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Haemophilus parainfluenzae was isolated from the bile specimens of 2 patients with acute cholecystitis. The strains were genetically unrelated by the random amplified polymorphic DNA (RAPD). The 2 H. parainfluenzae strains represented 11.7% of all positive bile cultures inoculated in blood culture bottles. The routine inoculation of bile specimens in media able to support growth of Haemophilus species should be considered.
Haemophilus influenzae is a frequent causal agent of serious infections in infants. Mostly these infections occur at the age of 3 months to 3 years. Reports about infections in the neonatal period were rare in the past and most of them were single cases. In the last years an increase of neonatal infections due to Haemophilus influenzae had been reported. In the period from June 1980 to January 1986 we saw 5 newborns with severe infections due to Haemophilus influenzae and one neonate infected by Haemophilus parainfluenzae. By discussion of our cases and by review of the literature we want to show important aspects of pathogenesis, clinical symptoms, diagnostics and therapy of neonatal infections due to bacteria of the genus Haemophilus.
Haemophilus parainfluenzae synthesizes an outer membrane protein adhesin which mediates binding to oral streptococci, salivary pellicle, and neuraminidase-treated erythrocytes. An indirect gold labeling technique and immunoelectron microscopy verified the location of this outer membrane protein. Further, a clustering of gold particles was observed in irregular patches at the cell surface.
Haemophilus parainfluenzae was capable of synthesizing 22 fatty acids. These fatty acids were equivalent to 4% of the bacterial dry weight. These fatty acids were localized in the membrane-wall complex, which contained the respiratory pigments, the quinone, and the phospholipids. The fatty acids which could be extracted with organic solvents comprised 86% of the total fatty acids of the cell. These fatty acids were distributed as 98% in the phospholipids and 1.9% in the neutral lipids, of which 0.5% were free fatty acids. Palmitic, palmitoleic, oleic, and vaccenic acids comprised 72% of the total fatty acids and were found almost exclusively in the phospholipids. The phospholipids also contained the cyclopropane fatty acids. The neutral lipids contained significant proportions of the odd-numbered branched and straight-chain fatty acids. The principal free fatty acids were n-dodecanoic and pentadecenoic acids. The nonextractable wall complex contained 14% of the total fatty acids. These wall fatty acids were rendered soluble only after saponification. The wall fraction contained all of the beta-hydroxymyristic acid and most of the myristoleic and pentadecenoic acids. The significance of the distribution of fatty acids between nonesterified, neutral lipid, phospholipid, and nonextractible wall remains to be determined.
We examined chloramphenicol-resistant Haemophilus parainfluenzae and Haemophilus ducreyi strains isolated in various parts of the world. The antibiotic resistance determinants were located on conjugative plasmids in H. ducreyi, but were chromosomally located in H. parainfluenzae. Both species produced chloramphenicol acetyltransferases (CATs) that were sensitive to 5,5'-dithiobis(2-nitrobenzoic acid) like the enteric type II and Haemophilus influenzae CAT enzymes, but differed from these enzymes in elution patterns and subunit molecular weight. Southern blot analysis showed the H. parainfluenzae and H. ducreyi CAT genes were molecularly related to the enteric type II class as well as the H. influenzae CAT. Heterogeneity of the physiochemical properties of the CATs was observed; however, the data suggested that all three Haemophilus spp. have a common ancestral source for the CATs.
Transformation pathways in two closely related bacterial species, Haemophilus parainfluenzae and Haemophilus influenzae, were studied. Both organisms rapidly take up transforming DNA within minutes into specialized membranous structures on the cell surface (transformasomes). DNA within transformasomes is in a protected state, inaccessible to external DNase or internal restriction and modification enzymes. However, the subsequent processing of donor DNA differs in these two organisms. In H. influenzae, linear DNA immediately undergoes degradation from one end at a constant rate, leaving a lower-molecular-weight intermediate in the transformasome. The end undergoing degradation is searching for homologous regions of the chromosome. Once pairing is initiated, the remaining lower-molecular-weight DNA exits from the transformasome, and a single strand undergoes efficient integration. In contrast, in H. parainfluenzae little degradation of donor DNA is observed, with the majority remaining intact within the transformasomes after 1 h. Thus, whereas only 10% of donor DNA molecules leave the protected state after 1 h, portions of each molecule appear to become quantitatively integrated.
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Haemophilus parainfluenzae isolates recovered from patients with respiratory diseases were studied for their ability to undergo genetic transformation by isogenic DNA. Two chromosomal markers, streptomycin resistance and nalidixic acid resistance, were tested for transformation efficiencies in H. parainfluenzae recipients from three biotypes. Most efficient in transformation was biotype II, followed by biotype I, while biotype III was nontransformable. Lack of transformation was not owing to poor donor activity of DNA, but to inability of the cells to develop competence. Strains that formed clumps in liquid media were nontransformable. Since the transformable biotype II is one of the prevalent biotypes world wide, one can speculate that DNA transformation probably plays a major role in the spread of drug resistance in H. parainfluenzae.
Haemophilus parainfluenzae is a normal inhabitant of the nose and oropharynx. The authors report a case of adult vertebral osteomyelitis due to this organism that occurred 3 months after nasal septoplasty. Successful therapy was accomplished by a combination of inpatient and outpatient therapy.
Haemophilus parainfluenzae endocarditis is characterized by great variation in the acuteness of presentation, difficulty in isolation of the pathogen, a 50% to 60% incidence of major arterial emboli, and variability of response to therapy. Prosthetic valve endocarditis (PVE) due to H parainfluenzae biotype II occurred in a 14-year-old girl with congenital heart disease and a Starr-Edwards mitral valve prosthesis. Management was complicated by a prolonged culture-negative period (eight days), intermittent bacteremia (only five of 15 positive blood cultures), an embolus to the right femoral artery, progressive congestive heart failure, and urgent prosthestic valve replacement. Cure was achieved with 44 days of ampicillin sodium-gentamicin sulfate therapy monitored by serum bactericidal titers.
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.
Haemophilus parainfluenzae is an increasingly reported cause of infective endocarditis. In vitro studies have shown this organism to bae almost universally sensitive to chloramphenicol. However, therapy for H parainfluenzae endocarditis with chloramphenicol as a single agent has been disappointing. This has been attributed to the bacteriostatic activity of chloramphenicol, whereas bactericidal agents are essential for cure of infective endocarditis. We successfully treated a patient with H parainfluenzae endocarditis with chloramphenicol alone after in vitro testing showed chloramphenicol to be bactericidal against the organism. When it is documented that chloramphenicol has bactericidal activity against the causative organism, it alone can be effective therapy for H parainfluenzae endocarditis.
Haemophilus parainfluenzae was isolated from the urethral discharge of a man with urethritis. The patient responded favorably to treatment with amoxicillin. Although the facts suggest that this case of urethritis may have been caused by H. parainfluenzae, a possible etiologic role of other microorganisms is not ruled out.
A case of Haemophilus parainfluenzae urinary tract infection is reported, with clinical history and bacteriologic data. Other reports of this organism causing urinary tract infection could not be found. The importance of correlating data from clean-catch urine microscopic analysis, Gram stain, and culture is emphasized, together with the possible modes of spread in a compromised host.
Recent surveys in Vancouver showed most healthy children were colonized with beta-lactamase-producing Haemophilus parainfluenzae. Such organisms might alter the effects of penicillins on throat bacteria by local inactivation. To test this hypothesis in vitro, three isolates of beta-lactamase-producing Haemophilus parainfluenzae were each mixed on a membrane with ampicillin-sensitive strains of Haemophilus influenzae type b or group A Streptococcus pyogenes and exposed to ampicillin. When tested alone, susceptible strains were rapidly killed but when tested together with a beta-lactamase producer, they were protected, indicating efficient ampicillin degradation by Haemophilus parainfluenzae strains. If similar interactions occur in vivo, the effects of beta-lactams on throat bacteria could be significantly altered in the presence of beta-lactamase-producing Haemophilus parainfluenzae.
BACKGROUND: Haemophilus spp. had been previously suggested as a potential pathogen in genitourinary infections that could be sexually transmitted. In order to check that suggestions we have determined the incidence, pathogenic role, possible sexual transmission and susceptibility to antibiotics in isolates of Haemophilus parainfluenzae and Haemophilus influenzae from genital tract infections. The microbiological samples were taken during a period of four years from patients attended in a Service of Sexual Transmission Diseases and the data were further reviewed. METHODS: The study included 5,572 genital specimens from 2,182 women prostitutes with different genitourinary infections and from 825 men with urethritis. Microbiological samples were cultured in a non-specific media for genital pathogens and species of Haemophilus spp. and clinical circumstances of isolation were evaluated. Susceptibility tests were performed by using a standard microdilution test. RESULTS: Haemophilus spp. was isolated in 155 samples (2.8%) using a non-selective culture method. H. parainfluenzae was isolated in 100 cases (64.5%), Haemophilus influenzae in 45 cases (29%) and Haemophilus spp. in 10 strains (6.4%). Haemophilus spp. was isolated as a sole pathogen in men with urethritis (8 cases), epididymo-orchitis (2 cases), cervicitis and/or vaginitis (9 cases) and Bartholin's Abscess (2 cases). The most frequent biotypes were H. parainfluenzae biotype II (43%) and III (19%), and H. influenzae biotype IV (35.5%). Beta lactamase activity and ampicillin resistance were present in 29% of the H. parainfluenzae strains and in the 26.7% of clinical isolates of H. influenzae. CONCLUSIONS: 1) Haemophilus spp. was isolated from genitourinary infections at a low frequency in the studied group. 2) The pathogenic role of Haemophilus spp. was suggested when was isolated as a sole pathogen present from some infections of the genitourinary tract such as urethritis in men and Bartholin's abscess in women. 3) The susceptibility to antibiotics in the clinical isolates of Haemophilus spp. from genitourinary infections was similar previously reported studies performed in Spain.
Four, NAD-independent, clinical isolates of Haemophilus parainfluenzae were recovered from a genital ulcer, a purulent skin lesion, a sputum specimen and a throat swab respectively. With the exception of NAD requirement, the strains exhibited the biochemical characteristics of H. parainfluenzae biotype II. The genetic relationship between these isolates and a standard strain of H. parainfluenzae was determined by testing transforming activities of two chromosomal markers, streptomycin resistance and nalidixic acid resistance. The clinical isolates were efficient donors and recipients in transformation. In addition, we demonstrated transfer of the genes conferring NAD independence to typical, NAD-requiring H. parainfluenzae and Haemophilus influenzae strains.
Specific, opsonizing antibodies against Haemophilus parainfluenzae were demonstrated in serum by measuring their enhancing effect on the nitroblue tetrazolium (NBT)-reduction of normal human granulocytes, phagocytizing the homologous bacteria. Patients with septicemia and/or endocarditis and carriers of H. parainfluenzae were studied. In late phase sera of the first group such antibodies were detected in 6 of 9 cases. Opsonizing antibodies against H. parainfluenzae were not detected in any of the carrier sera. A dose-response effect was observed when a positive late phase serum was tested in serial 2-fold dilutions. The enhancement of the NBT-reduction was eliminated by absorption of serum with homologous antigen. The detection of opsonizing antibodies, essential for the immune defense against H. parainfluenzae might be helpful for evaluation of the pathogenicity of this organism, which so far is considered as a rare causative agent.