Chronic Bronchitis in Immunocompromised Patients: Association with a Novel Mycoplasma Species

  • D. Webster
  • H. Windsor
  • C. Ling
  • D. Windsor
  • D. Pitcher


Patients with primary antibody deficiency are prone to recurrent bronchitis, often caused by nonencapsulated Haemophilus influenzae and streptococcal infection. Productive cough often persists even after elimination of these organisms with antibiotics. During an investigation into the cause of unexplained chronic bronchitis in these patients, a novel Mycoplasma species (designated A39) was first isolated from the sputum of a man with X-linked agammaglobulinaemia. Screening of sputa from a further 45 patients with primary antibody deficiency showed that 10 were positive for a similar organism using culture and/or a polymerase chain reaction based on sequences within the 16S ribosomal RNA gene. A comparison of the sequence data showed that the organism was distinct from but similar to Mycoplasma pneumoniae and other closely related mycoplasmas found in humans and animals. Electron microscopy showed some unique morphological characteristics. Although respiratory symptoms improved after elimination of A39 from the sputum of the patient with X-linked agammaglobulinaemia, further work is needed to establish the organism as a pathogen.


Haemophilus Influenzae Mycoplasma Pneumoniae Throat Swab Common Variable Immunodeficiency CVID Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank nurses Cilla Freud and Irene Wahlberg, along with Ms. J. Lewin and the staff of the Royal Free Hospital microbiology and electron microscopy department for help in managing and investigating the patients. All experiments described in this paper comply with the current laws of the country in which they were performed.


  1. 1.
    Samuelson A, Borrelli S, Gustafson R, Hammarstrom L, Smith CIE, Jonasson J et al. (1995) Characterisation of Haemophilus influenzae isolates from the respiratory tract of patients with primary antibody deficiency: evidence for persistent colonisation. Scand J Infect Dis 27:303–313PubMedGoogle Scholar
  2. 2.
    Hermaszewski RA, Webster ADB (1993) Primary hypogammaglobulinaemia: a survey of clinical manifestations and complications. QJM 86:31–42PubMedGoogle Scholar
  3. 3.
    Franz A, Webster ADB, Furr PM, Taylor-Robinson D (1997) Mycoplasmal arthritis in patients with primary immunoglobulin deficiency: clinical features and outcome in 18 patients. Br J Rheumatol 36:661–668CrossRefPubMedGoogle Scholar
  4. 4.
    Roifman CM, Rao CP, Lederman HM, Lavi S, Quinn P, Gelfand EW (1986) Increased susceptibility to mycoplasma infection in patients with hypogammaglobulinaemia. Am J Med 80:590–594PubMedGoogle Scholar
  5. 5.
    Hannan PCT, Windsor HM, Ripley PH (1997) In vitro susceptibilities of recent field isolates of Mycoplasma hyopneumoniae and Mycoplasma hyosynoviae to valnemulin (Econor®), tiamulin and enrofloxacin and the in vitro development of resistance to certain antimicrobial agents in Mycoplasma hyopneumoniae. Res Vet Sci 63:157–160PubMedGoogle Scholar
  6. 6.
    Jin H, Webster ADB, Vihinen M, Sideras P, Vorechovsky I, Hammarstrom et al. (1995) Identification of Btk mutations in 20 unrelated patients with X-linked agammaglobulinaemia (XLA). Hum Mol Genet 4:693–700PubMedGoogle Scholar
  7. 7.
    Heilmann C, Jensen L, Jensen JS, Lundstrom K, Windsor D, Windsor H, Webster D (2001) Treatment of resistant mycoplasma infection in immunocompromised patients with a new pleuromutilin antibiotic. J Infect 43:234–238CrossRefPubMedGoogle Scholar
  8. 8.
    Poveda JB, Nicholas R (1998) Serological identification of mycoplasmas by growth and metabolic tests. In: Miles R, Nicholas R (eds) Methods in molecular biology, vol 104. Mycoplasma protocols. Humana Press, Totowa, NJ, pp 105–111Google Scholar
  9. 9.
    Poveda JB (1998) Biochemical characteristics in mycoplasma identification. In: Miles R, Nicholas R (eds) Methods in molecular biology, vol 104. Mycoplasma protocols. Humana Press, Totowa, NJ, pp 69–78Google Scholar
  10. 10.
    Ochert AS, Boulder AW, Birnbaum W, Johnson NW, Teo CG (1994) Inhibitory effects on the polymerase chain reaction by salivary fluids: potency and removal. PCR Methods Appl 3:365–368PubMedGoogle Scholar
  11. 11.
    Cadieux N, Lebel P, Brousseau R (1993) Use of a triplex polymerase chain reaction for the detection and differentiation of Mycoplasma pneumoniae and Mycoplasma genitalium in the presence of human DNA. J Gen Microbiol 2431–2437Google Scholar
  12. 12.
    Johansson K-E, Heldtander M, Pettersson B (1998) Characterisation of mycoplasmas by PCR and sequence analysis with universal 16S rDNA primers. In: Miles R, Nicholas R (eds) Methods in molecular biology, vol 104. Mycoplasma protocols. Humana Press, Totowa, NJ, pp 145–165Google Scholar
  13. 13.
    Altschul SF, Gish W, Miller W, Myers EW, Lipman DJ (1990) Basic local alignment search tool. J Mol Biol 215:403–410CrossRefPubMedGoogle Scholar
  14. 14.
    Harasawa R, Mizusawa H, Nozawa K, Nakagawa T, Asada K, Kato I (1993) Detection and tentative identification of dominant mycoplasma species in cell cultures by restriction analysis of the 16S-23S intergenic spacer region. Res Microbiol 144:489–493CrossRefPubMedGoogle Scholar
  15. 15.
    Carson JL, Hu P-C, Collier AM (1992) Cell structural and functional elements. In: Maniloff J, McElhaney RN, Finch LR, Baseman JB (eds) Mycoplasmas, molecular biology and pathogenesis. American Society for Microbiology, Washington DC, pp 63–72Google Scholar
  16. 16.
    Tully JG, Taylor-Robinson D, Cole RM, Rose DL (1981) A newly discovered mycoplasma in the human urogenital tract. Lancet i:1288–1291Google Scholar
  17. 17.
    Chapel H, Geha R, Rosen F (2003) Primary immunodeficiency diseases: an update. Clin Exp Immunol 132:9–15PubMedGoogle Scholar
  18. 18.
    Hill AC (1985) Mycoplasma testudinis, a new species isolated from a tortoise. Int J Syst Bacteriol 35:489–492Google Scholar
  19. 19.
    Montagnier L, Blanchard A (1993) Mycoplasmas as cofactors in infection due to the human immunodeficiency virus. Clin Infect Dis 17 [Suppl 1]:309–315Google Scholar
  20. 20.
    Hodgin LA, Hogenauer G (1974) The mode of action of pleuromutilin derivatives: effect on cell-free polypeptide synthesis. Eur J Biochem 47:527–533PubMedGoogle Scholar
  21. 21.
    Webster ADB, Furr PM, Hughes-Jones NC, Gorick BD, Taylor-Robinson D (1988) Critical dependence on antibody for defence against mycoplasmas. Clin Exp Immunol 71:383–387PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • D. Webster
    • 1
  • H. Windsor
    • 2
  • C. Ling
    • 3
  • D. Windsor
    • 2
  • D. Pitcher
    • 4
  1. 1.Department of Clinical ImmunologyRoyal Free HospitalLondonUK
  2. 2.Mycoplasma Experience Ltd.ReigateUK
  3. 3.Department of Medical MicrobiologyRoyal Free HospitalLondonUK
  4. 4.Respiratory and Systemic Infection LaboratoryCentral Public Health LaboratoryLondonUK

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