis by both organisms.

Case Report: A preterm infant of 27 gestational weeks showed rapid progressive hydrocephalus internus with seizures after low grade intraventricular hemorrhage in the second week of life. After implantation of a ventricle drainage CSF revealed pathologic findings (331 cells/µl, 76% neutrophils, protein 557mg/dl, lactate 4.1mmol/l), CrP in blood samples was increasing (221mg/l). CSF cultures and PCR identified mycoplasma hominis and ureaplasma urealyticum. Additional treatment with ciprofloxacine (6mg/kg/12h) under monitoring of serum levels did not improve the clinical situation. CSF cultures and PCR remained positive. The clinical course was complicated by a discontinuating status epilepticus. Anticonvulsive therapy with pyridoxine, phenobarbital, diazepam, midazolam, phenytoin, propofol and thiopental was ineffective. Due to the clinical deterioration in this extremely preterm infant, intensive care treatment was stopped at this point.

Discussion: Meningitis by mycoplasma hominis and ureaplasma urealyticum in preterm infants is rare (McDonald et al., 1988). In unusual clinical courses, especially with the combination of hydrocephalus internus, seizures and signs of an infection, a CNS-affection with mycoplasms or ureaplasms should be considered. An empiric recommendation for antibiotic treatment, especially in preterm newborns, is not existing. There are few case reports with different antibiotic strategies and outcomes. Ciprofloxacine was ineffective in our case. There are no reports on effectiveness and safety in treatment with newer antibiotics like moxifloxacine yet.