Mycoplasma genitalium: Accurate Diagnosis Is Necessary for Adequate Treatment
Mycoplasma genitalium: Accurate Diagnosis Is Necessary for Adequate Treatment
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DOI：
10.1093/infdis/jix104
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发表时间：
2017-07-15
影响因子：
6.4
通讯作者：
Gaydos, Charlotte A.
中科院分区：
文献类型：
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作者：
Gaydos, Charlotte A.
背景生殖支原体很难在培养物中生长，但自从研究分子扩增测定法出现以来，已经更能够研究疾病关联。聚合酶链反应（PCR）和其他分子检测已证实与不良疾病结局相关，如男性尿道炎或非淋菌性尿道炎，女性不良生殖后遗症，如宫颈炎、尿道炎和盆腔炎（PID），包括与人类免疫缺陷病毒风险相关。缺乏商业可用的诊断测定限制了广泛的常规测试。越来越多的报告表明，在研究中检测到的阿奇霉素耐药率很高，这增加了对可用的商业诊断检测方法以及检测耐药标志物的标准化方法的需求。本文综述了M.生殖器和测定来预测阿奇霉素的抗生素敏感性。使用检索词生殖支原体（Mycoplasma genitalium）、M.生殖器、诊断和检测。早期的PCR诊断测试集中在MPa粘附基因和16S核糖体RNA基因。随后，一种以核糖体为靶点的转录介导的扩增技术被开发出来并广泛应用于M.生殖器较新的方法已经激增，包括定量PCR的有机体负荷，AmpliSens PCR，PCR的pdhD基因，基于PCR的微阵列的多种性传播感染，和多重PCR。美国食品和药物管理局尚未批准，尽管有几种检测试剂盒在欧洲获得了CE认证。同时，许多研究检测，包括PCR，基因测序，熔解曲线分析，已开发出检测23 S核糖体RNA基因突变，赋予耐药性阿奇霉素。最近开发的一种检测方法可以检测两种M。生殖器和阿奇霉素耐药突变。建议开发更多的商业检测方法，以诊断这种微生物并指导治疗选择，并通过监管批准提供。需要进行研究以确定常规M的成本效益。对有症状的患者进行生殖器检测，并对所有感染和传播性传播感染的高危人群进行筛查。
Background. Mycoplasma genitalium is very difficult to grow in culture but has been more able to be studied for disease associations since the advent of research molecular amplification assays. Polymerase chain reaction (PCR) and other molecular assays have demonstrated an association with adverse disease outcomes, such as urethritis or nongonococcal urethritis in men and adverse reproductive sequelae in women-for example, cervicitis, endometritis, and pelvic inflammatory disease (PID), including an association with risk for human immunodeficiency virus. The lack of commercially available diagnostic assays has limited widespread routine testing. Increasing reports of high rates of resistance to azithromycin detected in research studies have heightened the need available commercial diagnostic assays as well as standardized methods for detecting resistance markers. This review covers available molecular methods for the diagnosis of M. genitalium and assays to predict the antibiotic susceptibility to azithromycin.Methods. A PubMed (US National Library of Medicine and National Institutes of Health) search was conducted for literature published between 2000 and 2016, using the search terms Mycoplasma genitalium, M. genitalium, diagnosis, and detection.Results. Early PCR diagnostic tests focused on the MPa adhesion gene and the 16S ribosomal RNA gene. Subsequently, a transcription-mediated amplification assay targeting ribosomes was developed and widely used to study the epidemiology of M. genitalium. Newer methods have proliferated and include quantitative PCR for organism load, AmpliSens PCR, PCR for the pdhD gene, a PCR-based microarray for multiple sexually transmitted infections, and multiplex PCRs. None yet are cleared by the Food and Drug Administration in the United States, although several assays are CE marked in Europe. As well, many research assays, including PCR, gene sequencing, and melt curve analysis, have been developed to detect the 23S ribosomal RNA gene mutations that confer resistance to azithromycin. One recently developed assay can test for both M. genitalium and azithromycin resistance mutations at the same time.Conclusions. It is recommended that more commercial assays to both diagnose this organism and guide treatment choices should be developed and made available through regulatory approval. Research is needed to establish the cost-effectiveness of routine M. genitalium testing in symptomatic patients and screening in all individuals at high risk of acquiring and transmitting sexually transmitted infections.