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Fatal Septicemia Due to Mycoplasma arginini: A New Human Zoonosis Ariane Yechouron, Johanne Lefebvre, Hugh G. Robson, David L. Rose, and Joseph G. Tully
From the Division of Infectious Diseases. Departments of Medicine and Microbiology. Royal Victoria Hospital. Montreal. Quebec. Canada; the Chlatnvdia-Ureaplasma Program. Laboratoire de sante publique du Quebec. Sainte-Anne-de-Bellevue, Quebec. Canada; and the Mycoplasma Section. National Institute ofAllergy and Infectious Diseases. National Institutes of Health. Frederick. Maryland
The last two decades have brought to light much new information on the biology, host distribution, and pathogenicity of wall-less prokaryotes. These organisms, now assigned to the class Mollicutes. are found frequently in the respiratory and urogenital tracts of most vertebrates, in the gut or hemolymph of a wide variety of insects, and as intracellular or surface inhabitants of plants [I]. Most Mollicutes organisms also differ from other prokaryotes in having a growth requirement for cholesterol or serum, in possessing a smaller genome (400-1,000 mD), and in having very limited metabolic and enzymatic activities. The known Mollicutes flora of humans currently consists of 14 distinct organisms, including 12 established species of the genus Mycoplasma and the species Ureaplasma urealyticum and Acholeplasma laidlawii. The majority of Mycoplasma species of humans occur as commensals in the oropharynx or lower urogenital tract [2, 3]. However, several organisms are established pathogens, including Mycoplasma pneumoniae, the agent of mycoplasmal pneumonia; Mycoplasma hominis, which causes some postpartum infections [4] and other types of septicemias [57]; and Mycoplasma[ermentans, a species recently associated with fatal infections in patients with and without AIDS [8]. U. urealyticum has also been recognized as a pathogen in the lower urogenital tract of humans (non-gonococcal urethritis) [2] and in the respiratory tract of neonates [9]. Of the remaining 80 known Mycoplasma species, most are associated with animal hosts. The mycoplasmal flora of any one animal species usually consists of a number of Mycoplasma species unique to that host [10]. However, a few Mycoplasma species, including Mycoplasma arginini. can be iso-
Received 3 January 1992; revised 20 April 1992. Reprints or correspondence: Dr. Ariane Yechouron, Centre hospitalier de Verdun. Laboratoire de microbiologie. 4000 boulevard Lasalle. Verdun. Quebec. Canada H4G 2A3.
Clinical Infectious Diseases 1992;15:434-8 © 1992 by The University of Chicago. All rights reserved. 1058-4838/92/1503-0008$02.00
lated from a number of different animal hosts [10]. M. arginini has been recovered from sheep, goats, cattle, and various felines [11-18]. As with mycoplasmas of humans, most mycoplasmas found in animals are commensals that colonize the respiratory and urogenital tracts [10]. Mycoplasmas are also clearly involved in a variety of animal diseases, including pneumonia, arthritis, mastitis, conjunctivitis. and genitourinary infections [19]. Animal mycoplasmas have yet to be clearly associated with human disease, and few isolations of these organisms from human tissues or fluids have been reported. We report here a fatal case of M. arginini pneumonia and septicemia in an immunocompromised patient.
Case Report A 64-year-old man was admitted to the hospital with a l-week history of bilateral arm pain following an intravenous human immune globulin infusion. Until a few weeks prior to admission, he worked in a slaughterhouse, where he slaughtered sheep, cows, and chickens. He had had stage-IVB nonHodgkin's lymphoma for the previous 3 years and had received prednisone therapy in the past year. His immune status was known to be depressed since he had been hypogammaglobulinemic (IgG, 4 giL; IgM, 256 mg/L) and to streptomycin (MIC, 128 mg/L). The MICs of tetracycline and ciprofloxacin were 0.5 mg/L, and the MIC of doxycycline was
Fatal Septicemia Due to Mycoplasma arginini: A New Human Zoonosis Ariane Yechouron, Johanne Lefebvre, Hugh G. Robson, David L. Rose, and Joseph G. Tully
From the Division of Infectious Diseases. Departments of Medicine and Microbiology. Royal Victoria Hospital. Montreal. Quebec. Canada; the Chlatnvdia-Ureaplasma Program. Laboratoire de sante publique du Quebec. Sainte-Anne-de-Bellevue, Quebec. Canada; and the Mycoplasma Section. National Institute ofAllergy and Infectious Diseases. National Institutes of Health. Frederick. Maryland
The last two decades have brought to light much new information on the biology, host distribution, and pathogenicity of wall-less prokaryotes. These organisms, now assigned to the class Mollicutes. are found frequently in the respiratory and urogenital tracts of most vertebrates, in the gut or hemolymph of a wide variety of insects, and as intracellular or surface inhabitants of plants [I]. Most Mollicutes organisms also differ from other prokaryotes in having a growth requirement for cholesterol or serum, in possessing a smaller genome (400-1,000 mD), and in having very limited metabolic and enzymatic activities. The known Mollicutes flora of humans currently consists of 14 distinct organisms, including 12 established species of the genus Mycoplasma and the species Ureaplasma urealyticum and Acholeplasma laidlawii. The majority of Mycoplasma species of humans occur as commensals in the oropharynx or lower urogenital tract [2, 3]. However, several organisms are established pathogens, including Mycoplasma pneumoniae, the agent of mycoplasmal pneumonia; Mycoplasma hominis, which causes some postpartum infections [4] and other types of septicemias [57]; and Mycoplasma[ermentans, a species recently associated with fatal infections in patients with and without AIDS [8]. U. urealyticum has also been recognized as a pathogen in the lower urogenital tract of humans (non-gonococcal urethritis) [2] and in the respiratory tract of neonates [9]. Of the remaining 80 known Mycoplasma species, most are associated with animal hosts. The mycoplasmal flora of any one animal species usually consists of a number of Mycoplasma species unique to that host [10]. However, a few Mycoplasma species, including Mycoplasma arginini. can be iso-
Received 3 January 1992; revised 20 April 1992. Reprints or correspondence: Dr. Ariane Yechouron, Centre hospitalier de Verdun. Laboratoire de microbiologie. 4000 boulevard Lasalle. Verdun. Quebec. Canada H4G 2A3.
Clinical Infectious Diseases 1992;15:434-8 © 1992 by The University of Chicago. All rights reserved. 1058-4838/92/1503-0008$02.00
lated from a number of different animal hosts [10]. M. arginini has been recovered from sheep, goats, cattle, and various felines [11-18]. As with mycoplasmas of humans, most mycoplasmas found in animals are commensals that colonize the respiratory and urogenital tracts [10]. Mycoplasmas are also clearly involved in a variety of animal diseases, including pneumonia, arthritis, mastitis, conjunctivitis. and genitourinary infections [19]. Animal mycoplasmas have yet to be clearly associated with human disease, and few isolations of these organisms from human tissues or fluids have been reported. We report here a fatal case of M. arginini pneumonia and septicemia in an immunocompromised patient.
Case Report A 64-year-old man was admitted to the hospital with a l-week history of bilateral arm pain following an intravenous human immune globulin infusion. Until a few weeks prior to admission, he worked in a slaughterhouse, where he slaughtered sheep, cows, and chickens. He had had stage-IVB nonHodgkin's lymphoma for the previous 3 years and had received prednisone therapy in the past year. His immune status was known to be depressed since he had been hypogammaglobulinemic (IgG, 4 giL; IgM, 256 mg/L) and to streptomycin (MIC, 128 mg/L). The MICs of tetracycline and ciprofloxacin were 0.5 mg/L, and the MIC of doxycycline was
