Haemophilus influenzae

Haemophilus influenzae is a Gram-negative, non-motile, coccobacillary, facultatively anaerobic, capnophilic pathogenic bacterium of the family Pasteurellaceae. The bacteria are mesophilic and grow best at temperatures between 35 and 37 °C.
H. influenzae was first described in 1893 by Richard Pfeiffer during an influenza pandemic when he incorrectly identified it as the causative microbe, which is why the bacterium was given the name "influenzae". H. influenzae is responsible for a wide range of localized and invasive infections, typically in infants and children, including pneumonia, meningitis, or bloodstream infections. Treatment consists of antibiotics; however, H. influenzae is often resistant to the penicillin family, but amoxicillin/clavulanic acid can be used in mild cases. Serotype B H. influenzae has been a major cause of meningitis in infants and small children, frequently causing deafness and mental degradation. However, the development in the 1980s of a vaccine effective in this age group has almost eliminated this in developed countries.
This species was the first organism to have its entire genome sequenced.

Physiology and metabolism

Structure

H. influenzae is a small Gram-negative bacterium, approximately 0.3 micrometer to 1 micrometer. Like other Gram-negative bacteria, H. influenzae has a thin peptidoglycan layer surrounded by an outer membrane containing lipopolysaccharide. Some types of H. influenzae contain a polysaccharide capsule around the outer membrane to aid in protection and colonization. The bacteria are pleomorphic, meaning the shape of the bacterium is variable, however it is typically coccobacillus or rod-shaped. H. Influenzae contains pili, which are specialized to adhere to the human nasopharynx. The H. Influenzae pili, unlike those of E. coli, resist unwinding, allowing for stronger adhesion to resist expulsion when coughing or sneezing. A minority of non-typeable, or unencapsulated, H. influenzae employ a variety of attachment techniques, such as pili, adhesins, or Hia and Hap proteins. Though the bacteria possess pili, they are not used for traditional movement or motility, and the bacterium is still considered to be non-motile.
The cell wall of H. influenzae bacterium contains various proteins, referred to as autotransporters, for adherence and colony formation. H. influenzae prefers to bind to mucus linings or non-ciliated epithelial cells, which is facilitated by Hap? autotransporters in the cell wall binding with unknown receptors within the epithelium. The Hap? autotransporters also facilitate the formation of microcolonies of the bacteria. These microcolonies are likely responsible for the formation of various biofilms within the body, such as those responsible for middle ear or lung infections.

Penicillin binding proteins

Penicillin binding proteins catalyze steps in peptidoglycan metabolism. They carry out essential processes needed to build and modify the cell wall. These proteins are the targets blocked by penicillin and other beta-lactam antibiotics that bind to PBPs, hence their name. Some antibiotic-resistant isolates of H. Influenzae contain modified PBPs that resist beta-lactam action by producing beta-lactamases to degrade these antibiotics. This resistance is likely due to a N526K mutation, or R517H substitution in conjunction with another unknown mutation. The R517H substitution alone did not have a lower affinity for penicillin, and therefore cannot cause resistance alone. Beta-lactamase emergence in the 1970s caused the therapy for severe cases of H. influenzae to be changed from ampicillin to cephalosporins, however further resistance to cephalosporins has occurred due to changes in the transpeptidase domain of penicillin binding protein 3.

Serotypes

H. influenzae isolates were initially characterized as either encapsulated or unencapsulated. Encapsulated strains were further classified on the basis of the immune response to the type of polysaccharides in their capsule. The six generally recognized types of encapsulated H. influenzae are: a, b, c, d, e, and f. H. Influenzae type b, also known as Hib, is the most common form, recognizable by its polyribosyl ribitol phosphate capsule, and found mostly in children. Types a, e, and f have been isolated infrequently, while types d and c are rarely isolated. Unencapsulated strains are more genetically diverse than the encapsulated group. Unencapsulated strains are termed nontypable because they lack capsular serotypes; however, all H. influenzae isolates can now be classified by multilocus sequence typing and other molecular methods. Most NTHi strains are considered to be part of the normal human flora in the upper and lower respiratory tract, genitals, and conjunctivae.

Metabolism

H. influenzae uses the Embden–Meyerhof–Parnas pathway for glycolysis and the pentose phosphate pathway, which is anabolic rather than catabolic. The citric acid cycle is incomplete and lacks several enzymes that are found in a fully functioning cycle. The enzymes missing from the TCA cycle are citrate synthase, aconitate hydratase, and isocitrate dehydrogenase. H. influenzae has been found in both aerobic and anaerobic environments, as well as environments with different pH's.

Genome and genetics

H. influenzae was the first free-living organism to have its entire genome sequenced. The sequencing was completed by Craig Venter and his team at the Institute for Genomic Research, now part of the J. Craig Venter Institute. Haemophilus was chosen because one of the project leaders, Nobel laureate Hamilton Smith, had been working on it for decades and was able to provide high-quality DNA libraries. The sequencing method used was whole-genome shotgun, which was completed and published in Science in 1995.
The genome of strain Rd KW20 consists of 1,830,138 base pairs of DNA in a single circular chromosome that contains 1604 protein-coding genes, 117 pseudogenes, 57 tRNA genes, and 23 other RNA genes. About 90% of the genes have homologs in E. coli, another gamma-proteobacterium. In fact, the similarity between genes of the two species ranges from 18% to 98% protein sequence identity, with the majority sharing 40–80% of their amino acids.
Conjugative plasmids can frequently be found in H. influenzae. It is common that the F+ plasmid of a competent Escherichia coli bacterium conjugates into the H. influenzae bacterium, which then allows the plasmid to transfer among H. influenzae strands via conjugation.

Role of transformation

H. influenzae mutants defective in their rec1 gene are very susceptible to being killed by the oxidizing agent hydrogen peroxide. This finding suggests that rec1 expression is important for H. influenzae survival under conditions of oxidative stress. Since it is a homolog of recA, rec1 likely plays a key role in recombinational repair of DNA damage. Thus, H. influenzae may protect its genome against the reactive oxygen species produced by the host's phagocytic cells through recombinational repair of oxidative DNA damages. Recombinational repair of a damaged site of a chromosome requires, in addition to rec1, a second homologous undamaged DNA molecule. Individual H. influenzae cells are capable of taking up homologous DNA from other cells by the process of transformation. Transformation in H. influenzae involves at least 15 gene products, and is likely an adaptation for repairing DNA damage in the resident chromosome.

Culture methods and diagnosis of infections

Culture

Bacterial culture of H. influenzae is performed on agar plates. The strongest growth is seen on chocolate agar at 37 °C in a CO₂-enriched incubator. The ideal CO₂ concentration for the culture is ~5%. However adequate growth is often seen on brain-heart infusion agar supplemented with hemin and nicotinamide adenine dinucleotide
Colonies of H. influenzae appear as convex, smooth, pale, grey, or transparent colonies with a mild odor. H. influenzae will only grow on blood agar if other bacteria are present to release these factors from the red blood cells, forming 'satellite' colonies around these bacteria. For example, H. influenzae will grow in the hemolytic zone of Staphylococcus aureus on blood agar plates; the hemolysis of cells by S. aureus releases NAD which is needed for its growth. H. influenzae will not grow outside the hemolytic zone of S. aureus due to the lack of nutrients in these areas.

Diagnosis of infections

Clinical features of a respiratory tract infection may include initial symptoms of an upper respiratory tract infection mimicking a viral infection, usually associated with low-grade fevers. This may progress to the lower respiratory tract within a few days, with features often resembling those of wheezy bronchitis. Sputum may be difficult to expectorate and is often grey or creamy in color. The cough may persist for weeks without appropriate treatment. Many cases are diagnosed after presenting chest infections that do not respond to penicillins or first-generation cephalosporins. A chest X-ray can identify alveolar consolidation.
Clinical diagnosis of invasive H. influenzae infection is typically confirmed by bacterial culture, latex particle agglutination tests, or polymerase chain reaction tests on clinical samples obtained from an otherwise sterile body site. In this respect, H. influenzae cultured from the nasopharyngeal cavity or throat would not indicate H. influenzae disease, because these sites are colonized in disease-free individuals.
Although highly specific, bacterial culture of H. influenzae lacks sensitivity. Use of antibiotics prior to sample collection greatly reduces the isolation rate by killing the bacteria before identification is possible. Recent work has shown that H. influenzae uses a highly specialized spectrum of nutrients where lactate is a preferred carbon source.