Serious neurological sequelae were identified during hospitalization in >20% of children with H. influenzae meningitis. [24] However instead of killing the bacteria the neutrophils are themselves killed (though such an oxidative burst likely causes DNA damage in the H. influenzae cells). [20], An oral vaccination has been developed for non-typeable Haemophilus influenzae (NTHi) for patients with chronic bronchitis but it has not shown to be effective in reducing the number and severity of COPD exacerbations. Rarely occurring in infants under 3 months [16], The serious complications of HiB are brain damage, hearing loss, and even death. However, antibiotic sensitivity testing is not possible with LAT alone, so a parallel culture is necessary. Few reports have described increased rates of H. influenzae non–type b invasive disease in regions where Hib conjugate vaccines have been used [16–18], but molecular typing studies were not performed to determine whether increased rates were due to serotype replacement. The pre- and postvaccine periods were defined as the 3.5-year interval before and 1-year interval after 9 September 1999, respectively. Colonies of H. influenzae appear as convex, smooth, pale, grey, or transparent colonies. Two scenarios may be responsible for this response: It is unclear why H. influenzae is not affected by the immune response. It is one cause of neonatal infection.[6]. Naturally acquired disease caused by H. influenzae seems to occur in humans only. Abstract. Fildes agar is best for isolation. H. influenzae will grow in the hemolytic zone of Staphylococcus aureus on blood agar plates; the hemolysis of cells by S. aureus releases factor V which is needed for its growth. H. influenzae type a strains were isolated from meningitis case patients that were identified before (lanes 6–7 and 12–14) and after (lanes 8 and 15–20) introduction of routine H. influenzae type b (Hib) immunization. Periods before (prevaccine) and after (postvaccine) initiation of the Hib immunization campaign are noted as lines below the figure. )[15], Macrolide antibiotics (e.g., clarithromycin) may be used in patients with a history of allergy to beta-lactam antibiotics. RE: Haemophilus influenzae b (Hib) disease. There is not yet sufficient evidence on how effective this pentavalent vaccine is in relation to the individual vaccines. In the present study, we provide evidence for serotype replacement with H. influenzae type a associated with the use of the Hib conjugate vaccine, Study siteThe metropolitan region of Salvador is comprised of 30 municipalities in Northeast Brazil, with a total population of 3,208,893 inhabitants [19]. A chest X-ray can identify alveolar consolidation.[7]. [10] Beyond this, H. influenzae is a finicky bacterium to culture, and any modification of culture procedures can greatly reduce isolation rates. [11] Because the method relies on antigen rather than viable bacteria, the results are not disrupted by prior antibiotic use. However, the finding of this study suggests that, as global immunization coverage expands, continued surveillance for H. influenzae will be needed to monitor potential increases in disease due to serotype replacement, We thank the clinical, laboratory, and administrative staff of Hospital Couto Maia (Salvador, Brazil), especially Ana Maria Maia and Neide Oliveira Silva; Tatiana Silva Lôbo, Ricardo Martinez Pinheiro, Cássio Ribeiro, and Steve Copolla for their participation in data collection and processing; Maviany Mota for technical assistance with the laboratory analyses; Brendan Flannery for assistance with the statistical analyses; Marlene Tavares B. de Carvalho, Neci Ivo Ramos, and Helena Macedo for providing information on the Haemophilus influenzae type b immunization program and meningitis case notifications; Leonard W. Mayer for advice during the laboratory analysis and confirmation of the serotyping results; Art Reingold for review of the manuscript; Warren D. Johnson, Jr., and Lee W. Riley for critical advice during study implementation and manuscript preparation; and, most of all, the study patients and their families, Financial support: Oswaldo Cruz Foundation/Brazilian Ministry of Health (grant 0250.250.415); Brazilian National Research Council (grants 300.861/96-6, 521.132/98-3, 350.052/95-6, and Financiadora das Instituições das Pesquisas 4196086200); National Institutes of Health (grants TW-00919, TW-00018, and TW-00905), Informed consent was obtained from patients or guardians according to procedures approved by the institutional review boards of the Oswaldo Cruz Foundation, Brazilian Ministry of Health, and Weill Medical College of Cornell University, and human experimentation guidelines of the Brazilian Ministry of Health, New York–Presbyterian Hospital, and US Department of Health and Human Services were followed in the conduct of the clinical research, The authors do not have any agreements or relationships that would represent a conflict of interest with respect to the study, Oxford University Press is a department of the University of Oxford. However, increases in the rate of disease due to non-Hib other than H. influenzae type a were not observed. However, strong evidence of serotype replacement has not been detected anywhere since Hib conjugate vaccines were introduced in the late 1980s [10]. Since it is a homolog of recA, rec1 likely plays a key role in recombinational repair of DNA damage. On the other hand, reduction of Hib carriage may open ecological niches for H. influenzae non–type b strains and therefore potentially increase the risk of colonization and invasive disease by these strains [9, 10]. With increasing reports of virulent H. influenzae type a [11, 15, 30] and H. influenzae type f [26, 27] strains isolated from different regions of the world and with the expanding global use of Hib conjugate vaccines, serotype replacement may become an emerging and more widespread possibility, Clinically, the virulence of H. influenzae type a strains was indistinguishable from that of Hib: the case-fatality ratios among H. influenzae type a and H. influenzae non–type a meningitis patients were 23% and 16%, respectively (table 2). Haemophilus influenzae disease is a name for any illness caused by bacteria called H. influenzae.Some of these illnesses, like ear infections, are mild while others, like bloodstream infections, are very serious. Of the 4 case patients with H. influenzae type a meningitis interviewed, 2 had completed a 3-dose Hib immunization schedule, and 2 had received 2 doses of the vaccine (table 3). The neutrophils phagocytize H. influenzae, thereby activating an oxidative respiratory burst. Without question, the public health priority for H. influenzae disease is the widespread introduction of the Hib conjugate vaccine in developing countries, where the cost of conjugate vaccines has thus far precluded their use. Polymerase chain reaction (PCR) assays have been proven to be more sensitive than either LAT or culture tests, and highly specific. of sporadic (non-epidemic) bacterial meningitis in this age group, and Therefore, Hib immunization contributed to an increased risk for H. influenzae type a meningitis through selection of circulating H. influenzae type a clones. Outbreaks of H. influenzae type a disease have been reported [11, 15], but H. influenzae type a cases identified in this study were not clustered in space or time and did not occur in specific risk groups, other than the pediatric population targeted by the immunization campaign. Sputum may be difficult to expectorate and is often grey or creamy in color. Hib is an important cause of meningitis, pneumonia, and epiglottitis in the pediatric population and is responsible each year for >2 million cases of invasive disease and 300,000 deaths worldwide among children aged <5 years [1]. Vaccines that target unencapsulated H. influenzae serotypes are in development. Furthermore, long-term surveillance in countries such as the United States, which have used conjugate vaccines for >10 years, has not found sustained increases in the rates of H. influenzae non–type b invasive disease [29]. Clinical features may include initial symptoms of an upper respiratory tract infection mimicking a viral infection, usually associated with fevers, often low-grade. A standardized data entry form was used to obtain information about demographic characteristics, clinical presentation, and outcome after discharge from the medical record.


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