第一例在澳大利亚感染嗜血性支原体的病例报告，该病例导致一名动物护理员持续发热。

First Report of Candidatus Mycoplasma haemohominis Infection in Australia Causing Persistent Fever in an Animal Carer.

机构信息

Department of Immunology and Infectious Diseases, Gold Coast Health Service, Gold Coast, Australia.

Department of Haematology, Gold Coast University Hospital and Griffiths University, Gold Coast, Australia.

出版信息

Clin Infect Dis. 2021 Feb 16;72(4):634-640. doi: 10.1093/cid/ciaa089.

DOI:10.1093/cid/ciaa089

PMID:32006025

Abstract

BACKGROUND

Hemotropic mycoplasmas (hemoplasmas) infect animals and humans and can lead to clinical syndromes mainly characterized by hemolytic anemia. A novel pathogen, Candidatus Mycoplasma haemohominis, was recently associated with a case of human hemoplasmosis in Europe. Here we report the first detection of this pathogen in an Australian patient exhibiting persistent fever, hemolytic anemia, and pancytopenia over a 10-month period.

METHODS

After exhaustive negative testing for human infectious diseases, whole genome sequencing (WGS) was performed on the patient's bone marrow aspirate, using an Illumina NextSeq500 platform. Conventional polymerase chain reaction (PCR), followed by Sanger sequencing, was then performed on blood samples using novel Mycoplasma-specific primers targeting the 16S ribosomal RNA gene. In addition, a Mycoplasma-specific fluorescence in situ hybridization (FISH) assay was developed to differentiate Mycoplasma cells from other erythrocyte inclusions (eg, Pappenheimer and Howell-Jolly bodies) which are morphologically similar to bacterial cocci by light microscopy.

RESULTS

WGS analysis revealed that approximately 0.04% of the total number of unmapped reads to human genome corresponded to Mycoplasma species. A 1-kb Mycoplasma 16S fragment was successfully amplified by conventional PCR, and sequence analyses revealed 100% identity with Candidatus Mycoplasma haemohominis. FISH confirmed that several (approximately 2%) epierythrocytic inclusions initially observed by light microscopy corresponded to Mycoplasma cells.

CONCLUSIONS

This represents the second report of hemolytic anemia associated with hemoplasma infection in a human, and the first report of human hemoplasmosis in Australia. This study highlights the importance of new and emerging diagnostic approaches and need for further investigations on the epidemiology of Candidatus Mycoplasma haemohominis in Australia.

摘要

背景

噬血支原体（hemoplasmas）感染动物和人类，可导致主要表现为溶血性贫血的临床综合征。最近，一种新型病原体，Candidatus Mycoplasma haemohominis，与欧洲的一例人类噬血支原体病相关。本研究报告首例在澳大利亚患者中发现该病原体，该患者在 10 个月期间持续发热、溶血性贫血和全血细胞减少。

方法

在对患者进行详尽的人类传染病阴性检测后，使用 Illumina NextSeq500 平台对其骨髓抽吸物进行全基因组测序（WGS）。然后，使用针对 16S 核糖体 RNA 基因的新型支原体特异性引物对血液样本进行常规聚合酶链反应（PCR），随后进行 Sanger 测序。此外，开发了一种支原体特异性荧光原位杂交（FISH）检测法，通过光镜区分支原体细胞和其他形态上与细菌球菌相似的红细胞内含物（如 Pappenheimer 和 Howell-Jolly 小体）。

结果

WGS 分析显示，人类基因组中未映射到人类基因组的总读数中约有 0.04%对应于支原体物种。通过常规 PCR 成功扩增了 1-kb 支原体 16S 片段，序列分析显示与 Candidatus Mycoplasma haemohominis 完全一致。FISH 证实，最初通过光镜观察到的几个（约 2%）红细胞外包涵体对应于支原体细胞。