Population-based study of non-typable Haemophilus influenzae invasive disease in children and neonates

Falla, Timothy J.; Crook, Derrick W.; Kraak, W.A.G.; Nichols, W. W.; Anderson, E. C.; Jordens, J. Zoe; Slack, Mary P. E.; Dobson, Simon; Moxon, E. Richard; Mayon-White, D.

doi:10.1016/0140-6736(93)93059-a

Cited by 94 publications

(66 citation statements)

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“…Data from the United Kingdom, including capsular genotyping, corroborated these prevalence figures, including 7 cases of bacteremic nontypeable H. influenzae infection in previously healthy children outside the neonatal period [23]. With universal implementation of conjugate Hib vaccination, the percentage of residual invasive H. influenzae disease attributable to nonencapsulated strains appears to be increasing.…”

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confidence: 58%

A Virulent Non-Encapsulated Haemophilus Influenzae.

&NA;

1996

The Pediatric Infectious Disease Journal

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. The specific microbial virulence factors that allow nonencapsulated H influenzae to cause serious disease remain unknown, and to our knowledge, the ability of such organisms to cause invasive disease in an animal model has never before been demonstrated. Case HistoryA 30-month-old white boy was in his usual state of good health until 6 days before admission, when he developed a low-grade fever and abdominal pain. He was seen by his primary pediatrician, who noted right otitis media and prescribed amoxicillin, which was not taken because of vomiting. Three days before admission, he was seen in an emergency department, where he appeared lethargic and dehydrated with unresolved otitis media. There were no meningeal signs on examination. His peripheral leukocyte count was 21,000/mm3 with 580Zo neutrophils and 180Zo band forms. A blood sample was obtained for culture, the patient received intravenous rehydration and 50 mg/kg ceftriaxone intravenously, and was discharged home to resume amoxicillin administration.The child continued to be irritable and listless with fever to 39.20C over the ensuing 48-72 h but was able to take liquids and amoxicillin. He was carefully examined daily by his pediatrician who, on day 6 of symptoms, noted the development of passive

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supporting

confidence: 58%

A Virulent Non-Encapsulated Haemophilus Influenzae.

&NA;

1996

The Pediatric Infectious Disease Journal

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“…13 In 1 large population-based study, serotype b accounted for 383 of 408 cases (94%), nontypable strains caused an additional 24 cases, and no disease caused by serotype a was noted. 14 In another population-based study in 1986, 1324 of 1872 isolates (71%) from invasive disease were type b; 14 of 1872 (0.7%) were type a. 6 Invasive disease caused by nonserotype b encapsulated organisms occurred almost exclusively in persons older than 5 years.…”

Section: Discussionmentioning

confidence: 99%

Invasive Serotype a Haemophilus influenzaeInfections With a Virulence Genotype Resembling Haemophilus influenzae Type b: Emerging Pathogen in the Vaccine Era?

et al. 2001

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ABSTRACT. Objective. Haemophilus influenzae type b causes severe disease in nonimmune infants and young children; other serotypes are uncommon pathogens and thought to have low virulence. Some have hypothesized that with the virtual elimination of H influenzae type b, other serotypes might acquire virulence traits and emerge as important pathogens of children. We describe the clinical, epidemiologic, and molecular biologic features of 5 cases of severe disease attributable to Haemophilus influenzae type a.Methods. After observing 4 cases of invasive disease caused by H influenzae type a, we reviewed microbiology records at 3 reference laboratories that perform all serotyping in Utah and surveillance databases. Strains of H influenzae type a and control strains were examined by Southern blotting with the use of the cap probe pUO38 and by pulsed-field gel electrophoresis. The putative virulence mutation, the IS1016-bexA deletion, was detected by polymerase chain reaction amplification and sequencing.Results. During a 10-month period, we observed 5 children with severe invasive disease caused by H influenzae type a. No isolates of H influenzae type a had been submitted to the reference laboratories between 1992 and 1998. The median age of patients was 12 months (range: 6 -48 months). Four of 5 had meningitis and bacteremia; 1 had purpura fulminans. Three isolates, representing 1 of 2 pulsed-field gel electrophoresis patterns, contained the IS1016-bexA deletion and were associated with particularly severe disease.Conclusions. We describe an unusual cluster of severe disease caused by H influenzae type a that resembles the clinical and epidemiologic features of H influenzae type b disease. Our data support the hypothesis that the IS1016-bexA deletion may identify more virulent strains of H influenzae. Pediatrics 2001;108(1). URL: http://www. pediatrics.org/cgi/content/full/108/1/e18; Haemophilus influenzae, epidemiology, virulence, serotyping, pathogenicity.

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“…Non-type b H. infl uenzae appears to be more common in persons with underlying medical illnesses, such as immunosuppressive conditions (3,4,17). The extent to which non-b H. infl uenzae causes invasive disease is not fully known (17). In some countries, only Hib disease is reportable; therefore, information on other serotypes is lacking.…”

mentioning

confidence: 99%

“…Infections caused by nonencapsulated strains are more common in adults and are more likely to be associated with pneumonia, whereas infections caused by encapsulated strains tend to occur in younger children with a predominance of meningitis and bacteremia (3,17). Non-type b H. infl uenzae appears to be more common in persons with underlying medical illnesses, such as immunosuppressive conditions (3,4,17). The extent to which non-b H. infl uenzae causes invasive disease is not fully known (17).…”

mentioning

confidence: 99%