Invasive Disease Due to Nontypeable Haemophilus influenzae among
Children in Arkansas
Joshua M. O'Neill,1* Joseph W. St. Geme III,2
David Cutter,2 Elisabeth E. Adderson,3 Juliana Anyanwu,3
Richard F. Jacobs,1 and Gordon E. Schutze1,4
Department of Pediatrics,1 Department of Pathology, University of
Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock,
Arkansas,4 Departments of Pediatrics and Molecular Microbiology,
Washington University School of Medicine, St. Louis, Missouri,2
Department of Infectious Disease, St. Jude Children's Research Hospital,
Memphis, Tennessee3
Received 11 October 2002/ Returned for modification 5 November 2002/ Accepted
6 May 2003
In this study, we reviewed cases of invasive disease due tonontypeable Haemophilus influenzae among children hospitalizedat Arkansas Children's Hospital from 1993 to 2001. A total of
28 cases were examined, including 21 associated with bacteremiaand 4
associated with meningitis. Of the patients examined,86% were
4 years of age,
and 68% had underlying medical conditions.Characterization of the
bacterial isolates by multilocus sequencetype genotyping revealed
significant overall genetic diversity,similar to the diversity in
the general population structurefor nontypeable H. influenzae.
However, four separate pairsof isolates were closely related
genetically, a relationshipconfirmed by pulsed-field gel
electrophoresis and Southern hybridizationstudies using probes for
the major H. influenzae adhesin genes.These results suggest
that selected strains of nontypeable H.influenzae may have
more invasive potential, especially in youngchildren and patients
with underlying medical conditions. Atthis point, the specific
factors that contribute to enhancedvirulence remain unclear.
* Corresponding author. Mailing address: Arkansas Children's
Hospital, 800 Marshall St., Little Rock, AR 72202-3591. Phone: (501) 364-1416.
Fax: (501) 364-3551. E-mail:
ONeillJoshua@uams.edu.
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