Indirect Sandwich Enzyme-Linked Immunosorbent Assay for Rapid Detection of Haemophilus influenzae Type b Infection

We report the development and testing of an enzyme-linked immunosorbent assay with excellent sensitivity for the detection of Haemophilus influenzae type b (HI(b)) antigen in clinical specimens from patients with HI(b) meningitis. The assay, an indirect sandwich technique, uses polystyrene balls as a solid phase and an alkaline phosphatase-labeled goat anti-rabbit globulin conjugate. Specimens are incubated with polystyrene balls armed with burro anti-HI(b) antiserum, and recognition antibody is visualized by addition of alkaline phosphatase-labeled anti-globulin, together with the enzyme substrate p-nitrophenyl phosphate. Concentrations of antigen are determined from standard curves prepared by using purified HI(b) capsular antigen polyribophosphate. The assay reproducibly detects polyribophosphate at concentrations between 1 and 5 ng/ml. Cross-reactions have not as yet been encountered in simulated and authentic clinical specimens containing other species including Escherichia coli, Klebsiella pneumoniae, group B Streptococcus, Pseudomonas aeruginosa, Streptococcus pneumoniae, Staphylococcus aureus, Neisseria meningitidis, and Listeria monocytogenes. In preliminary tests with 11 spinal fluid specimens, 2 serum specimens, and 5 urine specimens from patients with culture-proved HI(b) meningitis, antigen was detected in all specimens in concentrations ranging from 1 to 7,000 ng/ml. Antigen was not detected in any of 62 clinical specimens which were culture negative for HI(b), including 11 spinal fluid specimens from patients with bacterial meningitis caused by microorganisms other than HI(b). The enzyme-linked immunosorbent assay technique described here is considerably simpler than radioimmunoassay and, based on concurrent tests with 14 positive clinical specimens, may be more sensitive than counterimmunoelectrophoresis. It seems, therefore, to hold considerable promise for clinical use in rapid detection of systemic HI(b) infections.     

School-Age Consequences of Haemophilus influenzae Type b Meningitis

Divided 126 school-age children who had been treated earlier in life for Haemophilus influenzae Type b (Hib) meningitis into subgroups with and without neurologic complications, and compared these groups to each other and to sibling controls. Outcomes assessed included neuropsychological abilities, behavioral adjustment, school performance, and adaptive behavior. Analyses revealed that outcomes were less favorable for the postmeningitis (PM) children with complications than for either PM children without complications or siblings. Differences were apparent in neuropsychological testing, teacher ratings of behavior, and a measure of adaptive behavior. PM children without complications were indistinguishable from siblings. Although analyses failed to show variation between groups as a function of sex or age at testing, differences on one verbal measure were found only at lower socioeconomic levels. Findings clarify the school-age consequences of Hib meningitis and document the need to consider disease and social variables in evaluating the impact of early neurologic disease on development.     

Typing of Haemophilus influenzae by Coagglutination and Conventional Slide Agglutination

Coagglutination was compared with conventional slide agglutination for the typing of 297 clinical isolates of Haemophilus sp. A 100% correlation was found with the H. influenzae type b isolates. Coagglutination showed no false-positive reactions with the nontypable strains of H. influenzae and H. parainfluenzae isolates; however, conventional slide agglutination exhibited many false-positive and non-interpretable reactions.     

Avidity determinations for Haemophilus influenzae Type b anti-polyribosylribitol phosphate antibodies

Determination of antibody avidity measurements can be difficult in human serum depending on the population evaluated. We evaluated three approaches for the determination of antibody avidity for immunoglobulin G (IgG). These approaches were (i) elution of bound antibody with increasing concentrations of a chaotropic agent using a single serum dilution, (ii) binding interference of multiple serum dilutions by a single concentration of a chaotrope, and (iii) elution of multiple serum dilutions by a single concentration of a chaotrope. Parameters that affect the determination of avidity measurements and their limitations were evaluated with pre- and post-Haemophilus influenzae type b conjugate vaccination sera (n=89). We determined that elution of low-avidity antibodies present in multiple dilutions of the serum sample by a single concentration of a chaotrope (0.15 M sodium thiocyanate [NaSCN]) was optimal for the determination of avidity measurements throughout a wide range of IgG concentrations (0.94 to 304.6 microg/ml). The percent reduction in concentration as determined by the elution assay with 0.15 M NaSCN correlated highly (r=0.84) with weighted averages obtained by an elution assay with multiple solutions of NaSCN. The correlation (r=0.57) between elution and binding interference, when a single concentration of a chaotrope was used, was lower than the correlation between the two elution methods (r=0.84). We found that the serum dilution, the heterogeneity of the antibody population, and the concentration of the chaotrope were the primary variables affecting avidity determinations. In this study, we present multiple analysis methods depending on the methodology used. We also present the factors that affect the analysis of avidity determinations given the polyclonal nature of human sera. This experimental approach should benefit the evaluation of similar antibodies induced by other bacterial polysaccharide vaccines.     

Avidity Determinations for Haemophilus influenzae Type b Anti-Polyribosylribitol Phosphate Antibodies

Determination of antibody avidity measurements can be difficult in human serum depending on the population evaluated. We evaluated three approaches for the determination of antibody avidity for immunoglobulin G (IgG). These approaches were (i) elution of bound antibody with increasing concentrations of a chaotropic agent using a single serum dilution, (ii) binding interference of multiple serum dilutions by a single concentration of a chaotrope, and (iii) elution of multiple serum dilutions by a single concentration of a chaotrope. Parameters that affect the determination of avidity measurements and their limitations were evaluated with pre- and post-Haemophilus influenzae type b conjugate vaccination sera (n = 89). We determined that elution of low-avidity antibodies present in multiple dilutions of the serum sample by a single concentration of a chaotrope (0.15 M sodium thiocyanate [NaSCN]) was optimal for the determination of avidity measurements throughout a wide range of IgG concentrations (0.94 to 304.6 μg/ml). The percent reduction in concentration as determined by the elution assay with 0.15 M NaSCN correlated highly (r = 0.84) with weighted averages obtained by an elution assay with multiple solutions of NaSCN. The correlation (r = 0.57) between elution and binding interference, when a single concentration of a chaotrope was used, was lower than the correlation between the two elution methods (r = 0.84). We found that the serum dilution, the heterogeneity of the antibody population, and the concentration of the chaotrope were the primary variables affecting avidity determinations. In this study, we present multiple analysis methods depending on the methodology used. We also present the factors that affect the analysis of avidity determinations given the polyclonal nature of human sera. This experimental approach should benefit the evaluation of similar antibodies induced by other bacterial polysaccharide vaccines.     

Differential Complement Resistance Mediates Virulence of Haemophilus influenzae Type b

Studies were undertaken to gain insight into the virulence of type b in contrast to the other Haemophilus influenzae capsular types. A relationship was found between the comparative virulence of H. influenzae types in humans and their resistance to the bactericidal effect of antibody-free complement. Type b was most resistant to the bactericidal effect of complement. The other types could be divided into three groups based upon their susceptibility to complement; this grouping was also related to their structural similarities. No association between virulence and either the biotype, source of isolate, in vitro association with peripheral polymorphonuclear leukocytes, or the total amount of capsular polysaccharide was found. However, among the type b strains, higher levels of cell-associated polysaccharide were associated with increased resistance to complement. The relative virulence of the six H. influenzae types in the infant rat model was generally similar to that in humans. After intraperitoneal challenge, type b and type a strains had the lowest 50% effective doses for bacteremia, removed by several logs from the values of the other types. By intranasal challenge, type b strains produced higher rates and levels of bacteremia than did type a strains. High levels of natural bactericidal antibodies to types c and e were found in adult female rats; this finding alone could not account for the differences in virulence among the H. influenzae types in the infant rat model. We propose that the virulence of type b strains is due to their greater resistance to the bactericidal activity of serum complement alone. Resistance to type b disease requires serum antibody to induce the complement-mediated reaction.     

Separation of Serum Bactericidal and Opsonizing Activities for Haemophilus influenzae Type b

When assay conditions permitted bacterial growth, immune serum had no bactericidal activity for Haemophilus influenzae but promoted rapid phagocytic killing of this organism by human leukocytes.     

Age-Related Susceptibility to Haemophilus influenzae Type b Disease in Rabbits

Anti-type b antibodies were detected in newborns and in most 6- to 8-week-old rabbits, similar to those observed in humans. Culture of the pharynx and rectum of rabbits at varied ages failed to yield Haemophilus influenzae type b. Bacteria with cross-reacting antigens were observed in both the pharyngeal and rectal cultures from rabbits of varied ages. Rabbits without preexisting serum anti-type b antibodies were highly susceptible to septicemia and death after injection of small numbers of H. influenzae type b. Passively acquired antibody, whether observed in newborns or injected into animals without preexisting antibodies, conferred a high degree of protection against H. influenzae type b.     

Identification of Haemophilus influenzae type b by a monoclonal antibody coagglutination assay.

A coagglutination assay using monoclonal antibody is described for the identification of Haemophilus influenzae type b. An immunoglobulin G2a monoclonal antibody, Hb-2, directed against a serotype-specific outer membrane protein of H. influenzae type b was adsorbed to Staphylococcus aureus Cowan 1 cells. In a dot enzyme immunoassay, Hb-2 reacted with 453 of 455 H. influenzae type b isolates and did not react with H. influenzae of other serotypes, untypeable H. influenzae strains, or other bacterial species. The Hb-2 coagglutination assay was evaluated by testing 136 H. influenzae type b strains selected on the basis of multilocus enzyme genotypes, 5 strains of another serotype, and 94 untypeable H. influenzae strains. The specificity of the coagglutination assay was demonstrated by the inhibition of the reaction by free Hb-2 monoclonal antibodies. The coagglutination assay was as specific as the dot enzyme immunoassay and can be rapidly performed and easily interpreted.     

CD1 Presents Antigens from a Gram-Negative Bacterium,Haemophilus influenzae Type b

Human CD1 is a family of nonpolymorphic major histocompatibility complex class I-like molecules capable of presenting mycobacterial lipids, including lipoarabinomannan (LAM), to double-negative (DN; CD4⁻ CD8⁻) as well as CD8⁺ T cells. Structural similarities between LAM and the capsular polysaccharides of gram-negative bacteria led us to consider the latter as candidate CD1 ligands. We derived two CD1-restricted DN T-cell populations which proliferated to Haemophilus influenzae type b (Hib) antigen. One T-cell population also proliferated to proteinase K-treated Hib antigen, suggesting that it recognized a nonpeptide. Our work thus expands the universe of T cell antigens to include nonpeptides distinct from mycobacterial lipids and suggests a potential role for CD1-restricted T cells in immunity to Hib.Human CD1 is a family of nonpolymorphic major histocompatibility complex (MHC) class I-like molecules (CD1a to CD1d) (4, 7, 15, 18). Although CD1 is encoded outside the MHC, its association with β2-microglobulin relates it structurally to MHC class I. CD1 molecules are expressed on immature thymocytes (19) and antigen-presenting cells (APC) including cytokine-activated macrophages (13), B cells (22, 23), and dermal dendritic cells (9). Recent studies have revealed that CD1 possesses the unique function of presenting nonpeptide antigen (Ag) to T cells (3, 17, 21, 24). A prototypic Ag presented in the context of CD1 is lipoarabinomannan (LAM), a mannose polymer substituted at one end with arabinose and at the other with a phosphatidic acid containing tubulostearic and palmitic acids. De-O-acylation of LAM totally abrogated T-cell responsiveness, suggesting that the lipid moiety was required for Ag recognition (21). Since gram-negative bacteria contain lipoglycans structurally analogous to LAM (2, 11, 14, 20), we sought to isolate CD1-restricted T cells which recognize antigens from Haemophilus influenzae type b (Hib), a representative gram-negative bacterium.     

Rapid ampicillin susceptibility testing for Haemophilus influenzae.

Recent isolations of strains of Haemophilus influenzae resistant to ampicillin necessitate the development of a rapid, dependable, reproducible method of determining their antibiotic susceptibility. An agar-dilution method permitting susceptibility determinations on clinical specimens within 6-18 hours of specimen collection was designed. Chocolate agar biplates were made with one side having no additive and the other containing 2 mug/ml ampicillin. Seventy clinical specimens (cerebrospinal fluid, joint fluid, ear fluid, pleural fluid, blood culture broth) were streaked directly onto both sides of the plates when received in the laboratory and incubated at 35-37 C in 10% CO2. Reliable, readable results were usually available within 6-18 hours of receipt of the specimen and correlated completely with minimum inhibitory concentrations (MIC) determined by the agar-dilution plate method, although standard disk susceptibilities occasionally indicated false resistance. Susceptible strains (MIC less than 2 mug/ml) grew on the antibiotic-free side of the biplate only. The rapid determination of ampicillin susceptibility allows optimal antibiotic selection for the treatment of Haemophilus influenzae infections with early discontinuation of potentially toxic supplementary drugs.     

Identification of a new locus involved in expression of Haemophilus influenzae type b lipooligosaccharide.

Previous studies have shown that changes in the expression of the Haemophilus influenzae type b (Hib) lipooligosaccharide (LOS) epitope reactive with monoclonal antibody (MAb) 5G8 can be correlated with alterations in the virulence of some Hib strains. To identify the locus involved in expression of this particular LOS epitope, a genomic library was constructed in the plasmid shuttle vector pGJB103 from Hib strain DL42, which constitutively expressed LOS reactive with MAb 5G8. This library was used to transform a second Hib strain (DL180) that normally does not express this LOS epitope, and a recombinant clone was identified that bound MAb 5G8. Subcloning of different regions of the Hib DL42 DNA insert in this recombinant plasmid determined that a 1.9-kb EcoRI fragment, designated lex-2, was responsible for transforming Hib strain DL180 to reactivity with MAb 5G8. Nucleotide sequence analysis revealed the presence of two contiguous open reading frames (ORFs) in lex-2, the first of which contained 18 tandem repeats of the nucleotide tetramer GCAA near its 5' end. Sequence analysis of PCR-derived products from MAb 5G8-reactive and -nonreactive Hib DL180 colonies established that 18 GCAA repeats were associated with expression of the LOS epitope that bound MAb 5G8. Mutational analysis determined that a functional ORF 2 was essential for expression of the MAb 5G8-reactive LOS epitope. The nucleotide tetramer GCAA repeat present in ORF 1 was also detected in at least two different chromosomal regions in all Hib strains tested. The availability of the cloned lex-2 locus should facilitate future analysis of the complex regulatory mechanisms involved in expression of LOS epitopes by this pathogen.     

Rapid identification of Haemophilus influenzae serovar b by gas liquid chromatography using carbohydrate fingerprints

Carbohydrates from whole-cell hydrolysates of 18 strains of the species Haemophilus influenzae (5 strains belonging to serovar b) were analysed by gas-liquid chromatography. The identity of the carbohydrate components was confirmed by comparison with the retention times of reference sugars and by gas chromatography mass spectrometry. Evidence was obtained that Haemophilus influenzae serovar b can easily be identified by the presence of one large peak representing ribitol. The method described can be routinely applied in bacteriological laboratories equipped with a gas chromatograph. It gives results within approximately 4 h, it is reproducible and easy to perform. Even single colonies isolated directly from agar plates can be used for analysis without further subculturing.     

Human Antibody Response to Individual Outer Membrane Proteins of Haemophilus influenzae Type b

To evaluate the potential of outer membrane proteins of Haemophilus influenzae as a vaccine, sera from 11 healthy persons and from 23 patients convalescing from disease caused by Haemophilus influenzae type b were assayed for antibodies to individual outer membrane proteins of a single type b isolate, strain Eag, by a gel radioimmunoassay. All 23 patients, ranging in age from 2 months to 62 years, with 17 patients being 24 months or less, had antibodies to some of these proteins in their sera (range, antibodies to 4 to 17 proteins per patient). Although the intensity and spectrum of the response varied, all patients had antibodies to one particular outer membrane protein and 19 patients had antibodies to another, with those patients 5 years and older having antibodies to more proteins than did infants (24 months). In the two cases examined, convalescent sera had greater amounts and broader spectra of antibodies than did acute sera. In addition, 10 of 11 healthy subjects not known to have had systemic H. influenzae disease also had antibodies to individual outer membrane proteins, with older children having greater amounts than did their younger siblings and with children showing a different spectrum of response than that for adults. Thus, antibodies to outer membrane proteins are commonly found in humans. Also, these results and those demonstrating that hyperimmune rabbit antisera to strain Eag reacted with each of five type b substrains possessing some different outer membrane proteins indicate considerable cross-reactivity among these proteins. These results encourage continued consideration of outer membrane proteins in a vaccine.     

Rapid method for determining antimicrobial susceptibility of Haemophilus influenzae.

A method was developed to determine the susceptibility of Haemophilus influenzae to ampicillin, cefamandole, and chloramphenicol by using the MS-2 system (Abbott Laboratories) for determining minimum inhibitory concentrations (MIC). The MS-2 results for 132 strains of H. influenzae were compared with the results of agar disk diffusion, agar dilution, and beta-lactamase tests. Twenty-four strains (18.2%) of H. influenzae were resistant to ampicillin by the agar dilution method, as opposed to 25 strains by the MS-2 method. For a beta-lactamase-negative strain, the agar dilution MIC was 4 micrograms/ml, and the MS-2 MIC was 16 micrograms/ml. Twenty-one strains produced beta-lactamase; two beta-lactamase-negative strains were resistant by MS-2, agar dilution, and agar disk diffusion. In addition, one beta-lactamase-negative strain, for which the agar dilution MIC was 32 micrograms/ml and the MS-2 MIC was 16 micrograms/ml, was sensitive by agar disk diffusion. Overall, the MS-2 method compared favorably with the agar dilution method for determining the MIC of ampicillin, cefamandole, and chloramphenicol for H. influenzae.     

Regulatory T Cells in the Antibody Response to Haemophilus influenzae Type b Polysaccharide

An in vitro culture system for the induction of an antipolysaccharide response was used to study the cellular interactions which determine the magnitude and nature of this B-lymphocyte response. Healthy adult volunteers were vaccinated with the Haemophilus influenzae type b polysaccharide (PRP)-tetanus toxoid (TT) conjugate vaccine. Optimal in vitro anti-PRP and anti-TT antibody responses were obtained when B cells were cultured with equal amounts of T cells. The in vitro response is antigen dependent and antigen specific. Culturing with PRP mixed with TT in the presence of T cells induces the highest number of anti-PRP antibody-secreting cells (ASC) (128.4 ×/÷ 15.9 [geometric mean ×/÷ standard deviation] immunoglobulin M [IgM] anti-PRP ASC/10⁶ cells; 9.3 ×/÷ 7.6 IgG anti-PRP ASC/10⁶ cells). Culturing without T cells induced no anti-PRP ASC; culturing with only PRP, in the presence of T cells, yielded low numbers of anti-PRP ASC (3.7 ×/÷ 5.2 IgM anti-PRP ASC/10⁶ cells and 1.2 ×/÷ 2.2 IgG anti-PRP ASC/10⁶ cells). Transwell studies showed that the requirements for the antibody response against the polysaccharide are different from those of an antiprotein response. Cytokines formed as a consequence of contact between protein-specific B and T cells were on their own not sufficient to activate TT-specific B cells (8.4 ×/÷ 1.4 anti-TT ASC/10⁶ cells); direct contact between T and B cells appeared to be an absolute requirement. However, physical contact between B and T cells in one compartment of the Transwell system resulted in the release of soluble factors able to stimulate B cells in the other compartment to secrete antipolysaccharide antibodies (164 ×/÷ 1.6 anti-PRP ASC/10⁶ cells).     

Characterization of Haemophilus influenzae type b fimbriae.

We confirmed that the fimbriae of Haemophilus influenzae type b conferred hemagglutinating activity (HA) towards human erythrocytes, and erythrocytes of certain other species. Most (17/25) cerebrospinal fluid isolates lacked detectable HA on direct testing, but selective enrichment for fimbriation (f+) indicated that 22 of 25 strains could produce these surface structures. HA was unchanged from pH 4.5 to 9.5 and was not inhibited by mannose or certain other simple sugars. The HA titer of a suspension of three f+ strains was slightly decreased at 50 degrees C; HA was lost by heating at 60 degrees C for 3 min. Growth on a variety of solid and liquid media and under differing degrees of oxygenation did not change the HA titer of a suspension of three f+ strains. Fimbriation was not lost on repeated subculture. Wild-type fimbriated strains, and those derived by transformation, did not contain detectable plasmid DNA. Transformation of a strain lacking fimbriae to f+ was associated with the appearance of an outer membrane protein of 24 kilodaltons. This protein was purified from one strain to homogeneity on sodium dodecyl sulfate-polyacrylamide gel electrophoresis by selective detergent solubilization and ammonium sulfate fractionation. Colonization capacity was equivalent with an isogenic untypable strain lacking or possessing fimbriae. Fimbriae of type b H. influenzae possess characteristics similar to those structures on other gram-negative bacteria; their role in cell physiology or pathogenesis of invasive disease is unknown.