Characterization of invasive isolates of S. pneumoniae, H. influenzae, and N. meningitidis in Latin America and the Caribbean: SIREVA II, 2000-2005

OBJECTIVES: To analyze the phenotypical characteristics and the susceptibility to antibiotics of the circulating strains of Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis circulating in Latin America and the Caribbean from 2000-2005. Potential coverage by conjugate vaccines was evaluated. METHODS: Conventional methods were used to study the distribution of the serotypes or serogroups of 17 303 strains of S. pneumoniae, 2 782 strains of H. influenzae, and 6 955 strains of N. meningitidis isolated from cases of pneumonia, meningitis, sepsis, bacteriemias, and other invasive processes. The antimicrobial susceptibilities of the study strains were evaluated. The isolates came from 453 sentinel surveillance sites in 19 countries in Latin America and four in the Caribbean, as part of the SIREVA II (Network Surveillance System for the Bacterial Agents Responsible for Pneumonia and Meningitis) project. RESULTS: S. pneumoniae serotype 14 was the most frequently isolated (21.1 percent), especially in children under 6 years of age (29.1 percent). The potential coverages by hepta-, nona-, deca-, and trideca-valent antipneumonia conjugate vaccines were 59.0 percent, 73.4 percent, 76.5 percent, and 85.9 percent, respectively. Of the isolates, 63.3 percent were sensitive to penicillin. H. influenzae serotype b was present in 72.2 percent of the isolations from children under 2 years of age, whereas 8.6 percent produced serotypes a, c, d, e, and f, and 19.2 percent could not be serotyped. The rate of H. influenzae beta-lactamase-producing strains isolated from children under 2 years of age was 16.3 percent. The most frequent N. meningitidis serogroups were B (69.0 percent) and C (25.7 percent); 65.8 percent and 99.2 percent of the strains were susceptible to penicillin and rifampicin, respectively. CONCLUSIONS: These results highlight the importance of comprehensive epidemiological surveillance of S. pneumoniae, H. influenzae and N. meningitidis in Latin America and the Caribbean. The great heterogeneity found in the distribution of S. pneumoniae serotypes among the countries studied could reduce immunization coverage. Conducting a specific analysis of each country to adjust the introduction of new conjugate vaccines and determine the best immunization plan is recommended

Frequency of occurence and antimicrobial resistance in isolates of bacterial conjunctivitis in patients at the University Hospital of the West Indies [abstract]

OBJECTIVE: There is paucity of published data on bacterial conjunctivitis in patients at the University Hospital of the West Indies and the wider community in Jamaica. This report analyses 208 bacterial isolates from 198 eye swab cultures of patients with clinical diagnosis of conjunctivitis in this hospital. METHODS: Culture of eye swabs was done by routine methodology, and anti-microbial susceptibility tests were performed by the standard disc-diffusion technique. RESULTS: Two hundred and eight bacterial isolates were encountered in the 198 ocular cultures. Eighty of these (32.9 percent) were likely contaminants (normal commensal from skin of the eyelid). The common isolates in order of frequency in the remaining 128 were: Haemophilus influenzae pneumoniae 12 (9.4 percent) and Pseudomonas aeruginosa 5 (3.9 percent). These four organisms together accounted for over two-thirds (69.5 percent) of the 128 isolates. More than 90 percent of these strains were susceptible to chloraphenicol and gentamicin. CONCLUSIONS: The contamination rate in eye swab cultures is very high and there is need for improvement of the collection procedures. Haemophilus influenzae remains the most common pathogen of bacterial conjunctivitis as in many other parts of the world. The common eye preparations such as chloramphenicol and gentamicin (alternatively, tobramycin) continue to be highly effective against pathogens from conjunctivitis at the University Hospital of the West Indies. (AU)

Antimicrobial sensitivity of Haemophilus influenzae isolates from bacterial conjunctivitis

Haemophilus influenzae is one of the common bacterial pathogens which affect children. Resistance to frequently use antibiotics is becoming a significant problem in community isolates of common pathogens. A retrospective review was conducted of the serotypes and antimicrobial sensitivity of H influenzae isolates from bacterial conjunctivitis, over an 18-month period. Data on antimicrobial sensitivity (obtained by the National Committee for Clinical Laboratory Standards disk diffusion method) and B-lactamase production, and typing results, were analysed. Ninety-nine islolates were recovered, of which 87 were typed. Most isolates were recovered from children under one year of age. Ninety-three percent were unencapsulated and biotypes I and IV were most common. H influenzae type b was recovered only twice. B-lactamase was produced by 41 percent isolates while four isolates were ampicillin-resistant but did not produce B-lactamase. All isolates were sensitive to chloramphenicol and 45 percent were co-trimoxazole sensitive. H influenzae is commonly isolated from bacterial conjunctivitis in Barbados and, as elsewhere, the majority of isolates are from small children and are non-encapsulated. However, there is a high prevalence of B-lactamase production, which may serve as a reservoir for transfer to more invasive encapsulated strains of H influenzae within the oropharyngeal flora.(Au)

Epidemiology of haemophilus influenzae invasive disease in Jamaica, 1990-1993

Haemophilus influenzae (H influenzae) invasive disease was studied retrospectively over a four-year period in children admitted to the Bustamante Hospital for Children in Kingston, Jamaica. A total of 86cases were identified. The mean estimated annual incidence of H influenzae invasive disease in Kingston and St. Andrew was 39 per 100,000 children under 5 years of age. The majority (77percent) of cases were in the under 2-year age group. A distinct seasonal pattern was noted, with a significantly higher proportion of patients (57-73percent) presenting in the cooler months. Meningitis was the most common clinical diagnosis, accounting for 76percent of the cases. Poor outcome was demonstrated in 21.5percent of patients with meningitis. Sensitivity testing of H influenzae isolates revealed a resistance rate of 26percent for ampicillin and 7percent for chloramphenicol. The epidemiological findings in this study provide reasonable guidelines for empiric antibiotic therapy and also support the need to seriously consider vaccine prophylaxis in Jamaican children.(Au)

Antimicrobial sensitivity of Haemophilus influenzae isolates from bacterial conjunctivitis - Poster abstract

OBJECTIVE: To review retrospectively the serotypes and antimicrobial sensitivity of Haemopilus influenzae isolates from bacterial conjunctivitis. DESIGN AND METHODS: Laboratory records over a 9 month period were reviewed. Data on antimicrobial sensitivity (obtained) by the NCCLS disk diffusion method) and á-lactamase production, and typing results, were analysed. RESULTS: 34 isolates were recovered, of which 31 were typed. Most isolates were recovered from children under one year of age. Seventy-one percent were un-encapsulated and bio-types I and IV were most common. H influenzae type b was recovered only once. á=lactamase was produced by 45 percent isolates (14/31) while one was ampicillin-resistant but did not produce á-lactamase. All isolates were sensitive to chloramphenicol and 60 percent were co-trimoazole sensitive. CONCLUSIONS: H influenzae is commonly isolated from bacterial conjunctivitis in Barbadians, and the majority of isolates are from infants and are non-encapsualted. However, there is a high prevalence of á-lactamase production, which may serve as a reservoir for transfer to more invasive encapsulated strains within the oropharyngeal flora.(AU)

The epidemiology of Haemophilus influenzae invasive disease n the Kingston and St. Andrew Region, Jamaica - abstract

Haemophilus influenzae invasive disease was studied retrospectively over a four year period in children admitted to the Bustamante Hospital for Children in Kingston, Jamaica. A total of 86 cases wwere identified. The estimated annual incidence of H. influenzae invasive disease in Kingston and St Andrew ranged from 39 to 45 per 100,000 children <5 years of age. The majority (77 percent ) of cases were in the < 2 year age group. A distinct seasonal pattern was noted, with a significantly higher proportion of patients (57 - 73 percent ) presenting in the cooler months. Similar seasonal variations have been described in the literature. Meningitis was the most clinical diagnosis, accounting for 76 percent of the cases. Poor outcome was demonstrated in 21.5 percent of patients with meningitis. Sensitivity testing of Haemophilus isolates revealed a resistance rate oof 26 percent for ampicillin and 7 percent for chloramphenicol. The epidemiological findings in this study do not differ significantly from those described in the literature for many developed countries. (AU)

Haemophilus influenzae laboratory diagnosis

Haemophilus influenzae (HI) is a small, pleomorphic, encapsulated, non-motile, gram negative bacillus which was first isolated from respiratory tract secretions by Pfeiffer in 1893(AU)

Acute purulent pericarditis in children caused by haemophilus influenzae

Acute purulent pericarditis caused by haemophilus influenzae is an unusual condition, especially in childhood. In most cases, respiratory symptoms are the presenting features, and children aged less than 4 years are most often affected. A high index of suspicion and aggresive microbiological and cardiological evaluation are often warranted to make an early diagnosis. We herein report two cases of pericarditis caused by H.influenzae in children aged less than two years. Pericardiocentesis was performed in each case. Early recognition, rapid diagnosis and aggressive medical and surgical therapy are paramount in the successful treatment of this condition (AU)

Bacterial meningitis in children in Barbados: a decade later - abstract

Forty-eight paediatric patients admitted with bacterial meningitis during a 10-year period, comprising 22 males (46 percent) and 26 females (54 percent), were reviewed. Ages ranged between 7 weeks and 12 years (mean 2.7 years). The mean 10-year incidence was 29/10,000 ward admissions, with a peak incidence of 69/10,000 admissions in 1989. The highest seasonal prevalence occurred during the dry months. Twenty-five patients (52 percent) were less than 2 years of age. Predominant symptoms were fever (85 percent), gastrointestinal (65 percent), and lethargy (40 percent). Frequently associated illnesses included upper respiratory infections in 21 (44 percent), and otitis media in 5(10 percent) of cases. H. influenzae was cultured from the cerebrospinal fluid in 34 cases (71 percent), S. pneumoniae in 4 cases (8 percent), and no organism in 10 cases (21 percent). Thirteen patients (27 percent) had received antibiotic therapy within a week of admission. Initial therapy consisted of parenteral ampicillin and chloramphenicol in 37 cases (77 percent), penicillin and chloramphenicol in 9 cases (19 percent) chlodramphenicol in 1 (2 percent), and trimethoprin/sulfamethoxazole in 1 case (2 percent). These data support a case for routine administration of H. influenzae B vaccine which will lead to the eradication of, or reduction of the overall incidence of bacterial meningitis in childhood (AU)

The prevalence of nasal carriage of streptococcus pneumoniae and haemophilus influenzae in children from birth to three years of age attending immunization clinics - abstract

The population comprised ninety-six "well" children less than three years of age attending routine immunization clinics in four health centres in the Port-of-Spain area. The aim was to determine nasal carriage levels of pneumococcus and haemophilus influenzae amongst these children. The children were "well" and had not received antibiotics within two weeks of sampling. Swab were taken, using nasal and per-nasal seabs and innoculated immediately on growth media. They were then cultured and the organisms identified and sub typed. The population had an average age of 9.6 months: 52 percent were male. Fifty-three per cent of the children had a history of having had an upper respiratory tract infection within the 2 weeks preceding the specimen collection. Positive isolation of pneumococcus was obtained in 23 percent of the children. This result is surprisingly low and contrasts with levels ranging from 48 percent in North Carolina (Lada et al, 1974), and 53 percent in Dakar, Senegal to 100 percent in Papua, New Guinea (Gratten et al, 1984). Twenty-two per cent of the children yielded positive isolates of haemophilus influenzae. This again is a surprisingly low yield level. The accuracy of these results needs confirmation or refutation by further studies. Furthermore, the presence of other organisms, which could perhaps be the dominant organisms and which were not specifically cultured for in this study, needs to be considered (AU)

Meningitis in childhood - Bahamas 1979 - 1983

Meningitis is certaily one of the most notorious disease in infancy and childhood. While there have been numerous articles dealing with this subject in the medical literature, there has been no study of meningitis in the under 12 age group in the Bahamas. This publication presents a retrospective look at the experience at the Princess Margaret Hospital, Nassau, Bahamas 1979 -1983

Treatment of sickle cell disease in early childhood in Jamaica

The Jamaican sickle cell cohort study, based on neonatal diagnosis of all cases of sickle cell disease among 100 000 consecutive births, has identified acute splenic sequestration (ASS) and pneumoccocal disease as the most important complications in early life. The etiology of ASS is unknown and prophylaxis is therefore not possible. For first attacks, attention has been directed to parental education to achieve earlier diagnosis. Recurrent attacks may be prevented by prophylactic splenectomy. A controlled trial on the prevention of pneumococcal disease has indicated many pneumococcal septicemias in children given the 14 valent pneumococcal vaccine between the ages of 6 months and 3 years. No pneumococcal isolations occurred during the same period in children given monthly long-acting prophylactic penicillin. A controlled trial of foliate supplementation for 1 year in children aged 6 months to 4 years indicated no difference between control and treatment groups in hemoglobin levels or weight and height velocity. The MVC was 4 fl less in the supplemented group. A controlled trial of feeder vessel photocoagulation in the therapy of proliferative retionpathy indicated significantly less vitreous hemorrhage in treated patients but choroidal neovascularization was a common complication of xenon arc therapy and retinal tears commonly followed the use of Argon laser. A new trial of scatter therapy is in progress. (AU)

Bacterial meningitis in children in Barbados

A retrospective study is reported on 43 cases of pyogenic meningitis in children aged 4 months - 15 years seen during a 5-year-period at the Queen Elizabeth Hospital, Barbados. Associated illnesses included upper respiratory tract infections, pharyngitis, otitis media and broncho-pneumonia for which twelve patients (28 percent) had been partially treated prior to admission. Patients were treated with combinations of co-trimoxazole, penicillin and chloramphenicol. H. influenzae was the most common organism isolated (67 percent of cases). Fifty seven per cent and 40 percent of H. influenzae strains respectively were resistant to co-trimoxazole and ampicillin or amoxicillin. Neurological sequelae were observed in 37 percent of cases at follow-up visits. In view of the overwhelmimg predominance of H. influenzal meningitis in this age group and its patterns of resistance, initial treatment with chloramphenicol alone is recommended for suspected childhood meningitis in Barbados (AU)

Safety and immunogenicity of a new Haemophilus influenzae type b vaccine in infants under one year of age

64 healthy infants, 2-3 months old, were randomly assigned to one of three vaccination groups which either diphtheria-pertussis-tetanus (DPT) vaccine, Haemophilus influenzae type b capsular polysaccharide polyribosyl-ribitol phosphate (PRP) vaccine, or PRP+P (with pertussis adjuvant) vaccine in three doses at intervals of two months. Local and systemic reactions occurred most frequently after DPT vaccination and least frequently for PRP alone. Data for 60 infants from whom complete sera sets were available indicated that 70 percent of the infants who received three doses of PRP+P showed two fold or greater increases in titers of antibody to PRP with final values above the level assumed to give protection against invasive H. influenzae type b disease (>0.15 ug/ml). In contrast, less than 10 percent of infants who received PRP vaccine alone showed 2-fold or greater increases (Summary)

Early splenomegaly in homozygous sickle-cell disease: an indicator of susceptibility to infection

135 children with homozygous sickle-cell (SS) disease diagnosed at birth have been followed for 1-5 years. Severe bacterial infections were confined to those in whom the spleen was first palpable at or before 1 year of age and were commonest in those in whom the spleen was first palpable at or before age 6 months. Regular follow-up of children with SS disease diagnosed at birth will identify children particularly at risk of severe infections. (Summary)

Haemophilus influenzae as an agent of urinary tract infection

Two cases of urinary tract infection due to H. Influenzae, an unusual urinary pathogen, are described. One was an adult female who presented with endometritis; the other was a male infant who had posterior urethral valves. Increased awareness of the potential existence of this at this site is a prequisite to diagnosis since it does not grow on the conventional media used for urine cultures (AU)