Diagnosis and treatment of mycoplasmal septic arthritis: a systematic review

  • Y. Chen
  • Z. Huang
  • X. Fang
  • W. Li
  • B. Yang
  • W. ZhangEmail author
Review Article



Septic arthritis caused by Mycoplasma is rare. The diagnosis and effective treatment of mycoplasmal septic arthritis remains a serious problem for clinicians. The aim of this systematic review was to document the available evidence on the diagnosis and treatment methods for mycoplasmal septic arthritis and to provide guidance for clinicians.


The PubMed, EMBASE, and Cochrane Library databases were searched in December 2018.The searches were limited to the English language. Article screening and data extraction and compilation were conducted by two independent reviewers. All the included studies were assessed using the Methodological Index for Non-randomized Studies (MINORS) tool.


There was a total of 33 articles including 34 cases of mycoplasmal septic arthritis and eight of them were periprosthetic joint infection (PJI). Twenty-four patients (70.6%) were immunocompromised, and the synovial fluid white blood cell (WBC) count was significantly lower in the immunocompromised group than in the immunocompetent group (48,527 × 106/L vs. 100,640 × 106/L; P = 0.009). The traditional culture method took longer, and the positivity rate was lower than that of nucleic acid testing (50% vs. 100%; P = 0.016). Only 19.2% (5/26) of patients treated with empiric antibiotics were relieved of symptoms, while 82.4% (28/34) of patients achieved satisfactory results after being treated with antibiotics against Mycoplasma.


The possibility of mycoplasmal septic arthritis should be considered if patients with joint infections have a history of immunocompromised, repeated negative cultures, and poor empiric antibiotic treatment results. The rational use of nucleic acid testing technologies can help in the clinical diagnosis and treatment of mycoplasmal septic arthritis.


Mycoplasmal septic arthritis Periprosthetic joint infection Immunocompromise Nucleic acid testing 


Funding information

This paper is supported by Natural Science Foundation of Fujian Province (grant numbers 2018I0006, 2019I0011, and 2018Y4003).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Bariteau JT, Waryasz GR, McDonnell M, Fischer SA, Hayda RA, Born CT (2014) Fungal osteomyelitis and septic arthritis. J Am Acad Orthop Surg 22:390–401. CrossRefPubMedGoogle Scholar
  2. 2.
    Marks M, Marks JL (2016) Viral arthritis. Clinical medicine 16:129–134. CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Kurtz SM, Ong KL, Lau E, Bozic KJ, Berry D, Parvizi J (2010) Prosthetic joint infection risk after TKA in the Medicare population. Clin Orthop Relat Res 468:52–56. CrossRefPubMedGoogle Scholar
  4. 4.
    Ong KL, Kurtz SM, Lau E, Bozic KJ, Berry DJ, Parvizi J (2009) Prosthetic joint infection risk after total hip arthroplasty in the Medicare population. J Arthroplast 24:105–109. CrossRefGoogle Scholar
  5. 5.
    Wang DA, Tambyah PA (2015) Septic arthritis in immunocompetent and immunosuppressed hosts. Best Pract Res Clin Rheumatol 29:275–289. CrossRefPubMedGoogle Scholar
  6. 6.
    Zeller V, Kerroumi Y, Meyssonnier V, Heym B, Metten MA, Desplaces N, Marmor S (2018) Analysis of postoperative and hematogenous prosthetic joint-infection microbiological patterns in a large cohort. J Infect 76:328–334. CrossRefPubMedGoogle Scholar
  7. 7.
    Cassell GHCBC (1981) Mycoplasmas as agents of human disease. N Engl J Med 304:80–89CrossRefGoogle Scholar
  8. 8.
    George MD, Cardenas AM, Birnbaum BK, Gluckman SJ (2015) Ureaplasma septic arthritis in an immunosuppressed patient with juvenile idiopathic arthritis. J Clin Rheumatol 21:221–224. CrossRefPubMedGoogle Scholar
  9. 9.
    Franz A, Webster AD, Furr PM, Taylor-Robinson D (1997) Mycoplasmal arthritis in patients with primary immunoglobulin deficiency: clinical features and outcome in 18 patients. Rheumatology 36:661–668. CrossRefGoogle Scholar
  10. 10.
    van Doornum GJ, Schutten M, Voermans J, Guldemeester GJ, Niesters HG (2007) Development and implementation of real-time nucleic acid amplification for the detection of enterovirus infections in comparison to rapid culture of various clinical specimens. J Med Virol 79:1868–1876. CrossRefPubMedGoogle Scholar
  11. 11.
    Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. ANZ J Surg 73:712–716. CrossRefGoogle Scholar
  12. 12.
    Hu S, Singh M, Wong J, Auckley D, Hershner S, Kakkar R, Thorpy MJ, Chung F (2018) Anesthetic management of narcolepsy patients during surgery: a systematic review. Anesth Analg 126:233–246. CrossRefPubMedGoogle Scholar
  13. 13.
    Thoendel M, Jeraldo P, Greenwood-Quaintance KE, Chia N, Abdel MP, Steckelberg JM, Osmon DR, Patel R (2017) A novel prosthetic joint infection pathogen, Mycoplasma salivarium, identified by metagenomic shotgun sequencing. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 65:332–335. CrossRefGoogle Scholar
  14. 14.
    Buchsel M, Pletschen L, Fleiner M, Hacker G, Serr A (2016) A case of septic arthritis caused by a Mycoplasma salivarium strain resistant towards ciprofloxacin and clarithromycin in a patient with chronic lymphatic leukemia. Diagn Microbiol Infect Dis 86:115–117. CrossRefPubMedGoogle Scholar
  15. 15.
    Smith BJ, Crowe A, Comahig J, Sheorey H, Stanley P (2016) A 27-year-old woman with an unusual cause of periprosthetic joint infection. Clin Infect Dis 62:1463. CrossRefPubMedGoogle Scholar
  16. 16.
    Westley BP, Horazdovsky RD, Michaels DL, Brown DR (2016) Identification of a novel mycoplasma species in a patient with septic arthritis of the hip and seal finger. Clin Infect Dis 62:491–493. CrossRefPubMedGoogle Scholar
  17. 17.
    Wynes J, Harris W, Hadfield RA, Malay DS (2013) Subtalar joint septic arthritis in a patient with hypogammaglobulinemia. J Foot Ankle Surg 52:242–248. CrossRefPubMedGoogle Scholar
  18. 18.
    Sato H, Iino N, Ohashi R, Saeki T, Ito T, Saito M, Tsubata Y, Yamamoto S, Murakami S, Kuroda T, Tanabe Y, Fujisawa J, Murai T, Nakano M, Narita I, Gejyo F (2012) Hypogammaglobulinemic patient with polyarthritis mimicking rheumatoid arthritis finally diagnosed as septic arthritis caused by Mycoplasma hominis. Intern Med 51:425–429. CrossRefPubMedGoogle Scholar
  19. 19.
    Vlachou M, Dialyna P, Bartsocas C, Dimitriadis D (2012) Iotanflammatory or septic arthritis associated with mycoplasma pneumonia in children: two case reports and review of the literature. Eur J Orthop Surg Traumatol 22:721–726. CrossRefPubMedGoogle Scholar
  20. 20.
    Wu TS, Yu KH, Kuo AJ, Chia JH, Lu SC, Leu HS, Huang CT (2012) Mycoplasma hominis septic arthritis with concomitant gouty arthritis. J Clin Rheumatol 18:411–412. CrossRefPubMedGoogle Scholar
  21. 21.
    Han Z, Burnham CA, Clohisy J, Babcock H (2011) Mycoplasma pneumoniae periprosthetic joint infection identified by 16S ribosomal RNA gene amplification and sequencing: a case report. J Bone Joint Surg Am 93:e103. CrossRefPubMedGoogle Scholar
  22. 22.
    MacKenzie CR, Nischik N, Kram R, Krauspe R, Jager M, Henrich B (2010) Fatal outcome of a disseminated dual infection with drug-resistant Mycoplasma hominis and Ureaplasma parvum originating from a septic arthritis in an immunocompromised patient. Int J Infect Dis 14(Suppl 3):e307–e309. CrossRefPubMedGoogle Scholar
  23. 23.
    Phuah CL, Javid B, Aliyu SH, Lever AM (2007) A case of Mycoplasma hominis septic arthritis postpartum. J Infect 55:e135–e137. CrossRefPubMedGoogle Scholar
  24. 24.
    Mian AN, Farney AC, Mendley SR (2005) Mycoplasma hominis septic arthritis in a pediatric renal transplant recipient: case report and review of the literature. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg 5:183–188. CrossRefGoogle Scholar
  25. 25.
    Sendi P, Zimmerli W, Michot M (2004) Spondylitis and arthritis due to Mycoplasma hominis: the case for awareness in undefined pleuropneumonia. Clin Infect Dis 39:1250–1251. CrossRefPubMedGoogle Scholar
  26. 26.
    O’Sullivan MVINM, Johnson DW, Rencken K, Byrne S, Graham MM, Playford EG (2004) Disseminated pyogenic Mycoplasma pneumoniae infection in a renal transplant recipient, detected by broad-range polymerase chain reaction. Clin Infect Dis 39:e98–e99CrossRefGoogle Scholar
  27. 27.
    Lapusan DLDL, Hamilos DL (2001) Disseminated septic arthritis in a patient with common variable hypogammaglobulinemia. Ann Allergy Asthma Immunol 86:368–372CrossRefGoogle Scholar
  28. 28.
    Asmar BI, Andresen J, Brown WJ (1998) Ureaplasma urealyticum arthritis and bacteremia in agammaglobulinemia. Pediatr Infect Dis J 17:73–76. CrossRefPubMedGoogle Scholar
  29. 29.
    Frangogiannis NG, Cate TR (1998) Endocarditis and Ureaplasma urealyticum osteomyelitis in a hypogammaglobulinemic patient. A case report and review of the literature. J Infect 37:181–184. CrossRefPubMedGoogle Scholar
  30. 30.
    Garcia-Porrua C, Blanco FJ, Hernandez A, Atanes A, Galdo F, Moure R, Alonso A (1997) Septic arthritis by Mycoplasma hominis: a case report and review of the medical literature. Ann Rheum Dis 56:699–700. CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Bonilla HF, Chenoweth CE, Tully JG, Blythe LK, Robertson JA, Ognenovski VM, Kauffman CA (1997) Mycoplasma felis septic arthritis in a patient with hypogammaglobulinemia. Clin Infect Dis 24:222–225. CrossRefPubMedGoogle Scholar
  32. 32.
    Steuer A, Franz A, Furr PM, Taylor-Robinson D, Webster ADB, Hughes GRV (1996) Common variable immunodeficiency presenting as a Mycoplasma hominis septic arthritis. J Inf Secur 33:235–237. CrossRefGoogle Scholar
  33. 33.
    Luttrell LM, Kanj SS, Corey GR, Lins RE, Spinner RJ, Mallon WJ, Sexton DJ (1994) Mycoplasma hominis septic arthritis: two case reports and review. Clin Infect Dis 19:1067–1070. CrossRefPubMedGoogle Scholar
  34. 34.
    Clough W, Cassell GH, Duffy LB, Rinaldi RZ, Bluestone R, Morgan MA, Meyer RD (1992) Septic arthritis and bacteremia due to Mycoplasma resistant to antimicrobial therapy in a patient with systemic lupus erythematosus. Clin Infect Dis 15:402–407. CrossRefPubMedGoogle Scholar
  35. 35.
    Lehmer RR, Andrews BS, Robertson JA, Stanbridge EJ, de la Maza L, Friou GJ (1991) Clinical and biological characteristics of Ureaplasma urealyticum induced polyarthritis in a patient with common variable hypogammaglobulinaemia. Ann Rheum Dis 50:574–576. CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Nylander N, Tan M, Newcombe DS (1989) Successful management of Mycoplasma hominis septic arthritis involving a cementless prosthesis. Am J Med 87:348–352. CrossRefPubMedGoogle Scholar
  37. 37.
    Jorup-Rönström C, Ahl T, Hammarström L, Smith CIE, Rylander M, Hallander H (1989) Septic osteomyelitis and polyarthritis with ureaplasma in hypogammaglobulinemia. Infection 17:301–303. CrossRefPubMedGoogle Scholar
  38. 38.
    SK K (1988) Mycoplasma hominis septic arthritis. Ann Plast Surg 20:163–166Google Scholar
  39. 39.
    Sneller M, Wellborne F, Barile MF, Plotz P (1986) Prosthetic joint infection with Mycoplasma hominis. J Infect Dis 153:174–175. CrossRefPubMedGoogle Scholar
  40. 40.
    McDonald MI, Moore JO, Harrelson JM, Browning CP, Gallis HA (1983) Septic arthritis due tomycoplasma hominis. Arthritis Rheum 26:1044–1047. CrossRefPubMedGoogle Scholar
  41. 41.
    Johnston CL, Webster AD, Taylor-Robinson D, Rapaport G, Hughes GR (1983) Primary late-onset hypogammaglobulinaemia associated with inflammatory polyarthritis and septic arthritis due to Mycoplasma pneumoniae. Ann Rheum Dis 42:108–110. CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    So AK, Furr PM, Taylor-Robinson D, Webster AD (1983) Arthritis caused by Mycoplasma salivarium in hypogammaglobulinaemia. Br Med J 286:762–763. CrossRefGoogle Scholar
  43. 43.
    Verinder DG (1978) Septic arthritis due to mycoplasma hominis. A case report and review of the literature. J Bone Joint Surg Br 60-B:224–224. CrossRefPubMedGoogle Scholar
  44. 44.
    Webster AD, Taylor-Robinson D, Furr PM, Asherson GL (1978) Mycoplasmal (ureaplasma) septic arthritis in hypogammaglobulinaemia. Br Med J 1:478–479. CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Keiser PB, Nutman TB (2004) Strongyloides stercoralis in the immunocompromised population. Clin Microbiol Rev 17:208–217. CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Garcia-Arias M, Balsa A, Mola EM (2011) Septic arthritis. Best Pract Res Clin Rheumatol 25:407–421. CrossRefPubMedGoogle Scholar
  47. 47.
    Ferreyra M, Coiffier G, Albert JD, David C, Perdriger A, Guggenbuhl P (2017) Combining cytology and microcrystal detection in nonpurulent joint fluid benefits the diagnosis of septic arthritis. Joint Bone Spine 84:65–70. CrossRefPubMedGoogle Scholar
  48. 48.
    Young L, Sung J, Stacey G, Masters JR (2010) Detection of Mycoplasma in cell cultures. Nat Protoc 5:929–934. CrossRefPubMedGoogle Scholar
  49. 49.
    Capoccia R, Greub G, Baud D (2013) Ureaplasma urealyticum, Mycoplasma hominis and adverse pregnancy outcomes. Curr Opin Infect Dis 26:231–240. CrossRefPubMedGoogle Scholar
  50. 50.
    Ferrarini MG, Siqueira FM, Mucha SG, Palama TL, Jobard E, Elena-Herrmann B, V ATR, Tardy F, Schrank IS, Zaha A, Sagot MF (2016) Insights on the virulence of swine respiratory tract mycoplasmas through genome-scale metabolic modeling. BMC Genomics 17:353. CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Poveda JB (1998) Biochemical characteristics in mycoplasma identification. Methods Mol Biol 104:69–78. CrossRefPubMedGoogle Scholar
  52. 52.
    Loens K, Ieven M (2016) Mycoplasma pneumoniae: current knowledge on nucleic acid amplification techniques and serological diagnostics. Front Microbiol 7:448. CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Khodakov D, Wang C, Zhang DY (2016) Diagnostics based on nucleic acid sequence variant profiling: PCR, hybridization, and NGS approaches. Adv Drug Deliv Rev 105:3–19. CrossRefPubMedGoogle Scholar
  54. 54.
    Jensen JS, Cusini M, Gomberg M, Moi H (2016) 2016 European guideline on Mycoplasma genitalium infections. J Eur Acad Dermatol Venereol 30:1650–1656. CrossRefPubMedGoogle Scholar
  55. 55.
    Kessler HHDD, Pierer K, Young KK, Liao Y, Santner BI, Eber E, Roeger MG, Stuenzner D, Sixl-Voigt B, Marth E (1997) Rapid detection of Mycoplasma pneumoniae by an assay based on PCR and probe hybridization in a nonradioactive microwell plate format. J Clin Microbiol 35:1592–1594PubMedPubMedCentralGoogle Scholar
  56. 56.
    Margulies M, Egholm M, Altman WE, Attiya S, Bader JS, Bemben LA, Berka J, Braverman MS, Chen YJ, Chen Z, Dewell SB, Du L, Fierro JM, Gomes XV, Godwin BC, He W, Helgesen S, Ho CH, Irzyk GP, Jando SC, Alenquer ML, Jarvie TP, Jirage KB, Kim JB, Knight JR, Lanza JR, Leamon JH, Lefkowitz SM, Lei M, Li J, Lohman KL, Lu H, Makhijani VB, McDade KE, McKenna MP, Myers EW, Nickerson E, Nobile JR, Plant R, Puc BP, Ronan MT, Roth GT, Sarkis GJ, Simons JF, Simpson JW, Srinivasan M, Tartaro KR, Tomasz A, Vogt KA, Volkmer GA, Wang SH, Wang Y, Weiner MP, Yu P, Begley RF, Rothberg JM (2005) Genome sequencing in microfabricated high-density picolitre reactors. Nature 437:376–380. CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Pendleton KM, Erb-Downward JR, Bao Y, Branton WR, Falkowski NR, Newton DW, Huffnagle GB, Dickson RP (2017) Rapid pathogen identification in bacterial pneumonia using real-time metagenomics. Am J Respir Crit Care Med 196:1610–1612. CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Salter SJ, Cox MJ, Turek EM, Calus ST, Cookson WO, Moffatt MF, Turner P, Parkhill J, Loman NJ, Walker AW (2014) Reagent and laboratory contamination can critically impact sequence-based microbiome analyses. BMC Biol 12:87. CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Spuesens EB, Meyer Sauteur PM, Vink C, van Rossum AM (2014) Mycoplasma pneumoniae infections--does treatment help? J Infect 69(Suppl 1):S42–S46. CrossRefPubMedGoogle Scholar
  60. 60.
    Kasprzykowska U, Sobieszczanska B, Duda-Madej A, Secewicz A, Nowicka J, Gosciniak G (2018) A twelve-year retrospective analysis of prevalence and antimicrobial susceptibility patterns of Ureaplasma spp. and Mycoplasma hominis in the province of Lower Silesia in Poland. Eur J Obstet Gynecol Reprod Biol 220:44–49. CrossRefPubMedGoogle Scholar
  61. 61.
    Pereyre S, Gonzalez P, De Barbeyrac B, Darnige A, Renaudin H, Charron A, Raherison S, Bebear C, Bebear CM (2002) Mutations in 23S rRNA account for intrinsic resistance to macrolides in Mycoplasma hominis and Mycoplasma fermentans and for acquired resistance to macrolides in M. hominis. Antimicrob Agents Chemother 46:3142–3150. CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Nummi M, Mannonen L, Puolakkainen M (2015) Development of a multiplex real-time PCR assay for detection of Mycoplasma pneumoniae, Chlamydia pneumoniae and mutations associated with macrolide resistance in Mycoplasma pneumoniae from respiratory clinical specimens. SpringerPlus 4:684. CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Bebear C, Pereyre S, Peuchant O (2011) Mycoplasma pneumoniae: susceptibility and resistance to antibiotics. Future Microbiol 6:423–431. CrossRefPubMedGoogle Scholar
  64. 64.
    Beeton ML, Spiller OB (2017) Antibiotic resistance among Ureaplasma spp. isolates: cause for concern? J Antimicrob Chemother 72:330–337. CrossRefPubMedGoogle Scholar
  65. 65.
    Krausse R, Schubert S (2010) In-vitro activities of tetracyclines, macrolides, fluoroquinolones and clindamycin against Mycoplasma hominis and Ureaplasma ssp. isolated in Germany over 20 years. Clin Microbiol Infect 16:1649–1655. CrossRefPubMedGoogle Scholar
  66. 66.
    Paakkonen M, Peltola H (2013) Treatment of acute septic arthritis. Pediatr Infect Dis J 32:684–685. CrossRefPubMedGoogle Scholar
  67. 67.
    Smith JW, Piercy EA (1995) Infectious arthritis. Clin Infect Dis 20:225–230; quiz 231. CrossRefPubMedGoogle Scholar
  68. 68.
    Parvizi J, Gehrke T, Chen AF (2013) Proceedings of the international consensus on periprosthetic joint infection. Bone Joint J 95-B:1450–1452. CrossRefPubMedGoogle Scholar
  69. 69.
    Prendki V, Ferry T, Sergent P, Oziol E, Forestier E, Fraisse T, Tounes S, Ansart S, Gaillat J, Bayle S, Ruyer O, Borlot F, Le Falher G, Simorre B, Dauchy FA, Greffe S, Bauer T, Bell EN, Martha B, Martinot M, Froidure M, Buisson M, Waldner A, Lemaire X, Bosseray A, Maillet M, Charvet V, Barrelet A, Wyplosz B, Noaillon M, Denes E, Beretti E, Berlioz-Thibal M, Meyssonnier V, Fourniols E, Tliba L, Eden A, Jean M, Arvieux C, Guignery-Kadri K, Ronde-Oustau C, Hansmann Y, Belkacem A, Bouchand F, Gavazzi G, Herrmann F, Stirnemann J, Dinh A (2017) Prolonged suppressive antibiotic therapy for prosthetic joint infection in the elderly: a national multicentre cohort study. Eur J Clin Microbiol Infect Dis 36:1577–1585. CrossRefPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2019

Authors and Affiliations

  1. 1.Department of Orthopedic SurgeryThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
  2. 2.Department of Laboratory MedicineThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina

Personalised recommendations