Immune response to nontypeable Hemophilus influenzae in the general population and among children with otitis media with effusion

Severe Presentation of Nontypeable Haemophilus influenzae (NTHi) Infection in a Previously Healthy Toddler

Background

Cellulitis is the inflammation of the skin and subcutaneous tissue. It is usually caused by Gram-positive organisms such as Staphylococcus and Streptococcus pyogenes infection. Nontypeable Haemophilus influenzae (NTHi) is an uncommon cause of cellulitis. Hence, we report on this case.

Case Presentation

A previously healthy 19-month-old girl presented with a fever and two-day history of progressive right leg swelling and redness. Her physical examination revealed significant induration and swelling of her right lower leg but no obvious signs of abscess formation. Given the clinical picture, she was admitted as a case of cellulitis. Parenteral clindamycin was started empirically, as the blood culture preliminary report showed Gram-negative rods. Ceftriaxone was added to broaden the coverage. Final blood culture grew NTHi. Despite the use of proper antibiotics (amoxicillin clavulanic acid), the clinical course was complicated with abscess formation that required surgical intervention.

Conclusions

We are reporting a previously healthy child who developed NTHi cellulitis of the lower leg. To the best of our knowledge, there have been no formal reports pertaining to leg cellulitis following infection by NTHi, yet published in UAE, and reports of HIB cellulitis of the extremities still appear to be rare; hence, we report on this case.

Invasive disease due to nontypeable Haemophilus influenzae among children in Arkansas

In this study, we reviewed cases of invasive disease due to nontypeable Haemophilus influenzae among children hospitalized at Arkansas Children's Hospital from 1993 to 2001. A total of 28 cases were examined, including 21 associated with bacteremia and 4 associated with meningitis. Of the patients examined, 86% were Collapse

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MESH Headings

• Adolescent
• Arkansas/epidemiology
• Bacteremia/epidemiology
• Bacteremia/microbiology
• Bacterial Proteins/genetics
• Blotting, Southern
• Child
• Child, Preschool
• Electrophoresis, Gel, Pulsed-Field
• Female
• Genetic Variation
• Genotype
• Haemophilus Infections/epidemiology
• Haemophilus Infections/microbiology
• Haemophilus influenzae/classification
• Haemophilus influenzae/genetics
• Hospitalization
• Humans
• Infant
• Infant, Newborn
• Male
• Sequence Analysis, DNA

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Grants

• R01 AI049322 NIAID NIH HHS
• CA023944-20 NCI NIH HHS
• R01-AI44167 NIAID NIH HHS
• R25 CA023944 NCI NIH HHS
• R01 DC002873 NIDCD NIH HHS
• P30 CA21765 NCI NIH HHS
• R01-AI49322 NIAID NIH HHS
• P30 CA021765 NCI NIH HHS
• R01 AI044167 NIAID NIH HHS
• R01-DC02873 NIDCD NIH HHS

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Affiliation(s)

Joshua M O'Neill Department of Pediatrics, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, Arkansas, USA.
Joseph W St Geme
David Cutter
Elisabeth E Adderson
Juliana Anyanwu
Richard F Jacobs
Gordon E Schutze

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Immunologic aspects of otitis media

The middle ear cleft is a modified gas pocket which functions normally when the gas contents are regulated by a normal eustachian tube, resulting in equalization of middle ear pressure to that of the environment. The most important regulator of this middle ear pressure is the eustachian tube, a critical passageway from the nasopharynx into the middle ear. Any alteration of eustachian tube mucociliary function caused by virus, allergy, pollutants, or alteration of the normal homeostasis of the nasopharynx will result in eustachian tube obstruction. This, in turn, leads to underventilation of the middle ear, and transudation of fluid. If bacteria or virus or viral-bacterial interaction leads to infectious disease of the middle ear, an immune response is produced as a result of the inflammatory response, allowing lymphocytes and antigen-presenting cells to enter into the middle-ear mucosa. This article summarizes the immunologic reactivity in the middle ear following a viral-bacterial inflammatory reaction in the middle-ear mucosa. Although secretory IgA is critical for protection of the nasopharynx, its function in the middle ear has still not been resolved. The evidence strongly suggests that IgG1 and IgG3 subclasses are responsible for eradication of middle ear pathogens. Finally, a review of alternative approaches to the prevention of otitis media is briefly discussed in this critical period of emergence of resistant bacteria to available antibiotics.

The immunological role of the outer membrane proteins of non-typable Hemophilus influenzae in otitis media with effusion in children

Specific IgG and IgA antibodies against the outer membrane proteins of non-typable Hemophilus influenzae were investigated in otitis media with effusion in children. Amounts of these antibodies were determined in middle ear effusions (MEEs) and in sera by enzyme-linked immunosorbent assay. At the same time the amounts of total IgG and IgA antibodies in MEEs in comparison with those in sera were analyzed by laser nephelometry. The amounts of specific and total IgG and IgA in the MEEs were higher than those in the sera. The MEEs/sera ratios of IgG and IgA antibodies in the children with mucoid effusions were higher than those in the children with serous effusions. The exception involved IgG determined by laser nephelometry. These data support the hypothesis that bacterial infections and the subsequent immune response contribute to the prolongation of otitis media with effusion in children, especially when effusions become mucoid.