Haemophilus influenzae biotype VIII

Multiple interspecies recombination events documented by whole-genome sequencing in multidrug-resistant Haemophilus influenzae clinical isolates

Introduction

Haemophilus influenzae (Hi) was long known as an easy-to-treat bacterium, but increasing resistance against beta-lactams and other critically important antibiotics is now a growing concern. We describe here the whole-genome sequencing (WGS) analysis of three non-typeable Hi isolates received in 2018-2019 by the Belgian National Reference Centre (NRC) for Haemophilus influenzae, as they presented an unusual multi-resistant profile.

Methods

All three isolates were sequenced by WGS and mapped to the reference isolate Hi Rd KW20. Shorten uptake signal sequences (USSs) known to be associated with homologous recombination were sought in ftsI, murE and murF genes, and inner partial sequences were compared against the blast nucleotide database to look for similarity with other Haemophilus species. Their antimicrobial resistance (AMR) genotype was studied. Core-genome multilocus sequence typing (MLST) was performed on the NTHi database pubMLST to place our isolates in the actual worldwide epidemiology.

Results

The isolates also harboured interspecies recombination patterns in the murF-murE-ftsI region involved in cell wall synthesis. The three isolates were multidrug resistant and two of them were also resistant to amoxicillin-clavulanic acid and showed a reduced susceptibility to meropenem. All three isolates belonged to the MLST clonal complex (CC) 422, and WGS revealed that the three were very similar. They harboured mobile genetic elements (carrying blaTEM-1B, mefA and msrD genes associated with resistance), mutations in gyrA and parC linked to fluoroquinolone resistance as well as remodelling events in ompP2 that might be related to lower carbapenem susceptibility.

Conclusion

The Hi evolution towards antimicrobial multiresistance (AMR) is a complex and poorly understood phenomenon, although probably linked to a large degree to the presence of USSs and exchange within the family Pasteurellaceae. To better understand the respective roles of clonal expansion, horizontal gene transfers, spontaneous mutations and interspecies genetic rearrangements in shaping Hi AMR, both analysis of Hi communities over time within individuals and worldwide monitoring of non-typeable Hi causing infections should be conducted.

Haemophilus influenzae: a forgotten cause of neonatal sepsis?

Due to the introduction of the conjugate vaccine against serotype b, neonatal sepsis caused by Haemophilus influenzae became very rare. There is little data in Belgium concerning the prevalence of H. influenzae early onset neonatal sepsis and articles about neonatal sepsis and H. influenzae published in the last decade are scarce. We report two invasive infections with a non-typeable H. influenzae. These cases show that neonatal sepsis caused by non-typeable H. influenzae may be underestimated and we believe that there is need for a better registration of this kind of infection.

Haemophilus influenzae as an airborne contamination in child day care centers

BACKGROUND

The aim of this study was to assess the exposure of children to airborne Haemophilus influenzae in day care centers.

METHODS

Air samples were taken using an Andersen impactor in 32 rooms designed for children stay. The concentrations of airborne bacteria were calculated as colony forming units (CFU) (growing on trypticase soy agar) per cubic meter of air (CFU/m(3)). The compositions of bioaerosol were determined on blood trypticase soy agar and Haemophilus selective agar. Isolated strains were identified using API NH strips and apiweb software. The antibiotic resistance of H influenzae strains was determined by the disk diffusion method.

RESULTS

Compared with the proposed criteria for microbiologic quality of indoor air, the rooms were characterized by the very high bacterial contamination of the air. The prevailing component of bacterial aerosol was gram-positive cocci. Airborne H influenzae strains were found in 25% of the investigated rooms and were mostly classified as biotype II (33%).

CONCLUSION

It may be accepted that the exposure to airborne H influenzae is typical of child day care centers in contrast to indoor environments with older population. Child day care center contribute to the expansion of H influenzae in human population via air. Generally, airborne H influenzae isolates from the investigated child day care centers were susceptible to older antibiotics such as ampicillin and amoxicillin-clavulanic acid.

Role of biofilm formation in the persistent colonization of Haemophilus influenzae in children from northern India

The human nasopharynx is a major ecological niche for Haemophilus influenzae colonization. Establishment of infection is critically dependent on the persistence of bacteria in the nasopharynx. Various factors are presumed to mediate this persistence and the influence of biofilm formation has been under scrutiny for a long time. In a prospective population-based study, the nasopharyngeal colonization pattern of 250 children <2 years old was traced to gain further insights into the phenomenon. The association between biofilm formation and persistence was delineated by quantitative biofilm assay, while the true nature of biofilm formers was further evaluated by electron microscopy studies. H. influenzae isolates obtained in this study, when analysed by phenotypic and genotypic means, revealed a clonal distribution of strains within the population. The biofilm formation ability of the isolates was found to be significantly associated with bacterial persistence (P<0.001). The isolates having biofilm formation ability were found to be 7.1 times more likely to persist in the nasopharynx than non-biofilm formers. This study provides direct evidence indicating the intricate relationship between biofilm formation and the persistence of bacteria. Our results emphasize the need to evaluate the potential for biofilm formation before designing preventive and therapeutic strategies.

Comparison of three commercial test systems for biotyping Haemophilus influenzae and Haemophilus parainfluenzae

The biotypes of Haemophilus influenzae and Haemophilus parainfluenzae isolates were determined with three commercially available biochemical test kits: the IDS RapID NH system, the Neisseria-Haemophilus identification test (NHI card), and the API NH strip. The API NH strip performed best, correctly classifying the biotypes of 371 of 380 (97.6%) different challenge strains.

High ampicillin resistance in different biotypes and serotypes of Haemophilus influenzae colonizing the nasopharynx of healthy school-going Indian children

Haemophilus influenzaeis one of the main causes of otitis media, sinusitis, meningitis, pneumonia and septicaemia in children, and the development of ampicillin resistance inH. influenzaeis a cause of serious concern. The aim of the present study was to determine the prevalence of ampicillin resistance inH. influenzaecolonizing the nasopharynx of school-going healthy North Indian children, and to compare the distribution of different biotypes and serotype b in this population. A total of 2400 school-going healthy children from 45 rural and 45 urban schools were enrolled. Nasopharyngeal swabs were collected from the children and cultured.H. influenzaewas isolated from 1001 (41·7 %) of the 2400 nasopharyngeal swabs collected. All theseH. influenzaeisolates were biotyped and serotyped, and their antibiotic susceptibility tested. All eight biotypes were present in this population. The most prevalent biotypes were I (19·6 %), II (16·8 %) and III (25·0 %). Of the 1001 isolates, 316 (31·6 %) wereH. influenzaetype b and 685 (68·4 %) were non-type bH. influenzae, and 22·9 % were resistant to ampicillin, 41·9 % to chloramphenicol, 27·5 % to erythromycin and 67·3 % to co-trimoxazole. Of the 316H. influenzaetype b isolates, 44·0 % were ampicillin resistant, while only 13·1 % non-type bH. influenzaeisolates were ampicillin resistant. Of the 229 ampicillin-resistantH. influenzaeisolates, 196 (85·6 %) were positive forβ-lactamase; 93·4 % (214/229) were biotypes I, II and III, of which 49 % were biotype I, 27·9 % were type II and 16·6 % were type III. Most of the strains belonging to biotypes III–VIII were ampicillin sensitive. Ampicillin resistance is significantly more common in biotype I and serotype b than in other biotypes and serotypes.

Invasive Haemophilus influenzae in the Republic of Ireland

Prior to the general availability of Haemophilus influenzae type b vaccine in the Republic of Ireland, a two-year study of the epidemiology of invasive Haemophilus influenzae disease was carried out. Of 137 invasive strains of Haemophilus influenzae examined in a central laboratory, 94.2% were serotype b and 90.5% were biotype I. Seventeen percent of serotype b strains produced beta-lactamase, and 2.3% were resistant to both ampicillin and chloramphenicol. The majority of serotype b strains were electrophoretic types of the electrophoretic 12 clone family, principally 12.5. Meningitis was the most common infection caused by serotype b. The study data extend the current knowledge of strains of Haemophilus influenzae causing invasive disease in the Republic of Ireland.

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.

Evaluation of two rapid methods for identifying and biotyping Haemophilus influenzae

Several rapid method kits (one to four hours) have become available for the identification of Haemophilus and related genera. Two kits (the "Rapid NH" system and the "RIM Haemophilus" system), which include the identification and biotyping of H influenzae, were investigated for the rapid identification and biotyping of 193 isolates of H influenzae and the results compared with those obtained by more standard overnight methods. The kits were convenient to use and gave reliable and rapid speciation of all isolates. Both test systems were unreliable for biotyping: 42 isolates were wrongly biotyped by the RIM kit and 40 isolates wrongly biotyped by the rapid NH kit. It is concluded that the test kits may be useful for the rapid identification of H influenzae but that they are not reliable for the biotyping of this species.

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.

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.

Outer membrane protein and biotype analysis of non-serotypable strains of Haemophilus influenzae

Strains of Haemophilus influenzae (n = 161) were isolated from inpatients with symptoms of pulmonary infection. Conventional tests showed that 144 strains were non-serotypable and all belonged to one of eight biotypes. The common biotypes were 2 (41%), 3 (27.1%), 1 (13.2%) and 5 (10.4%). The outer membrane protein (OMP) profiles of 59 non-serotypable strains were examined by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE). A comparison of OMP profiles suggested a possible association between several strains belonging to biotype 2. Although no clear correlation was established between biotype or OMP profile cluster groups and the age or clinical state of the patients from whom the strains were isolated, SDS-PAGE analysis was a useful technique for the epidemiological study of non-serotypable H influenzae.

Characterization of Haemophilus influenzae isolated from patients with otitis media

Two hundred and twenty-three Haemophilus influenzae strains isolated from patients with otitis media throughout France were characterized by biotype, serotype, antibiotic susceptibility, type of beta-lactamase production and human erythrocyte agglutination properties. All strains fell in one of two groups. One group consisted of encapsulated type b strains, 50% of which were biotype I, often resistant to ampicillin (38.5% of beta-lactamase producing strains) and seldom positive for haemagglutination (3.8%). The second group was composed of non-encapsulated strains, 42% of which were of biotype II, 10.6% beta-lactamase producers and 10.5% positive for haemagglutination.

Determination of biotypes of Haemophilus influenzae and Haemophilus parainfluenzae a comparison of methods and a description of a new biotype (VIII) of H. parainfluenzae

A total of 180 strains of Haemophilus influenzae and 119 strains of Haemophilus parainfluenzae were characterized with respect to biotype (i.e., production of indole, urease, and ornithine decarboxylase) using conventional biochemical methods and two commercially available biotyping systems: Trio-Tube Haemophilus system (Carr Microbiologicals) and the Rapid NH System (Inovative Diagnostic Systems). Concordance between the results of the Trio-Tube system and conventional biochemicals was achieved with 294 of the 299 test organisms (98.3%). With the Rapid NH System, concordance with the results of conventional biochemical tests was observed with 275 of the 299 tests strains (92.0%). One previously unrecognized biotype of H. parainfluenzae, designated biotype VIII, is described. Typical reactions of this biotype include indole production but no production of urease or ornithine decarboxylase.

Types and subtypes of 73 strains of Haemophilus influenzae isolated from patients more than 6 years of age with meningitis in The Netherlands

Strains of Haemophilus influenzae isolated in The Netherlands between 1975 and 1984 from patients with meningitis were analysed in order to determine whether older patients are infected with particular types or subtypes of the organism. Of 1154 patients with H. influenzae meningitis 73 (6.3%) were more than 6 years of age. Thirty-one strains (42%) were of serotype b, one strain was of serotyped, one strain was of serotype f and 40 strains (55%) were non-typable. Twenty-eight type b strains were available for subtyping by analysis of the major outer-membrane proteins by sodium dodecylsulphate (SDS)-polyacrylamide gel electrophoresis (PAGE), by serotyping of their lipopolysaccharides and by biotyping. Twenty-one strains were outer-membrane protein subtype 1,24-lipopolysaccharide serotype 1 and 24 biotype I. Seventeen strains (61%) combined these characteristics. This percentage did not differ significantly from the percentage found for strains isolated from patients of all age groups (80%). The 32 non-typable H. influenzae strains analysed had different outer-membrane protein patterns as seen by SDS-PAGE. Five biotypes were found, among which biotype II was predominant (21/32). The results indicated that (i) patients more than 6 years of age were infected by subtypes of H. influenzae b strains which were not significantly different from the strains isolated from younger patients, (ii) non-typable strains of H. influenzae were much more common (55%) in the older age group than in the younger (1.2%) and (iii) that these non-typable strains were not of a particular subtype.