Flying Fox Hemolytic Fever, Description of a New Zoonosis Caused by Candidatus Mycoplasma haemohominis

Abstract

Background Hemotropic mycoplasmas, previously classified in the genus Eperythrozoon, have been reported as causing human infections in Brazil, China, Japan and Spain. Methods In 2017, we detected DNA from “Candidatus Mycoplasma haemohominis” in the blood of a Melanesian patient from New Caledonia presenting with febrile splenomegaly,weight loss, life-threatening autoimmune haemolytic anemia and hemophagocytosis. The full genome of the bacterium was sequenced from a blood isolate. Subsequently, we tested retrospectively (2011-2017) and prospectively (2018-2019) patients who had been hospitalized with a similar clinico-biological picture. In addition, as these patients had been in contact with frugivorous bats (authorized under conditions for hunting and eating in New Caledonia) we investigated the role of these animals and their biting flies by testing them for hemotropic mycoplasmas. Results Fifteen patients were found to be infected by this hemotropic mycoplasma. Among them, four (27%) died following splenectomy performed for spontaneous spleen rupture, or to cure refractory autoimmune haemolytic anemia. The bacterium was cultivated from the patient's blood. The full genome of the Neocaledonian “Candidatus M. haemohominis” strain differed from that of a recently identified Japanese strain. Forty-six percent of 40 tested Pteropus bats and 100% of collected bat flies Cyclopodia horsfieldi (Nycteribiidae, Diptera) were positive. Human,bat and dipteran strains were highly similar. Conclusions The bacterium being widely distributed in bats, “Candidatus M. haemohominis” should be regarded as a potential cause of severe infections in humans.

Worldwide occurrence of haemoplasmas in wildlife: Insights into the patterns of infection, transmission, pathology and zoonotic potential

“…Fourteen of the 15 positive cases exhibited febrile autoimmune hemolytic anemia and hemophagocytosis. Comparative genome sequencing revealed that the average nucleotide identity (ANI) value between genomes of CMhh strain SWG34-3 reported by Hattori et al (2020) from a Japanese patient and CMhh strain Neocaledonica described by Descloux et al (2020) is ~98%, which is above the threshold for bacterial species delineation of ≥95% (Goris et al, 2007;Richter and Rosselló-Móra, 2009;Yoon et al, 2017), and therefore, demonstrates these two strains likely belong to the same species. Interestingly, most of the positive patients reported hunting and eating flying foxes, and closely related (up to 100%) 16s rRNA and dnaK genes sequences were detected in the flying foxes analyzed.…”

“…All rights reserved Eidolon fruit bats from Nigeria (Di Cataldo et al, 2020b) and Myotis chiloensis from Chile (Millán et al, 2019a). Recently, sequences with up to 100% identity to CMhh were identified in three Pteropus species in New Caledonia (Descloux et al 2020). However, many other sequences represent novel genotypes with variable similarity to previously identified hemotropic Mycoplasma species in other bats, ticks, rodents, primates, and carnivores (Becker et al, 2020).…”

“…Gonçalves et al (2020) detected hemoplasma DNA in ticks (Amblyomma sp.) and lice (Polyplax spinulosa) retrieved from rodents, Hornok et al, (2019) in ticks (Ixodes simplex) retrieved from bats, and Descloux et al (2020) in bat flies (Cyclopodia horsfieldi). However, neither study could determine…”

“…Attempts to propagate some hemoplasmas (e.g., M. suis and Ca. M. haemohominis) in vitro in axenic culture have been made; however, their growth was either very slow or displayed short-term in vitro maintenance in culture without productive growth (Schreiner, 2011;Descloux et al, 2020). To date, no in vitro in axenic cultures are available for successful and efficient cultivation of hemoplasmas, and thus almost all known hemoplasma species are considered as uncultivable in vitro.…”

Detection of zoonotic pathogens in animals performed at the University Hospital Institute Méditerranée Infection (Marseille – France)

“…Recently, in cooperation with the veterinary services of New Caledonia, the bacterial “Candidatus Mycoplasma haemohominis” species was recently detected in fruit bats of the Pteropus genus. This bacterium is responsible for haemolytic fever in humans, an emerging zoonosis [ 28 ].…”