Rare zoonosis (hemotrophic mycoplasma infection) in a newly diagnosed systemic lupus erythematosus patient followed by a Nocardia asteroides pneumonia

Abstract

Systemic lupus erythematosus (SLE) is per se a disease characterized by suppressed immune response and thus susceptibility to various opportunistic infections. We describe the case of a 21-yearold woman who developed a rare zoonosis -hemotrophic mycoplasma infection in the initial stage of SLE, complicated with Nocardia asteroides pneumonia afterwards. Nocardia infection coincided with initiation of glucocorticoids and cyclophosphamide therapy for SLE. After the treatment she recovered completely. To our knowledge the only case of human hemoplasmosis (then referred to as eperythrozoonosis) in medical literature was the one described by a group of Croatian authors 22 years ago. No cases of a hemotrophic mycoplasma infection in a SLE patient have been published up to now.

Novel hemotropic mycoplasmas are widespread and genetically diverse in vampire bats

“…These bacteria are thought to be transmitted through direct (blood and saliva) and possibly vector-borne contact [23–26] and can cause acute and chronic anemia in wildlife, humans, and domestic animals [27–30], particularly in immunocompromised hosts [31,32]. Almost all Mycoplasma spp., including hemoplasmas, appear to show host specificity that seems to be a result of the host–pathogen interaction during evolution; however, potential zoonotic or inter-species transmission has also been reported [30,31,33–35]. Among bat species studied to date, 16S rRNA gene sequence analyses have shown that hemoplasmas identified in little brown bats ( Myotis lucifugus ) from the United States demonstrated closest homology (~92%) with a hemoplasma detected in a human, Candidatus Mycoplasma haemohominis, and with Mycoplasma haemomuris detected in a small Japanese field mouse ( Apodemus argenteus ) [16,36].…”

Systemic Nocardia brasiliensis infection in a patient with systemic lupus erythematosus: successful diagnosis and therapy

“…Nocardia brasiliensis is one of the Nocardia spp . that has been most reported in local infection; however, it rarely causes systemic infection, even in patients with SLE . Here, we presented a patient with SLE with a systemic nocardiosis infection.…”

“…The other case of human nocardiosis with systemic infection caused by N. concava was reported in 2011 (and which was the first isolated strain in mainland China) . Nocardiosis, especially N. asteroids infection, has been increasingly recognized in systemic lupus erythematosus (SLE) …”

Infection rate of Eperythrozoon spp. in Chinese population: a systematic review and meta-analysis since the first Chinese case reported in 1991

“…Contact with livestock, or poultry and international travel have been reported as risk factors among those case report publications [9,10,42]. According to the available Eperythrozoon infection information in pigs or diary cows, multiple infection of different pathogens existed in eperythrozoonosis, which posed more threats for the farmers, herdsmen or milking workers.…”

“…The disease may manifest with fever, hemolytic anemia, swollen lymph nodes of the neck, an enlarged liver and spleen, leucopenia, neutropenia, thrombocytopenia and sometimes acute hemolysis, mild hepatitis and subclinical myocarditis [8-10]. Eperythrozoonosis actually is a microscopic diagnosis, and the causative agent was previously reported as ‘ Eperythrozoon ’.…”