Volume 15, Number 7—July 2009
Outbreaks of Hemotrophic Mycoplasma Infections in China
To the Editor: Infections caused by hemotrophic mycoplasmas (formerly called eperythrozoonoses ) in animals and humans have been emerging in the People’s Republic of China in recent years. To date, 6 hemotrophic Mycoplasma spp. have been identified in rodents and mammals (1). M. from pigs, M. wenyonii from cattle, and M. ovis from sheep have been confirmed; the human pathogen, which is most frequently observed in China, has not been genetically identified (2). However, the zoonotic potential of the bacteria is evident because the disease is more prevalent in farmers and veterinary doctors, who have frequent close contact with domestic animals, than in other persons (2). Vertical transmission from mother to fetus has also been confirmed (2). In animals, especially in piglets, the disease is characterized by febrile acute anemia, jaundice, and eventual death resulting from concurrent infection with other microbes (3–6). Infected humans may be asymptomatic or have various clinical signs, including acute fever, anemia, and severe hemolytic jaundice, especially in infected neonates. Pregnant women and newborns were reported to be more vulnerable to the disease than others and to show more severe clinical signs after infection (2).
We conducted an epidemiologic investigation of hemotrophic mycoplasma infections in China by reviewing all reported cases and outbreaks for 1994–2007. Clinical cases for >6 animal species (including pigs, cows, goats, horses, foxes, chickens, and humans) were reported during the period (Table). The number of reported cases varied from year to year. Human infections were confirmed by clinical and laboratory methods (2). We reinvestigated blood samples of >600 pigs with previous diagnoses of mycoplasma infection accompanied by clinical signs of fever and jaundice. Slides were made and stained in Giemsa-staining solution. We used light microscopy to look for the presence of M. suis on the erythrocyte surface. We also used fluorescence microscopy to look for the microbes by mixing a drop of infected blood with acridine orange solution (0.1 mg/mL). The microbes bound to red blood cells were examined with a confocal microscope. Positive cases were further confirmed by PCR using primers of the small subunit RNA gene sequences. All samples were PCR positive, but PCR sensitivity is higher than sensitivity of acridine orange staining, which is higher than sensitivity of Geimsa staining.
Hemotrophic mycoplasma infection is still a neglected zoonotic disease, which poses a threat to public health and the animal industry, especially in China (2,7). The prevalence of the disease in domestic animals (e.g., pigs) and humans has reached an alarming level (Table). Human infection rates in certain areas in China have been high; for example, in Inner Mongolia, samples collected from 1,529 randomly selected persons during 1994–1996 showed that 35.3% of the local population, 57.0% of local pregnant women, and 100% of newborns of infected mothers were positive for hemotrophic mycoplasma infection (2). Infections in animals in China have been recognized since 1995, and the number of cases has been increasing rapidly. For example, >600,000 pigs infected with M. suis were reported in 2003 (Table). These infections have had a large economic impact on regions where the infection is endemic (8). Infections in other animals, including cows, sheep, and foxes, were also common, indicating a high prevalence of the bacteria in China. However, because of the lack of in vitro cultivation systems that assist in characterizing pathogens, progress in species identification and molecular characterization of these pathogens has been slow. Thus far, names of hemotrophic mycoplasma species have been based on the hosts from which they were identified. Due to the zoonotic nature of these pathogens, more in-depth studies on these microorganisms are needed.
This work was supported by the Young Distinguished Scholar Grant from the National Natural and Scientific Committee, People’s Republic of China (grant no. 30625029).
- Hoelzle LE. Haemotrophic mycoplasmas: recent advances in Mycoplasma suis. Vet Microbiol. 2008;130:215–26.
- Yang D, Tai X, Qiu Y, Yun S. Prevalence of Eperythrozoon spp. infection and congenital eperythrozoonosis in humans in Inner Mongolia, China. Epidemiol Infect. 2000;125:421–6.
- Neimark H, Hoff B, Ganter M. Mycoplasma ovis comb. nov. (formerly Eperythrozoon ovis), an eperythrocytic agent of haemolytic anaemia in sheep and goats. Int J Syst Evol Microbiol. 2004;54:365–71.
- Pitcher DG, Nicholas RA. Mycoplasma host specificity: fact or fiction? Vet J. 2005;170:300–6.
- Stoffregen WC, Alt DP, Palmer MV, Olsen SC, Waters WR, Stasko JA. Identification of a haemomycoplasma species in anemic reindeer (Rangifer tarandus). J Wildl Dis. 2006;42:249–58.
- Henderson JP, O'Hagan J, Hawe SM, Pratt MC. Anaemia and low viability in piglets infected with Eperythrozoon suis. Vet Rec. 1997;140:144–6.
- Hoelzle LE, Hoelzle K, Helbling M, Aupperle H, Schoon HA, Ritzmann M, MSG1, a surface-localised protein of Mycoplasma suis is involved in the adhesion to erythrocytes. Microbes Infect. 2007;9:466–74.
- Wu J, Yu J, Song C, Sun S, Wang Z. Porcine eperythrozoonosis in China. Ann N Y Acad Sci. 2006;1081:280–5.