Neonatal infections with Haemophilus species.

During a 27 month study seven nonserotypable strains of Haemophilus influenzae and two of Haemophilus parainfluenzae were isolated from nine neonates. Seven had early infection associated with respiratory distress or conjunctivitis; three had septicaemia one of whom died. The incidence of haemophilus septicaemia was 0.23 per 1000 live births.     

Reye's syndrome in Haemophilus influenzae B septicaemia: case report

A case of culture-proven Haemophilus influenzae type B septicaemia in association with probably Reye's syndrome is presented. This is the second reported case of Reye's syndrome with this organism and the first in a tropical climate. The features of this child's presentation are described and implications for doctors in areas where Haemophilus influenzae infection is common are discussed.     

Role of non-capsulated Haemophilus influenzae as a respiratory pathogen in children

During a 12-month surveillance period from 1981-1982, non-capsulated Haemophilus influenzae was detected in nasopharyngeal aspirates from 64 (14%) of the 449 children hospitalized for middle or lower respiratory infection. An antibody response to H. influenzae was indicated in 15(23%) of the 64 patients with H. influenzae present in nasopharyngeal aspirate and in 10(3%) of the 385 patients with a negative finding. Thus, serological evidence of H. influenzae infection was demonstrated in 25(6%) of all the 449 children with respiratory infection. Of 13 patients with cultures positive for H. influenzae acute otitis media, an antibody response was seen in only 4(30%) patients. H. influenzae infection was associated with infections caused by other microbes in 20 children (80%), with viral infections in 60% and with pneumococcal infections in 24% of cases. An infection focus was present in 15(79%) of the 25 patients with H. influenzae infection; pneumonia was present in 10 cases and acute otitis media in 9 cases. Non-specific laboratory evidence of bacterial infection was seen in 11 patients (58%); C-reactive protein was increased in 7 and erythrocyte sedimentation rate in 9 patients. It is concluded that non-capsulated H. influenzae is a genuine respiratory pathogen in children. H. influenzae infections appear to be secondary to preceding viral or other bacterial infections in children who are carriers of this strain.     

Isolation of respiratory bacterial pathogens from the throats of healthy infants fed by different methods.

Most bacterial infections are caused by organisms that have already colonized the host. Bacterial attachment to pharyngeal cells and proliferation may be necessary to infect the lower respiratory tract or middle ear. We investigated the incidence of pathogenic bacteria isolated from the throat of healthy infants with different feeding methods. The protecting role of breastmilk is also discussed. The incidence of respiratory bacterial pathogens isolated from the oropharynx of 113 normal infants with different feeding methods was investigated. Group A beta haemolytic Streptococcus, Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis were selected as respiratory bacterial pathogens. No respiratory bacterial pathogens were detected in breastfed and mixed-fed infants. Haemophilus influenzae and Moraxella catarrhalis were isolated from the oropharynx of formula-fed infants. The incidence of respiratory bacterial pathogens did differ among infants with different feeding methods. These results suggest that breastmilk may inhibit the colonization by respiratory bacterial pathogens of the throat of infants, by enhancing mucosal immunity against respiratory tract infection.     

杭州市上呼吸道感染患儿分离的流感嗜血杆菌分离株的血清分型及其对氨苄西林的耐药性分析

目的：了解从呼吸道感染患儿分离出的流感嗜血杆菌血清分型及其对氨苄西林耐药性。方法：流感嗜血杆菌的鉴定采用V因子,X因子和V+X因子试验,血清分型采用玻片凝集法,β内酰胺酶检测采用头孢硝噻酚法,药敏试验采用纸片扩散法和E-test法。结果：2006年12月至2007年7月共分离到的流感嗜血杆菌152株,其中男性患儿108株,占71.0%,女性患儿44株,占29.0%。血清分型显示不可分型流感嗜血杆菌148株,占97.4%,可分型流感嗜血杆菌4株,占2.6%;可分型菌株中,a,d,e,f型各1株,无b,c型菌株发现。34株菌株(22.4%) 产生β内酰胺酶。152株流感嗜血杆菌中,全部菌株成功完成药敏试验,113株菌株(74.3%)对氨苄西林敏感;141株菌株用E-test法检验了最低抑菌浓度（MIC）,氨苄西林MIC50为0.25 μg/mL,MIC90为12 μg/mL。结论：该研究中流感嗜血杆菌分离株以不可分型菌株占绝对优势,74.3%流感嗜血杆菌对氨苄西林敏感。［中国当代儿科杂志,2009,11（3）：217-220］     

Incidence of Haemophilus influenzae in the throats of healthy infants with different feeding methods

BACKGROUND: Haemophilus influenzae is the major cause of otitis media and lower respiratory tract infection in childhood. In the presence of human milk, which contains numerous host defense factors, Haemophilus influenzae may be inhibited in attaching to and colonizing pharyngeal cells. We investigated the incidence of H. influenzae in the throats of 162 healthy infants with different feeding methods: 70 breast-fed, 49 mixed-fed and 43 formula-fed infants. METHODS AND RESULTS: Haemophilus influenzae was identified using standard microbiological procedures and the API NH system. The incidence of H. influenzae in breast-fed infants, mixed-fed infants and formula-fed infants was 0, 0 and 7.0% respectively. CONCLUSION: The results suggest that the colonization of H. influenzae in the throat was inhibited by the presence of breast milk.     

Uvulitis in three children: etiology and respiratory distress.

Uvulitis is an uncommonly reported disorder with the potential for significant morbidity. We describe three cases of uvulitis seen within a six month period in our emergency department. In two cases with respiratory distress, but without epiglottitis, Haemophilus influenzae was isolated from throat or blood cultures. The third case was associated with group A streptococcus tonsillitis and no respiratory compromise. Atypical presentations of upper airway infection with H. influenzae may be increasingly common.     

小儿急性呼吸道感染细菌分布及耐药状况

目的：研究大连市儿童医院小儿急性呼吸道感染细菌分布及耐药状况。方法：选择2006年1月至2007年2月医院门诊及病房新住院的急性呼吸道感染患儿930例,急性上呼吸道感染（AURI）364例,急性下呼吸道感染（ALRI）566例。AURI组患儿未用抗菌药物或只口服过1~2次抗菌药物,均采集咽拭子;ALRI患儿均静脉用抗菌药物>3 d,采集痰液及支气管肺泡灌洗液。采用ATB系统（Bio-Merieux,法国）进行菌种鉴定,采用纸片扩散法（Kirby-Bauer）对分离菌株进行药敏试验。结果：930份呼吸道分泌物分离菌株404株（43.4%）,流感嗜血杆菌、副流感嗜血杆菌、肺炎链球菌分别占分离菌株的22.5%,12.1%,7.4%。AURI分离菌株中流感嗜血杆菌、副流感嗜血杆菌、肺炎链球菌分别占43.9%,22.0%,9.1%,大肠埃希菌、肺炎克雷伯杆菌、非发酵菌属各占4.5%,8.3%,3.0%。ALRI分离菌株中,上述菌株分别占12.1%,7.4%,6.6%及16.9%,13.2%,21.8%。流感及副流感嗜血杆菌对氨苄青霉素、复方新诺明耐药率分别为29.3%,32.9%,对羟氨苄/克拉维酸及头孢噻吩、头孢克洛、头孢呋辛等耐药率为10.0%~12.1%,对头孢噻肟耐药率为5.7%。AURI组与ALRI组流感及副流感嗜血杆菌对氨苄青霉素（P<0.01）、羟氨苄/克拉维酸（P<0.05）、头孢克洛（P<0.05）、四环素（P<0.05）、复方新诺明（P<0.01）等耐药率比较差异有显著性,ALRI组耐药率高于AURI组。结论：监测期间大连市小儿急性呼吸道细菌感染主要流行菌株是流感及副流感嗜血杆菌,其对氨苄青霉素有较高的耐药性。ALRI与AURI细菌的分布不同,ALRI革兰阴性杆菌所占比例较高,其中流感及副流感嗜血杆菌对常用抗菌药物氨苄青霉素、羟氨苄/克拉维酸、头孢克洛的耐药率相对较高。     

儿童流感嗜血杆菌感染临床特征及药敏分析

目的　了解流感嗜血杆菌在儿童中的感染情况及特点 ,为预防儿童流感嗜血杆菌感染和合理使用抗生素提供参考。方法　对复旦大学儿科医院 2 0 0 0年 1月至 2 0 0 2年 12月期间住院呼吸道感染患儿采用一次性鼻导管深插气管 ( 10～ 15cm)负压吸取痰液 ,部分患儿采集咽拭子、脑脊液、血液及其他体液做细菌培养。结果　共获痰标本 12 5 6 0份 ,其他体液、分泌物等共 84 94份 ,其中脑脊液 888份。 ( 1)培养流感嗜血杆菌阳性 4 2 0株 ( 4 2 0个病例 )。 2 0 0 0、2 0 0 1、2 0 0 2年分别为 10 1株、173株和 14 6株。 ( 2 )流感嗜血杆菌感染同时合并其他病原体感染病例有 172例 ( 4 0 1% ) ,支原体和呼吸道合胞病毒 (RSV) ,各占混合感染组中的 2 5 0 %。 ( 3) 4 2 0例病例中 ,<6个月患儿占 2 2 9% ,～ 12个月龄患儿占 2 0 2 % ,～ 3岁患儿占 2 7 4 % ,～ 5岁患儿占 15 7% ,≥ 5岁患儿为 13 8%。 ( 4 ) 3年药敏平均耐药率结果 :氨苄西林为 13 6 % ,头孢唑林、头孢克洛、头孢噻肟的耐药率分别为 16 1%、7 7%和 4 0 % ,氯霉素的耐药率为 5 9%。 2 0 0 1和 2 0 0 2两年药敏平均耐药率结果 :氨苄西林 /舒巴坦的耐药率为 13 2 % ,环丙沙星耐药率为 0 9%。 2 0 0 2的药敏结果显示 ,阿奇霉素的耐药率仅为 0 8%     

儿童社区获得性肺炎病原微生物分布特点分析

目的：了解儿童社区获得性肺炎（CAP）病原微生物分布规律,为临床诊断和合理用药提供依据。方法：1560例年龄在1个月至9岁间的CAP患儿于入院2 h内、抗感染药物治疗前分别采集呼吸道分泌物和静脉血进行多病原联合检测。免疫荧光法检测鼻咽拭子标本中呼吸道病毒抗原,痰液用于行细菌培养,ELISA法检测静脉血中肺炎支原体及肺炎衣原体IgM。结果：在1560例CAP患儿中,痰培养细菌579株,其中革兰阳性菌213株（36.8%）,革兰阴性菌366株（63.2%）;检出前5位的细菌包括流感嗜血杆菌（7.50%）、肺炎链球菌（6.73%）、金黄色葡萄球菌（6.35%）、卡他莫拉菌（5.19%）和大肠埃希氏菌（3.46%）,前5位细菌中产酶菌占检出全部细菌的3.3%。其他病原体感染中,呼吸道合胞病毒感染率最高,为12.88%,其次为肺炎支原体（7.88%）和肺炎衣原体（8.91%）。混合感染严重,其中呼吸道合胞病毒与流感嗜血杆菌混合感染最为常见。多数病原微生物在1岁以下患儿中的感染率高于1岁以上患儿。结论：流感嗜血杆菌、呼吸道合胞病毒、肺炎支原体、肺炎衣原体为儿童CAP的主要病原体,多数病原微生物在1岁以下患儿中感染率高于1岁以上患儿,多种病原菌混合感染率高。     

A cluster of early neonatal sepsis and pneumonia caused by nontypable Haemophilus influenzae

Nine premature infants developed early onset sepsis and/or pneumonia with Haemophilus influenzae during a period of 53 months (January 2000 -May 2004). Their respiratory problems were pneumonia-like rather than classic respiratory distress syndrome. In 8 of the cases, the pathogen was a beta-lactamase-negative, nontypable H. influenzae. In the remaining case, the Haemophilus identified was type d. Before January 2000, no case of beta-lactamase-negative, nontypable H. influenzae sepsis or pneumonia had been recorded.     

2016~2018年儿童呼吸道感染病原菌谱与耐药监测

目的 了解儿童呼吸道感染的病原菌种类、分布特点和耐药情况，为临床提供病原学诊断及合理使用抗菌药物的依据。方法 选取2016年1月至2018年12月因呼吸道感染就诊的15 047例患儿为研究对象，采集患儿痰标本送检，通过Phoenix-100全自动微生物鉴定药敏系统对分离的病原菌进行鉴定和药敏分析。结果 从17 174份送检的痰标本中检出阳性标本2 395份，阳性率为13.95%；共分离出2 584株病原菌，其中革兰阴性菌1 577株（61.03%），革兰阳性菌967株（37.42%），真菌40株（1.55%）。最常见的病原菌依次为流感嗜血杆菌（33.90%）、肺炎链球菌（33.55%）、卡他莫拉菌（19.20%）和金黄色葡萄球菌（3.64%）。2 331例感染阳性患儿中有251例混合感染，以流感嗜血杆菌合并肺炎链球菌感染发生率最高。病原菌检出率以冬春季较高，夏秋季较低（P < 0.05）。各年龄组患儿病原菌检出率比较差异有统计学意义（P < 0.05），其中1个月~ < 1岁组患儿病原菌检出率最高。肺炎链球菌和金黄色葡萄球菌对万古霉素、利奈唑胺和替考拉宁敏感率均为100%，流感嗜血杆菌除对氨苄西林、复方新诺明和头孢呋辛敏感率较低，对其他药物敏感率均较高。结论 儿童呼吸道感染病原菌以流感嗜血杆菌、肺炎链球菌和卡他莫拉菌为主，且常见混合型感染。不同季节、不同年龄段病原菌检出率不同。不同病原菌耐药性有不同特点，临床应依据药敏结果合理选用抗生素。     

2006至2009年复旦大学附属儿科医院呼吸道感染患儿5种常见细菌构成比和耐药性分析

目的 了解复旦大学附属儿科医院4年中呼吸道感染患儿呼吸道标本中化脓性链球菌、肺炎链球菌、金黄色葡萄球菌、流感嗜血杆菌和卡他莫拉菌耐药率变化。方法 以2006至2009年在复旦大学附属儿科医院诊断为呼吸道感染的患儿为研究对象,采集咽拭子或痰标本行细菌培养。细菌鉴定采用NCCLS/CLSI 2006至2009年标准及英国BSAC标准。采用琼脂扩散法（KB）对5种常见细菌进行药物敏感实验,结果参照CLSI 2006至2009年标准,肺炎链球菌青霉素药物敏感实验采用E-test检测。结果 2006至2009年呼吸道标本中共分离到细菌3 169株,其中化脓性链球菌1 225株、肺炎链球菌341株、金黄色葡萄球菌297株、流感嗜血杆菌248株、卡他莫拉菌237株。①化脓性链球菌在上呼吸道细菌中构成比为74.5％~78.8％,流感嗜血杆菌和卡他莫拉菌在上下呼吸道细菌中的构成比有逐年上升趋势（P<0.05）。②2006至2009年,化脓性链球菌对红霉素耐药率为86.8％～94.7％,未发现青霉素耐药株;青霉素不敏感肺炎链球菌比例为1.4％~20.8％,4年间差异有统计学意义（P=0.007）,肺炎链球菌对红霉素耐药率为91.1％~97.9％;金黄色葡萄球菌对红霉素耐药率为50.0％~54.9％,耐甲氧西林金黄色葡萄球菌比例为7.7％~11.4％;上述3种细菌对万古霉素均敏感。流感嗜血杆菌和卡他莫拉菌β-内酰胺酶阳性率分别为17.0％~31.3％和83.1％~100％,流感嗜血杆菌对头孢呋辛耐药率较低,卡他莫拉菌对环丙沙星和阿莫西林/克拉维酸高度敏感。结论 化脓性链球菌和肺炎链球菌对青霉素高度敏感。化脓性链球菌、肺炎链球菌及金黄色葡萄球菌对红霉素高度耐药。产酶的流感嗜血杆菌对第2代头孢菌素高度敏感,卡他莫拉菌对喹诺酮类和酶抑制剂复合制剂高度敏感。     

Lack of correlation of in vitro adherence of Haemophilus influenzae to epithelial cells with frequent occurrence of otitis media

The adherence to human epithelial cells, biotype and capsular type of 175 Haemophilus influenzae cultured from the upper respiratory tract were studied in a prospective study of children with recurrent otitis media. Forty-three children who had greater than 2 episodes of acute otitis media (AOM) during the first year of life were followed for at least 1 year. Cultures of the oropharynx were done periodically, and the middle ear fluid (MEF) was cultured at the time of AOM. H. influenzae was recovered from MEF in 44% of the 136 AOM episodes recorded. Thirty-one children had at least one episode of AOM caused by H. influenzae; the remaining 12 children, designated as "controls," had no otitis or had AOM caused by other organisms. The possible differences between carriage and infection strains were evaluated by comparison of MEF and oropharyngeal isolates, by pairwise comparison of MEF and oropharyngeal isolates and by pairwise comparison of multiple isolates from each host recovered at the time of AOM and during infection-free intervals. No significant differences in patterns of adherence, capsular type or biotype were found. The lack of correlation between these characteristics and infection suggests either that H. influenzae organisms have determinants of virulence yet to be defined or that variations in host susceptibility permit infection by the strain colonizing the upper respiratory tract. Adherence per se may be less important in the development of infection than in establishing and maintaining colonization within the host.     

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目的 了解2000-2007年广州地区急性呼吸道感染儿童流感嗜血杆茵(Hi)耐药性和2000-2003年分离的Hi血清分型情况,有效指导临床合理用药.方法 采集2000年1月至2007年12月广州市儿童医院门诊及住院的急性呼吸道感染患儿鼻咽分泌物或深部吸痰标本,应用Hi选择培养基进行分离培养;用E-teat法检测Hi对阿莫西林/克拉维酸、头孢呋辛、头胞曲松、氨苄西林、头胞克洛的耐药性,用K-B法检测Hi对阿奇霉素、四环素、氯霉素、复方新诺明的耐药性;采用头孢硝基噻酚显色反应法检测β-内酰胺酶.用玻片凝集法对2000-2003年分离的381株Hi进行血清分型.结果 在8年时间内,Hi对阿莫西林,克拉维酸、头孢呋辛、头胞曲松、阿奇霉素敏感性较高,对氨苄西林、头胞克洛、氯霉素、四环素的耐药率呈逐年上升趋势,复方新诺明的耐药率高迭72.13%;氨苄西林耐药的Hi多重耐药率达82.51%.Hi的产酶率也由2000年的9.91%上升到2007年的36.48%.200-2003年所分离381株Hi的血清分型以不定型株为主,占95.53%,Hib仅占1.57%.结论 广州地区急性呼吸道感染儿童流感嗜血杆菌血清分型以不定型株为主,Hib分离率不高;广州地区急性呼吸道感染儿童Hi的耐药性和产酶率有逐年上升趋势;治疗Hi感染以β-内酰胺类抗茵药物为首选.     

Acute epiglottitis: therapeutic consequences of change in the resistance of Haemophilus influenzae serotype B

From July 1977 to May 1987, 27 children with acute epiglottitis were treated in our intensive care unit. Haemophilus influenzae type b was identified by positive blood culture in 14 of 27 cases. Until 1983 the first 11 children were treated with ampicillin (100 mg/kg) for a mean duration of 10 days according to the standard therapeutic regimen and/or proven sensitivity from blood cultures (5 of 11 cases). The first finding of an ampicillin resistant Haemophilus influenza type b strain dates from January 1984. From this date on initial antibiotic therapy consisted of cefotaxime (100 mg/kg). Blood cultures proved good sensitivity to cefotaxime (100%) but an increasing rate of resistance to ampicillin (3 of 9 identified strains). Haemophilus influenzae septicemia in acute epiglottitis is verified by the isolation of Haemophilus influenzae type b from blood cultures (14/27) and the additional pneumonias (14/27). Additional meningitis as seen is a very rare complication. Facing these potentially life-threatening secondary foci of this invasive infection, an effective antibiotic therapy is mandatory. Our experiences confirm recommendations from US, UK, Australia, and Spain, where ampicillin was replaced by third generation cephalosporins as initial antibiotic therapy due to the increasing rate of resistance of Haemophilus influenzae type b.     

下呼吸道感染患儿支气管肺泡灌洗液的病原学研究

目的 研究下呼吸道感染患儿病原体特点,为临床医生合理使用抗生素提供依据。方法 选取2017年1月至2018年6月因下呼吸道感染住院且接受纤维支气管镜治疗的108例患儿为研究对象,收集其支气管肺泡灌洗液,通过多重实时荧光PCR检测其病原体。结果 在108例患儿中,检测出病原体85例（78.7%）,其中单一病原体感染检出52例（48.1%）,多重病原体感染检出33例（30.6%）。肺炎支原体检出率最高,共检出38例（35.2%）,其中36~ < 72月龄患儿检出率最高;其次为肺炎链球菌及流感嗜血杆菌,各检出29例（26.9%）,其中肺炎链球菌主要集中于24月龄以下患儿。检出率较低的为鲍曼不动杆菌、白色念珠菌及肺炎克雷伯杆菌,各检出3例（2.8%）。在31例支气管肺炎患儿中,流感嗜血杆菌检出率最高（9例,29%）。在34例大叶性肺炎患儿中,肺炎支原体检出率最高（22例,65%）。在22例支气管异物合并支气管肺炎患儿中,肺炎链球菌检出率最高（10例,45%）。结论 在下呼吸道感染患儿中,肺炎支原体检出率最高,其次为肺炎链球菌及流感嗜血杆菌。不同年龄、不同类型下呼吸道感染患儿的病原体检出率存在差异。     

Postinfectious thrombocytosis as an acute phase reaction: the example of Haemophilus influenzae meningitis

The postinfectious thrombocytosis occurring in 11 children with Haemophilus influenzae meningitis and/or septicaemia shows regular progress. The rise of thrombocyte concentrations starts around the 5th day after onset of antibiotic therapy, reaches values above 500,000/microliter between the 9th and 12th day, and relapses afterwards to normal values, which are reached around the 20th day. The range of thrombocytosis is influenced by the severity and complications (subdural effusions, secondary infection) of the infection as well as by the age of the patient. An inverse course of serum concentrations of C-reactive protein and thrombocyte concentrations points to the influence of this humoral reaction on the thrombocytic acute phase reaction.     

Differences in the epidemiology of childhood community-acquired bacterial meningitis between two ethnic populations cohabiting in one geographic area

A comparison of the epidemiology of community-acquired bacterial meningitis between Jewish and Bedouin populations cohabiting one geographical area is reported here. During the years 1981 to 1985, 100 children younger than 13 years old with community-acquired bacterial meningitis were hospitalized. Seventy-one patients were younger than 12 months. The principal bacteria isolated were Haemophilus influenzae 42%; Streptococcus pneumoniae 29% and Neisseria meningitidis 20%. The case fatality rate was 12%. The chance of acquiring meningitis during the first 5 years of life was twice as common among Bedouins than among Jews (328/100,000 vs. 173/100,000, respectively; P less than 0.0001). The most common cause of meningitis during the first year of life was S. pneumoniae among Bedouins and H. influenzae among Jews. Meningitis caused by H. influenzae and S. pneumoniae was usually associated with respiratory morbidity during fall and winter among Jews, but with diarrheal morbidity during summer and fall among Bedouins. Since the most prevalent type of morbidity among Jews results from respiratory infections and among Bedouins from diarrhea, our findings suggest that community-acquired bacterial meningitis is associated with the type of morbidity most prevalent in the community at any given season rather than with a specific type of infection.     

Clinical implications of preseptal (periorbital) cellulitis in childhood.

The available hospital records of all pediatric patients diagnosed as having periorbital, preseptal or orbital cellulitis over a five-year period were reviewed and compared to previously reported series. Only two of 39 patients had orbital cellulitis. The 37 patients with preseptal cellulitis had two characteristic clinical presentations. Twenty-two children had local trauma, abscesses, insect bites, or impetigo as the inciting event for their cellulitis. Infection was usually caused by staphylococci or streptococci. In contrast, 15 children, 12 of whom were under 36 months, had associated upper respiratory tract infections and otitis. Haemophilus influenzae was the most commonly implicated pathogen and the children were at risk of bacteremia and metastastic infection. Determination of the location of the infection in the orbit and consideration of the clinical presentation of the patient with infection in and about the orbit are of assistance in choosing appropriate therapy. Young children who have upper respiratory tract symptoms in association with preseptal cellulitis should receive antibiotic coverage for Haemophilus.