Bordetella holmesii in children suspected of pertussis in Argentina.

We describe nine patients (eight aged <1 year) clinically diagnosed with pertussis yet laboratory-confirmed with Bordetella holmesii infections, a human pathogen normally isolated from blood. Most patients reported cough and cold symptoms. No death was reported. We report B. holmesii isolation in infants with respiratory symptoms in Argentina.

Suspected Brazilian purpuric fever in a toddler with overwhelming Epstein-Barr virus infection.

We describe a toddler from Connecticut who developed purulent conjunctivitis, fever, and a morbilliform rash. Blood cultures were positive for Haemophilus influenzae biogroup aegyptius; further investigation was performed to assess the possibility that the illness was consistent with Brazilian purpuric fever, which, to our knowledge, has not been reported in the United States. This isolate shared morphological and some biochemical characteristics with previously studied H. influenzae biogroup aegyptius strains but differed according to slide agglutination testing, plasmid characterization, and ribotyping. Blood and tissue samples obtained during his hospitalization were also positive for Epstein-Barr virus. The child died 8 days after hospitalization. Fifty other cases of invasive H. influenzae infection were identified by active surveillance studies. Of the 49 viable surveillance isolates, 10 were biotype III (two of which had the same ribotype as the strain from our case.

Genetic structure of Neisseria meningitidis serogroup C epidemic strains in south Brazil.

In the present study we report the results of an analysis, based on serotyping, multilocus enzyme electrophoresis (MEE), and ribotyping of N. meningitidis serogroup C strains isolated from patients with meningococcal disease (MD) in Rio Grande do Sul (RS) and Santa Catarina (SC) States, Brazil, as the Center of Epidemiology Control of Ministry of Health detected an increasing of MD cases due to this serogroup in the last two years (1992-1993). We have demonstrated that the MD due to N.meningitidis serogroup C strains in RS and SC States occurring in the last 4 years were caused mainly by one clone of strains (ET 40), with isolates indistinguishable by serogroup, serotype, subtype and even by ribotyping. One small number of cases that were not due to an ET 40 strains, represent closely related clones that probably are new lineages generated from the ET 40 clone referred as ET 11A complex. We have also analyzed N.meningitidis serogroup C strains isolated in the greater São Paulo in 1976 as representative of the first post epidemic year in that region. The ribotyping method, as well as MEE, could provide useful information about the clonal characteristics of those isolates and also of strains isolated in south Brazil. The strains from 1976 have more similarity with the actual endemic than epidemic strains, by the ribotyping, sulfonamide sensitivity, and MEE results. In conclusion, serotyping with monoclonal antibodies (C:2b:P1.3), MEE (ET 11 and ET 11A complex), and ribotyping by using ClaI restriction enzyme (Rb2), were useful to characterize these epidemic strains of N.meningitidis related to the increased incidence of MD in different States of south Brazil. It is mostly probable that these N.meningitidis serogroup C strains have poor or no genetic correlation with 1971-1975 epidemic serogroup C strains. The genetic similarity of members of the ET 11 and ET 11A complex were confirmed by the ribotyping method by using three restriction endonucleases.

Brazilian purpuric fever caused by Haemophilus influenzae biogroup aegyptius strains lacking the 3031 plasmid.

Brazilian purpuric fever (BPF) is a life-threatening pediatric infection caused by Haemophilus influenzae biogroup aegyptius (Hae), an organism formerly associated with only self-limited purulent conjunctivitis. Strains of Hae causing BPF have a 24-MDa plasmid with a specific AccI restriction pattern designated 3031. This plasmid was thought to code for a virulence factor because it had been detected only among Hae strains isolated from BPF cases or their contacts. From 3 typical BPF cases recently identified in São Paulo State, sterile-site Hae isolates were obtained; these isolates were similar to earlier BPF-associated Hae except they did not possess a 3031 plasmid. HindIII restricted chromosomal DNA from these strains was probed with purified 3031 plasmid DNA under high-stringency conditions. There was no evidence that 3031 plasmid DNA had become chromosomally integrated. It appears that the 3031 plasmid does not code for BPF-specific virulence factors.

Ribotyping as an additional molecular marker for studying Neisseria meningitidis serogroup B epidemic strains.

The molecular method of ribotyping was used as an additional epidemiological marker to study the epidemic strains of Neisseria meningitidis serogroup B, referred to as the ET-5 complex, responsible for the epidemic which occurred in greater São Paulo, Brazil. Ribotyping analysis of these strains showed only a single rRNA gene restriction pattern (Rb1), obtained with ClaI restriction enzyme. This method, as well as multilocus enzyme electrophoresis, provided useful information about the clonal characteristics of the N. meningitidis serogroup B strains isolated during this epidemic. The N. meningitidis serogroup B isolates obtained from epidemics which occurred in Norway, Chile, and Cuba also demonstrated the same pattern (Rb1). Ribotyping was a procedure which could be applied to a large number of isolates and was felt to be appropriate for routine use in laboratories, especially because of the convenience of using nonradioactive probes.

Characterization of epidemic Neisseria meningitidis serogroup C strains in several Brazilian states.

Epidemic strains of the Neisseria meningitidis C:2b:P1.3 electrophoretic type 11 complex were responsible for an outbreak in Curitiba, Parana State, Brazil, from 1990 to 1991. Strains of this complex were also isolated in other Brazilian states and were responsible for a meningococcal disease epidemic in São Paulo State in 1990. Serotyping both with monoclonal antibodies and by multilocus enzyme electrophoresis was useful for typing these epidemic strains related to the increased incidence of meningococcal disease. The genetic similarity of members of the electrophoretic type 11 complex was confirmed by the ribotyping method by using EcoRI or ClaI endonuclease restriction enzymes.

[Isolation of Haemophilus aegyptius associated with Brazilian purpuric fever, of Chloropidae (Diptera) of the genera Hippelates and Liohippelates]. / Isolamento de Haemophilus aegyptius associado à febre purpúrica brasileira, de cloropídeos (Diptera) dos gêneros Hippelates e Liohippelates.

The recognition of the Brazilian purpuric fever (BPF) in 1984 led to a number of studies which showed a relation between this disease and conjunctivitis caused by Haemophilus aegyptius. The increase in cases of conjunctivitis in children associated with higher population density of eye gnats (Chloropidae: Hippelates) has been reported since last century. This phenomenon is related to the attraction that those flies show for the eyes, secretions and wounds, from where they feed on. Although there are evidences on the role of these flies in the mechanical transmission of seasonal bacterial conjunctivitis, the isolation of Haemophilus aegyptius from them in their natural habitat had not been demonstrated yet. In this study Haemophilus aegyptius associated to BPF was isolated from two pools of chloropids collected around the eyes of children with conjunctivitis which were identified as Liohippelates peruanus (Becker) and a new species Hippelates neoproboscideus.

Isolamento de Haemophilus aegyptius associado a febre purpurica brasileira de cloropideos (diptera) dos generos Hippelates e Lioheppelates / Isolation of Haemophilus aegyptius associated to brazilian purpuric fever from Hippelates and Liohippelates flies (Diptera: Chloropidae)

O reconhecimento da Febre Purpurica Brasileira (FPB), em 1984, originou uma serie de estudos que revelaram uma correlacao desta doenca com conjuntivites causadas por Haemophilus aegyptius. A associacao do aumento de conjuntivites em criancas e a maior densidade populacional de cloropideos do genero Hippelates ja havia sido verificada desde o seculo passado. Este fenomeno esta relacionado ao tropismo que estes insetos apresentam pelos olhos, secrecoes e feridas de onde se alimentam....

[Brazilian purpuric fever, virulence in an animal model of Haemophilus aegyptius (H. influenzae biogroup aegyptius). Grupo de Estudo da Febre Purpúrica Brasileira]. / Febre purpúrica brasileira, virulência em modelo animal do Haemophilus aegyptius (H. influenzae biogrupo aegyptius).

Brazilian purpuric fever (BPF) is caused by invasive strains of Haemophilus aegyptius (H. influenzae biogroup aegyptius, Hae). These strains were differentiated from Hae strains associated only with conjunctivitis (non-invasive Hae strains) through specific molecular markers. Complement-depleted infant rat model was used to study the invasive and non-invasive Hae strains to compare their virulence potential. Inoculating 10(5) bacteria in the rats, the invasive strains caused 80 to 100% bacteremia and the intensity of bacteremia was 10(2.5 +/- 0.49) to > 10(4.69) cfu/ml of blood. Using the same infectious dose, the non-invasive strains did not cause frequent bacteremia (0 to 50%) and the intensity was 0 to 10(3.69 +/- 0.53) cfu/ml of blood. The infectious doses able to cause 50% of bacteremia in the rats (BD 50%) varied from < 10(3) to 10(4.2) bacteria for the invasive strains, whereas the BD 50% were 10(6.2) to > 10(7.3) bacteria for non-invasive strains. Passive immunization using antisera to invasive strains protected rats against bacteremia caused by homologous strains, but not by heterologous strain. By comparing the bacteremia caused by Hae and bacteremia caused by H. influenzae b (Eagan strain, Hib), it was demonstrated that Hib had higher virulence potential. This animal model was useful to clarify the virulence potential of invasive Hae strains.

Comparative efficacy of oral rifampin and topical chloramphenicol in eradicating conjunctival carriage of Haemophilus influenzae biogroup aegyptius. Brazilian Purpuric Fever Study Group.

Persistent conjunctival carriage of the Haemophilus influenzae biogroup aegyptius (Hae) strain (BPF clone) responsible for Brazilian purpuric fever (BPF) has been documented. Topical chloramphenicol is routinely used to treat conjunctivitis in areas affected by BPF in Brazil. Although the BPF clone is susceptible to chloramphenicol, we observed a number of children treated with topical chloramphenicol for conjunctivitis who still developed BPF. During an investigation of an outbreak of BPF in Mato Grosso State, Brazil, we compared oral rifampin (20 mg/kg/day for 4 days) with topical chloramphenicol for eradication of conjunctival carriage of H. influenzae biogroup aegyptius among children with presumed BPF clone conjunctivitis. Conjunctival samples were taken for culture on the day treatment was initiated and a mean of 8 and 21 days later. At 8 days the eradication rates for oral rifampin and topical chloramphenicol were 100 and 44%, respectively (P = 0.003); at 21 days they were 100 and 50% (P = 0.01). Oral rifampin was more effective than topical chloramphenicol for eradication of the BPF clone and may be useful in prevention of BPF.

Febre purpúrica brasileira. Caracterizaçäo rápida das cepas invasoras de Haemophilus aegyptius / Brazilian purpuric fever. Fast characterization of invasive strains of Haemophilus aegyptius

Cepas de H. aegyptus isoladas em surtos de Febre Purpúrica Brasileira (FPB) no Brasil, foram caracterizadas pelo método de aglutinaçäo em lâmina utilizando um anti-soro produzido com cepa de H. aegyptius isolada de cultura de sangue de paciente com FPB. Através desse método foi possível identificar cepas de H. aegyptius responsáveis por surtos de conjuntivite com características antigênicas iguais às cepas isoladas de FPB. A sensibilidade e especificidade da soroaglutinaçäo em lâmina foi de 97,7% e 89,6% respectivamente, podendo ser utilizado como método de triagem em estudos de conjuntivites purulentas, para detectar cepas invasivas de H. aegyptius associada a FPB, possibilitando assim a implantaçäo de medias que ampliem a eficiência na prevençäo e na vigilância epidemiológica da doença

[Brazilian purpuric fever. Fast characterization of invasive strains of Haemophilus aegyptius]. / Febre purpúrica brasileira. Caracterização rápida das cepas invasoras de Haemophilus aegyptius.

Strains of H. aegyptius isolated during outbreak of Brazilian Purpuric Fever (BPF) in Brazil were characterized antigenically by slide agglutination test utilizing antiserum produced with a H. aegyptius strain isolated from blood culture from a patient with BPF. By means of this method, it were identified H. aegyptius strains responsible for outbreaks of conjunctivitis with identical antigenic characteristics to strains isolated from BPF. The sensitivity and specificity of slide seroagglutination test was 97.7% and 89.6% respectively; therefore this assay was efficient to be used as a screening method in the studies of purulent conjunctivitis for detecting high risk populations for BPF, and to implement measures that will increase the efficiency of epidemiologic surveillance.