Ureaplasma parvum meningitis in neonates: A retrospective case study and literature review

Abstract

Objective: To investigate the clinical characteristics and advances in diagnosis and treatment of neonatal Ureaplasma parvum (U. parvum) meningitis.

Methodology: Clinical manifestations, diagnosis, treatment, and follow‑up data of a neonate with persistent fever, normal blood routine, but persistently abnormal cerebrospinal fluid (CSF) results due to U. parvum meningitis were retrospectively analyzed. A literature review was conducted to identify relevant studies reporting on neonatal U. parvum meningitis published until May 2025.

Results: A male infant born at 35+2 weeks of gestation with premature rupture of membranes for eight hours was admitted at 17 days of age with persistent fever. The routine blood test was normal, while the CSF suggested purulent meningitis. Empirical treatment was ineffective, and metagenomic next‑generation sequencing (mNGS) of CSF confirmed U. parvum meningitis. The infant recovered after three weeks of azithromycin treatment, but a language delay was found at two‑year follow‑up. The literature review identified 17 reports of neonatal U. parvum meningitis. Main manifestations included fever and convulsions, or initial circulatory and respiratory symptoms. CSF in the included studies showed leukocytosis, decreased glucose, and elevated protein. Diagnosis was mainly based on mNGS, and the predominant treatment consisted of macrolides, sometimes combined with quinolones, for 3–10 weeks. Two patients relapsed after drug withdrawal, and one had elevated liver enzymes. Major neurological complications included hydrocephalus, ventricular dilatation, cerebral hemorrhage, infarction, malacia, and herniation. Most cases had a favorable prognosis, with rare developmental delay.

Conclusion: Clinical manifestations of neonatal U. parvum meningitis are nonspecific. Some patients present with normal blood routine but purulent CSF. U. parvum meningitis should be suspected in patients with poor response to empirical antibiotics and confirmed by CSF mNGS. Macrolides are biologically rational and commonly used for neonatal U. parvum meningitis; however, the optimal regimen and duration remain unclear due to limited and heterogeneous case-based evidence.