Emerg Infect DisEIDEmerging Infectious Diseases1080-60401080-6059Centers for Disease Control and Prevention19624945274423309-017410.3201/eid1507.090174Letters to the EditorOutbreaks of Hemotrophic Mycoplasma Infections in ChinaOutbreaks of Hemotrophic Mycoplasma Infections in ChinaHuZhe1YinJigang1ShenKefeiKangWeiChenQijunJilin University, Changchun, People’s Republic of China (Z. Hu, J. Yin, K. Shen, W. Kang, Q. Chen)Swedish Institute for Infectious Disease Control and Karolinska Institutet, Stockholm, Sweden (Q. Chen)These authors contributed equally to this article.Address for correspondence: Qijun Chen, Swedish Institute for Infectious Disease Control and Karolinska Institutet, Nobels väg 16, Stockholm 171 81, Sweden; email: qijun.chen@smi.se7200915711391140Keywords: Hemotrophic mycoplasmashemoplasmasChinabacterialetter

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 (36). 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.

Number of reported hemotrophic mycoplasma infections, China, 1994–2007*
YearSpecies
HumanCowSwineSheepFox
1994200NRNRNRNR
1995331132NR231NR
19961,229259147NRNR
19972,262691,282126NR
199874064127115NR
19993,8611,4603972,493954
20001,9712,920140NR371
20013293297,775NR16,697
2002126NR17,068NR17,068
200388084600,0331,87731,208
2004462515,604206NR
200545111927,2682,91620
200647515,916536465
200745231,6865360

*NR, no record.

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.

Suggested citation for this article: Hu Z, Yin J, Shen K, Kang W, Chen Q. Outbreaks of hemotrophic mycoplasma infections in China [letter]. Emerg Infect Dis [serial on the Internet]. 2009 Jul [date cited]. Available from http://www.cdc.gov/EID/content/15/7/1139.htm

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).

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