First evidence of an endogenous Spiroplasma sp infection in humans manifesting as unilateral cataract associated with anterior uveitis in a premature baby

Purpose: To elucidate a previously unknown aetiology of rapidly progressive unilateral cataract in a premature baby associated with severe anterior uveitis. Methods: The lens and vitreous material were saved as part of a special protocol in a 4-month-old premature baby at the time of pars plana lensectomy with anterior vitrectomy. We performed (1) microbiological cultures to detect viable bacterial and fungal organisms; (2) PCR reaction to viral, bacterial and fungal agents; (3) transmission electron microscopy (TEM). In addition, serological examinations were performed for HSV-1 and -2, CMV, VZV and Mycoplasma infection. Results: PCR detected Spiroplasma sp.; TEM confirmed the presence of Spiroplasma within the lens fibres. Serological testing and microbiological cultures of the vitreous and lens were negative. Conclusion: Endogenous Spiroplasma infection in a premature baby may manifest as rapidly progressive acquired unilateral cataract with anterior uveitis. Beyond this, Spiroplasma infection has never been reported to occur naturally in vertebrates, although experimentally Spiroplasma mirum produces panophthalmitis associated with cataract in a wide range of rodents and in chicks. In acquired infantile cataract with inflammatory signs, PCR and TEM should be performed in the lensectomy/vitrectomy material to detect infectious agents not evident on routine laboratory and microbiological examinations.