Non-type b Haemophilus influenzae infections in adults with reference to biotype

[Non-type b Haemophilus influenzae: a rare cause of meningitis in an infant with a guarded prognosis]

Non-Type b Haemophilus is a rare cause of invasive secondary localization in young children. We here report the case of a child aged 11 months old who had Meningitis due to Non-Type b Haemophilus, a gram -negative bacilli of polymorphous appearance still exceptionally described in the literature, whose origin was undetermined and whose evolution was fatal. Clinicians and microbiologists should suspect the presence of these infrequent serotypes, especially on a particular case.

Deep obstetrical and gynecological infections caused by non-typeable Haemophilus influenzae

Six patients with deep obstetrical and gynecological infections due to non-typeable Haemophilus influenzae are presented. 3 patients had tubo-ovarian abscesses, 2 septic abortions and 1 postpartum sepsis. All our patients with tubo-ovarian abscesses had used intra-uterine contraceptive devices until admission and all had a protracted course of illness. Both patients with septic abortion had a severe course, one of them with disseminated intravascular coagulation demanding treatment in the intensive care unit. The patient with postpartum infection had a milder course. The possibility of infection with H. influenzae and the emergence of beta-lactamase producing strains warrant adequate culture procedures in women with obstetrical and gynecological infections in order to ensure proper treatment.

Neonatal, urogenital isolates of biotype 4 nontypeable Haemophilus influenzae express a variant P6 outer membrane protein molecule

The P6 outer membrane protein is a highly conserved molecule which is present on the surface of all strains of Haemophilus influenzae. Sixty strains of nontypeable H. influenzae which caused invasive disease or colonized the female urogenital tract were studied with monoclonal antibodies 7F3 and 4G4, which recognize different surface-exposed epitopes on the P6 molecule. All 60 strains expressed the epitope recognized by 4G4, whereas 47 of 60 strains expressed the epitope recognized by antibody 7F3. The 7F3-nonreactive strains were all biotype 4 and were recovered from the blood of neonates or postpartum women or from the female urogenital tract. The P6 genes from two 7F3-nonreactive strains were cloned, and the nucleotide sequences were determined. Analysis of amino acid sequences, immunoassays with synthetic peptides, and site-directed mutation of the P6 gene indicate that the epitope recognized by antibody 7F3 is conformational and that the sequence Asp-Ile-Thr is critical in maintaining the conformation of the epitope. We conclude that the unusually virulent clone family of biotype 4 strains of nontypeable H. influenzae express a variant P6 molecule which has an alteration in a highly conserved surface-exposed epitope.

Haemophilus influenzae bacteremia following first trimester abortion

While genital tract infections with Haemophilus influenza (H. influenzae) are recognized with increasing frequency, this organism still remains an uncommon cause of maternal infection. The association of this pathogen with spontaneous abortion is extremely rare and has been described only in cases of midtrimester abortion. We report a case of H. influenzae bacteremia following first trimester spontaneous abortion and review the literature.

Pericarditis caused by beta-lactamase-producing Haemophilus influenzae: report of two cases in adults and review of the literature

Two adult patients with pericarditis caused by beta-lactamase producing Haemophilus influenzae are reported and their management reviewed. Both had pharyngitis, epiglottitis, pneumonia, empyema, or septicemia and were cured with antimicrobics and pericardial drainage (one by catheter and one by surgery). Eleven previously reported cases of pericarditis caused by Haemophilus influenzae are also reviewed. In reviewing this rare cause of bacteria pericarditis, it is important to recognize the antibiotic resistance profile, the incidence of pericardial tamponade, and the use of surgical drainage. Antibiotic selection for this organism is also discussed, as well as the importance of biotyping.

Recovery of blood-borne bacteria from human urine

Recovery from the urine of organisms causing bacteraemia may depend on the bacterial species involved. The survival of the more common species of bacteria which cause bacteraemia was examined in human urine, serum and normal saline. All species survived well or grew in serum. Haemophilus influenzae, Streptococcus pneumoniae, Streptococcus sanguis and group A streptococci were killed in all urine samples. The number of colony-forming units of Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus saprophyticus and group B streptococci either remained the same or increased in the urine, while the numbers of Escherichia coli and Klebsiella pneumoniae increased rapidly. These data suggest that the observed differences in recovery from urine of these bacterial species that cause bacteraemia are related to the viability of the species in human urine.

Distribution and relationship to serotype of Haemophilus influenzae biotypes isolated from upper respiratory tracts of children and adults in Papua New Guinea

The relationship between serotypes and biotypes of 505 carriage strains of Haemophilus influenzae isolated from the upper respiratory tracts of well children, children with pneumonia, and healthy adults was studied. All except serotype c were significantly associated with one or two specific biotypes (P less than 0.001). No encapsulated organisms belonging to biotypes V, VI, or VII were encountered. No significant difference in the interaction of biotypes and serotypes isolated from well and sick children was present. Both encapsulated and nonserotypable biotype I H. influenzae strains were commonly carried in the upper respiratory tracts of healthy Melanesian children. The distribution of nonserotypable H. influenzae strains occurred throughout all biotypes, and the frequency of nonencapsulated biotype III and IV strains differed significantly from serotypable organisms with the same biotype (P less than 0.001).

Rapid species identification and biotyping of respiratory isolates of Haemophilus spp

Three commercially available systems, the 4-h Minitek Enterobacteriaceae III, the Haemophilus Trio-Tube, and the Micro-ID, were evaluated for their capacities to identify and biotype 308 respiratory isolates of Haemophilus spp. When compared with aminolevulinic acid test results, the definitive identification method used in this study, these systems demonstrated no significant differences in their capacities to differentiate Haemophilus influenzae from Haemophilus parainfluenzae. They were in agreement with the standard method of species identification approximately 50% of the time. When sucrose was added to the Minitek and Trio-Tube configurations, the efficiency rate of species identification increased to more than 95%. The Micro-ID could not be modified to incorporate this additional biochemical parameter. The performance of the sucrose-supplemented Minitek and Trio-Tube systems, compared to the combined results of Micro-ID and aminolevulinic acid, produced correlations of 94 and 90%, respectively. Rapid and accurate methodologies are available for combined species identification and biotyping of Haemophilus spp.

Pneumonia and bacteremia associated with Haemophilus influenzae serotype d

Haemophilus influenzae serotype d was isolated from three women with pneumonia and underlying cardiopulmonary disease. Two of the strains were isolated from blood, and the third strain was isolated from sputum. The biotypes of the isolates were I, IV, and VI.

Differentiation of Haemophilus spp. in Respiratory isolate cultures by an indole spot test

Indole spot tests using isolated, nonhemolytic colonies of Haemophilus species were positive for 90 of 151 (60%) respiratory isolates of Haemophilus influenzae, whereas 67 to 72 (93%) isolates of H. influenzae from cerebrospinal fluid and blood specimens were indole positive. Only 4 of 117 (3%) Haemophilus parainfluenzae isolates were positive for indole spot tests. Thus, indole-positive, nonhemolytic Haemophilus isolates in respiratory cultures can be presumptively identified as H. influenzae.

Lethal meningoencephalitis and septicemia caused by Haemophilus influenzae type f in an adult with multiple myeloma

A patient with chemotherapy-treated multiple myeloma developed overwhelming sepsis and meningoencephalitis with Haemophilus influenzae type f. Typable H. influenzae other than type b has only rarely been reported as a cause of serious disease in adults. The patient's immunosuppressed status presumably predisposed her to this unusual infection.