Mycoplasma salivarium in the Blood of a Child with Leukemia James E. Gregory, PhD, Josie L. Chisom, and J. Lawrence Naiman, MD Philadelphia, Pennsylvania

Mycoplasma salivarium was recovered from the blood of a fiveyear-old girl who had leukemia and subsequently developed pneumonitis. The patient's pneumonitis failed to respond to nafcillin, a cell-wall-active antibiotic, but eventually she recovered from the pneumonia after a regimen of erythromycin. Sputum, oropharyngeal, and nasopharyngeal cultures revealed normal bacterial flora; a blood culture was negative for bacteria. Throat and sputum cultures were negative for mycoplasma; however, M salivarium was recovered from the patient's blood. The patient had a cold hemagglutinin titer of 1:250. Mycoplasma salivarium is the most commonly recovered species of Mycoplasma in the oral cavity.1 This organism may be recovered from saliva, tooth scrapings, and the oropharynx by using conventional mycoplasma media. In the oral cavity, the presence of this mycoplasma is considered as normal mycoplasmal flora because, to date, it has not been associated with disease. The present recovery of this organism from the blood of a child with leukemia merits consideration in that, in addition to this blood dyscrasia, the patient developed a pneumonitis that did not respond to cell-wall-active antibiotics. Treatment with erythromycin (which is effective against mycoplasma) caused a decrease in the symptoms of pneumonia and eventually cleared up this condition. The patient did not harbor mycoplasma in her sputum, oropharynx, or her nasopharynx, but the organisms were found in her blood. M pneumoniae was not recovered from the respiratory tract of this patient, however, a titer of 1:250 for cold hemagglutinins was de-

Presented at the 76th Annual Meeting of the American Society for Microbiology, Atlantic City, New Jersey, May 2-7, 1976. From the Departments of Microbiology and Pediatrics, St. Hospital for Children, PhiladelChristopher's phia, Pennsylvania. Requests for reprints should be addressed to Dr. James E. Gregory, Department of Microbiology, Howard University College of Medicine, Washington, DC 20059.

termined. The significance of this unusual recovery (M salivarium) remains obscure.

Case Report A five-year-old white female had been entirely well when she developed a gradual onset of malaise and poorly localized pains in her arms, legs, abdomen, and back. These symptons progressed over a six-week period. Toward the end of this period, she developed fever and easy bruisability. A blood smear examined at this time showed hematologic changes suggestive of leukemia, prompting referral to St. Christopher's Hospital for Children. Initial blood counts were as follows: hemoglobin, 7.7 gm/dl; leucocytes, 4,500/cu mm with 20 percent blastforms; and platelets, 11,000/cu mm. A bone marrow aspirate confirmed the diagnosis of acute lymphoblastic leukemia. At this time, serum antibody titers were less than 1:8 against both Herpes simplex virus and Mycoplasma pneumoniae. Following induction chemotherapy, consisting of vincristine and prednisone, the patient entered complete remission. She then received prophylactic cranial irradiation and five intrathecal injections of methotrexate. She was placed on maintenance chemotherapy with daily 6-mercaptopurine, weekly methotrexate and cytoxan, with monthly "pulses" of vincristine and prednisone. Cytoxan

JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 70, NO. 11, 1978

was discontinued after four months owing to the development of hemorrhagic cystitis. Eight months after the initial diagnosis of leukemia, the patient developed a cough, which was at first mild and nonproductive. It later became progressive and was characterized by the production of greenish sputum. Concomitant with this she became febrile, lethargic, and anorexic; one brief period of dyspnea also occurred. The patient was brought to St. Christopher's Hospital for Children and admitted. Physical examination during this period revealed a temperature of 104F and a respiratory rate of 40 per minute. Chest auscultation revealed rales at the right posterior lung base and at the left axilla. The rest of the examination was essentially normal. The laboratory examination showed a hemoglobin concentration of 11.0 gm/dl and a white blood cell count of 13,200/cu mm with 85 percent neutrophils, nine percent lymphocytes, four percent eosinophils, and one percent bands. Routine sputum, nasopharyngeal, and throat cultures grew normal flora. Blood and urine cultures were negative for bacteria. The patient was started on intravenous nafcillin, 500 mg every six hours. She received physical therapy and postural drainage following heated saline aerosols. Two days following admission, a cold hemagglutinin test was found to be positive with a titer of 1:250, raising the question of Mycoplasma infection. Throat, sputum, and blood specimens were obtained for the possible recovery of a Mycoplasma. The patient's therapy was changed from nafcillin to erythromycin, 200 mg orally four times a day. Sputum and throat cultures were negative for Mycoplasma pneumoniae; however, M salivarium was recovered from her blood. The patient continued to improve clinically and after ten days of erythromycin therapy, she was dis-

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Mycoplasma salivarium in the blood of a child with leukemia.

Mycoplasma salivarium in the Blood of a Child with Leukemia James E. Gregory, PhD, Josie L. Chisom, and J. Lawrence Naiman, MD Philadelphia, Pennsylva...
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