Aportaciones moleculares al estudio de las infecciones causadas por Mycoplasma pneumoniae y Mycoplasma genitalium

Zusammenfassung

This doctoral thesis, entitled ""Molecular contributions to the study of infections caused by Mycoplasma pneumoniae and Mycoplasma genitalium"", is based on the development and optimization of molecular methods for the study of antibiotic resistance in species of the genus Mycoplasma. Mycoplasma pneumoniae is an exclusively human pathogen that causes different clinical pictures, pneumonia being the most interesting, causing 4-8% of community-acquired pneumonias. This percentage rises to 20-40% at epidemic peaks in the general population, mainly affecting children, adolescents or the elderly. Mycoplasma genitalium is a sexually transmitted pathogen directly related to non-gonococcal urethritis (NGU) and with greater evidence in cases of urethritis not caused by gonococcus or chlamydia (NNG), in which it represents between 10-35% of cases in the population groups at greatest risk, such as men who have sex with other men (MSM) or those patients who attend sexual health clinics. It not only affects the male sex, but in women it is related to cervicitis, pelvic inflammatory disease, preterm birth and abortion. Both species lack a cell wall, which makes them inherently resistant to numerous antimicrobials. First-line treatment is macrolides and ketolides, such as azithromycin or clarithromycin, respectively. As alternatives, we have quinolones and tetracyclines. Fluoroquinolones are contraindicated in children due to their potential toxicity in developing cartilage. Similarly, tetracyclines are not recommended in children under 8 years of age due to teeth damage in this age group. In the case of M. pneumoniae, various studies had described the generation of strains resistant to macrolides after exposure to these antibiotics in vitro, but it was not until the early 2000s when the appearance of the first strains resistant to macrolides was reported in Japan. macrolides in vivo. Since then, these strains have spread widely throughout Asia, where we find regions with resistance rates close to 100%, and to a lesser extent in America and Europe, which can be a major problem when establishing an empirical treatment. In the case of M. genitalium, the situation is similar, given the high capacity of this bacterium to develop resistance to different treatments in the context of antibiotic pressure. In this thesis, the usefulness of molecular techniques in both pathogens has been evaluated. The first part deals with the contribution of molecular methods applied to M. pneumoniae, both at the epidemiological level and in the detection of antimicrobial resistance, while the second part focuses on M. genitalium and molecular techniques for its diagnosis and detection of treatment resistance.