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      A Novel Hemotropic Mycoplasma (Hemoplasma) in a Patient With Hemolytic Anemia and Pyrexia

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          Abstract

          A patient with chronic moderate neutropenia, acute hemolysis, and pyrexia was found to be infected with a novel hemoplasma species. A clinical response to doxycyline was noted, and moxifloxacin was added subsequently to aid infection clearance. This represents the first report of hemolysis in association with confirmed hemoplasma infection in a human.

          Abstract

          A patient with chronic moderate neutropenia, acute hemolysis, and pyrexia was found to be infected with a novel hemoplasma species. A clinical response to doxycyline was noted, and moxifloxacin was added subsequently to aid infection clearance. This represents the first report of hemolysis in association with confirmed hemoplasma infection in a human.

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          Most cited references8

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          Prevalence of Mycoplasma suis (Eperythrozoon suis) infection in swine and swine-farm workers in Shanghai, China.

          To determine the prevalence of Mycoplasma suis infection in swine, swine-farm workers, and swine veterinarians in Shanghai, China. 172 swine and 65 workers and veterinarians from 19 commercial swine farms. Blood samples were collected from all study subjects. Blood samples were examined for the presence of M suis by means of compound and scanning electron microscopy. A species-specific PCR assay was developed for detection of M suis DNA extracted from blood samples. Relationships between infection status of swine and sex, age, geographic location, and clinical signs of disease were evaluated by use of a C(2) test. The phylogenetic relationship between partial 16S ribosomal RNA (rRNA) sequences from swine and human isolates of M suis was determined. 86% (148/172) of swine and 49% (32/65) of humans had positive PCR assay results for M suis infection. Swine infection status was not associated with any variable, with the exception of pyrexia and subcutaneous bleeding. The partial 16S rRNA sequences from human and swine isolates of M suis were 98% homologous and in the same phylogenetic cluster as a previously identified swine isolate of M suis. A large proportion of swine and humans in close contact with those swine were infected with M suis in Shanghai, China. The close phylogenetic relationship between swine and human isolates of M suis suggested possible interspecies transmission; however, additional research is required to better assess that possibility.
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            Haemotropic mycoplasmas

            Practical relevance The feline haemotropic mycoplasmas (‘haemoplasmas') are a group of bacteria that can induce haemolytic anaemia in cats. Mycoplasma haemofelis is the most pathogenic of the species; ‘Candidatus Mycoplasma haemominutum’ and ‘Candidatus Mycoplasma turicensis’ are less pathogenic. The natural route of transmission of feline haemoplasma infection has not been confirmed, but fleas are implicated. When disease results, common clinical signs are pallor, lethargy, anorexia, weight loss, depression, dehydration and pyrexia. Treatment with tetracyclines or fluoroquinolones is usually effective at resolving clinical disease, but clearance of infection may not result. Global importance The feline haemoplasmas are found worldwide, although prevalence varies geographically. Patient group Older male non-pedigree cats are believed to be at increased risk of haemoplasma infection, although younger cats are possibly more likely to show clinical disease associated with M haemofelis. Clinical challenges The significance of feline haemoplasma infection is difficult to determine due to the existence of asymptomatic carrier cats and the variable pathogenicity of the haemoplasma species. Polymerase chain reaction (PCR) results should be interpreted in the light of the patient's clinical signs and haematological findings, infecting haemoplasma species and level of haemoplasma DNA present in the blood. Trial antibiotic treatment for haemoplasmosis may be warranted in suspected cases while awaiting PCR results. Evidence base Aspects of feline haemoplasmosis, particularly risk factors, pathogenesis, diagnostic methods and treatment, have been the focus of much recent research. This article draws on the current evidence base with a view to helping clinicians diagnose and manage cases more effectively.
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              Development and application of a universal Hemoplasma screening assay based on the SYBR green PCR principle.

              Hemotropic mycoplasmas (hemoplasmas) are the causative agents of infectious anemia in several mammalian species. Their zoonotic potential has recently been substantiated by the identification of a feline hemoplasma isolate in an immunocompromised human patient. Although species-specific diagnostic molecular methods have been developed, their application as screening tools is limited due to the species diversity of hemoplasmas. The goals of this study were to develop a universal hemoplasma screening assay with broad specificity based on the SYBR green PCR principle, to compare the assay with hemoplasma-specific TaqMan PCR, and to analyze potential tick vectors and human blood samples to address the zoonotic potential. The newly developed PCR assay based on the 16S rRNA gene amplified feline, canine, bovine, porcine, camelid, and murine hemoplasmas, as well as Mycoplasma penetrans and Mycoplasma pneumoniae. The lower detection limit for feline and canine hemoplasmas was 1 to 10 copies/PCR. The assay exhibited 98.2% diagnostic sensitivity and 92.1% diagnostic specificity for feline hemoplasmas. All 1,950 Ixodes ticks were PCR negative, suggesting that Ixodes ticks are not relevant vectors for the above-mentioned hemoplasma species in Switzerland. None of the 414 blood samples derived from anemic or immunocompromised human patients revealed a clear positive result. The SYBR green PCR assay described here is a suitable tool to screen for known and so-far-undiscovered hemoplasma species. Positive results should be confirmed by specific TaqMan PCR or sequencing.
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                Author and article information

                Journal
                Clin Infect Dis
                cid
                cid
                Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
                Oxford University Press
                1058-4838
                1537-6591
                01 December 2011
                21 October 2011
                21 October 2011
                : 53
                : 11
                : e147-e151
                Affiliations
                [1 ]Department of Microbiology, Derriford Hospital, Plymouth
                [2 ]School of Veterinary Sciences, University of Bristol, United Kingdom
                [3 ]Mycoplasma Laboratory, Statens Serum Institut, Copenhagen, Denmark
                [4 ]Micropathology Ltd., University of Warwick Science Park, Coventry
                [5 ]Respiratory and Systemic Infections Laboratory, Health Protection Agency Centre for Infections, London
                [6 ]Department of Haematology, Derriford Hospital, Plymouth, United Kingdom
                Author notes
                Correspondence: Séverine Tasker, BSc, BVSc, PhD, School of Veterinary Sciences, University of Bristol, Langford, Bristol BS40 5DU, UK ( s.tasker@ 123456bristol.ac.uk ).
                [a]

                J. A. S. and S. T. contributed equally to this paper as joint first authors.

                [b]

                V. J. C. and M. H. are joint last authors.

                Article
                10.1093/cid/cir666
                3205199
                22021921
                b6ca30a1-de72-45a9-9b2f-bd6da50782ab
                © The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please email:journals.permissions@oup.com.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 8 April 2011
                : 17 August 2011
                Categories
                Electronic Article

                Infectious disease & Microbiology
                Infectious disease & Microbiology

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