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Premium member Presentation Transcript HAEMOPHILUS INFLUENZAE: HAEMOPHILUS INFLUENZAE Dr.T.V.Rao MD Dr.T.V.Rao MD 1PowerPoint Presentation: Scientific classification Kingdom: Bacteria Phylum: Proteobacteria Class:Gamma Proteobacteria Order:Pasteurellales Family:Pasteurellaceae Genus:Haemophilus Species:H. influenzae Binomial name Haemophilus influenzae Dr.T.V.Rao MD 2History: History Pfeiffer 1892 Mistaken as causative of Human Influenza Isolated by Smith, Andrewes and Laidlaw in 1933 Need one or both of Accessory growth factors X and V present in the Blood Dr.T.V.Rao MD 3Overview- Haemophilus: Overview- Haemophilus Small Non-motile Gram-negative rods Transmitted via respiratory droplets, or direct contact with contaminated secretions Normal flora of the human respiratory tract and oral cavity. Dr.T.V.Rao MD 4Haemophilus species of clinical importance: Haemophilus species of clinical importance 1. H. influenzae - type b is an important human pathogen 2. H. ducreyi - sexually transmitted pathogen (chancroid) 3. Other Haemophilus are normal flora - H. parainfluenzae – pneumonia & endocarditis - H. aphrophilus – pneumonia & endocarditis - H. aegyptius – pink eye (purulent conjunctivitis) Dr.T.V.Rao MD 5Haemophilus Influenza: Aerobic gram-negative bacteria Polysaccharide capsule Six different serotypes (a-f) of polysaccharide capsule 95% of invasive disease caused by type b (Hib) Haemophilus Influenza Dr.T.V.Rao MD 6Genus Haemophilus: Genus Haemophilus Small, Non motile, Non sporing Oxidase test positive Pleomorphic Gram Negative Dr.T.V.Rao MD 7Haemophilus Influenza (Pfeiffer Bacillus ): Haemophilus Influenza (Pfeiffer Bacillus ) The size is 3 x 0.3 microns Gram negative Non Motile Non sporing Pleomorphic Appear as clusters or Coccobacillary forms in infected CSF When isolated capsulated Stained with Loffler's methylene blue Dr.T.V.Rao MD 8Microscopic Appearance by Gram staining: Microscopic Appearance by Gram staining Dr.T.V.Rao MD 9Haemophilus influenza: Haemophilus influenza Dr.T.V.Rao MD 10Haemophilus Species: Haemophilus Species Haemophilus species require hemoglobin for growth: X-factor ( hemin): Heat-stable substance V-factor (NAD): Heat- labile, coenzyme I, nicotinamide adenine dinucleotide, found in blood or secreted by certain organisms H. influenzae satellitism around and between the large, white, hemolytic staphylococciHaemophilus Influenzae: Mode of Transmission: Droplet infection and discharge from the upper respiratory tract during the infectious period. Incubation Period Unknown, probably short, 2-4 days. Infectious Period - As long as the organism is present, even in the absence of nasal discharge. - Noninfectious within 24 to 48 hours after the start of effective antibiotics. Haemophilus Influenzae Dr.T.V.Rao MD 12Cultural Characteristics: Cultural Characteristics Fastidious growth requirements Factors X and V are essential for growth X is Hemin heat stable Porphyrins for synthesis of Cytochromes V factor Coenzyme Nicotinamide adenine dinucleotide or NAD phosphate acts as hydrogen acceptor Aerobic 37 0 c Grows in Blood agar Dr.T.V.Rao MD 13H. influenzae on a blood agar plate.: H . influenzae on a blood agar plate. H. influenza, in a Gram stain of a sputum sample, appear as Gram-negative coccobacilli. Haemophilus influenza requires X and V factors for growth. In this culture Haemophilus has only grown around the paper disc that has been impregnated with X and V factors. There is no bacterial growth around the discs that only contain either X or V factor. Dr.T.V.Rao MD 14Satellitisim: Satellitisim When Staph aureus is streaked across plate of Blood agar with a species containing H Influenza the colonies which are large develop along the streak of Staphylococcus and small further away Dr.T.V.Rao MD 15Biochemical Characters: Biochemical Characters Glucose + Xylose + Lactose – Sucrose – Mannitol – Nitrites reduced Indole differs on B type causes Meningitis Dr.T.V.Rao MD 16Resistance: Resistance Heating at 55 0 c for 30mt destroys Drying and Disinfectants destroy Dr.T.V.Rao MD 17Antigenic Properties: Antigenic Properties Contains 3 Major surface antigens 1 Capsular polysaccharide 2 Outer membrane proteins (OMP) 3 Lipopolysaccharides ( LPS ) Dr.T.V.Rao MD 18Pittman Classification: Pittman Classification The major antigenic determinant of capsulated strains into six capsular types type a to f Typing by agglutination Quelling reactions precipitation and co agglutination or ELISA 95% of H, Influenza isolates belong to type b Dr.T.V.Rao MD 19Type b characteristics: Type b characteristics Has unique characters contains Pentose sugars Ribose Ribitol, instead of Hexose in others and hexosamines The capsular polyribosyl ribitol phosphate ( PRP ) of Hib induces IgG IgM and IgA antibodies –Bactericidal and opsonic and protective. So Hib PRP employed for Immunization Dr.T.V.Rao MD 20PowerPoint Presentation: Haemophilus influenzae type b Clinical Features* *prevaccination era Dr.T.V.Rao MD 21Non typable Strains: Non typable Strains H Influenza lacking capsule are non typable are most relevant in clinical infections Outer membrane proteins OMP of Hib are classified into 13 subtypes H Influenza lipo polysaccharides are more complex Genome of the organism is sequenced Dr.T.V.Rao MD 22Pathogenicity : Pathogenicity A Human pathogen Can produce invasive and Non invasive lesions Prominent organism in producing Meningitis Can produce laryngoepiglottitis,Conjuctivitis,Bactereima Pneumonia, Arthritis Endocarditis, Pericarditis Dr.T.V.Rao MD 23Most strains are opportunistic Pathogens : Most strains are opportunistic Pathogens Most strains of H. influenza are opportunistic pathogens; that is, they usually live in their host without causing disease, but cause problems only when other factors (such as a viral infection or reduced immune function) create an opportunity. Dr.T.V.Rao MD 24Most Important Clinical Illness associated with H influenzae: Most Important Clinical Illness associated with H influenzae Dr.T.V.Rao MD 25Clinical Presentation: Pneumonia: Severe shortness of breath, rapid heart rate, fever, cough and evidence of pneumonia by chest radiograph. Septic Arthritis: Swelling, warmth, pain with movement and decreased mobility of a single large weight-bearing joint. Clinical Presentation Dr.T.V.Rao MD 26PowerPoint Presentation: Dr.T.V.Rao MD 27Haemophilus Influenza: Mode of Transmission: Droplet infection and discharge from the upper respiratory tract during the infectious period. Incubation Period Unknown, probably short, 2-4 days. Infectious Period - As long as the organism is present, even in the absence of nasal discharge. - Noninfectious within 24 to 48 hours after the start of effective antibiotics. Haemophilus Influenza Dr.T.V.Rao MD 28Haemophilus influenza type b Meningitis: Haemophilus influenza type b Meningitis Accounted for approximately 50%-65% of cases in the prevaccine era Hearing impairment or neurologic sequelae in 15%-30% Case-fatality rate 2%-5% despite of effective antimicrobial therapy Dr.T.V.Rao MD 29Secondary Infections: Secondary Infections Respiratory tract infections, Otitis media Sinusitis Chronic Bronchitis Dr.T.V.Rao MD 30Haemophilus Meningitis: Haemophilus Meningitis Carries a High Mortality of 90% if not treated The Bacteria reach Meninges from nasopharynx Dr.T.V.Rao MD 31Laryngo epiglottitis: Laryngo epiglottitis Causes Epiglottis Obstructive Laryngitis > 2 years children are vulnerable Can be fatal in 2 hours Dr.T.V.Rao MD 32Pneumonia: Pneumonia Pneumonia along with Meningitis Lobar Pneumonia Bronchopneumonia Can present with Empyema Dr.T.V.Rao MD 33Suppurative Lesions: Suppurative Lesions Arthritis Endocarditis Pericarditis Haematogenous dissemination Otitis Media Cellulitis Dr.T.V.Rao MD 34Laboratory Diagnosis: Laboratory Diagnosis On Microscopy Gram Negative Pleomorphic organisms are seen Capsulated with polysaccharide antigen in CSF Urine also detect Antigen Dr.T.V.Rao MD 35Culturing and Isolation: Culturing and Isolation Can be grown on Blood agar and Chocolate agar Need 5 – 10 % carbon dioxide A streak of Staphylococcus should be streaked across the plate at 37 0 c Opaque colonies appear shows as Satellitisim Iridescence Demonstrates on Leviathan medium Blood culture Dr.T.V.Rao MD 36Detection of Antigen: Detection of Antigen Capsular polysaccharide antigen can be detected in CSF of Meningitis and Urine from systemic infections By Latex agglutination Counter Immuno Electrophoresis Dr.T.V.Rao MD 37Treatment: Treatment Cefotaxime Ceftazidime Ampicicillin, Contrimixazole Plasmid born resistance set in Ampicillin Amoxycillin with Clavulanate Clarithromycin Dr.T.V.Rao MD 38Haemophilus influenza type b Medical Management: Haemophilus influenza type b Medical Management Hospitalization required Treatment with an effective 3rd generation cephalosporin, or chloramphenicol plus ampicillin Ampicillin-resistant strains now common throughout the United States Dr.T.V.Rao MD 39Epidemiology and Prevention: Epidemiology and Prevention Similar to Pneumococci Infection enters through Respiratory tract Immunity is type specific HIB is protected by PRP vaccine Poorly immunogenic in children below 2 years Rifampicin can be given for 4 days and prevents secondary infection and eradicates carrier state. Dr.T.V.Rao MD 40Public Health Action: Public Health Action Dr.T.V.Rao MD 41Current Vaccines: Current Vaccines Haemophilus B conjugate vaccine Wide spread use of H influenza type b vaccine has reduced H influenza type b meningitis in children by 95% Dr.T.V.Rao MD 42Newer vaccines: Newer vaccines The previous vaccines PRP is immunogenic in older children PRP is poorly immunogenic in children below two years Immunogenicity can be improved when coupled with Protein carriers like diphtheria and tetanus Toxoid Used in young children Dr.T.V.Rao MD 43PowerPoint Presentation: Dr.T.V.Rao MD 44Public Health Aspect of other Haemophilus strains: Public Health Aspect of other Haemophilus strains H. ducreyi Sexually transmitted disease - chancroid H. influenzae biogroup aegyptius Brazilian Purpuric Fever H. aegyptius “pink eye” (purulent conjunctivitis) H. aphrophilus pneumonia Infective endocarditis Dr.T.V.Rao MD 45H,influenzae and other Species : H,influenzae and other Species Dr.T.V.Rao MD 46Haemophilus ducreyi- Chancroid: Haemophilus ducreyi- Chancroid ~5,000 cases per year in the US Major cause os STD’s Dr.T.V.Rao MD 47Haemophilus ducreyi: Haemophilus ducreyi Ducrey 1890 Produces Chancroid lesions Chancroid or soft sore – A Venereal disease Tender non indurated irregular ulcers of Genetalia Infection is localized spreading to only to regional lymph nodes Lymph nodes enlarged and painful Dr.T.V.Rao MD 48H.ducreyi: H.ducreyi Short ovoid bacilli 1 – 1.5 x 0.6 microns End to end pairing in short chains Gram –ve appear as Gram +ve Bipolar staining Bacilli in small groups appear as parallel chains giving school of fish appearance Dr.T.V.Rao MD 49Growth and Culturing: Growth and Culturing Grows on Fresh clotted Rabbit blood Grows on Chorioallontoic membrane of chick embryo Small grey translucent colonies are produced Dr.T.V.Rao MD 50Chemotherapy for H ducrei: Chemotherapy for H ducrei Sulphonamides Erythromycin Contrimixazole Ciprofloxacin Ceftriaxone Dr.T.V.Rao MD 51Haemophilus aegypticus: Haemophilus aegypticus Also called Koch - Weeks Bacillus Identified as Bio type of H influenza Produces pink eye Sulphonamides and Gentamycin effective Dr.T.V.Rao MD 52H.parainflunza: H.parainflunza Requires only V factor and not X factor Dr.T.V.Rao MD 53H.aphrophilus: H.aphrophilus Requires X and V factors Produces Bacterial endocarditis Brain abscess Sinusitis Abscess Dr.T.V.Rao MD 54HACEK GROUP: HACEK GROUP Haemophilus Para influenza H paraphorophilus Actinobacillus Cardiobacterium homnis Eikenella corrodens Kingela kingie Dr.T.V.Rao MD 55PowerPoint Presentation: Programme Created by Dr.T.V.Rao MD for Medical and Paramedical Students in the Developing World Email email@example.com Dr.T.V.Rao MD 56 You do not have the permission to view this presentation. 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