{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T04:26:21Z","timestamp":1788323181280,"version":"build-2803163510"},"reference-count":25,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,6,2]],"date-time":"2020-06-02T00:00:00Z","timestamp":1591056000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transplant Infectious Dis"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:italic>Ureaplasma<\/jats:italic>\n                    species (spp.) are common colonizers of the urogenital tract but may cause systemic infection in immunocompromised patients. They release significant amounts of ammonia via urea hydrolysis and have been recently implicated in the pathogenesis of hyperammonemia syndrome after organ transplantation. We describe a unique case of hyperammonemia syndrome after kidney transplant caused by\n                    <jats:italic>U\u00a0urealyticum<\/jats:italic>\n                    infection, and the first, to our knowledge, case of a fluoroquinolone\u2010resistant\n                    <jats:italic>Ureaplasma<\/jats:italic>\n                    strain causing hyperammonemia syndrome. A 17\u2010year\u2010old female developed intermittent fevers, rising creatinine, sterile pyuria and debilitating polyarthritis approximately 1\u00a0year after kidney transplant. Serum ammonia level was elevated, and urine PCR was positive for\n                    <jats:italic>U\u00a0urealyticum<\/jats:italic>\n                    . Near the end of treatment with levofloxacin, she had rebound hyperammonemia, which preceded clinical relapse of polyarthritis and encephalopathy. Blood and urine PCR and synovial fluid culture were positive for\n                    <jats:italic>U urealyticum<\/jats:italic>\n                    . Susceptibility testing showed fluoroquinolone resistance, but she responded well to azithromycin and doxycycline. The frequency of\n                    <jats:italic>Ureaplasma<\/jats:italic>\n                    spp. infection in immunocompromised patients is probably underestimated due to diagnostic challenges. Ammonia levels were helpful biomarkers of response to antimicrobial therapy in our case. Susceptibility testing of clinical isolates should be pursued. In serious\n                    <jats:italic>Ureaplasma<\/jats:italic>\n                    spp. infections, particularly in immunocompromised patients, two empiric antibiotics may be indicated given the potential for antimicrobial resistance.\n                  <\/jats:p>","DOI":"10.1111\/tid.13328","type":"journal-article","created":{"date-parts":[[2020,5,16]],"date-time":"2020-05-16T13:30:10Z","timestamp":1589635810000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Hyperammonemia syndrome due to Ureaplasma urealyticum in a kidney transplant recipient: A case of disseminated disease from a fluoroquinolone\u2010resistant isolate"],"prefix":"10.1111","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3808-4436","authenticated-orcid":false,"given":"Andrea B.","family":"Higgins","sequence":"first","affiliation":[{"name":"Department of Medicine The Warren Alpert Medical School of Brown University Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8489-108X","authenticated-orcid":false,"given":"Dimitrios","family":"Farmakiotis","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases The Warren Alpert Medical School of Brown University Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0268-0188","authenticated-orcid":false,"given":"Ralph","family":"Rogers","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases The Warren Alpert Medical School of Brown University Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adena J.","family":"Osband","sequence":"additional","affiliation":[{"name":"Department of Surgery (Transplantation) The Warren Alpert Medical School of Brown University Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angie","family":"Seo","sequence":"additional","affiliation":[{"name":"Department of Medicine The Warren Alpert Medical School of Brown University Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Medicine The Warren Alpert Medical School of Brown University Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark P.","family":"Birkenbach","sequence":"additional","affiliation":[{"name":"Department of Pathology The Warren Alpert Medical School of Brown University Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donna","family":"Crabb","sequence":"additional","affiliation":[{"name":"Division of Laboratory Medicine Department of Pathology University of Alabama at Birmingham Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Alabama at Birmingham Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sixto","family":"Leal","sequence":"additional","affiliation":[{"name":"Division of Laboratory Medicine Department of Pathology University of Alabama at Birmingham Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Waites","sequence":"additional","affiliation":[{"name":"Division of Laboratory Medicine Department of Pathology University of Alabama at Birmingham Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reginald","family":"Gohh","sequence":"additional","affiliation":[{"name":"Division of Nephrology The Warren Alpert Medical School of Brown University Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Morrissey","sequence":"additional","affiliation":[{"name":"Department of Surgery (Transplantation) The Warren Alpert Medical School of Brown University Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerard J.","family":"Nau","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases The Warren Alpert Medical School of Brown University Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,6,2]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/00365540600675734"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01628-07"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e318199d19a"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/tid.12937"},{"issue":"10","key":"e_1_2_7_6_1","first-page":"ofz399","article-title":"Invasive Ureaplasma infection in patients receiving rituximab and other humoral immunodeficiencies\u2010A case report and review of the literature. Open Forum","volume":"6","author":"Jhaveri VV","year":"2019","journal-title":"Infect Dis"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.aaa8419"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2017.04.009"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2016.09.026"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15545"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2019.03.419"},{"key":"e_1_2_7_12_1","doi-asserted-by":"crossref","first-page":"e13298","DOI":"10.1111\/tid.13298","article-title":"Hyperammonemia syndrome due to Ureaplasma infection after liver\u2010kidney transplant","author":"Cannon CA","year":"2020","journal-title":"Transpl Infect Dis"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00671-16"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dky238"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.3109\/09563070310001612826"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2006.01680.x"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2010.03.142"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2014.09.008"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofz033"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2020.02.003"},{"key":"e_1_2_7_21_1","unstructured":"Clinical and Laboratory Standards Institute.Methods for antimicrobial susceptibility testing of human Mycoplasmas. Approved guideline. CLSI Document M43\u2010A. Clinical Laboratory Standards Institute Wayne. PA 2011."},{"key":"e_1_2_7_22_1","doi-asserted-by":"crossref","unstructured":"WaitesKB DuffyLB XiaoL.Detection of human mycoplasmas and ureaplasmas from clinical specimens by culture and PCR. Clinical Microbiology Procedure Handbook Laber A Editor. 2016 ASM Press. Chapter 3.15 2016.","DOI":"10.1128\/9781555818814.ch3.15.1"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/tid.13032"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.53.3.183"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.06342-11"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofz360.1621"}],"container-title":["Transplant Infectious Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Ftid.13328","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tid.13328","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/tid.13328","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tid.13328","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,1]],"date-time":"2023-10-01T01:54:49Z","timestamp":1696125289000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/tid.13328"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,2]]},"references-count":25,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2020,10]]}},"alternative-id":["10.1111\/tid.13328"],"URL":"https:\/\/doi.org\/10.1111\/tid.13328","archive":["Portico"],"relation":{},"ISSN":["1398-2273","1399-3062"],"issn-type":[{"value":"1398-2273","type":"print"},{"value":"1399-3062","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,2]]},"assertion":[{"value":"2020-04-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-05-02","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-06-02","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e13328"}}