Haemophilus Aphrophilus Research Articles

Kingella kingae endocarditis: A rare case of mitral valve perforation

Kingella kingae, a HACEK (Haemophilus parainfluenzae, Aggregatibacter actinomycetemcomitans, Aggregatibacter aphrophilus, Cardiobacterium hominis, Eikenella corrodens, Kingella kingae) organism, is a common resident of the upper airway in children; it has been associated with endocarditis in children with pre-existing heart conditions. This case report describes K. kingae endocarditis leading to valvular damage in a previously healthy 18-month-old child. Our patient developed a K. kingae bacteremia that was later complicated by meningitis, septic embolic stroke, and endocarditis of the mitral valve, leading to perforation of the posterolateral leaflet. The patient was initially treated conservatively with cefotaxime but, subsequently, required a mitral valve repair with a pericardial patch and annuloplasty. This report draws attention to the need for clinicians to be aware of the potentially serious complications of K. kingae infection in young children. If K. kingae infection is suspected then therapy should be initiated promptly with a β-lactam, followed by early echocardiographic assessment. This case also highlights the lack of specific guidelines available for K. kingae endocarditis.

Microbiota of deciduous endodontic infections analysed by MDA and Checkerboard DNA-DNA hybridization

To evaluate the microbiota of endodontic infections in deciduous teeth by Checkerboard DNA-DNA hybridization after uniform amplification of DNA in samples by multiple displacement amplification (MDA). Forty samples from the root canal system of deciduous teeth exhibiting pulp necrosis with or without radiographically detectable periradicular/interradicular bone resorption were collected and 32 were analysed, with three individuals contributing two samples; these were MDA-amplified and analysed by Checkerboard DNA-DNA hybridization for levels of 83 bacterial taxa. Two outcome measures were used: the percentage of teeth colonized by each species and the mean proportion of each bacterial taxon present across all samples. The mean amount of DNA in the samples prior to amplification was 5.2 (±4.7) ng and 6.1 (±2.3) μg after MDA. The mean number of species detected per sample was 19 (±4) (range: 3-66) to the nearest whole number. The most prevalent taxa were Prevotella intermedia (96.9%), Neisseria mucosa (65.6%), Prevotella nigrescens (56.2%) and Tannerella forsythia (56.2%). Aggregatibacter (Haemophilus) aphrophilus and Helicobacter pylori were not detected. P. intermedia (10%), Prevotella tannerae (7%) and Prevotella nigrescens (4.3%) presented the highest mean proportions of the target species averaged across the positive samples. Root canals of infected deciduous teeth had a diverse bacterial population. Prevotella sp. were commonly found with P. intermedia, Prevotella tannerae and Prevotella nigrescens amongst the most prominent species detected.

MICROBIOLOGICAL DIAGNOSIS OF THE SEVERE CHRONIC PERIODONTITIS

In total, 14 adult patients with severe chronic periodontitis were evaluated for the presence of associated anaerobic and aerobic bacteria. Subgingival plaque specimens from three pocket depths per patient were obtained. Microaerophilic and facultative anaerobic bacteria, probably involved in the periodontitis, were isolated in six (42.9%) patients. These were Gram negative species involving Aggregatibacter (Haemophilus) aphrophilus (14.3%), Haemophilus parainfluenzae (7.1%), Kingella denitrificans (7.1%) and Moraxella osloensis (7.1%) as well as Gram-positive species, including Arcanobacterium (Actinomyces) pyogenes (7.1%) and Rhodococcus equi (7.1%). Anaerobic microbiology was completed for 12 patients. Of them, suspected periodontopathogens were isolated in seven (58.3%) patients and comprised Prevotella intermedia (in 41.7% of the patients) and Porphyromonas gingivalis (25%) as well as Porphyromonas endodontalis (8.3%). Tannerella forsythia was detected by PCR in half of the 12 cases. In conclusion, the presence of periodontopathogens as well as other bacterial species of possible importance should be considered in the patients with severe chronic periodontitis.

Aortic endograft infection: A report of 2 cases

Introduction Endograft infection has received less attention than other complication, so that little is known about the general features, risk factors, and treatment. The purpose of this short series is to examine our experience of infective complications after EVAR. Material and methods Between November 2000 and December 2008, 247 patients underwent endograft repair for abdominal aortic aneurysm. Follow-up protocol included clinical visit and computed-tomography angiography 1, 4 and 12 months after the intervention, and yearly thereafter. No duplex control was performed on a regular basis. Results Median follow-up was 16 months (range, 3–92); two patients (2/244, 0.8%) developed an endograft infection, 12 and 36-months after the intervention respectively. On admission, both patients complained septic-like fever and abdominal discomfort; leukocytes-labelled scans did not reveal pathologic traits whereas spiral computed-tomography confirmed the suspicious of endograft infection. They underwent endograft removal and extra-anatomic axillo-bifemoral by-pass; both survived and are still alive 12 and 6-months after the intervention. Isolated micro-organisms were Candida albicans and Escherichia coli in one patient, and Haemophilus aphrophilus in the other. Conclusion Endograft infection is an uncommon occurrence, Spiral computed-tomography seems to be an essential diagnostic tool. Graft removal was successful in our high-risk patients. A multicenter registry should be started to define guidelines.

IDENTIFICAÇÃO BACTERIANA E SENSIBILIDADE ANTIMICROBIANA DO FLUIDO DE LAVAGEM TRAQUEOBRÔNQUICA DE CÃES SADIOS E DOENTES

Research of antimicrobials use and resistance in food animals have been developed in various countries, although few studies include the bacteria prevalence in respiratory tract of companion animal. The aim of this paper was to verify antimicrobial resistance profile from bronchoalveolar lavage fluid of health and sick dogs. Twenty animals were evaluated, 10 in the health group (group 1) and 10 in respiratory distress group (group 2). The bronchoalveolar lavage was performed through an endotracheal tube or guided by a rigid endoscope. Culture, identification and bacterial sensibility of the fluid were performed through agar diffusion method. The bacterial isolated were: Haemophilus aphrophilus, Staphylococcus aureus, S. epidermidis, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosas e Proteus mirabilis. Of all samples, 63% showed resistance to at least one class of antibiotics. Therefore antibiotic resistance is present in sick as well in health animals and ceftriaxone and amoxicilin associated with clavulanic acid are effective against respiratory tract bacteria. KEY WORDS: Antibiotic resistance, bacteria, respiratory distress.

Epidural Abscess Caused by Haemophilus aphrophilus Misidentified as Pasteurella Species

Haemophilus aphrophilus is one of the normal oropharyngeal flora and rarely implicated as a pathogen of spinal infection. A case of H. aphrophilus bacteremia complicated with epidural abscess, psoas muscle abscess, and spondylodiscitis is described in this report. The pathogen was mis-identified as Pasteurella spp. at the very start, and was confirmed by the molecular method. He was successfully treated with adequate antibiotics and surgery. The clinical features of sixteen previously reported cases of spinal infection caused by H. aphrophilus are reviewed.

Pyogenic Ventriculitis Complicating Aggregatibacter aphrophilus Infective Endocarditis: A Case Report and Literature Review

Pyogenic ventriculitis (PV) is an uncommon, but frequently fatal infection that results from inflammation of the ventricular ependymal lining associated with a purulent ventricular system. PV has been rarely reported as a secondary complication of infective endocarditis. Prompt diagnosis and treatment with appropriate culture-directed antibiotics with adequate central nervous system penetration is crucial when managing patients who are suspected of having PV. The present study reports on a fatal case of a previously well 42-year-old alcoholic woman with infective endocarditis caused by Aggregatibacter aphrophilus, with secondary brain abscess and spontaneous rupture into the ventricles causing PV.

Cervical spondylodiscitis with spinal epidural abscess caused by Aggregatibacter aphrophilus

Spondylodiscitis caused by Aggregatibacter aphrophilus, formerly known as Haemophilus paraphrophilus, is an unusual condition and can be very difficult to diagnose. We report a case of cervical spondylodiscitis complicated by spinal epidural abscess in a 63-year-old woman, without underlying predisposing conditions. The source of infection was identified as a periodontal infection. The patient was successfully treated with systemic antibiotics.

Endocardite infecciosa por Haemophilus aphrophilus: relato de caso

OBJETIVO: Descrever o caso de uma criança com endocardite infecciosa causada por Haemophilus aphrophilus. DESCRIÇÃO: Menino com febre e calafrios há 20 dias. À internação, apresentava-se febril, descorado e sem sinais de instabilidade hemodinâmica; à ausculta cardíaca, tinha sopro holosistólico em foco mitral. Os exames laboratoriais identificaram anemia (hemoglobina = 9,14 g/dL), leucócitos totais de 11.920 mm³, plaquetas de 250.000 mm³, velocidade de sedimentação das hemácias e proteína C reativa elevadas. O ecocardiograma revelou imagem em válvula mitral, sugestiva de vegetação. Com a hipótese de endocardite, foi iniciada antibioticoterapia com penicilina cristalina (200.000 UI/kg/dia) associada à gentamicina (4 mg/kg/dia). No terceiro dia de tratamento, foi identificado Haemophilus aphrophilus em hemoculturas, sendo então trocado o esquema antibiótico para ceftriaxona (100 mg/kg/dia). No 20º dia de internação, encontrava-se pálido, mas sem febre e sem outras queixas. Os exames mostravam hemoglobina = 7,0 g/dL, leucócitos = 2.190 mm³, plaquetas = 98.000 mm³, razão normatizada internacional = 1,95 e R = 1,89. Foi feita hipótese de reação adversa ao ceftriaxona, que foi substituído por ciprofloxacina, 20 mg/kg/dia, até completar 6 semanas de tratamento. Após 72 horas da troca, houve normalização dos exames. Durante seguimento ambulatorial, apresentou insuficiência mitral grave, sendo submetido a troca de válvula por prótese metálica 9 meses após quadro agudo. Há 3 anos encontra-se bem, em acompanhamento ambulatorial. COMENTÁRIOS: É rara a identificação de agentes do grupo HACEK (Haemophilus ssp, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens e Kingella kingae) em crianças com endocardite infecciosa. O caso apresentado, sem fatores de risco relacionados a esses agentes, reafirma a necessidade de tentar sempre identificar o agente etiológico das endocardites para adequação do tratamento.

PROSTHETIC JOINT INFECTION DUE TO HAEMOPHILUS APHROPHILUS

A case of prosthetic joint infection due to Haemophilus aphrophilus is presented. A 76-year-old woman, with a long historyof pain in her left hip and raised inflammatory markers, underwent prosthetic joint excision. Six samples of pus and tissue were taken from thejoint and Haemophilus aphrophilus was cultured from 3 of these specimens. We review the clinical and microbiological findings. Treatment withciprofloxacin after removal of the prosthesis resulted in clinical improvement.

Infective endocarditis due to <i>Haemophilus aphrophilus</i>: a case report

Objective: To report the case of a child with infective endocarditis caused by Haemophilus aphrophilus. Description: Boy with 20 days of fever and chills. On admission, he was febrile, pale and with no signs of hemodynamic instability; on cardiac auscultation, a mitral-related holosystolic murmur was observed. Laboratory examination identified anemia (hemoglobin = 9.14 g/dL), total leukocytes of 11,920 mm 3 , platelets of 250,000 mm 3 , elevated sedimentation velocity of red cells and elevated C-reactive protein. The echocardiogram revealed image on mitral valve, resembling vegetation. Considering endocarditis, antibiotic therapy was started with crystalline penicillin (200,000 UI/kg/day) in association with gentamicin (4 mg/kg/day). On the third day of treatment, Haemophilus aphrophilus was identified in the blood cultures and the antibiotic scheme was replaced with ceftriaxone (100 mg/kg/ day). On the 20th day of evolution, the patient was pale but with no fever or other complaints. Examinations showed hemoglobin = 7.0 g/dL, leukocytes = 2,190 mm 3 , platelets = 98,000 mm 3 , international normalized ratio = 1.95 and R = 1.89. Considering the hypothesis of adverse reaction to ceftriaxone, a 6-week replacement treatment with ciprofloxacin (20 mg/kg/day) was started. Examination results normalized after 72 hours of the replacement therapy. During ambulatory follow-up, patient presented with severe mitral regurgitation, undergoing a valve replacement with a metallic prosthetic valve 9 months after acute event. Patient has done well throughout the 3-year ambulatory follow-up. Comments: Identification of agents of the HACEK group (Haemophilus ssp, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens and Kingella kingae) in children with infective endocarditis is rare. This case report, with no HACEK agent-related risk factors, reinforces the need for identification of the etiological agent of endocarditis to ensure adequate treatment.

Brain Abscess Secondary to Dental Braces

We report a case of Haemophilus aphrophilus brain abscess presenting 6 weeks after application of dental braces in an adolescent patient with a formerly undetected patent foramen ovale. Neither brain abscess nor invasive H. aphrophilus infection has previously been associated with dental braces. Application or tightening of dental braces may cause bacteremia and invasive disease from oral commensals.

The sodA gene as a target for phylogenetic dissection of the genus Haemophilus and accurate identification of human clinical isolates

The genus Haemophilus constitutes a heterogeneous group of Pasteurellaceae species, and conventional identification of isolates other than Haemophilus influenzae and Haemophilus parainfluenzae is often challenging. Here, simple colony-PCR and sequencing assays with the same pair of degenerate primers were used to characterize a 449- to 458-bp fragment ( sodA int) internal to the sodA gene encoding the manganese-dependent superoxide dismutase in type strains of all 15 Haemophilus species and Actinobacillus actinomycetemcomitans. The topology of a sodA int-based phylogenetic tree was in general agreement with that inferred from the analysis of 16S rRNA and other housekeeping gene sequences, but allowed more confident delineation of the main clusters of species. The sodA int sequences showed a markedly higher divergence than those of the corresponding 16S rRNA genes, and 38 independent human clinical isolates were identified by comparing their sodA int sequence to those of the type species. Except for one Haemophilus aphrophilus strain, all isolates were unambiguously characterized in spite of a high intraspecific sodA int sequence diversity. This study provides a comprehensive sequence-based phylogenetic analysis of the entire genus Haemophilus, and confirms that sodA is a potent target for the identification of clinical isolates of Pasteurellaceae. This approach might contribute to the taxonomic reappraisal of this family, and to the development of diagnostic tools.

Reclassification of Actinobacillus actinomycetemcomitans, Haemophilus aphrophilus, Haemophilus paraphrophilus and Haemophilus segnis as Aggregatibacter actinomycetemcomitans gen. nov., comb. nov., Aggregatibacter aphrophilus comb. nov. and Aggregatibacter segnis comb. nov., and emended description of Aggregatibacter aphrophilus to include V factor-dependent and V factor-independent isolates

The aim of this study was to reinvestigate the relationships and the generic affiliations of the species Actinobacillus actinomycetemcomitans, Haemophilus aphrophilus, Haemophilus paraphrophilus and Haemophilus segnis. The nicotinamide phosphoribosyltransferase gene (nadV) conferring V factor-independent growth was identified in Haemophilus aphrophilus. The gene encodes a polypeptide of 462 amino acids that shows 74.5 % amino acid sequence identity to the corresponding enzyme from Actinobacillus actinomycetemcomitans. Ten isolates of Haemophilus paraphrophilus all carried a nadV pseudogene. DNA from Haemophilus aphrophilus was able to transform Haemophilus paraphrophilus into the NAD-independent phenotype. The transformants carried a full-length nadV inserted in the former locus of the pseudogene. The DNA-DNA relatedness between the type strains of Haemophilus aphrophilus and Haemophilus paraphrophilus was 77 %. We conclude that the division into two species Haemophilus aphrophilus and Haemophilus paraphrophilus is not justified and that Haemophilus paraphrophilus should be considered a later heterotypic synonym of Haemophilus aphrophilus. Forty strains of Actinobacillus actinomycetemcomitans, Haemophilus aphrophilus and Haemophilus segnis were investigated by multilocus sequence analysis. The 40 strains form a monophyletic group clearly separate from other evolutionary lineages of the family Pasteurellaceae. We propose the transfer of Actinobacillus actinomycetemcomitans, Haemophilus aphrophilus and Haemophilus segnis to a new genus Aggregatibacter gen. nov. as Aggregatibacter actinomycetemcomitans comb. nov. (the type species; type strain ATCC 33384(T)=CCUG 13227(T)=CIP 52.106(T)=DSM 8324(T)=NCTC 9710(T)), Aggregatibacter aphrophilus comb. nov. (type strain ATCC 33389(T)=CCUG 3715(T)=CIP 70.73(T)=NCTC 5906(T)) and Aggregatibacter segnis comb. nov. (type strain HK316(T)=ATCC 33393(T)=CCUG 10787(T)=CCUG 12838(T)=CIP 103292(T)=NCTC 10977(T)). The species of the genus Aggregatibacter are independent of X factor and variably dependent on V factor for growth in vitro.

Cardiobacterium hominis endocarditis: two cases and a review of the literature

Cardiobacterium hominis, a member of the HACEK group (Haemophilus parainfluenzae, Haemophilus aphrophilus, and Haemophilus paraphrophilus, Actinobacillus actinomycetemcomitans, C. hominis, Eikenella corrodens, and Kingella species), is a rare cause of endocarditis. There are 61 reported cases of C. hominis infective endocarditis in the English-language literature, 15 of which involved prosthetic valve endocarditis. There is one reported case of C. hominis after upper endoscopy and none reported after colonoscopy. Presented here are two cases of C. hominis prosthetic valve endocarditis following colonoscopy and a review of the microbiological and clinical features of C. hominis endocarditis. Patients with C. hominis infection have a long duration of symptoms preceding diagnosis (138+/-128 days). The most common symptoms were fever (74%), fatigue/malaise (53%), weight loss/anorexia (40%), night sweats (24%), and arthralgia/myalgia (21%). The most common risk factors were pre-existing cardiac disease (61%), the presence of a prosthetic valve (28%), and history of rheumatic fever (20%). Of the 61 cases reviewed here, the aortic valve was infected in 24 (39%) and the mitral valve in 19 (31%) patients. The average duration of blood culture incubation before growth was detected was 6.3 days (range, 2-21 days). Complications were congestive heart failure (40%), central nervous system (CNS) emboli (21%), arrhythmia (16%), and mycotic aneurysm (9%). C. hominis is almost always susceptible to beta-lactam antibiotics. Ceftriaxone is recommended by the recently published American Heart Association guidelines. The prognosis of C. hominis native valve and prosthetic valve endocarditis is favorable. The cure rate among 60 patients reviewed was 93% (56/60). For prosthetic valve endocarditis, the cure rate was 16/17 (94%). Valve replacement was required in 27 (45%) cases.

A New Selective Medium for Isolation of Actinobacillus Actinomycetemcomitans

A new selective medium, designated GCHB, was developed for the isolation of Actinobacillus actinomycetemcomitans from clinical specimens. A sole inhibitory substrate was used, bacitracin at 100 u/ml. All serotypes (a to g) of A. actinomycetemcomitans strains grew well on the medium. The average growth recovery of A. actinomycetemcomitans on GCHB medium was 89.1% of that on nonselective blood medium. Growth of Haemophilus aphrophilus was significantly inhibited on the medium with an average recovery of 0.01%. The proportion of contaminating bacteria among total cultivable bacteria from clinical samples on GCHB was one to ten times lower than that on TSBV.

Die solitäre abszedierende Osteomyelitis des Kieferköpfchens

We report on a rare case of secondary chronic osteomyelitis of the left condyle. Haemophilus aphrophilus could be isolated from the abscess material. The condyle was resected and reconstructed with an endoprosthesis in the same operation.Possible causes of the rare location of secondary chronic osteomyelitis are assembled in a review of the literature and compared with the actual case.We suggest the inoculation of microorganisms through the needle of a local anesthetic injection, bacterial contamination during the tooth extraction, or bacteremia following the dental extraction to be possible causes for the infection.

Arthrite d'épaule à Haemophilus aphrophilus

We report a case of shoulder arthritis due to Haemophilus aphrophilus. The patient, a 56 year-old woman, was immunocompetent. She presented with a septic arthritis of the left shoulder without portal of entry. A synovial fluid sample was cultured and positive for a gram-negative bacillus after 8 days. It was identified as Haemophilus aphrophilus, in the HACCEK group, by PCR ARN 16S. We did not find any associated endocarditis. The patient recovered. As far as we know, this is only the 5th reported case of arthritis due to this microorganism.

A case of Haemophilus aphrophilus and Mobiluncus mulieris hepatic abscess

Mobiluncus spp. are gram variable anaerobic rods found mainly in the human vagina and are associated with bacterial vaginosis. Haemophilus aphrophilus is a Gram-negative coccobacillus and is part of the normal flora colonising the mouth and pharynx. We report the case of a 52-year-old lady with a liver abscess from which both M. mulieris and H. aphrophilus were isolated, this is the first reported case of these two organisms co-existing within a liver abscess.

Piercing and tattoos in patients with congenital heart disease ? is it a problem?

Piercing and tattooing enjoy widespread popularity in modern society. Patients with congenital heart disease are at elevated risk for infective endocarditis. However, it is not yet known whether piercing and tattooing are dangerous for these patients.A search of the literature provided 10 published cases of infective endocarditis after piercing or tattooing. Affected patients were adolescents or young adults ranging in age from 13 to 30 years (5 male, 5 female). Four of the patients had a known cardiac risk factor for endocarditis (bicuspid aortic valve, postoperative trans-position of the great arteries, postoperative coarctation, postoperative aortic valve stenosis). Piercing preceded endocarditis in 9 cases (4 times mouth, 2 ear, 1 nose, 1 breast, 1 navel), one tattoo. The following agents were isolated: S. aureus in 4 cases, 2 S. epidermidis, 1 Str. viridans, 1 Neisseria mucosa, 1 Haemophilus aphrophilus, 1 Haemophilus parainfluenzae. All patients were treated with antibiotics. Six patients underwent cardiac surgery (5 of them valve replacement). Patients with congenital heart disease constitute less than 1% of the population. Thus, they are clearly overrepresented in the published literature. Epidemiologic conclusions are not possible from these data. However, patients with congenital heart disease and their parents should be strongly advised against piercing and tattooing with regard to the risk of infective endocarditis.