First Human Systemic Infection Caused by Spiroplasma

Abstract

c Spiroplasma species are organisms that normally colonize plants and insects. We describe the first case of human systemic infection caused by Spiroplasma bacteria in a patient with hypogammaglobulinemia undergoing treatment with biological diseasemodifying antirheumatic agents. Spiroplasma turonicum was identified through molecular methods in several blood cultures. The infection was successfully treated with doxycycline plus levofloxacin. CASE REPORTA 73-year-old Caucasian woman presented to the emergency room complaining of a 2-month history of intermittent fevers of up to 38°C, proximal myalgias, a frontal headache, apathy, fatigue, and progressive swelling of the limbs. Physical examination revealed bilateral conjunctival injection. Heart murmurs were not detected, and the remainder of the examination was also normal.The patient had a history of rheumatoid arthritis and for the last 10 years had been receiving continuous biological diseasemodifying antirheumatic agents for frequent flare-ups. The biologic agents used had sequentially included etanercept, rituximab, and tocilizumab. The latter had been given for the last 3 years, until it was replaced with certolizumab 3 months before admission because of inadequate pain control. Other relevant clinical data included a selective IgM deficiency diagnosed 1 year before, with undetectable serum IgM levels, and long-term cholestatic liver disease of unknown etiology. The patient lived in an urban setting, and she denied contact with plants or animals or insect bites. There was no other epidemiological or personal background of interest.On admission, her blood tests revealed microcytic anemia suggestive of chronic disease (hemoglobin concentration, 10 g/dl [reference range, 12 to 15.5 g/dl]). Acute-phase reactants were elevated, with a C-reactive protein level of 141 mg/dl (reference range, Ͻ5 mg/dl), an erythrocyte sedimentation rate of 103 mm/h (reference range, 0 to 10 mm/h), and a fibrinogen level of 768 mg/dl (reference range, 150 to 500 mg/dl). The hepatic cholestasis enzymes were increased, similar to the patient's usual levels, with a normal bilirubin concentration. Serum IgM was undetectable (Ͻ5 mg/dl [reference range, 60 to 250 mg/dl]), and levels of IgG were low (304 mg/dl [reference range, 680 to 1,530 mg/dl]). Her serum was negative for markers of autoimmunity, the usual serum tumor markers, rheumatoid factor, and anti-citrullinated peptide antibodies. Urinalysis and serum and urine electrophoresis results were unremarkable. Thoracic computed tomography (CT) revealed mild bilateral posterobasal pleural effusion with bilateral infiltrates in "frosted glass" suggestive of heart failure. Cranial, abdominal, and pelvic CT did not show abnormal findings.Two blood culture sets were drawn. Each blood culture set included an aerobic and an anaerobic bottle (Bactec 9240; BectonDickinson Diagnostic Instrument Systems). Empirical antibiotic therapy with intravenous cefuroxime was started on admission. After 48 h of incubation, the two blood culture sets became...

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“…To our knowledge, only two cases of human infection have been reported: the first in a premature infant with an unilateral cataract necessitating vitrectomy and lensectomy, and a very recent one in a patient with rheumatoid arthritis under therapy with certolizumab and profound selective IgM deficiency (13,14). Diagnosis of Spiroplasma sp.…”

Spiroplasma spp.: A Plant, Arthropod, Animal and Human Pathogen

“…Two additional cases of human infections due to Spiroplasma were reported in 2015 [81,82]. Both patients had a deficiency of the immune system due to hypogammaglobulinaemia or to pharmacologic immunosuppression, after transplantation.…”

“…Both patients had a deficiency of the immune system due to hypogammaglobulinaemia or to pharmacologic immunosuppression, after transplantation. In the first case, a patient with rheumatoid arthritis and hypogammaglobulinaemia presented on admission, clinical signs of infection, no signs of autoimmune disease, and negative tumor makers [82]. The only sign of bacterial infection was a positive blood culture, but the bacteriological examination after Gram staining was negative.…”

Sustainable farming of the mealworm Tenebrio molitor for the production of food and feed

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