Characterization of nontypable Haemophilus influenzae isolates recovered from adult patients with underlying chronic lung disease reveals genotypic and phenotypic traits associated with persistent infection

Nontypable Haemophilus influenzae (NTHi) has emerged as an important opportunistic pathogen causing infection in adults suffering obstructive lung diseases. Existing evidence associates chronic infection by NTHi to the progression of the chronic respiratory disease, but specific features of NTHi associated with persistence have not been comprehensively addressed. To provide clues about adaptive strategies adopted by NTHi during persistent infection, we compared sequential persistent isolates with newly acquired isolates in sputa from six patients with chronic obstructive lung disease. Pulse field gel electrophoresis (PFGE) identified three patients with consecutive persistent strains and three with new strains. Phenotypic characterisation included infection of respiratory epithelial cells, bacterial self-aggregation, biofilm formation and resistance to antimicrobial peptides (AMP). Persistent isolates differed from new strains in showing low epithelial adhesion and inability to form biofilms when grown under continuous-flow culture conditions in microfermenters. Self-aggregation clustered the strains by patient, not by persistence. Increasing resistance to AMPs was observed for each series of persistent isolates; this was not associated with lipooligosaccharide decoration with phosphorylcholine or with lipid A acylation. Variation was further analyzed for the series of three persistent isolates recovered from patient 1. These isolates displayed comparable growth rate, natural transformation frequency and murine pulmonary infection. Genome sequencing of these three isolates revealed sequential acquisition of single-nucleotide variants in the AMP permease sapC, the heme acquisition systems hgpB, hgpC, hup and hxuC, the 3-deoxy-D-manno-octulosonic acid kinase kdkA, the long-chain fatty acid transporter ompP1, and the phosphoribosylamine glycine ligase purD. Collectively, we frame a range of pathogenic traits and a repertoire of genetic variants in the context of persistent infection by NTHi.

Ultrasound imaging and characterization of biofilms based on wavelet de-noised radiofrequency data

The ability to non-invasively image and characterize bacterial biofilms in children during nasopharyngeal colonization with potential otopathogens and during acute otitis media would represent a significant advance. We sought to determine if quantitative high-frequency ultrasound techniques could be used to achieve that goal. Systematic time studies of bacterial biofilm formation were performed on three preparations of an isolated Haemophilus influenzae (NTHi) strain, a Streptococcus pneumoniae (Sp) strain and a combination of H. influenzae and S. pneumoniae (NTHi + Sp) in an in vitro environment. The process of characterization included conditioning of the acquired radiofrequency data obtained with a 15-MHz focused, piston transducer by using a seven-level wavelet decomposition scheme to de-noise the individual A-lines acquired. All subsequent spectral parameter estimations were done on the wavelet de-noised radiofrequency data. Various spectral parameters-peak frequency shift, bandwidth reduction and integrated backscatter coefficient-were recorded. These parameters were successfully used to map the progression of the biofilms in time and to differentiate between single- and multiple-species biofilms. Results were compared with those for confocal microscopy and theoretical evaluation of form factor. We conclude that high-frequency ultrasound may prove a useful modality to detect and characterize bacterial biofilms in humans as they form on tissues and plastic materials.

Surface anchoring of a bacterial adhesin secreted by the two-partner secretion pathway

In Gram-negative bacteria, most surface-associated proteins are present as integral outer-membrane proteins. Exceptions include the Haemophilus influenzae HMW1 and HMW2 adhesins and a subset of other proteins secreted by the two-partner secretion system. In the present study we sought to determine the mechanism by which HMW1 is anchored to the bacterial surface. In initial experiments we found that HMW1 forms hair-like fibres on the bacterial surface and is usually present as pairs that appear to be joined together at one end. Further analysis established that HMW1 is anchored to the multimeric HMW1B outer membrane translocator, resulting in a direct correlation between the level of surface-associated HMW1 and the quantity of HMW1B in the outer membrane. Mutagenesis and polyethylene glycol maleimide labelling revealed that anchoring of HMW1 requires the C-terminal 20 amino acids of the protein and is dependent upon disulphide bond formation between two conserved cysteine residues in this region. Immunolabelling studies demonstrated that the immediate C-terminus of HMW1 is inaccessible to surface labelling, suggesting that it remains in the periplasm or is buried in HMW1B. Coexpression of HMW1 lacking the C-terminal 20 amino acids and wild-type HMW1 supported the conclusion that the C-terminus of HMW1 occupies the HMW1B pore. These observations may have broad relevance to proteins secreted by the two-partner secretion system, especially given the conservation of C-terminal cysteine residues among surface-associated proteins in this family.

The phasevarion: a genetic system controlling coordinated, random switching of expression of multiple genes

Several host-adapted bacterial pathogens contain methyltransferases associated with type III restriction-modification (R-M) systems that are subject to reversible, high-frequency on/off switching of expression (phase variation). To investigate the role of phase-variable expression of R-M systems, we made a mutant strain lacking the methyltransferase (mod) associated with a type III R-M system of Haemophilus influenzae and analyzed its phenotype. By microarray analysis, we identified a number of genes that were either up- or down-regulated in the mod mutant strain. This system reports the coordinated random switching of a set of genes in a bacterial pathogen and may represent a widely used mechanism.

Destabilization of tetranucleotide repeats in Haemophilus influenzae mutants lacking RnaseHI or the Klenow domain of PolI

A feature of Haemophilus influenzae genomes is the presence of several loci containing tracts of six or more identical tetranucleotide repeat units. These repeat tracts are unstable and mediate high frequency, reversible alterations in the expression of surface antigens. This process, termed phase variation (PV), enables H.influenzae to rapidly adapt to fluctuations in the host environment. Perturbation of lagging strand DNA synthesis is known to destabilize simple sequence repeats in yeast and Escherichia coli. By using a chromosomally located reporter construct, we demonstrated that the mutation of an H.influenzae rnhA (encoding RnaseHI) homologue increases the mutation rates of tetranucleotide repeats ∼3-fold. Additionally, deletion of the Klenow domain of DNA polymerase I (PolI) resulted in a ∼35-fold increase in tetranucleotide repeat-mediated PV rates. Deletion of the PolI 5′>3′ exonuclease domain appears to be lethal. The phenotypes of these mutants suggest that delayed or mutagenic Okazaki fragment processing destabilizes H.influenzae tetranucleotide repeat tracts.

FtsK activities in Xer recombination, DNA mobilization and cell division involve overlapping and separate domains of the protein

Escherichia coli FtsK is a multifunctional protein that couples cell division and chromosome segregation. Its N-terminal transmembrane domain (FtsK(N)) is essential for septum formation, whereas its C-terminal domain (FtsK(C)) is required for chromosome dimer resolution by XerCD-dif site-specific recombination. FtsK(C) is an ATP-dependent DNA translocase. In vitro and in vivo data point to a dual role for this domain in chromosome dimer resolution (i) to directly activate recombination by XerCD-dif and (ii) to bring recombination sites together and/or to clear DNA from the closing septum. FtsK(N) and FtsK(C) are separated by a long linker region (FtsK(L)) of unknown function that is highly divergent between bacterial species. Here, we analysed the in vivo effects of deletions of FtsK(L) and/or of FtsK(C), of swaps of these domains with their Haemophilus influenzae counterparts and of a point mutation that inactivates the walker A motif of FtsK(C). Phenotypic characterization of the mutants indicated a role for FtsK(L) in cell division. More importantly, even though Xer recombination activation and DNA mobilization both rely on the ATPase activity of FtsK(C), mutants were found that can perform only one or the other of these two functions, which allowed their separation in vivo for the first time.

Preservation of Haemophilus influenzae and Haemophilus parainfluenzae at -70 degrees C

We have studied the viability of Haemophilus spp. preserved for 5 to 12 months at -70 degrees C. The following media were used: Laboratoire de Santé Publique du Québec (LSPQ) preservation medium, trypticase soy broth with 10 degrees C (vol/vol) glycerol and 40 degrees C (vol/vol) horse serum (TSBG), and Levinthal's broth (LB) medium. Three clinical isolates of both H. influenzae and H. parainfluenzae were used. After 5 months no differences in viability were observed between strains preserved in TSBG and strains preserved in LB, but a significant loss of viability was observed in strains preserved in LSPQ medium. No significant changes in antimicrobial susceptibility were observed after 5-month storage in any medium. After 12 months, TSBG appeared to be the most suitable cryopreservation medium for the six strains tested. We conclude that TSBG represents a good medium for the maintenance of Haemophilus spp. at -70 degrees C for up to 1 year.

Global versus local regulatory roles for Lrp-related proteins: Haemophilus influenzae as a case study

Lrp (leucine-responsive regulatory protein) plays a global regulatory role in Escherichia coli, affecting expression of dozens of operons. Numerous lrp-related genes have been identified in different bacteria and archaea, including asnC, an E. coli gene that was the first reported member of this family. Pairwise comparisons of amino acid sequences of the corresponding proteins shows an average sequence identity of only 29% for the vast majority of comparisons. By contrast, Lrp-related proteins from enteric bacteria show more than 97% amino acid identity. Is the global regulatory role associated with E. coli Lrp limited to enteric bacteria? To probe this question we investigated LrfB, an Lrp-related protein from Haemophilus influenzae that shares 75% sequence identity with E. coli Lrp (highest sequence identity among 42 sequences compared). A strain of H. influenzae having an lrfB null allele grew at the wild-type growth rate but with a filamentous morphology. A comparison of two-dimensional (2D) electrophoretic patterns of proteins from parent and mutant strains showed only two differences (comparable studies with lrp(+) and lrp E. coli strains by others showed 20 differences). The abundance of LrfB in H. influenzae, estimated by Western blotting experiments, was about 130 dimers per cell (compared to 3,000 dimers per E. coli cell). LrfB expressed in E. coli replaced Lrp as a repressor of the lrp gene but acted only to a limited extent as an activator of the ilvIH operon. Thus, although LrfB resembles Lrp sufficiently to perform some of its functions, its low abundance is consonant with a more local role in regulating but a few genes, a view consistent with the results of the 2D electrophoretic analysis. We speculate that an Lrp having a global regulatory role evolved to help enteric bacteria adapt to their ecological niches and that it is unlikely that Lrp-related proteins in other organisms have a broad regulatory function.

Evaluation of phase variation of nontypeable Haemophilus influenzae lipooligosaccharide during nasopharyngeal colonization and development of otitis media in the chinchilla model

Nontypeable Haemophilus influenzae (NTHI) has four loci, lic-1 to lic-3 and lgtC, that generate phase-variable lipooligosaccharide (LOS) structures. lic-1, which is required for the expression of phosphorylcholine (ChoP), is the best characterized and is associated with an enhanced ability of H. influenzae to persist within the nasopharynges of infant rats. Recent data indicate that LOS impacts various aspects of NTHI virulence in the chinchilla model of nasopharyngeal colonization and otitis media (OM). In this study the effects of ChoP expression and the sequences of lic-1 to lic-3 and lgtC of NTHI strain 2019 were evaluated in the chinchilla OM model. Nasopharyngeal colonization data showed that a switch from the ChoP(-) to the ChoP(+) phenotype was observed as early as day 3 after intranasal inoculation. Chinchillas colonized by strains with the ChoP(+) phenotype demonstrated a significantly higher level of NTHI 2019 per milliliter of nasal lavage fluid than chinchillas colonized with predominantly the ChoP(-) variant (P < 0.05). The concentration of cells with the ChoP(+) phenotype in the middle ear was 3 log units higher than that of cells with the ChoP(-) variant (P < 0.01). There was a statistically significant association between ChoP(+) expression in the nasal lavage and the development of OM with culture-positive middle ear fluids in this model. These data suggest that expression of the ChoP(+) phenotype promotes enhanced nasopharyngeal colonization and development of OM.

Quantitation of bacterial adherence by image analysis

In studies of the adherence of pathogenic bacteria to host eukaryotic cells in vitro, the counting of the bacteria is often challenging, especially if many experiments are involved. We developed a method to use digital imaging and computer-aided recognition for the quantitation of bacteria attached to cultured cells. We employed an immunocytochemical method to stain the bacteria and leave the hosts cells relatively unstained. We describe this method for use with five species of bacteria, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, and Chlamydia pneumoniae. To demonstrate an application of this method, we studied the attachment of H. influenzae and S. pneumoniae to target epithelial cell lines derived from the respiratory tract.

The identification a novel gene required for lipopolysaccharide biosynthesis by Haemophilus influenzae RM7004, using transposon Tn916 mutagenesis

Mutagenesis with the transposon Tn916 was used as a strategy to identify genes required for synthesis of the Gal alpha (1-4) beta Gal component of Haemophilus influenzae strain RM7004 lipopolysaccharide. Insertion of Tn916 into an open reading frame (ORF) encoding a protein with 75% homology to the Escherichia coli methionine related protein (Mrp) is described. Mutations in mrp resulted in loss of reactivity with monoclonal antibody (mAb) 4C4, which recognises Gal alpha (1-4) beta Gal, and expression of LPS with a different electrophoretic profile to that of wild-type RM7004. An unexpected feature of this mutation was that it appeared to influence the number of copies of 5'-CAAT-3' present in lic2A, a gene which is also required for biosynthesis and phase variable expression of the Gal alpha (1-4) beta Gal LPS epitope.

Neutrophil response to nontypable Haemophilus influenzae in respiratory infections

Sputa from patients with respiratory infections by nontypable Haemophilus influenzae (H. influenzae) were investigated by electron microscopy. The cell wall of H. influenzae appeared wavy and nonwavy. In the cell wall the peptidoglycan layer was ill-defined. These patients had adequate IgG response in the serum against H. influenzae. However neither capsule nor fimbriae were found. Different stages of phagocytosis and destruction of the bacteria by polymorphonuclear neutrophils (PMN) were observed. PMNs were also found to phagocytose the debris. Evidences were found that the debris is formed mainly by the destruction of polymorphonuclear neutrophil. Extracellular lysosomes were also observed, which may have a role in destruction of both bacteria and host tissue. It was concluded that nontypable H. influenzae are nonfimbriated and noncapsulated during infection. Debris are the end product of PMN destruction, and phagocytosis of debris by PMNs has a role in the pathogenesis of chronic respiratory diseases.

Adherence of Haemophilus influenzae to middle ear mucosa injured by killed H. influenzae

Repetitive acute otitis media is due to recurrent bacterial infection of middle ear superimposed on chronic otitis media with effusion. Endotoxin, one of the constituents of Haemophilus influenzae, is present in some cases in the middle ear effusion of otitis media with effusion and has been demonstrated experimentally to damage the middle ear mucosa. The aim of this study was to determine the effect of killed H. influenzae on the adherence of H. influenzae and H. parainfluenzae to the middle ear epithelial cells. The numbers of adherent organisms per epithelial cell in ears inoculated previously with killed H. influenzae or with normal saline (0.9% NaCl) were compared. Prior middle ear inoculation of killed H. influenzae enhanced the adherence of H. influenzae to middle ear epithelial cells, but it had little effect on the adherence of H. parainfluenzae. H. influenzae adhered to middle ear epithelial cells in greater numbers than H. parainfluenzae. Results demonstrate that a middle ear pathogen adheres to middle ear epithelial cells presumably damaged by killed H. influenzae, whereas a non-pathogen does not. These findings might partly explain the increased susceptibility of an ear with chronic otitis media with effusion to recurrent infection with H. influenzae.

Effect of fusafungine on adherence of Haemophilus influenzae type b to human epithelial cells in vitro

Haemophilus influenzae, a normal host of the nasopharynx of humans, may become a pathogen. The first step of infection is adherence to epithelial cells of the nasopharynx through glycopeptidic adhesins, or pili. Adherence to human epithelial cells in continuous lines, HeLa and Hep2, of 8 piliated strains of Haemophilus influenzae isolated from human infections of the respiratory tract was studied in vitro in the presence of fusafungine, a local bacteriostatic antibiotic. When the bacteria were grown in the presence of 0.5 x the MIC, fusafungine afforded 45-75% of adherence inhibition, but this inhibitory effect did not parallel the MICs. In contrast, no significant effect could be observed either when epithelial cells were exposed to 0.5 x the MIC before use in the adherence assay, or when this assay was performed in the presence of 0.5 x the MIC of fusafungine. The partial adherence inhibition observed suggests that fusafungine interacts with the bacterial binding sites but that other mechanisms may contribute to the inhibitory process. This effect of fusafungine should prevent but not eradicate colonization of the nasopharyngeal mucosa by Haemophilus influenzae and may account for the therapeutic efficacy reported in infections of the respiratory tract due to Haemophilus influenzae.

A comparison of the adherence of fimbriated and nonfimbriated Haemophilus influenzae type b to human adenoids in organ culture

Adherence of fimbriated and nonfimbriated variants of a single strain of Haemophilus influenzae type b to organ cultures of human adenoidal tissue was measured by three assays, two of which were quantitative. In one assay, the adherence of radioactively labeled bacteria was measured; the numbers of CFU of bacteria per gram of adenoidal tissue were 16.0 +/- 6.7 for fimbriated bacteria and 10.2 +/- 4.0 for nonfimbriated bacteria (P less than 0.05). In the second assay, adherent CFU were determined directly; the results were 23.4 +/- 17.2 CFU/g of tissue for fimbriated bacteria and 5.1 +/- 2.2 CFU/g for the nonfimbriated variant (P less than 0.02). By combining data from the two assays it appears that fimbriated and nonfimbriated bacteria do not compete for the same site on the tissue, and that the adherent bacteria do not change their state of fimbriation under the assay conditions used. In contrast, the third assay, scanning electron microscopy, showed very poor adherence of nonfimbriated bacteria. Fimbriated bacteria, on the other hand, adhered in clusters to nonciliated epithelial cells. Overall, the data indicate that fimbriae enhance adherence of H. influenzae type b to a type of tissue that is a normal site of human colonization and that nonfimbriated bacteria adhere by a distinctly different mechanism.

Growth-enhancing effects of culture filtrates of sputum isolates on the L-forms of Haemophilus influenzae

The growth-enhancing effects of culture filtrates of respiratory pathogenic bacteria, including Haemophilus influenzae, as well as normal floral bacteria other than Neisseria perflava and Branhamella catarrhalis on L-forms of H. influenzae were examined in vitro, using five species of major respiratory pathogenic bacteria and seven species of normal floral bacteria commonly isolated from the sputum of patients with chronic respiratory tract infections. The growth-enhancing factor(s) was present in the filtrates prepared from the culture of respiratory pathogenic Streptococcus pneumoniae and Staphylococcus aureus, the effects of which were as potent as those of a culture filtrate of B. catarrhalis used as the positive control. The culture filtrates of respiratory pathogenic Pseudomonas aeruginosa and Klebsiella pneumoniae had weak growth-enhancing effects on H. influenzae L-forms. The culture filtrates of 21 strains of normal floral bacteria isolated from the sputum including alpha-hemolytic Streptococci, non-hemolytic Streptococci, Micrococcus roseus, coagulase-negative Staphylococci, and Neisseria spp. had growth-enhancing effects on the L-forms of H. influenzae. These data elucidate the significance of L-forms of H. influenzae in recurrent infections due to H. influenzae in patients with chronic respiratory tract infections.

Growth-enhancing effect of Branhamella catarrhalis culture filtrates on the L-forms of Haemophilus influenzae

Haemophilus influenzae is a common respiratory pathogen and recurrent infection due to H. influenzae is a phenomenon often present in patients with chronic respiratory tract infections. The effects of Neisseria perflava and B. catarrhalis culture filtrates on the growth and reversion of H. influenzae L-forms were determined using the L-forms of H. influenzae induced and subcultured in a medium containing 10% sucrose and these culture filtrates. When each culture filtrate of two strains of N. perflava was added, the viable count of revertants reached a peak of growth after 48 hr and exceeded 10(4) CFU/ml even 48 days after the subculture. Adding each culture filtrate of six strains of B. catarrhalis, the viable count of revertants from the L-forms of H. influenzae was much higher than that in the absence of any filtrate (negative control). The filtrate of a culture prepared from one of the six strains of B. catarrhalis was subjected to biochemical analysis. The molecular weight of the growth-enhancing factor(s) was determined to be approximately 1,000 to 5,000. Some peptide fractions showed growth-enhancing effects on the L-forms of H. influenzae. These findings suggest that culture filtrates may be important clues as to the correlation between recurrent infections due to H. influenzae and the growth of L-forms in the sputum of the patients with chronic respiratory tract infections, during or after the administration of beta-lactam antibiotics.

Susceptibility of phenotypic variants of Haemophilus influenzae type b to serum bactericidal activity: relation to surface lipopolysaccharide

After three serial passages of Haemophilus influenzae type b strain Fuju in rats, we recovered a variant, which differed in colonial morphology, serum sensitivity, and lipopolysaccharide configuration from the parent strain. The parent organism (Fuju) appeared iridescent and transparent on Levinthal agar, and the rat-passaged variant (rat3 Fuju) appeared iridescent and opaque. The transparent, parent strain Fuju was sensitive to the complement-mediated bactericidal activity of normal rat serum, and the opaque, rat-passaged strain rat3 Fuju was serum resistant. Serum killing of the serum-sensitive strain appeared to be mediated by the classic complement pathway. Both serum-resistant and serum-sensitive strains were killed equally well by immune rat and human serum. These two strains did not differ in the amount of capsular polysaccharide that they elaborated nor in their major outer membrane protein patterns on SDS-PAGE. Lipopolysaccharide isolated from these two strains demonstrated different electrophoretic mobility patterns. Furthermore, the organisms showed different reactivities with two monoclonal antibodies directed against determinants of Hib lipopolysaccharide. Thus, the difference in susceptibility to complement-mediated bactericidal activity of normal rat serum displayed by these two strains is associated with their phenotypes, appears to be unrelated to differences in major outer membrane proteins or in the amounts of capsular polysaccharide elaborated, and is associated with differences in surface lipopolysaccharides.

Antigenic heterogeneity of immunoglobulin A1 proteases from encapsulated and non-encapsulated Haemophilus influenzae

Indirect evidence suggests that immunoglobulin A1 (IgA1) proteases may be factors in the pathogenesis of certain infectious diseases, including meningitis, gonorrhoea, and destructive periodontitis. Bacterial IgA1 proteases are therefore potential candidates as vaccines. In this study, IgA1 proteases from 166 clinical isolates and reference strains of Haemophilus influenzae and Haemophilus aegyptius were compared with regard to specific activity and pattern of enzyme inhibition by antisera raised against IgA1 protease from nine selected strains of H. influenzae. A total of 93% of H. influenzae strains and all H. aegyptius strains had detectable IgA1 protease activity. The majority of strains cleaved a prolyl-seryl or a prolyl-threonyl peptide bond in the alpha 1 hinge region, whereas occasional H. influenzae strains possessed two separate IgA1 proteases with these two specific activities. Of the 155 IgA1 protease-producing strains, all except 12 could be assigned to one of 14 IgA1 protease "inhibition types," each defined by a characteristic pattern of inhibition by the nine antisera. There was no correlation between IgA1 protease type and biotype of the strains. However, among 92 encapsulated H. influenzae strains, a close correlation between capsular serotype and IgA1 protease type was observed. With the exception of serotype f, strains of all capsular serotypes produced an exclusive antigenic type of IgA1 protease. All 38 strains of serotype b produced IgA1 protease of inhibition type 1, which was never demonstrated in non-encapsulated H. influenzae strains. These results facilitate the detection of an antibody response against specific IgA1 proteases and are of practical value for a possible future vaccine against H. influenzae serotype b infections.

Differentiation of Haemophilus aegyptius and Haemophilus influenzae

This study aimed at clarifying the relationship of Haemophilus aegyptius and Haemophilus influenzae isolated from acute conjunctivitis in Egypt. Twenty-nine freshly isolated strains selected from a large clinical material were examined for morphological and growth characteristics, biochemical properties and susceptibility to selected antibiotics. H. aegyptius strains were clearly differentiated from strains of H. influenzae by their inability to grow on tryptic soy agar containing X + V factors, by their susceptibility to trooleandomycin, by a distinct bacillary morphology, and, in part, by not fermenting xylose. The results confirm that H. aegyptius is distinct from H. influenzae and provides reproducible means of differentiating the two species.

Haemophilus influenzae meningitis: the spectrum of disease in adults

Fifteen cases of Haemophilus influenzae (HI) meningitis in adults occurring of Cleveland during the last 11 years are presented. The majority of patients had factors predisposing to infection such as otitis, pneumonia, diabetes or alcoholism. In addition, 7 of the 15 patients developed meningitis at various intervals following head trauma and neurosurgery, and 3 patients required dural repairs for CSF rhinorrhea. The diagnosis of meningitis may be difficult to establish resulting in delay in appropriate therapy in some cases. Nuchal rigidity was absent frequently; CSF lymphocytosis can be seen initially. The CSF Gram stain may be negative or the pleomorphic nature of the organism on Gram-stain may make distinction from other gram-negative organisms difficult. The majority of patients had meningitis due to non-Type B HI in contrast to previous reports of this illness in children and adults. One of our patients had beta-lactamase producing HI isolated from CSF. We believe that chloramphenicol should be included in the initial empiric therapy for adults with meningitis and gram-negative coccobacillary rods on Gram-stain or negative CSF Gram-stains.

Biotypes of capsulated and non-capsulated Haemophilus influenzae. Correlation between biotypes and beta-lactamase production

396 Haemophilus influenzae strains were biotyped according to Kilian. 393 of the strains were assigned to biotypes I to V, while 3 strains remained unclassified. Eighty-nine per cent of the capsulated strains produced both urease and ornithine decarboxylase, biotypes I or IV, while 95 per cent of the non-capsulated strains produced only one of the enzymes, biotypes II, III, or V. Of consecutive strains from the upper respiratory tract, the incidence of beta-lactamase-positive strains was higher among capsulated than among non-capsulated strains (p less than 0.025). None of 133 non-capsulated beta-lactamase-positive strains produced both urease and ornithine decarboxylase, in contrast to 15 out of 147 non-capsulated beta-lactamase-negative strains (p less than 0.001). The type e strains were all of biotype IV and 3 of 7 consecutive strains were beta-lactamase-positive.

[Culture and morphological characteristics of Haemophilus influenzae and pneumococcus in bronchial infection]

In the cultures obtained by inoculating sputum samples faken from patients with bronchial infection into solid agar medium prepared on Hottinger's hydrolysate with fresh rabbit blood added Haemophilus influenzae produced colonies varying in their from (dome-shaped, conical, trapeziform), as well as in the morphology of the organisms. Pneumococci produced mainly flat colonies surrounded by the zone of alpha hemolysis. Along-side with isolated H. influenzae and pneumococcal colonies, symbiotic colonies could be observed. In these colonies pneumococci were diffused among H. influenzae.

On the nature of nontypable Haemophilus influenzae

193 Haemophilus cultures, including 71 nontypable H. influenzae isolates, were examined with respect to phage HP1 sensitivity, lysogeny for this and for other phages and for excretion of bacteriocins. Fifty of the 71 nontypable cultures were sensitive to phage HP1 but only three produced plaques. The other 47 isolates were thus probably not non-encapsulated derivatives of H. influenzae serotypes a, b, d, and e, which have discrete and characteristic phage HP1 restriction and modification systems, or serotype c which appears to be restriction negative. They could be derivatives of serotype f which does not give plaques with phage HP1. The nontypable three cultures that plated phage HP1 efficiently could be non-encapsulated serotype c derivatives. Fourteen of the phage HP1 insentitive non-typable cultures were found to be defectively lysogenic for this phage. Five of these were genetically transformed to wild type lysogens. Their phage produced plaques efficiently only on Rc strains and on a restriction-negative mutant of serotype d. These lysogenic nontypable isolates are thus modification (and restriction) negative and they are thus probably not nonencapsulated derivatives of serotypes a, b, d, e, or f. Fifty three of 56 serotype b cultures were found to excrete a bacteriocin, to which all other nonproducing Haemophilus cultures were more or less sensitive. The three restriction-negative nontypable H. influenzae cultures also excreted this bacteriocin but the other cultures listed did not do this. The tentative conclusion from this study is that nontypable H. influenzae isolates are probably not derivatives of the six known encapsulated strains.

Induction of L-forms of Haemophilus influenzae in vitro

The induction of L-forms of Haemophilus influenzae by penicillin, amoxycillin and glycine has been studies in vitro on a nutrient-agar medium. The minimal inducing concentrations of the antibiotics were generally the same as their minimal inhibitory concentrations, but the addition of a sub-inducing concentration of glycine lowered the minimal inducing concentration of penicillin. Preliminary observations have shown that L-forms are induced by penicillin or amoxycillin on a medium in which mucoid sputum forms the sole source of nutrients, and that they remain viable for at least 48 h in the absence of added osmotic stabiliser. The minimal inducing concentration on "sputum agar" is within the range of concentrations measured in sputum from patients receiving amoxycillin therapy. The implications of these observations in relation to bactericidal therapy of haemophilus infections of the respiratory tract are discussed.

Ampicillin-resistant Haemophilus influenzae type B possessing a TEM-type beta-lactamase but little permeability barrier to ampicillin

Ampicillin-resistant Haemophilus influenzae type B have been reported only during the past year. Five clinical isolates from the U.S. and Germany all had the TEM-type beta-lactamase which is known to be transferred widely among other gram-negative bacilli. Unlike those bacilli, however, the H. influenzae cell had very little barrier to entry of penicillins. This greater permeability of the H. influenzae cell to penicillins appeared to reduce the protective effect of its beta-lactamase, in that acquisition of the TEM-type beta-lactamase increased levels of resistance to penicillins much less for individual cells of H. influenzae than for those of Escherichia coli. Large inocula of either species appeared highly resistant. The unusually low level of resistance of individual cells of H. influenzae containing the TEM-type beta-lactamase may have delayed their emergence or recognition, and has unresolved clinical implications.

Molecular basis for the transformation defects in mutants of Haemophilus influenzae

To determine the molecular basis of transformation defects in Haemophilus influenzae, the fate of genetically marked, (32)P-labeled, heavy deoxyribonucleic acid (DNA) was examined in three mutant strains (rec(1) (-), rec(2) (-), and KB6) and in wild type having (3)H-labeled DNA and a second genetic marker. Transforming cells upon lysis with digitonin followed by low-speed centrifugation are separable into the supernatant fraction, containing mainly the unintegrated donor DNA, and the pellet, containing most of the resident DNA along with integrated donor DNA. Electron micrographs of digitonin-treated cells also indicate that the resident DNA is trapped inside a cellular structure but that cytoplasmic elements such as ribosomes are extensively released. DNA synthesis in digitonin-treated cells is immediately blocked, as is any further integration of donor DNA into the resident genome. Isopycnic and sedimentation analysis of supernatant fluids and pellets revealed that in strains rec(2) (-) and KB6 there is little or no association between donor and resident DNA, and thus there is negligible transfer of donor DNA genetic information. In these strains, the donor DNA is not broken into pieces of lower molecular weight as it is in strain rec(1) (-) and in the wild type, both of which show association between donor and recipient DNA. In strain rec(1) (-), although some donor DNA atoms become covalently linked to resident DNA, the incorporated material does not have the donor DNA transforming activity.

Effect of ultraviolet light on division and deoxyribonucleic acid synthesis in Haemophilus influenzae

The effects of ultraviolet (UV) light on cell morphology, deoxyribonucleic acid (DNA) synthesis, and protein synthesis in UV-sensitive and UV-resistant strains of Haemophilus influenzae were examined. Relatively low doses of UV induce lyses in the sensitive strains but not in the resistant mutant; however, UV temporarily blocks cell division of the resistant mutant, and elongated cells are formed after a period of incubation. Low doses of UV do not stop DNA synthesis in any of the strains examined; however, they do slow the rate of DNA synthesis in a manner consistent with the model correlating the kinetics of postirradiation DNA synthesis with the cell's ability to repair UV-induced DNA lesions. The data are not consistent with a model in which UV causes all DNA synthesis to stop for a time linearly dependent on dose.

An electron microscope study of thin sections of Haemophilus vaginalis (Gardner and Dukes) and some possibly related species

The line structure of Haemophilus vaginalis (Gardner and Dukes 1955) was compared with that of four, possibly related species (Butyribacterium rettgeri, Corynebacterium diphtheriae var. mitis, Lactobacillus acidophilus, Haemophilus influenzae) and an unrelated species, Neisseria haemolysans, which had shown a similar degree of Gram-variability as that of H. vaginalis. Although H. vaginalis was first described as a Gram-negative rod, its fine structure, particularly that of cell wall and septa, was more like that of Gram-positive organisms. Also N. haemolysans had a fine structure close to that of Gram-positive organisms, and its typical Gram-positive cell wall varied in. thickness from one cell to another.The study did not solve the problem of the classification of the so-called H. vaginalis, but the appearance of the few strains studied in the electron microscope suggests that it: should be included in Corynebacterium or Butyribacterium rather than in Lactobacillus.