A taxonomic study of the genus Haemophilus, with the proposal of a new species

Isolation of an outer membrane hemin-binding protein of Haemophilus influenzae type b

Haemophilus influenzae is a heme-dependent bacterium. However, little is known of the heme-iron uptake mechanism in this organism. By using a batch ligand affinity chromatography method, a hemin-binding protein of 39,500 molecular weight was isolated from total membranes derived from H. influenzae type b grown under iron-depleted but not under iron-sufficient conditions. Detection of the hemin-binding protein in a whole-cell binding assay demonstrated a surface-exposed location. Competition binding experiments indicated that this hemin-protein interaction was specific, since only hemin or heme-containing proteins, such as human hemoglobin and bovine catalase, but not protoporphyrin IX, iron-loaded human lactoferrin, or transferrin, could abrogate binding. In a limited survey of other H. influenzae strains, an identical hemin-binding protein was isolated, implying that this polypeptide may be structurally and functionally conserved among strains.

Identification of a genetic locus of Haemophilus influenzae type b necessary for the binding and utilization of heme bound to human hemopexin

The mechanism(s) used by Haemophilus influenzae to acquire the essential nutrient heme from its human host has not been elucidated. The heme carried by the high-affinity serum protein hemopexin is one potential source of this micronutrient in vivo. A colony-blot assay revealed that heme-human hemopexin-binding activity was shared among most capsular serotype b strains of H. influenzae but was uncommon among other strains. We have identified a recombinant clone binding heme-human hemopexin from a H. influenzae type b (Hib) genomic library expressed in Escherichia coli. Both the Hib strain and the heme-hemopexin-binding clone expressed a polypeptide of approximately 100 kDa that bound radiolabeled heme-hemopexin. Oligonucleotide linker insertion mutagenesis of the plasmid DNA from this recombinant clone was used to confirm that expression of the 100-kDa protein correlated with the heme-hemopexin-binding activity. Exchange of one of these mutant alleles into the Hib chromosome eliminated expression of both the 100-kDa protein and the heme-hemopexin-binding activity. Furthermore, this Hib mutant was unable to utilize heme-human hemopexin as a heme source.

Molecular epidemiology of Haemophilus influenzae type b in the Gambia

One hundred two invasive and 64 noninvasive isolates of Haemophilus influenzae were collected in the course of a 2-year prospective field study on the epidemiology of H. influenzae meningitis in The Gambia. The isolates were serotyped, biotyped, and subtyped by outer membrane protein (OMP) profile analysis (OMP subtyping). H. influenzae meningitis was found to be caused by serotype b (95%). In invasive disease, serotype a, although present in the throat of healthy children, caused only occasionally (5.9%) disease. The distribution of biotypes of H. influenzae appeared to be very similar to that found outside The Gambia. A distinct pattern of OMP subtypes, different from other parts of the world, is prevalent in H. influenzae type b (Hib) in The Gambia. OMP subtypes 2, 4, 5, 8, and 9 were observed to be predominant. These subtypes, except subtype 2, have not been described. L subtypes (subtypes 2, 4, and 8) were associated with invasive disease, whereas non-L subtypes (subtypes 5 and 9) were found more often in healthy carriers (P less than 0.001). A significant difference in geographical distribution was found in subtypes of noninvasive Hib strains (P less than 0.05). We conclude that in The Gambia H. influenzae invasive disease is caused mainly by type b strains with a limited number of OMP subtypes, which are different from the subtypes found elsewhere in the world. These data are important for the surveillance of Hib disease in developing countries and are baseline data for a Hib polyribosyl-ribitolphosphate-conjugated vaccine trial in The Gambia. Alternative Hib OMP vaccines should include a set of representative OMPs.

Biotypes of Haemophilus influenzae that are associated with noninvasive infections

In this study, we examined the biotypes of Haemophilus influenzae strains associated with noninvasive infections in hospitalized patients. Over an 18-month period, a total of 388 strains were isolated from patients of various ages (neonates to the elderly), and the biotypes of the strains were determined. Strains of biotype II accounted for 48% of the isolates; this was followed by strains of biotypes III and I (26 and 16%, respectively). The remaining 10% of the isolates were made up of strains of biotypes IV, V, VI, and VII. A total of 6% of strains were capsulated. The distribution of biotypes in specimens from the respiratory tract and associated sites was comparable to that obtained in similar investigations, but examination of isolates from neonatal and genital specimens did not support the concept that H. influenzae biotype IV is a major urogenital pathogen. Conflicting results regarding the incidence of certain biotypes in specimens, particularly those from the urogenital tract, may be due to the selection of different subpopulations of patients. Data relating to the specimens were used to evaluate the association between biotype and clinical diagnosis, the presence of other potential bacterial pathogens in the specimens, and the presence of viruses in the specimens. None of the differences in the distribution of biotypes which were examined was statistically significant.

Bacteriological study of juvenile periodontitis in China

The predominant cultivable bacteria associated with juvenile periodontitis (JP) in China were studied for the first time. Subgingival plaque samples were taken on paper points from 23 diseased sites in 15 JP patients and from 7 healthy sites in 7 control subjects. Serially diluted plaque samples were plated on nonselective blood agar and on MGB agar, a selective medium for the isolation of Actinobacillus actinomycetemcomitans. Fifteen or more isolated colonies from each sample (in sequence without selection) were purified for identification. The results indicated that the microflora in healthy sulci of the 7 control subjects was significantly different from that in diseased sites of JP patients. The predominant species in healthy sulci were Streptococcus spp. and Capnocytophaga gingivalis. In JP patients, Eubacterium sp. was found in significantly higher frequency and proportion. Actinobacillus actinomycetemcomitans was not detected in any samples. It appears that this species is not associated with juvenile periodontitis in China.

Resistance to trimethoprim in Haemophilus influenzae

The mechanisms of resistance to trimethoprim in eleven U.K. clinical isolates of Haemophilus influenzae were studied. The levels of dihydrofolate reductase (DHFR) activities in crude extracts from four resistant wild-types were similar to those in susceptible controls. However, activities in extracts from the other seven resistant wild-type isolates, and transformants of two of these, were at least triple those in the sensitive strains. Resistance to trimethoprim was also selected for in vitro during prolonged exposure to the drug and was associated with increased levels of DHFR specific activity in the mutants. DHFR enzymes were, however, still very susceptible to inhibition by trimethoprim. Activities in four extracts, including one from a transformant of a resistant mutant, were reduced by at least 45% following incubation with 10(-8) M trimethoprim. The results suggested that overproduction of the chromosomal DHFR enzyme may be the resistance mechanism in some organisms. The much lower DHFR activities measured in extracts from other resistant isolates may reflect synthesis of chromosomal enzymes that have reduced susceptibility to trimethoprim.

Biochemical typing of Actinobacillus pleuropneumoniae

A study was conducted to evaluate the possibility of using biochemical differences among strains of a given serotype of Actinobacillus pleuropneumoniae as epidemiological markers, to rapidly identify the source of infection in herds affected with swine pleuropneumonia. Out of 38 different biochemical and physiological tests performed on a total of 67 strains belonging to serotypes 1 and 5 of A. pleuropneumoniae, three fermentation tests, glycerol, lactose and raffinose, allowed the classification of serotype 1 strains into 6 phenotypic groups and serotype 5 strains into 4 of these groups. Groups II and III were exclusively composed of serotype 1 strains, whereas the majority of strains in groups I and IV belonged to serotypes 1 and 5 respectively, the latter comprising almost all the serotype 5 studied.

Neonatal Haemophilus influenzae infections

Nine cases of neonatal Haemophilus influenzae septicaemia were recorded in Finland during 1985-9; incidence was 2.8/100,000 live births, and 1.6% of all cases of neonatal septicaemia. The onset of the disease was early in all cases, ranging from 0-6 hours after delivery. Seven of the infants were preterm and three died (overall mortality 33%). H influenzae was isolated from blood in seven of the cases, and in two neonates with clinical signs of septicaemia it was found on several surface sites and the placenta. One of the eight strains of H influenzae was capsular type b and biotype I, the rest being non-typable--a distribution similar to those previously reported. Four of the uncapsulated strains were of biotype III, and three were of biotype II. None of the strains of H influenzae was of biotype IV, which has been reported to be characteristic of neonatal and genital isolates of H influenzae. All nine mothers had some sign of infection at the time of or shortly after delivery. H influenzae was isolated from five mothers: from the blood (n = 1) or from the placenta or cervix (n = 4). The use of intrauterine devices may be a possible risk factor for neonatal H influenzae infections; two of the mothers had such devices in place during their pregnancies.

Distribution of protein D, an immunoglobulin D-binding protein, in Haemophilus strains

Protein D, a novel surface protein of the bacterial species Haemophilus influenzae with specific affinity for human immunoglobulin (Ig) D was detected in all 127 H. influenzae strains studied. All strains representing different serotypes of encapsulated strains and different biotypes of nonencapsulated strains bound 125I-labeled IgD to a high degree (38 to 74%). Sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western blot (immunoblot) analysis showed that protein D from all H. influenzae strains had the same apparent molecular weight (i.e., 42,000) and reacted with all three different anti-protein D monoclonal antibodies. By Scatchard analysis, the number of protein D residues on a nontypeable H. influenzae strain was estimated to be approximately 2,800 per organism. The equilibrium constant for the reaction between a human IgD myeloma protein and IgD was found to be 5.8 x 10(8) M-1. Also, all strains of H. haemolyticus and H. aegypticus strains tested bound IgD, 21 to 28% and 41 to 48%, respectively. In extracts of those bacteria, a 42,000-molecular-weight protein reactive with IgD and all three anti-protein D monoclonal antibodies was found. In H. parainfluenzae, H. aphrophilus, H. paraphrophilus, and Actinobacillus actinomycetemcomitans, a 42,000-molecular-weight protein that was reactive with one to three of three anti-protein D monoclonal antibodies but not reactive with human IgD was detected with Western blot analysis. Other Haemophilus species (H. ducreyi, H. parasuis, H. parahaemolyticus, H. segnis, and H. haemoglobinophilus) did not react with human monoclonal IgD or anti-protein D antibodies. On the basis of the wide distribution of protein D among H. influenzae strains, we suggest that protein D could be a vaccine candidate.

The development of specific rRNA-derived oligonucleotide probes for Haemophilus ducreyi, the causative agent of chancroid

Part of a ribosomal ribonucleic acid (rRNA) cistron of Haemophilus ducreyi was enzymically amplified using conserved primers within the rRNA molecules, cloned in a plasmid vector, and sequenced. From the nucleotide sequence, eight oligonucleotides complementary to different regions in the 16S and 23S rRNA molecules were selected, chemically synthesized, and used as hybridization probes. Hybridization experiments with at least 41 H. ducreyi strains and 13 or 14 non-H. ducreyi strains revealed that all eight oligonucleotide probes were highly reliable and completely specific for H. ducreyi strains. Comparisons of 16S rRNA sequences confirm that H. ducreyi is a member of the Pasteurellaceae though not closely related to other species in this family.

Characterization of noncapsulate Haemophilus influenzae by whole-cell polypeptide profiles, restriction endonuclease analysis, and rRNA gene restriction patterns

Thirty-four clinical isolates of noncapsulate Haemophilus influenzae representing isolates with either related or dissimilar patterns of whole-cell polypeptide profiles on sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) were further characterized by restriction enzyme analysis (REA) and rRNA gene restriction patterns. Total cellular DNA was extracted by a rapid, microcentrifuge-scale method and digested with BamHI, which gave a pattern of about 18 discrete bands. This confirmed the five closely related groupings suggested by SDS-PAGE. Isolates dissimilar by SDS-PAGE were also distinguishable by REA. However, there was no correlation between the degrees of similarity estimated from whole-cell polypeptide profiles and those obtained from REA for the dissimilar isolates. Therefore, inferences of genetic relatedness made on the basis of these data should be interpreted with caution. rRNA gene restriction patterns also confirmed the groupings suggested by the other two techniques. We conclude that the three methods were highly discriminatory and that whole-cell polypeptide patterns or REA with BamHI would be appropriate techniques for epidemiological studies of noncapsulate H. influenzae.

Amoxycillin/clavulanate versus amoxycillin in recurrent otitis media and therapeutic failure in children

A total of 102 children with recurrent otitis media or therapeutic failure after treatment with phenoxymethyl penicillin were entered into a double-blind study with parallel groups, comparing treatment with amoxycillin/clavulanate suspension (Spektramox) for 7 days with amoxycillin suspension (Imacillin) for 10 days. Bacterial and clinical investigations were performed. A total of 91 patients were evaluated for efficacy at the first follow-up visit (10-12 days after start of treatment). Amoxycillin/clavulanate and amoxycillin showed equally high, satisfactory treatment results, i.e. more than a 90% response. Similarly, there was no statistically significant difference between the treatment groups at the second follow-up visit (about 30 days after start of treatment). Bacteriological cultures from the nasopharynx showed equal distribution of Haemophilus influenzae, Branhamella catarrhalis and Streptococcus pneumoniae between the study groups. Elimination of the initially occurring pathogens was equal in the two study groups with the exception of B. catarrhalis which was eliminated to a significantly higher extent with amoxycillin/clavulanate. Both drugs were well tolerated. In patients with recurrent otitis media or therapeutic failure, treatment with amoxycillin/clavulanate for 7 days results in high, satisfactory clinical effects and is comparable to treatment with amoxycillin for 10 days.

Immunoprophylaxis of otitis media

Prospects for an effective otitis media vaccine are bolstered by a number of encouraging observations. Results of pneumococcal polysaccharide vaccine trials beginning in 1975, the enormously enhanced immunogenicity of protein-Hib polysaccharide coupled vaccines in infants, and the apparent effectiveness of a protein-PCP coupled vaccine in experimental otitis media suggest that a pneumococcal vaccine targeted to prevent invasive and middle ear infections is not too distant. The identification of several conserved surface antigens on NTHi and demonstration of otitis media protection elicited by these antigens in an animal model give promise for the development of H. influenzae vaccines for otitis media. Evidence that attenuated influenza A virus vaccination may also be an effective strategy for otitis media prevention, at least in an animal model, suggests that priority should be given to testing the efficacy of influenza, parainfluenza and respiratory syncytial virus vaccines with respect to otitis media prevention. It seems quite likely that not one but several immunoprophylaxis approaches will be necessary to reduce the overall incidence of otitis media given the multifactorial nature of the disease. Increasing parent and physician concern with the high incidence of otitis media and its morbidity suggests high participation rates in vaccine trials and high utilization of vaccines shown to be protective. Even if a vaccine could reduce the incidence of otitis media by 30%, an annual health care savings of $300-750 million would be achieved.

Non-capsulated Haemophilus influenzae in the genital flora of pregnant and post-puerperal women

Non-capsulated Haemophilus influenzae may cause neonatal septicaemia. Genital carriage of this pathogen was studied in 3 mothers of infected neonates and in 2 pregnant women in the first trimester. A carrier state in 2 of the females was terminated by antibiotic therapy after 3 and 7 months, respectively. A previous carrier had no recurrence of H. influenzae in a subsequent pregnancy. A survey of 544 parturient women revealed a carrier rate of 1.8/1,000 (95% confidence limits: 0.1-11). Carriage of non-capsulated H. influenzae is thus rare, and pregnant women may be successfully treated in order to reduce the risk of neonatal infection. There was no evidence of immunodeficiency in women with non-capsulated H. influenzae in the genital tract.

Comparison of two commercial kits for identifying and biotyping Haemophilus parainfluenzae

The Minitek system and the more recently introduced Micro Scan HNID panels for the identification and biotyping of 98 V dependent Haemophilus isolates were compared. Identical results were obtained for 77 isolates. The discrepancy in the results of ornithine and urease was accounted for mainly by the mismatching of the identification by the two kits. When 13 isolates of H parainfluenzae with mismatched biotypes were re-examined, the results from Micro Scan correlated with 92% of those obtained by Christensen's urea broth and 100% by the ornithine test (Lab M); the corresponding figures for Minitek were 61% and 30%, respectively. Micro Scan was easy to handle on the bench and results were ready on the same day. These results suggest that further work is required to assess these two systems for the biotyping of H parainfluenzae.

V factor-dependent members of the family Pasteurellaceae in the porcine upper respiratory tract

A study was performed to obtain a better understanding of the diversity and ecology of members of the family Pasteurellaceae in the porcine respiratory tract. A collection of 132 V factor-dependent strains of Pasteurellaceae selected from porcine field isolates mainly from the respiratory tract were subjected to detailed characterization. In addition to the three hitherto recognized species Actinobacillus pleuropneumoniae, Haemophilus parasuis, and Haemophilus taxon "minor group," three distinct taxa were observed. Some of these taxa, which are provisionally designated taxa D, E, and F, would by traditional criteria be mistaken for H. parasuis but differed by several biochemical characteristics. To study the ecology of the V factor-dependent species, swabs from the nasal and oral cavities of 29 pigs were cultivated on selective and nonselective media. By studying approximately 30 isolates from each sample, the distribution and relative proportion of the individual taxa were determined. A. pleuropneumoniae was detected in samples from the tonsil areas of only two acutely ill animals. H. parasuis was isolated from the nasal cavities of four out of nine healthy pigs but from the oral cavities of only two animals. In contrast, taxon "minor group" and taxa D, E, and F were present in the oral cavities of the majority of pigs but were not detected in samples from their nasal cavities. The results indicate that all the observed V factor-dependent species of Pasteurellaceae except A. pleuropneumoniae, are members of the resident microflora of various mucosal surfaces of the porcine upper respiratory tract.

Chancroid and the role of genital ulcer disease in the spread of human retroviruses

Chancroid is the most prevalent form of genital ulcer disease in developing countries and is undergoing a resurgence in industrialized countries. As a result of a nonspecificity of the clinical findings, the etiologic diagnosis of genital ulcer disease requires laboratory support. Genital ulcer disease is a risk factor for the transmission of human retroviral infections. An understanding of this interaction is emerging and will impact on the treatment and control programs for the agents causing genital ulcer disease.

Haemophilus aphrophilus isolated from blood

H. aphrophilus was isolated from 11 successively cultivated blood samples of a male (72) with a fatal atypical endocarditis. Identification and differential diagnosis from Actinobacillus (Haemophilus) actinomycetemcomitans was done on the basis of phenotypic characters of the microorganism.

Identification of Haemophilus aphrophilus and Actinobacillus actinomycetemcomitans by DNA-DNA hybridization and genetic transformation

DNA-DNA hybridization was used to identify clinical isolates as Haemophilus aphrophilus or Actinobacillus actinomycetemcomitans. Some of the isolates were naturally competent for genetic transformation and were also used as DNA recipients for identification of other isolates. The results obtained by hybridization were supported by interstrain-to-intrastrain transformation ratios. Distinction between the closely related species H. aphrophilus and A. actinomycetemcomitans was generally clear-cut by both methods. Distinction of H. aphrophilus and A. actinomycetemcomitans from type and reference strains of a diversity of species in the family Neisseriaceae and other gram-negative species was also demonstrated by both methods. This is the first description of the identification of clinical isolates of H. aphrophilus or A. actinomycetemcomitans by using them as recipients in genetic transformation. The results suggest that this is a reliable system for identification of new clinical isolates belonging to these taxonomic entities.

Comparison of the RIM-H rapid identification kit with conventional tests for the identification of Haemophilus spp

A commercially available system, the RIM-H system (Austin Biological Laboratories, Austin, Tex.), was evaluated for its ability to rapidly and accurately identify various Haemophilus spp. A total of 110 clinical isolates were tested by both the RIM and conventional identification procedures. The RIM agreed with the standard identification for 100% of the Haemophilus influenzae (76 of 76) and 92.0% of the Haemophilus parainfluenzae (23 of 25) isolates tested. The identifications of Haemophilus parahaemolyticus, Haemophilus aphrophilus, and Haemophilus haemolyticus also correlated with those obtained by conventional methods. The RIM was found to be rapid and easy to use and was considered a suitable alternative to conventional identification procedures.

Cross-infection by non-encapsulated Haemophilus influenzae

From October, 1988, to January, 1989, 18 patients admitted to an acute medical chest ward were infected with an ampicillin-resistant beta-lactamase-producing strain of Haemophilus influenzae. All 18 isolates were non-encapsulated strains of biotype III and showed identical cell envelope protein profiles, as judged by sodium dodecyl sulphate-polyacrylamide gel electrophoresis. The organism was not isolated from repeated environmental samples but there was strong circumstantial evidence that a spirometer was a common iatrogenic source of the cross-infection.

Evaluation of a selective medium for the isolation and differentiation of Haemophilus influenzae and Haemophilus parainfluenzae from the respiratory tract of chronic bronchitics

Respiratory tract specimens from chronic bronchitic patients were cultured for Haemophilus species on conventional chocolate agar and a modified sucrose medium in order to determine the accuracy of the new medium in differentiating Haemophilus influenzae from Haemophilus parainfluenzae strains. Haemophilus influenzae biotypes II and III and Haemophilus parainfluenzae biotypes I and II were found to be the predominant strains isolated from the respiratory tract. The modified sucrose medium was found to be a rapid and reliable means of differentiating Haemophilus influenzae from Haemophilus parainfluenzae by sucrose fermentation, on initial isolation.

Use of a novel phosphatase test for simplified identification of species of the tribe Proteeae

Phosphatase activity of 334 isolates of the tribe Proteeae carefully identified to species level has been evaluated by using both a number of conventional tests and three versions of the novel methyl green-phenolphthalein (MGP) method (G. Satta. R. Pompei, G. Grazi, and G. Cornaglia, J. Clin. Microbiol. 26:2637-2641, 1988). We found that the different species of Proteeae show different and easily distinguishable. behaviors by the MGP method, while all of them behave in a uniform way in the conventional tests. On studying the mechanism underlying these different behaviors, we found that the phosphatase activity of Morganella morganii and Providencia stuartii is higher than that of all other members of the family Enterobacteriaceae. Furthermore, we found that all P. stuartii strains display the property (shared by virtually none of the other species of Enterobacteriaceae) of excreting significant amounts of phosphatase. This extracellular activity is reliably detected by the MGP method but not by conventional tests. Finally, by exploiting the peculiar phosphatase activity of this tribe, as revealed by the MGP method, we devised a simple scheme for routine identification of the species of Proteeae and evaluated its reliability by comparing it with three commonly used commercial kits. The new scheme proved much simpler, but also more reliable, since identifications obtained by this method were in almost complete accord (99%) with those of the reference identification schemes, while in the commercial systems examined the percentage of errors ranged from 13 to 14 in the identification of Providencia species.

Major subtypes of invasive Haemophilus influenzae from 1983 to 1985 in Atlanta, Ga

We compared outer membrane protein (OMP) patterns of Haemophilus influenzae isolated in metropolitan Atlanta, Ga., from July 1983 to June 1985. Of 74 randomly selected H. influenzae serotype b, biotype I, isolates (24% of the total number of H. influenzae, and 32% of the total number of H. influenzae serotype b, biotype I, isolates), 66 (89.2%) had the same OMP pattern. Of the remaining eight, five (6.7%) had an identical OMP pattern. The other three isolates had separate and distinct patterns. A greater diversity of OMP patterns was found with H. influenzae serotype b, biotype II, and nonserotypeable H. influenzae. Of the 18 H. influenzae serotype b, biotype II, isolates (5.8% of the total number of H. influenzae isolates), 1 had an OMP pattern similar to that of the predominate biotype I OMP type, 6 (33% of the biotype II) had the same pattern, and 11 had heterogeneous patterns. Of the 19 recoverable, nonserotypeable biotype II isolates (6.8% of the total number of H. influenzae), 18 had different OMP patterns, and no pattern was similar to those observed with serotype b. These findings indicate that most H. influenzae strains isolated during this 2-year period were indistinguishable by serotype, biotype, or OMP patterns.

Haemophilus infection in cystic fibrosis

Twenty seven patients with cystic fibrosis under the age of 12 years and 27 matched patients with asthma were followed up in a prospective study for one year. The isolation rate of non-capsulated strains of Haemophilus influenzae from cough swabs and sputum specimens taken at routine clinic visits every two months was significantly greater in cystic fibrosis than in asthma. Haemophilus para-influenzae was equally common in both groups. During exacerbations the isolation rate of H influenzae in cystic fibrosis was significantly greater than at other times, whereas in asthma there was no significant difference. The distribution of biotypes of H influenzae and H parainfluenzae was similar in the two groups. In cystic fibrosis, biotype I was associated with exacerbations. Biotype V was more common than in previous studies, but was not associated with exacerbations.

Frequent isolation of capnophilic bacteria in aspirate from Bartholin's gland abscesses and cysts

Aspirate samples were obtained from 73 patients undergoing surgery for a Bartholin's gland abscess or cyst. Capnophilic bacteria were isolated from 22% of cases, in contrast to previous reports of sporadic isolation. The three Streptococcus pneumoniae isolates were serotype 3 or 4. The eight Haemophilus influenzae isolates could not be serotyped; six of them were biotype II but the electrophoretic band patterns of their outer membrane proteins were heterogeneous, indicating that non-serotypable strains from the same anatomical site may not be related. Four Neisseria gonorrhoeae isolates and one strain of Neisseria subflava were recovered. The role of capnophilic bacteria in the pathogenesis of infections of the Bartholin's gland remains to be clarified.

Outbreak of multiresistant non-encapsulated Haemophilus influenzae infections in a pulmonary rehabilitation centre

15 out of 21 patients admitted to a pulmonary rehabilitation centre were infected with a non-encapsulated strain of Haemophilus influenzae. All isolates showed identical outer membrane protein patterns, harboured a 40 MD plasmid, produced beta-lactamase, and were resistant to amoxycillin, co-trimoxazole, chloramphenicol, and tetracycline. The strain was first isolated from sputum of another 3 patients in the same hospital ward. 2 of them later introduced it into the rehabilitation centre. The strain spread among the other patients over the next 2 months. The absence of a common iatrogenic source of the organism and its slow spread indicate that the most likely means of transmission was person to person.

Haemophilus isolated from unusual anatomical sites

During a 15-year period Haemophilus species were isolated from unusual anatomical sites in 80 patients, mostly adults. The origin of specimens was pus and swabs from suppurative lesions, fluids from serosal cavities and gall bladder, gut content, and blood in cases with a supposed tissue focus. In 17 patients Haemophilus species were isolated in pure culture, in 63 patients in conjunction with other bacteria. 17 patients had gynaecological complaints: bartholinitis, salpingitis, and vaginal discharge. 22 patients had gastrointestinal complaints, comprising 17 with appendicitis, peritonitis following perforation of gastric ulcer, gall-duct infections, and an abscess in the stomach wall, and 5 patients with colonization of the gut. 41 patients had soft tissue and bone infections.

Studies on the interactions of two different serotypes of Actinobacillus pleuropneumoniae

In vitro and in vivo interactions of various field strains of Actinobacillus pleuropneumoniae of serotypes 1, 2, 5 and 7 were studied. There was no influence of one serotype over the other when strains belonging to two serotypes were cultivated together in vitro. In vivo interactions showed predominance of serotype 1 over other serotypes when a strain of serotype 1 was inoculated together with a strain of serotype 2 or 5 in mice. Serotype 1 strain remained predominant irrespective of whether it was inoculated before or after the inoculation of serotype 2 strain. The mortality caused by the inoculation of two strains was higher than the mortality caused by a single strain. Early mortality was observed on inoculation of strains of serotype 2, 5 or 7 along with a strain of serotype 1. Both serotypes could be detected in the blood on cultural examination of mice infected with mixed serotypes.

Use of the RapID-ANA system and sodium polyanetholesulfonate disk susceptibility testing in identifying Haemophilus ducreyi

Haemophilus ducreyi has traditionally been difficult to identify. We have utilized simple test methods to identify 19 fresh isolates obtained during a recent outbreak of chancroid in Houston and six strains of H. ducreyi from other outbreaks. Tests were performed from growth on chocolate agar after 48 h of incubation at 35 degrees C with increased humidity and CO2. All isolates exhibited typical colonial morphology and Gram stain. Isolates were catalase negative and oxidase and nitrate positive (in enriched broth). The RapID NH system failed to identify these strains because of negative reactions with alkaline phosphatase and nitrate reductase. However, by using the RapID-ANA system, all strains were positive for alkaline phosphatase and arginine, glycine, and serine aminopeptidases. Their biochemical profiles were distinct from those obtained with 66 strains representing 13 species similar to H. ducreyi. We also investigated the use of sodium polyanetholesulfonate (SPS) disk susceptibility to identify and differentiate H. ducreyi from other species. All H. ducreyi isolates were susceptible, as evidenced by the presence of a zone of inhibition with an average size of 15 mm around the SPS disk. With the exceptions of Neisseria gonorrhoeae, Gardnerella vaginalis, and Capnocytophaga spp., no other strain showed any evidence of inhibition. The latter three organisms can be easily differentiated from H. ducreyi by various features including reactions in the RapID-ANA. We conclude that, by considering simple growth and biochemical characteristics, SPS susceptibilities, and reactions in RapID-ANA, it is possible for more clinical laboratories to definitively identify this organism.

Biology of Haemophilus ducreyi

The etiological agent of the sexually transmitted genital ulcer disease chancroid was first described in 1889 by Auguste Ducrey following repeated autoinoculation of purulent ulcer material from a series of patients. The organism was isolated on artificial media a decade later but has remained difficult to isolate consistently, resulting in controversy over its characteristics and role as the causative agent of chancroid. Because of its fastidious growth requirements, including unknown components in blood, the organism was included in the original description of the genus Haemophilus. Requirement for exogenous hemin and limited phenotypic characteristics, including structural and antigenic properties, suggested that Haemophilus ducreyi was a valid member of the genus Haemophilus. Recent studies of respiratory quinones, deoxyribonucleic acid hybridization, and competition for homologous transformation of the type species, H. influenzae, suggest that H. ducreyi is unrelated to any of the present species of the family Pasteurellaceae, which includes members of the genera Haemophilus, Actinobacillus, and Pasteurella. This review summarizes the early studies with H. ducreyi and our current knowledge of the microbiology of this important human pathogen.

Distribution of Haemophilus influenzae and Haemophilus parainfluenzae biotypes isolated from the human genitourinary tract

A total of 3,598 genital specimens from men and women was cultured for Haemophilus spp. using a simple selective culture method. Two hundred and thirty three samples (6.5%) were positive for Haemophilus spp., 216 Haemophilus parainfluenzae and 28 Haemophilus influenzae strains being isolated. Biotyping demonstrated that Haemophilus parainfluenzae biotype II was dominant at all sites, especially the male urethra, comprising 59% of all Haemophilus strains isolated. On the other hand, Haemophilus influenzae biotype IV was isolated from only six patients and thus was not a major genital biotype. The respective proportions of the two Haemophilus spp. recovered from various mucosal sites led to the supposition that the genitourinary colonization originated either from the upper respiratory tract or the gastrointestinal tract.

Typing of urogenital, maternal, and neonatal isolates of Haemophilus influenzae and Haemophilus parainfluenzae in correlation with clinical source of isolation and evidence for a genital specificity of H. influenzae biotype IV

Over a period of 6 years, 114 strains of Haemophilus influenzae and Haemophilus parainfluenzae were isolated from genital, mother-infant, or neonatal infections. Their serotypes, biotypes, antibiotic resistance phenotypes, and outer membrane protein (OMP) electrophoretic patterns were characterized and correlated with the various clinical outcomes. Genital H. influenzae and H. parainfluenzae appeared to behave mostly as opportunistic pathogens; for instance, 62% of the cases of endometritis or pelvic inflammatory disease were related to the presence of an intrauterine device. However, as seen clearly in one case, the strains may be sexually transmitted. The analysis of OMP patterns proved to be a very convenient method to seek evidence for the sexual origin of the infection. H. influenzae was more often involved in complicated genital infections than was H. parainfluenzae. Nontypeable and biotype II H. influenzae strains were the more frequent isolates, except in pelvic inflammatory diseases, in which biotype I prevailed, and in mother-infant infections, in which one-fourth of the cases were due to biotype IV. Characterization of H. influenzae isolates did not support a general concept of specific genital strains. However, strains of biotype IV clearly stood out with two characteristics: (i) a peritrichous fimbriation and (ii) a very peculiar homogeneous OMP pattern comprising an OMP of molecular weight approximately 18,000 unique to this biotype. These characteristics were also found in H. influenzae biotype IV strains isolated from genital infections in the United States and used as controls. H. influenzae biotype IV strains may thus correspond to a group somewhat adapted to the genital tract.

Cloning and sequencing of the immunoglobulin A1 protease gene (iga) of Haemophilus influenzae serotype b

Secretion of immunoglobulin A1 (IgA1) proteases is a characteristic of Haemophilus influenzae and several other bacterial pathogens causing infectious diseases, including meningitis. Indirect evidence suggests that the proteases are important virulence factors. In this study, we cloned the iga gene encoding immunoglobulin A1 (IgA1) protease from H. influenzae serotype b into Escherichia coli, in which the recombinant H. influenzae iga gene was expressed and the resulting protease was secreted. Sequencing a part of a 7.5-kilobase DNA fragment containing the iga gene revealed a large open reading frame with a strongly biased codon usage and having the potential of encoding a protein of 1,541 amino acids and a molecular mass of 169 kilodaltons. Putative promoter and terminator elements flanking the open reading frame were identified. Comparison of the deduced amino acid sequence of this H. influenzae IgA1 protease with that of a similar protease from Neisseria gonorrhoeae revealed several domains with a high degree of homology. Analogous to mechanisms known from the N. gonorrhoeae IgA protease secretion, we propose a scheme of posttranslational modifications of the H. influenzae IgA1 protease precursor, leading to a secreted protease with a molecular mass of 108 kilodaltons, which is close to the 100 kilodaltons reported for the mature IgA1 protease.

Nonculture detection of Haemophilus influenzae in sputum with monoclonal antibodies specific for outer membrane lipoprotein P6

Isolation of Haemophilus influenzae from sputum is hampered by overgrowth by other microorganisms or by antibiotic treatment of the patient. To overcome this problem in the detection of H. influenzae, an in situ immunoperoxidase staining technique was developed with monoclonal antibody (MAb) 8BD9, immunoglobulin subclass G2a. MAb 8BD9 appeared to be directed to an epitope on the outer membrane lipoprotein P6 of H. influenzae. The species specificity of MAb 8BD9 was analyzed by staining isolates from different bacterial species. MAb 8BD9 reacted with all 300 H. influenzae strains tested and with H. aegyptius and H. haemolyticus. Twenty-six of 30 H. parainfluenzae strains, other Haemophilus species, and other bacterial species often isolated from sputum were not stained. The staining technique was compared with culture of 845 routinely obtained sputum samples from patients with respiratory tract infections. In 829 sputa (98.1%), the results of both techniques were in agreement; 173 were positive for H. influenzae, and 656 were negative. With 14 sputum samples, the staining method gave a positive result for H. influenzae, but the bacterium was not cultured. This could be ascribed to antibiotic treatment of the patient (n = 7), the presence of other MAb 8BD9-positive Haemophilus species in the sputum (n = 5), and overgrowth by swarming Proteus mirabilis or by Branhamella catarrhalis. In the immunoperoxidase- and Gram-stained smears of two sputum samples, no bacteria were seen, although some H. influenzae was cultured. On the basis of these results, we conclude that immunoperoxidase staining with MAb 8BD9 is a fast and reliable extension of the available detection techniques for H. influenzae.

Antimicrobial susceptibilities of Haemophilus species in Hong Kong

Altogether 403 Haemophilus spp. were isolated in seven hospital laboratories in Hong Kong during June 1986, mostly from sputum. Of these 73% were Haemophilus influenzae and 27% Haemophilus parainfluenzae. All the isolates of H. influenzae were non-capsulated; Haemophilus spp. were not isolated from blood or cerebrospinal fluid (CSF) during the period of the study. Antimicrobial resistance, including multiple resistance, was common. Of all the strains of H. influenzae, 20% were resistant to 1 mg/l ampicillin, (all except one by production of TEM-1 beta-lactamase), 65% were resistant to 0.5 mg/l erythromycin, 25% to 1 mg/l tetracycline, 14% to 1 mg/l chloramphenicol (mediated by the production of a chloramphenicol-destroying enzyme) and less than 1% to 8 mg/l cefaclor and 0.5 mg/l trimethoprim. All isolates were susceptible to cephamandole and cefuroxime. Haemophilus parainfluenzae showed similar susceptibilities, except that a greater proportion of strains was sensitive to erythromycin and chloramphenicol. Only 50% of the ampicillin-resistant strains of H. influenzae and H. parainfluenzae contained detectable plasmids of 2-55 Mdal arranged in six to nine different plasmid profiles. Resistance to ampicillin and chloramphenicol has increased markedly in isolates of H. influenzae in Hong Kong over the last 5 years. This resistance may be associated with transposable genes.

Haemophilus infection in a colony of laboratory rats

During routine quality control of laboratory rodents, short gram-negative rods with satellite growth adjacent to a Staphylococcus strain were isolated from rats. They proved to be members of the family Pasteurellaceae. On the basis of their dependence on V factor they were classified as Haemophilus sp. Systematic investigations in our laboratory rat colony revealed a high prevalence of these bacteria. They were isolated from 75 of 446 rats (16.8%) which were monitored by culture during a 2-year investigation. Most strains were isolated from the lungs and the trachea; some were cultured from the nasal cavity and the female genital tract. Antibodies to these bacteria were detected in sera from 385 of 829 rats (46.5%) by using an indirect immunofluorescence test. The majority of culturally and serologically positive animals came from three separate holding areas; they all came from the same breeder. Investigation of rats immediately on receipt from the breeder showed that they were culturally and serologically positive for Haemophilus sp. Histological examination of rats which were monoinfected with Haemophilus sp. showed a mild inflammatory cell infiltration in the lungs and a light diffuse hyperemia. In the physiological and biochemical investigations of 53 isolates, all strains had an identical biochemical profile. On the basis of the 35 criteria examined, a definite classification is not possible. These Haemophilus bacteria are probably members of a hitherto unknown species.

Isolation and biochemical characterization of Haemophilus species isolated simultaneously from the oropharyngeal and anogenital areas

Several reports have described the high frequency of pharyngeal isolation of Haemophilus species. Few studies have compared the simultaneous isolation rate of this species in the oropharyngeal and anogenital areas. Using two selective media, heart infusion agar (HIA) supplemented with 5% defibrinated rabbit blood, 1% IsoVitaleX, and either bacitracin alone (100 micrograms/ml) or bacitracin (5 micrograms/ml), vancomycin (3 micrograms/ml), and polymyxin B (1 microgram/ml), we isolated Haemophilus species in both areas in 89 of 399 (22.2%) patients consulting a sexually transmitted disease clinic. Of those, 56 were males and 33 were females. We recovered Haemophilus species in the oropharyngeal area in 384 patients (96%), while rectal and genital areas were colonized in 48 (12.0%) and 55 (13.8%) patients, respectively (both areas were colonized in 14 patients). Haemophilus parainfluenzae was isolated almost twice as often in the anogenital area as was H. influenzae. H. influenzae biotypes II and III and H. haemolyticus were the more prevalent XV-requiring haemophili isolated from the oropharynx, while H. influenzae biotype IV was more prevalent in the anogenital area. H. parainfluenzae biotypes I, II, and III were more prevalent in the oropharynx, while biotypes I and II were more prevalent in the anogenital area.

DNA probes for the identification of Haemophilus ducreyi

Haemophilus ducreyi ATCC 33922, a virulent, well-characterized strain, was used to construct a genomic library in a bacteriophage expression vector. Three DNA fragments were selected for use as probes on the basis of their ability to encode H. ducreyi-specific proteins, as demonstrated by reactivity with rabbit polyclonal antiserum. With DNA-DNA hybridization, the three probes, labeled with 32P, reacted strongly with 16 strains of H. ducreyi obtained from a variety of sources. Thirty-seven other bacterial isolates, representing 33 different species and including organisms likely to be encountered in the urogenital tract, were also tested with the three probes. Twenty-eight of these isolates, including the genital pathogen Neisseria gonorrhoeae, showed no hybridization with the probes. In addition, herpes simplex virus-infected tissue culture cells and Treponema pallidum-infected rabbit testicular fluid were also completely nonreactive. Nine isolates, six belonging to other Haemophilus species and three belonging to Pasteurella species, reacted weakly with the probes when approximately 3.0 x 10(7) to 6.0 x 10(7) CFU was tested. When 10(5) to 10(6) CFU of these organisms was tested, the weak reactions could no longer be seen. Yet this number of H. ducreyi still reacted strongly. In fact, the three probes consistently detected 10(4) CFU of H. ducreyi in pure and mixed cultures and even produced a weak signal when only 10(3) CFU was present. It is clear from our results that use of these probes will greatly facilitate the laboratory diagnosis of this genital pathogen.

The avian haemophili

There are four currently recognized taxa to accommodate the avian haemophili: Haemophilus paragallinarum, Pasteurella avium, Pasteurella volantium, and Pasteurella species A (the last three being formerly united as Haemophilus avium). A range of other taxa has also been recognized, but they have been neither named nor assigned to a genus. All of these various taxa, legitimate and otherwise, have the common characteristic of requiring V factor, but not X factor, for in vitro growth. Several recent studies have established the phenotypic properties that allow the differentiation of the recognized taxa, both named and unnamed. The serological properties of H. paragallinarum, the causative agent of infectious coryza of chickens, has received considerable recent attention. In contrast, many questions on the pathogenicity and virulence mechanisms of H. paragallinarum remain unanswered. Another area requiring further work is the identification of those antigens responsible for inducing protective immunity in vaccinated or naturally infected chickens.

Deoxyribonucleic acid relatedness and phenotypic variation among human isolates of Eikenella corrodens

The type strain of Eikenella corrodens (Eiken 1958) Jackson and Goodman 1972 and eleven epidemiologically independent clinical isolates recovered from periodontal locations, putrid wounds, abscesses, and bacteraemias were investigated for their genomic relationships by DNA-DNA hybridization with the renaturation method, genome molecular complexity, DNA base composition and some phenotypic features. The bacterial strains studied were interrelated at or above the 80% DNA binding level, their chromosomal DNAs exhibiting a mean molecular mass of 1.7 x 10(9) daltons and a mean guanine plus cytosine content of 55.1 mol%. Variations in colonial morphology, hemolytic activity on sheep blood agar, reduction of nitrates, oxidation of carbohydrates, lipase, leucine, valine, and cystine aminopeptidase and acid phosphatase activities occurred among closely interrelated strains. The definition of the species and current identification keys must be emended accordingly.

Imported pedal chancroid: case report

A man aged 22 who had returned from the Fiji Islands to Denmark had chancroid on the left foot, but no history or sign of primary genital infection. The pedal location only is an unusual presentation of the disease, which was diagnosed only microbiologically. Chronic tropical ulcers therefore demand special microbiological attention.