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Abe Y, Takano C, Tie J, Isobe E, Ohirabaru A, Isahai I, Nishiyama H, Jike T, Masuda S, Okuda T. Sudden death of a child associated with invasive non-typeable Haemophilus influenzae infection with underlying IgG 2 subclass deficiency. Leg Med (Tokyo) 2023; 62:102240. [PMID: 36958272 DOI: 10.1016/j.legalmed.2023.102240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/02/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023]
Abstract
Haemophilus influenzae can be divided into typeable and non-typeable strains. Although non-typeable Haemophilus influenzae (NTHi) is less likely to be a fatal bacterium, invasive NTHi infection has been reported to increase worldwide. This study presents a case of sudden death of a child with invasive NTHi infection and underlying immunoglobulin G2 (IgG2) deficiency. A two years seven months male child with a high fever was found unresponsive in bed, lying face down on a soft pillow. Later, the hospital declared the subject dead. An autopsy revealed that the only noteworthy finding was tissue congestion. The histopathological findings disclosed neutrophils within blood vessels of major organs. Meanwhile, the formation of the micro abscess was not visible, which indicated bacteremia. The bacterial blood culture was positive for Haemophilus Influenzae. Polymerase chain reaction assay revealed the absence of an entire capsule locus. The transmission electron microscopy showed that the colonies did not have polysaccharide capsules. Based on the above findings, the strain was identified as NTHi. Furthermore, the value of serum IgG2 was deficient, indicating the presence of IgG2 subclass deficiency. The subject eventually died from asphyxia by smothering due to a comorbid condition with a high fever brought on by NTHi-induced bacteremia and lying face down. IgG2 subclass deficiency contributed to the development of invasive NTHi infection. The invasive NTHi infection might present a risk of sudden death, particularly for immunocompromised children. As forensic pathologists and pediatricians may encounter such a problematic clinical condition, they should be aware of this.
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Affiliation(s)
- Yuriko Abe
- Division of Medical Education, Nihon University School of Medicine, Tokyo, Japan; Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Chika Takano
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan; Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
| | - Jian Tie
- Department of Legal Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Eiji Isobe
- Department of Legal Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Ayumi Ohirabaru
- Department of Legal Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Isamu Isahai
- Department of Legal Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroyuki Nishiyama
- Department of Clinical Laboratory, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Toyoharu Jike
- Research Institute of Medical Research Support Center Electron Microscope Laboratory, Nihon University School of Medicine, Tokyo, Japan
| | - Shinobu Masuda
- Division of Oncologic Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
| | - Takahisa Okuda
- Department of Legal Medicine, Nihon University School of Medicine, Tokyo, Japan; Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan.
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Non-Typeable Haemophilus influenzae Invade Choroid Plexus Epithelial Cells in a Polar Fashion. Int J Mol Sci 2020; 21:ijms21165739. [PMID: 32785145 PMCID: PMC7461124 DOI: 10.3390/ijms21165739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 11/17/2022] Open
Abstract
Non-typeable Haemophilus influenzae (NTHI) is a pathogen of the human respiratory tract causing the majority of invasive H. influenzae infections. Severe invasive infections such as septicemia and meningitis occur rarely, but the lack of a protecting vaccine and the increasing antibiotic resistance of NTHI impede treatment and emphasize its relevance as a potential meningitis causing pathogen. Meningitis results from pathogens crossing blood-brain barriers and invading the immune privileged central nervous system (CNS). In this study, we addressed the potential of NTHI to enter the brain by invading cells of the choroid plexus (CP) prior to meningeal inflammation to enlighten NTHI pathophysiological mechanisms. A cell culture model of human CP epithelial cells, which form the blood-cerebrospinal fluid barrier (BCSFB) in vivo, was used to analyze adhesion and invasion by immunofluorescence and electron microscopy. NTHI invade CP cells in vitro in a polar fashion from the blood-facing side. Furthermore, NTHI invasion rates are increased compared to encapsulated HiB and HiF strains. Fimbriae occurrence attenuated adhesion and invasion. Thus, our findings underline the role of the BCSFB as a potential entry port for NTHI into the brain and provide strong evidence for a function of the CP during NTHI invasion into the CNS during the course of meningitis.
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Corkery-Lavender T, Watson O, Goktogan S. Non-typeable Haemophilus influenzae meningitis in a 3-year-old child. J Paediatr Child Health 2020; 56:473-474. [PMID: 31489741 DOI: 10.1111/jpc.14612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/12/2019] [Accepted: 08/16/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - Olivia Watson
- Paediatrics Department, Northern Beaches Hospital, Sydney, New South Wales, Australia
| | - Safak Goktogan
- Paediatrics Department, Northern Beaches Hospital, Sydney, New South Wales, Australia
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Baba H, Kakuta R, Tomita H, Miyazoe M, Saito M, Oe C, Ishibashi N, Sogi M, Oshima K, Aoyagi T, Gu Y, Yoshida M, Tokuda K, Endo S, Yano H, Kaku M. The first case report of septic abortion resulting from β-lactamase-negative ampicillin-resistant non-typeable Haemophilus influenzae infection. JMM Case Rep 2017; 4:e005123. [PMID: 29188070 PMCID: PMC5692239 DOI: 10.1099/jmmcr.0.005123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 10/04/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction. This is the first case report of septic abortion due to β-lactamase-negative ampicillin-resistant (BLNAR) non-typeable Haemophilus influenzae infection. In Japan, BLNAR H. influenzae is widespread and has become a clinical concern, especially in paediatrics and otolaryngology, but H. influenzae has not been previously recognized as a causative agent of obstetric or gynaecological infection. Case presentation. A 31-year-old pregnant woman presented at 17 weeks and 6 days of gestation with a high fever; she was admitted with a diagnosis of threatened premature delivery. Despite tocolytic treatment, she aborted spontaneously 2 h after admission and then entered septic shock. BLNAR H. influenzae was detected in both blood and vaginal cultures. Her condition gradually improved after several days of treatment with cefotaxime, and she was ultimately discharged without sequelae or complaints. Conclusion. Although penicillin with a β-lactamase inhibitor is currently recommended for the treatment of septic abortion, this combination will probably lead to treatment failure in the case of BLNAR H. influenzae infection. As this study reveals, H. influenzae can cause septic abortion; hence, future efforts should be undertaken to detect and therapeutically target this pathogen during pregnancy.
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Affiliation(s)
- Hiroaki Baba
- Department of Infection Control and Laboratory Diagnostics, Internal Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Risako Kakuta
- Department of Otolaryngology, Tohoku Medical and Pharmaceutical University Hospital, Miyagi, Japan
| | - Hasumi Tomita
- Department of Gynecology and Obstetrics, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Minako Miyazoe
- Department of Gynecology and Obstetrics, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Masatoshi Saito
- Department of Gynecology and Obstetrics, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Chihiro Oe
- Department of Infection Control and Laboratory Diagnostics, Internal Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Noriomi Ishibashi
- Department of Infection Control and Laboratory Diagnostics, Internal Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Misa Sogi
- Department of General Internal Medicine, Taiyo-kai Social Welfare Awachiiki Iryo Center, Chiba, Japan
| | - Kengo Oshima
- Department of Infection Control and Laboratory Diagnostics, Internal Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Tetsuji Aoyagi
- Department of Infection Control and Laboratory Diagnostics, Internal Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Yoshiaki Gu
- AMR Clinical Reference Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Makiko Yoshida
- Department of Infection Control and Laboratory Diagnostics, Internal Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Koichi Tokuda
- Department of Infection Control and Laboratory Diagnostics, Internal Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Shiro Endo
- Department of Infection Control, International University of Health and Welfare Shioya Hospital, Tochigi, Japan
| | - Hisakazu Yano
- Department of Microbiology and Infectious Diseases, Nara Medical University, Nara, Japan
| | - Mitsuo Kaku
- Department of Infection Control and Laboratory Diagnostics, Internal Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
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Kaneko M, Bando Y, Fujita T, Hirose Y, Suganuma E, Ishii M, Takahashi T. Encapsulated pleural effusion due to Haemophilus influenzae biotype II in a child with trisomy 21: A case report and literature review. IDCases 2017; 10:93-96. [PMID: 29062709 PMCID: PMC5645171 DOI: 10.1016/j.idcr.2017.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 09/23/2017] [Accepted: 09/25/2017] [Indexed: 11/19/2022] Open
Abstract
This is the second case report of pediatric encapsulated pleural effusion (EPE) due to Haemophilus influenzae. We represent typical images of chest X-P, CT, echography to find the EPE. Nontypeable H. influenzae was isolated from the throat after the discharge.
Haemophilus influenzae (Hi) can colonize in the upper respiratory tract and cause severe pulmonary infections, especially among immunocompromised children. Herein, we report a case of left encapsulated pleural effusion (EPE) due to Hi in a 24-month-old girl with trisomy 21. She was already vaccinated against Hi type b. The Hi biotype II was isolated from both the blood and aspirated sputum obtained upon admission. Ampicillin/sulbactam 180 mg/kg/day was administered intravenously for 34 days with oxygen supplementation for 4 days. She clinically recovered without undergoing thoracic drainage. One month after discharge, the girl developed acute otitis media, and the throat swab was cultured. Nontypeable Hi with the same biotype II was isolated, and the infection was controlled by administering antimicrobials. In this report, a literature review regarding the EPE due to Hi in children is also summarized. Pediatric clinicians should be aware of the possibility of Hi-related EPE because of its rapid progression, although it is rare in clinical settings. In addition, they need to consider the possibility of repetitive respiratory infections with Hi in a child with trisomy 21.
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Affiliation(s)
- Masanori Kaneko
- Department of Pediatrics, Kitasato University Medical Center, 6-100 Arai, Kitamoto, Saitama 364-8501, Japan
| | - Yuki Bando
- Department of Pediatrics, Kitasato University Medical Center, 6-100 Arai, Kitamoto, Saitama 364-8501, Japan
- Department of Infection Control and Prevention, Kitasato University Medical Center, 6-100 Arai, Kitamoto, Saitama 364-8501, Japan
- Corresponding author at: Department of Pediatrics, Kitasato University Medical Center, 6-100 Arai, Kitamoto, Saitama 364-8501, Japan.Department of PediatricsKitasato University Medical Center6-100 AraiKitamotoSaitama364-8501Japan
| | - Tomohiro Fujita
- Department of Clinical Laboratory, Kitasato University Medical Center, 6-100 Arai, Kitamoto, Saitama 364-8501, Japan
| | - Yoneji Hirose
- Department of Clinical Laboratory, Kitasato University Medical Center, 6-100 Arai, Kitamoto, Saitama 364-8501, Japan
| | - Eisuke Suganuma
- Division of Infectious Diseases and Immunology, Saitama Children’s Medical Center, 1-2 Shintoshin, Chuuou-ku, Saitama, Saitama 330-8777, Japan
| | - Masahiro Ishii
- Department of Pediatrics, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Takashi Takahashi
- Laboratory of Infectious Diseases, Kitasato Institute for Life Sciences & Graduate School of Infection Control Sciences, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8641, Japan
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Outer membrane protein P5 is required for resistance of nontypeable Haemophilus influenzae to both the classical and alternative complement pathways. Infect Immun 2013; 82:640-9. [PMID: 24478079 DOI: 10.1128/iai.01224-13] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The complement system is an important first line of defense against the human pathogen Haemophilus influenzae. To survive and propagate in vivo, H. influenzae has evolved mechanisms for subverting this host defense, most of which have been shown to involve outer surface structures, including lipooligosaccharide glycans and outer surface proteins. Bacterial defense against complement acts at multiple steps in the pathway by mechanisms that are not fully understood. Here we identify outer membrane protein P5 as an essential factor in serum resistance of both H. influenzae strain Rd and nontypeable H. influenzae (NTHi) clinical isolate NT127. P5 was essential for resistance of Rd and NT127 to complement in pooled human serum. Further investigation determined that P5 expression decreased cell surface binding of IgM, a potent activator of the classical pathway of complement, to both Rd and NT127. Additionally, P5 expression was required for NT127 to bind factor H (fH), an important inhibitor of alternative pathway (AP) activation. Collectively, the results obtained in this work highlight the ability of H. influenzae to utilize a single protein to perform multiple protective functions for evading host immunity.
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Caldeira NGS, de Filippis I, Catão Arruda T, Côrte Real ME, Batalha de Jesus A, de Almeida AECC. Haemophilus influenzae serotype b and a capsule-deficient type mutant (b-) invasive disease in a partially vaccinated child in Brazil. J Med Microbiol 2012; 62:655-657. [PMID: 23264458 DOI: 10.1099/jmm.0.052357-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We report a rare case of infection by two different types of Haemophilus influenzae strains in a child who received only one dose of the H. influenzae serotype b (Hib) conjugate vaccine (DTwP+Hib). The strains were recovered from blood and cerebrospinal fluid (CSF) and were phenotypically identified as Hib and non-typable H. influenzae, respectively, after serological tests. The two strains were characterized by PCR capsular typing, multilocus sequence typing and PFGE. Our results suggest that the infection was caused by the bloodstream invasion by a single Hib strain, followed by the diffusion of the bacteria across the blood-brain barrier and into the CSF. The strain recovered from the CSF, however, was identified as a capsule-deficient type mutant (b(-)) strain. Despite the high efficacy of the Hib conjugate vaccine, the increase in the numbers of strains able to escape the immune system of the vaccinated population advocates continued surveillance.
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Affiliation(s)
- Nathalia G S Caldeira
- Instituto Nacional de Controle de Qualidade em Saúde, INCQS/FIOCRUZ, Rio de Janeiro, Brazil
| | - Ivano de Filippis
- Instituto Nacional de Controle de Qualidade em Saúde, INCQS/FIOCRUZ, Rio de Janeiro, Brazil
| | | | | | - Alice Batalha de Jesus
- Instituto Nacional de Controle de Qualidade em Saúde, INCQS/FIOCRUZ, Rio de Janeiro, Brazil
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The burden of nonencapsulated Haemophilus influenzae in children and potential for prevention. Curr Opin Infect Dis 2012; 25:266-72. [PMID: 22561999 DOI: 10.1097/qco.0b013e32835310a4] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW In countries with established Haemophilus influenzae serotype b (Hib) immunization programmes, nonencapsulated H. influenzae (ncHi) is responsible for most invasive H. influenzae infections across all age groups and is associated with higher case fatality. A pneumococcal conjugate vaccine has recently been licensed, which may potentially also protect against invasive H. influenzae infections. RECENT FINDINGS Invasive ncHi disease is uncommon in childhood but has a much higher incidence in the first month of life. Most neonates with invasive ncHi infections are born prematurely and develop septicaemia in the first 48 h of life which can be fatal. After this period, invasive ncHi incidence falls rapidly and remains low throughout childhood. Most infants and children who develop invasive ncHi disease have significant underlying comorbidities, particularly neurological disease, malignancy and other conditions requiring immunosuppressive therapy. Although characteristically associated with respiratory tract infections, at least a quarter of invasive ncHi infections present with meningitis. SUMMARY A vaccine against ncHi could have an important preventive role in children with comorbidities. Future studies should focus on assessing specific risk factors for neonatal and childhood ncHi disease and long-term outcomes of children with invasive ncHi meningitis.
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