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Case Reports
. 2020 Jan;26(1):11-19.
doi: 10.3201/eid2601.190983.

Candidatus Mycoplasma haemohominis in Human, Japan

Norimichi Hattori, Makoto Kuroda, Harutaka Katano, Takahiro Takuma, Takayoshi Ito, Nana Arai, Ryo Yanai, Tsuyoshi Sekizuka, Sho Ishii, Yoko Miura, Takahiro Tokunaga, Hiroyuki Watanabe, Norihiro Nomura, Junichi Eguchi, Hideki Hasegawa, Tsuyoshi Nakamaki, Takaji Wakita, Yoshihito Niki
Case Reports

Candidatus Mycoplasma haemohominis in Human, Japan

Norimichi Hattori et al. Emerg Infect Dis. 2020 Jan.

Abstract

Hemotropic mycoplasmas are common pathogens in animals, but it remains unclear what role these pathogens play in human infections. We report clinical and biologic characterization of Candidatus Mycoplasma haemohominis infection in a 42-year-old man in Japan. The patient had severe hemophagocytic syndrome 1 month after an accidental needlestick injury. Metagenomic deep sequencing identified Candidatus M. haemohominis and determined its draft genome for an isolate from serum of the patient. A high copy number of the Candidatus M. haemohominis genome was detected in serum and bone marrow samples. Electron microscopy examination showed morphologic characteristics of Candidatus M. haemohominis. Levofloxacin monotherapy induced resistance caused by a gyrase A gene mutation in the quinolone resistance-determining region, but a combination treatment with moxifloxacin and minocycline was effective. We identified Candidatus M. haemohominis in a patient who had life-threatening symptoms related to multiple organ infection. Human infection with this mycoplasma might occur more frequently than has been generally recognized.

Keywords: Candidatus Mycoplasma haemohominis; Japan; bacteria; hemophagocytic syndrome; hemoplasma; human infection; metagenomics; mycoplasma.

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Figures

Figure 1
Figure 1
Whole-body erythema and pruritus in a 42-year-old man infected with Candidatus Mycoplasma haemohominis, Japan. Images show general erythema and pruritus covering >80% of the body surface area. A) Chest, B) back, C) arms, D) hands, E) feet.
Figure 2
Figure 2
Clinical course for a 42-year-old man infected with Candidatus Mycoplasma haemohominis, Japan. *For ALT, AST, and LDH, left y-axis is for AST and ALT and right y-axis is for LDH. ALT, alanine aminotransferase; AST, aspartate aminotransferase; CRP, C-reactive protein; DEX, dexamethasone; Hb, hemoglobin; LDH, lactate dehydrogenase; LVFX, levofloxacin; MINO, minocycline; MLFX, moxifloxacin; mPSL, methylprednisolone; PLT, platelets; STFX, sitafloxacin; WBC, white blood cells.
Figure 3
Figure 3
Distribution of Candidatus Mycoplasma haemohominis in a 42-year-old man, Japan. A) Peripheral blood smear showing coccoid forms. Small basophilic bodies are present on the surface of and outside erythrocytes (arrows). Arrowhead indicates a platelet. Giemsa stained. B) Hemophagocytosis (arrow) in bone marrow aspirate. Giemsa stained. C) Bone marrow biopsy specimen showing infiltration of plasma cells (arrows). Hematoxylin and eosin stained. Scale bars indicate 20 μm.
Figure 4
Figure 4
Prediction of presence of Candidatus Mycoplasma haemohominis in serum samples of a 42-year-old man, Japan. A) Relative percentage of candidate bacteria. B) Percentage of Mycoplasma spp. detected.
Figure 5
Figure 5
Analysis for Candidatus Mycoplasma haemohominis in serum of a 42-year-old man, Japan. A) Prediction that de novo assemblies contained bacteria and human DNA sequences. Bacteria-related sequences were identified by using read depth, % GC, and blastn (https://blast.ncbi.nlm.nih.gov) search results. Read depth indicates how many times next-generation sequencing confirmed the sequence at each nucleotide position. B) Phylogenetic tree of 16S rRNA genes of Mycoplasma spp. The tree was constructed by using FastTree version 2.1.10 (http://www.microbesonline.org). Scale bar indicates nucleotide substitutions per site. ID, identification.
Figure 6
Figure 6
Morphologic features of Candidatus Mycoplasma haemohominis isolated from a serum sample of a 42-year-old man, Japan. A) Spheres are bacterial particles with a diameter of 300–600 nm. Negative stained; scale bar indicates 200 nm. B) Bacteria on the surface of erythrocytes (arrows in the left panel). In situ hybridization showing bacteria on the surface of erythrocytes (arrows in the right panel). Giemsa stained; scale bar indicates 10 μm.
Figure 7
Figure 7
Copy number of the Candidatus Mycoplasma haemohominis genome in 1-μL serum samples from a 42-year-old man, Japan. Copy number was determined by using a real-time PCR. LVFX, levofloxacin; MINO, minocycline; MLFX, moxifloxacin.
Figure 8
Figure 8
Detection of a gyrA mutation in the QFDR of Candidatus Mycoplasma haemohominis genome isolated from in a 42-year-old man, Japan, who was given levofloxacin. Read-mapping analysis identified a nonsynonymous amino acid substitution in gyrA for quinolone-resistant Candidatus M. haemohominis from a serum sample. Bottom panel shows a schematic of the gyrA amino acid sequence and alignment with those of other QRDRs (17,18). Dots indicate identical amino acids corresponding to the Candidatus M. haemohominis sequence. Red indicates nucleotide or amino acid mutations. Arrow indicates direction of transcription. QRDR, quinolone resistance–determining region.
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