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Hemophilus
includes a number of species
that cause a wide variety of
infections
Attribution-NonCommercial-ShareAlike
4.0 International (CC BY-NC-SA 4.0)
Introduction
• It requires blood derived factor during growth
• Hemophilus influenzae is the major pathogen
• Gram positive coccobacilli, H influenzae requires hemin (factor
X) and NAD+ (factor V) for growth
• Other Hemophilus require only NAD+
• Typable H influenzae isolates are classified on the basis of seven
antigenically distinct capsular polysaccharides; isolates lacking
these polysaccharides are called non-typable
Introduction
Other Haemophilus species Disease
Haemophilus parainfluenzae sometimes causes pneumonia or bacterial
endocarditis
Haemophilus ducreyi chancroid
Haemophilus aphrophilus member of the normal flora of the mouth and
occasionally causes bacterial endocarditis
Haemophilus aegyptius conjunctivitis and Brazilian purpuric fever, non
typable strains
Haemophilus haemolyticus Example for non typable strains
Diseases caused
• Type b H influenzae was the most common cause of meningitis in children between the ages of 6 months and
2 years
• In meningitis: headache is followed rapidly by development of a stiff neck, with progression to coma and, in the
absence of treatment, death
• Treatment reduces the incidence of, but does not eliminate, problems such as deafness and learning
disabilities
• Type b H influenzae also causes cellulitis
• Epiglottitis: a condition in which the epiglottitis becomes inflamed and swells, closing off the upper airway.
(Suffocation can be prevented in some cases only by performing a tracheostomy)
• Nontypable H influenzae strains commonly cause infection of the middle ear (otitis media)
Diseases caused
• In adults, these organisms cause bronchitis and pneumonia, especially if some underlying disease of the
bronchi and lungs is present
• Nontypable H influenzae strains also commonly cause acute or chronic sinusitis in patients of all ages
• Chancroid is a venereal disease caused by H ducreyi.
• Lesions that resemble a syphilitic chancre result from sexual contact with an infected individual; they are
usually found on the genitals.
• Unlike syphilitic chancres, the lesions are painful and are associated with a remarkable degree of swelling of
lymph nodes in the inguinal area.
Diseases caused
H
influenzae
Meningitis
Cellulitis
Epigloittitis
Otitis media
Bronchitis
Pneumonia
H ducreyi Chancroid
Structure
• Gram-negative coccobacilli
• cell walls contain lipooligosaccharide, which resembles the lipopolysaccharide of Gram-negative bacilli but has
shorter side chains
• generally been thought not to make toxins or other extracellular products that account for their ability to
produce infection
• organisms require hemin (factor X) and/or nicotinamide adenine dinucleotide (NAD+) (factor V) for growth.
• Whereas NAD+ is released into the medium by red blood cells and is available to the bacteria in blood agar,
hemin is bound to red blood cells and is not released into the medium unless the cells are broken up as in
chocolate agar
Structure
• Haemophilus influenzae requires both factors X and V; accordingly, it grows on chocolate agar but not on blood
agar
• Haemophilus parainfluenzae requires only factor V and therefore is able to grow on blood agar
• All Haemophilus species grow more readily in an atmosphere enriched with CO2
• H ducreyi and some nontypable H influenzae strains will not form visible colonies on culture plates unless
grown in CO2-enriched atmosphere.
Structure
ClassificationHaemophilusinfluenzae
Typable
Non typable
• they display a capsular polysaccharide antigen
• six generally recognized types: a, b, c, d, e, and f
• They lack a capsule
Antigenic types
• polyribosyl ribitol phosphate (PRP) capsule is an important virulence factor
• it renders type b H influenzae resistant to phagocytosis by polymorphonuclear leukocytes
• Type b H influenzae is plainly the most virulent of the Haemophilus species and most common in childrens
• nontypable strains of H influenzae are the most common cause of Haemophilus infection in adults. Why?
• H influenzae also may be classified into six biotypes designated I through VI
• Most type b H influenzae strains fall into biotypes I or II
• whereas most non typable H influenzae strains fall into biotypes II through VI.
Pathogenesis
Haemophilus species do not produce substances that obviously damage
mammalian tissues, bacterial replication is probably the usual pathway for
disease production, with triggering of the complement cascade by classic and
alternative pathways, followed by accumulation of inflammatory cells.
Pathogenesis
• Organisms colonize the nasopharynx
• Spread from one human to another by direct contact or via secretions and/or aerosol
• They penetrate epithelial layers and capillary endothelium by unknown mechanisms, reaching the meninges
either directly via lymphatic drainage from the nasopharynx or indirectly by causing bacteremia
• meningitis in adults are due to nontypable strains
• they gain entry to the central nervous system by direct extension, often associated with infection of the
sinuses or middle ear and/or with trauma involving the sinuses or skull
Meningitis
Pathogenesis
• Cellulitis and epiglottitis are discussed together because their pathogenesis is probably quite similar
• Both are due to type b H influenzae, are likely to cause associated bacteremia, and occur more frequently in
children than adults
• Epiglottitis can be regarded as a cellulitis of the relatively loose submucosal connective tissues of the
epiglottis.
• A sore throat rapidly progresses to difficulty in breathing, stridor, obstruction of the air ways, and respiratory
arrest.
Cellulitis and Epiglottitis
Pathogenesis
• Cellulitis often involves the face or neck
• It sometimes seems to start at the buccal mucosa and
extend outward, supporting the idea that it also
results from local extension
Cellulitis and Epiglottitis
Pathogenesis
• Nontypable H influenzae is a major pathogen that colonizes the human respiratory tract
• Adherence of bacteria to mammalian tissues, which is mediated by pili (fimbriae)
• Respiratory infections caused by these organisms include sinusitis, otitis media, acute tracheobronchitis, and
pneumonia.
• Repeated bouts of otitis media are thought to be due to different strains; each infection may be associated
with emergence of antibody to distinctive surface proteins
• Haemophilus influenzae received its name because it was first isolated from the lungs of individuals who died
during an epidemic of influenza virus infection in 1890
Respiratory disease
Pathogenesis
• characterized by nausea, vomiting, hemorrhagic skin lesions, fever, weakness, and shock
• Haemophilus influenzae biogroup aegyptius can be cultured from the blood of affected patients.
• Many have had a history of conjunctivitis in the weeks preceding onset of the disease.
Brazilian Purpuric Fever
Diagnosis
• Cannot be distinguished on the basis of clinical presentation, physical examination, or cerebrospinal fluid
abnormalities from meningitis due to other common bacterial pathogens
• Detection of capsular material in the cerebrospinal fluid by counter immunoelectrophoresis is helpful in pre
treated patients
• Gram staining of CSF
• Blood culture is preferable for endocarditis
Control
• Type b H influenzae can be prevented by vaccination or prophylactic therapy
• The use of rifampin prophylaxis to prevent or eradicate nasopharyngeal colonization has been recommended
• The mainstay of therapy for H influenzae infection used to be ampicillin, since isolates were uniformly
susceptible to 0.5 μg/ml – but H influenzae isolates have produced β-lactamase
• Treatment with a combination of amoxicillin and clavulanic acid (a substance that covalently binds β-
lactamase) is effective against β-lactamase-producing strains, but has not been recommended for treating
meningitis
• Chloramphenicol - the drug of choice for meningitis caused by a penicillin-resistant H influenzae strain
• Third-generation cephalosporins, such as ceftriaxone or cefotaxime (meningitis)
• The addition of corticosteroids may reduce the incidence of complications such as deafness.
Control
• sulfa drugs are effective in treating upper and lower respiratory infections caused by
Haemophilus.
• Erythromycin should not generally be used to treat H influenzae infections
• The spread of soft chancre due to H ducreyi is best prevented by use of a condom
during sexual intercourse.
• Two-thirds of H ducreyi isolates produce β-lactamase.
• All isolates are susceptible in vitro to erythromycin

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Haemophilus

  • 1. Hemophilus includes a number of species that cause a wide variety of infections Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0)
  • 2. Introduction • It requires blood derived factor during growth • Hemophilus influenzae is the major pathogen • Gram positive coccobacilli, H influenzae requires hemin (factor X) and NAD+ (factor V) for growth • Other Hemophilus require only NAD+ • Typable H influenzae isolates are classified on the basis of seven antigenically distinct capsular polysaccharides; isolates lacking these polysaccharides are called non-typable
  • 3. Introduction Other Haemophilus species Disease Haemophilus parainfluenzae sometimes causes pneumonia or bacterial endocarditis Haemophilus ducreyi chancroid Haemophilus aphrophilus member of the normal flora of the mouth and occasionally causes bacterial endocarditis Haemophilus aegyptius conjunctivitis and Brazilian purpuric fever, non typable strains Haemophilus haemolyticus Example for non typable strains
  • 4. Diseases caused • Type b H influenzae was the most common cause of meningitis in children between the ages of 6 months and 2 years • In meningitis: headache is followed rapidly by development of a stiff neck, with progression to coma and, in the absence of treatment, death • Treatment reduces the incidence of, but does not eliminate, problems such as deafness and learning disabilities • Type b H influenzae also causes cellulitis • Epiglottitis: a condition in which the epiglottitis becomes inflamed and swells, closing off the upper airway. (Suffocation can be prevented in some cases only by performing a tracheostomy) • Nontypable H influenzae strains commonly cause infection of the middle ear (otitis media)
  • 5. Diseases caused • In adults, these organisms cause bronchitis and pneumonia, especially if some underlying disease of the bronchi and lungs is present • Nontypable H influenzae strains also commonly cause acute or chronic sinusitis in patients of all ages • Chancroid is a venereal disease caused by H ducreyi. • Lesions that resemble a syphilitic chancre result from sexual contact with an infected individual; they are usually found on the genitals. • Unlike syphilitic chancres, the lesions are painful and are associated with a remarkable degree of swelling of lymph nodes in the inguinal area.
  • 7. Structure • Gram-negative coccobacilli • cell walls contain lipooligosaccharide, which resembles the lipopolysaccharide of Gram-negative bacilli but has shorter side chains • generally been thought not to make toxins or other extracellular products that account for their ability to produce infection • organisms require hemin (factor X) and/or nicotinamide adenine dinucleotide (NAD+) (factor V) for growth. • Whereas NAD+ is released into the medium by red blood cells and is available to the bacteria in blood agar, hemin is bound to red blood cells and is not released into the medium unless the cells are broken up as in chocolate agar
  • 8. Structure • Haemophilus influenzae requires both factors X and V; accordingly, it grows on chocolate agar but not on blood agar • Haemophilus parainfluenzae requires only factor V and therefore is able to grow on blood agar • All Haemophilus species grow more readily in an atmosphere enriched with CO2 • H ducreyi and some nontypable H influenzae strains will not form visible colonies on culture plates unless grown in CO2-enriched atmosphere.
  • 10. ClassificationHaemophilusinfluenzae Typable Non typable • they display a capsular polysaccharide antigen • six generally recognized types: a, b, c, d, e, and f • They lack a capsule
  • 11. Antigenic types • polyribosyl ribitol phosphate (PRP) capsule is an important virulence factor • it renders type b H influenzae resistant to phagocytosis by polymorphonuclear leukocytes • Type b H influenzae is plainly the most virulent of the Haemophilus species and most common in childrens • nontypable strains of H influenzae are the most common cause of Haemophilus infection in adults. Why? • H influenzae also may be classified into six biotypes designated I through VI • Most type b H influenzae strains fall into biotypes I or II • whereas most non typable H influenzae strains fall into biotypes II through VI.
  • 12. Pathogenesis Haemophilus species do not produce substances that obviously damage mammalian tissues, bacterial replication is probably the usual pathway for disease production, with triggering of the complement cascade by classic and alternative pathways, followed by accumulation of inflammatory cells.
  • 13. Pathogenesis • Organisms colonize the nasopharynx • Spread from one human to another by direct contact or via secretions and/or aerosol • They penetrate epithelial layers and capillary endothelium by unknown mechanisms, reaching the meninges either directly via lymphatic drainage from the nasopharynx or indirectly by causing bacteremia • meningitis in adults are due to nontypable strains • they gain entry to the central nervous system by direct extension, often associated with infection of the sinuses or middle ear and/or with trauma involving the sinuses or skull Meningitis
  • 14. Pathogenesis • Cellulitis and epiglottitis are discussed together because their pathogenesis is probably quite similar • Both are due to type b H influenzae, are likely to cause associated bacteremia, and occur more frequently in children than adults • Epiglottitis can be regarded as a cellulitis of the relatively loose submucosal connective tissues of the epiglottis. • A sore throat rapidly progresses to difficulty in breathing, stridor, obstruction of the air ways, and respiratory arrest. Cellulitis and Epiglottitis
  • 15. Pathogenesis • Cellulitis often involves the face or neck • It sometimes seems to start at the buccal mucosa and extend outward, supporting the idea that it also results from local extension Cellulitis and Epiglottitis
  • 16. Pathogenesis • Nontypable H influenzae is a major pathogen that colonizes the human respiratory tract • Adherence of bacteria to mammalian tissues, which is mediated by pili (fimbriae) • Respiratory infections caused by these organisms include sinusitis, otitis media, acute tracheobronchitis, and pneumonia. • Repeated bouts of otitis media are thought to be due to different strains; each infection may be associated with emergence of antibody to distinctive surface proteins • Haemophilus influenzae received its name because it was first isolated from the lungs of individuals who died during an epidemic of influenza virus infection in 1890 Respiratory disease
  • 17. Pathogenesis • characterized by nausea, vomiting, hemorrhagic skin lesions, fever, weakness, and shock • Haemophilus influenzae biogroup aegyptius can be cultured from the blood of affected patients. • Many have had a history of conjunctivitis in the weeks preceding onset of the disease. Brazilian Purpuric Fever
  • 18. Diagnosis • Cannot be distinguished on the basis of clinical presentation, physical examination, or cerebrospinal fluid abnormalities from meningitis due to other common bacterial pathogens • Detection of capsular material in the cerebrospinal fluid by counter immunoelectrophoresis is helpful in pre treated patients • Gram staining of CSF • Blood culture is preferable for endocarditis
  • 19. Control • Type b H influenzae can be prevented by vaccination or prophylactic therapy • The use of rifampin prophylaxis to prevent or eradicate nasopharyngeal colonization has been recommended • The mainstay of therapy for H influenzae infection used to be ampicillin, since isolates were uniformly susceptible to 0.5 μg/ml – but H influenzae isolates have produced β-lactamase • Treatment with a combination of amoxicillin and clavulanic acid (a substance that covalently binds β- lactamase) is effective against β-lactamase-producing strains, but has not been recommended for treating meningitis • Chloramphenicol - the drug of choice for meningitis caused by a penicillin-resistant H influenzae strain • Third-generation cephalosporins, such as ceftriaxone or cefotaxime (meningitis) • The addition of corticosteroids may reduce the incidence of complications such as deafness.
  • 20. Control • sulfa drugs are effective in treating upper and lower respiratory infections caused by Haemophilus. • Erythromycin should not generally be used to treat H influenzae infections • The spread of soft chancre due to H ducreyi is best prevented by use of a condom during sexual intercourse. • Two-thirds of H ducreyi isolates produce β-lactamase. • All isolates are susceptible in vitro to erythromycin