Pathogen Safety Data Sheet: Infectious Substances - Haemophilus parainfluenzae

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Section I: Infectious agent

Name: Haemophilus parainfluenzae
Agent type: Bacteria


Family: Pasteurellaceae
Genus: Haemophilus
Species: parainfluenzae

Synonym or cross reference: None.

Characteristics: H. parainfluenzae are fastidious Gram-negative, non-motile coccobaccili. Cells are approximately 0.4 – 1.0 μm in diameter and 1.0 – 2.0 μm in lengthFootnote 1. They are opportunistic pathogens that occur in the oral cavity, pharynx, and lower genital tractFootnote 1Footnote 2.

Haemophilus species can be cultured on blood agar; addition of bacitracin prevents growth of most other bacteria found in the oral cavityFootnote 1. X factor is not required for growth of H. parainfluenzae; V factor is required for most strainsFootnote 1,Footnote 3. Strains of H. parainfluenzae are genetically diverse and phenotypically heterogenous for many of the enzymes typically used to classify bacteriaFootnote 1,Footnote 3,Footnote 4. Eight biotypes of H. parainfluenzae have been identified, which are based on production of tryptophanase, urease, and ornithine decarboxylaseFootnote 3,Footnote 4. H. parainfluenzae grow well in a microaerophilic environment with 5-10% CO2. Mature colonies appear after incubation at 35 °C for 18-48 hoursFootnote 5.

Section II: Hazard identification

Pathogenicity/toxicity: H. parainfluenzae is of low pathogenicity but is occasionally implicated in cases of systemic infectionFootnote 1. It is also responsible for about 1-3% of infective endocarditis casesFootnote 3,Footnote 6. Symptoms associated with infective endocarditis include presence of a new regurgitant murmur and feverFootnote 7. The mortality rate of Haemophilus-associated endocarditis is approximately 4-5%Footnote 8,Footnote 9.

Rare cases of systemic infections associated with H. parainfluenzae have been reported sporadically. These include meningitisFootnote 6,Footnote 10, respiratory tract infections, bacteremiaFootnote 5 neonatal sepsisFootnote 11,Footnote 12, osteomyelitisFootnote 13, pneumonia, and genitourinary tract infectionsFootnote 1,Footnote 14.

H. parainfluenzae has lipooligosaccharide components that contribute to its ability to adhere to, colonize, and invade host tissuesFootnote 15. Immunocompromised patients and areas where there is disruption of skin or mucosal barriers are particularly susceptible to infectionFootnote 5,Footnote 13. Individuals with underlying heart disease or prosthetic valves are more susceptible to H. parainfluenzae-associated endocarditisFootnote 8,Footnote 9.

H. parainfluenzae is not known to cause disease in animals, as the host range is restricted to humansFootnote 3.

Communicability: Vertical transmission of H. parainfluenzae resulting in neonatal infections has been reportedFootnote 11,Footnote 12. Presence of H. parainfluenzae in saliva, throat, mucous membranes, and lower genital tract raises the potential for transmission of H. parainfluenzae via intimate contactFootnote 16,Footnote 17.

Epidemiology: H. parainfluenzae infections occur worldwide. Approximately 65% of healthy individuals harbour H. parainfluenzae in the upper respiratory tractFootnote 5. H. parainfluenzae-associated infective endocarditis and meningitis are usually associated with childrenFootnote 10,Footnote 18.

Host range: HumansFootnote 1.

Infectious dose: Unknown.

Incubation period: Unknown.

Section III: Dissemination

Reservoir: Humans.

Zoonosis/Reverse zoonosis: None.

Vectors: None.

Section IV: Stability and viability

Drug susceptibility: Susceptibility profiles are highly variable. Some isolates are susceptible to beta-lactam antibiotics; cephalosporins, such as ceftriaxone and cefuroximeFootnote 13,Footnote 19; meropenemFootnote 13,Footnote 19; aminoglycosides, such as gentamicinFootnote 9; amoxicillin-clavulanic acid; and levofloxacinFootnote 19.

Drug resistance: Resistance profiles are highly variable; multidrug resistant isolates have been reportedFootnote 5,Footnote 20,Footnote 21. Some isolates are not susceptible to beta-lactams, such as ampicillinFootnote 2,Footnote 5; cephalosporins, such as ceftazidime and cefazolineFootnote 5; quinolones such as ciprofloxacinFootnote 13,Footnote 20; macrolides such as clarithromycinFootnote 20,Footnote 22; azalidesFootnote 20; ketolidesFootnote 20; licoasamidesFootnote 20; or streptograminsFootnote 20. Resistance has also been reported to tetracyclineFootnote 5, chloramphenicolFootnote 21,Footnote 23, and trimethoprim/sulphametoxazoleFootnote 5.

Susceptibility to disinfectants: Chloramine-TFootnote 24, 60-90% ethanol and isopropanolFootnote 24, sodium hypochloriteFootnote 24, chlorhexidine digluconateFootnote 24, povidone-iodine solutionsFootnote 24, quaternary ammonium compound formulationsFootnote 24, and hydrogen peroxideFootnote 24,Footnote 25 are effective against other Haemophilus species.

Physical inactivation: Specific data for H. parainfluenzae is unavailable but inactivation of bacteria can be achieved using UV lightFootnote 26, microwave radiationFootnote 27, moist heat (121°C for 15 minutes), and dry heat (170°C for 1 hour)Footnote 28.

Survival outside host: Haemophilus species persist in mucous for up to 18 hoursFootnote 29.

Section V: First aid and medical

Surveillance: Monitor for symptoms. Specimens (e.g., throat swabs, blood) are cultured on chocolate agar with bacitracinFootnote 1,Footnote 5. Due to the high degree of heterogeneity among H. parainfluenzae strains, phenotypic test methods may not provide sufficient specificity to discriminate between H. parainfluenzae and closely related speciesFootnote 3,Footnote 30,Footnote 31,. H. parainfluenzae can be identified using 16S rRNA sequencing or MALDI-TOF mass spectrometryFootnote 3.

Note: The specific recommendations for surveillance in the laboratory should come from the medical surveillance program, which is based on a local risk assessment of the pathogens and activities being undertaken, as well as an overarching risk assessment of the biosafety program as a whole. More information on medical surveillance is available in the Canadian Biosafety Handbook (CBH).

First aid/Treatment: Acute H. parainfluenzae infections are treated immediately with appropriate antibiotics. Beta-lactam agents (e.g., amoxicillin, ampicillin), cephalosporins, aminoglycosides, or a combination of these are commonly prescribedFootnote 8,Footnote 32. Duration of antibiotic therapy depends on the infectionFootnote 13. In 40% of infective endocarditis cases caused by H. parainfluenzae, the treatment is surgical valve replacementFootnote 8,Footnote 32.

Note: The specific recommendations for first aid/treatment in the laboratory should come from the post-exposure response plan, which is developed as part of the medical surveillance program. More information on the post-exposure response plan can be found in the CBH.

Immunization: None.

Note: More information on the medical surveillance program can be found in the CBH, and by consulting the Canadian Immunization Guide.

Prophylaxis: None.

Note: More information on prophylaxis as part of the medical surveillance program can be found in the CBH.

Section VI: Laboratory hazards

Laboratory-acquired infections: None reported to date.

Note: Please consult the Canadian Biosafety Standard (CBS) and CBH for additional details on requirements and guidelines for reporting exposure incidents.

Sources/Specimens: Mucous, blood, and biopsy specimensFootnote 13.

Primary hazards: Autoinoculation and exposure of mucous membranes to infectious material.

Special hazards: None.

Section VII: Exposure controls and personal protection

Risk group classification: H. parainfluenzae is a Risk Group 2 human pathogen and a Risk Group 2 animal pathogenFootnote 33.

Containment requirements: Containment Level 2 facilities, equipment, and operational practices outlined in the CBS for work involving infectious or potentially infectious materials, animals, or culturesFootnote 34.

Protective clothing: The applicable Containment Level 2 requirements for personal protective equipment and clothing outlined in the CBS should be followedFootnote 34.

Note: A local risk assessment will identify the appropriate hand, foot, head, body, eye/face, and respiratory protection, and the PPE requirements for the containment zone should be documented in Standard Operating Procedures.

Other precautions: Procedures that produce aerosols, or involve high concentrations or large volumes of H. parainfluenzae should be conducted in a biological safety cabinet. The use of needles or other sharp objects should be limited when possibleFootnote 34.

Section VIII: Handling and storage

Spills: Allow aerosols to settle. Wearing protective clothing, gently cover the spill with absorbent paper towel and apply suitable disinfectant, starting at the perimeter and working towards the centre. Allow sufficient contact time before clean upFootnote 35.

Disposal: All materials/substances that have come in contact with the infectious agent must be completely decontaminated before they are removed from the containment zone. This can be achieved by using a decontamination method that has been demonstrated to be effective against the infectious material, such as chemical disinfectants, autoclaving, irradiation, incineration, an effluent treatment system, or gaseous decontaminationFootnote 35.

Storage: The applicable Containment Level 2 requirements for storage outlined in the CBS should be followed. Containers of infectious material or toxins stored outside the containment zone should be labelled, leakproof, impact resistant, and kept either in locked storage equipment or within an area with limited accessFootnote 35.

Section IX: Regulatory and other information

Regulatory information: The import, transport, and use of pathogens in Canada is regulated under many regulatory bodies, including the Public Health Agency of Canada, Health Canada, Canadian Food Inspection Agency, Environment and Climate Change Canada, and Transport Canada. Users are responsible for ensuring they are compliant with all relevant acts, regulations, guidelines, and standards.

Canadian Regulatory Context: At the time of publication of this PSDS, this pathogen is subject to official control. The following is a non-exhaustive list of applicable designations, regulation, or legislation:

Updated: August, 2019

Prepared by: Centre for Biosecurity, Public Health Agency of Canada.

Although the information, opinions, and recommendations contained in this Pathogen Safety Data Sheet are compiled from sources believed to be reliable, we accept no responsibility for the accuracy, sufficiency, or reliability or for any loss or injury resulting from the use of the information. Newly discovered hazards are frequent and this information may not be completely up to date.

Copyright © Public Health Agency of Canada, 2019, Canada



Footnote 1

Brenner, D. J., N. R. Krieg, J. T. Staley, and G. M. Garrity. 2005. Bergey's Manual of Systematic Bacteriology, Second Edition, Volume Two The Proteobacteria. Springer, United States.

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Footnote 2

Cardines, R., L. Daprai, M. Giufre, E. Torresani, M. L. Garlaschi, and M. Cerquetti. 2015. Genital carriage of the genus Haemophilus in pregnancy: species distribution and antibiotic susceptibility. J. Med. Microbiol. 64:724-730.

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Footnote 3

Nørskov-Lauritsen, N. 2014. Classification, identification, and clinical significance of Haemophilus and Aggregatibacter species with host specificity for humans. Clin. Microbiol. Rev. 27:214-240.

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Footnote 4

Ledeboer, N. A., and G. V. Doern. 2015. Haemophilus, p. 695. In J. H. Jorgensen, M. A. Pfaller, and K. C. Carroll (eds.), Manual of Clinical Microbiology. ASM Press.

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Footnote 5

Kosikowska, U., A. Biernasiuk, P. Rybojad, R. Los, and A. Malm. 2016. Haemophilus parainfluenzae as a marker of the upper respiratory tract microbiota changes under the influence of preoperative prophylaxis with or without postoperative treatment in patients with lung cancer. BMC Microbiol. 16:62-016-0679-6.

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Footnote 6

Simberkoff, M. S. 2016. Haemophilus and Moraxella Infections, p. 1946. In L. Goldman (ed.), Goldman-Cecil medicine. Elsevier Saunders.

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Footnote 7

Thuny, F. 2016. Diagnostic Criteria for Infective Endocarditis, p. 81. In G. Habib (ed.), Infective Endocarditis. Springer.

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Footnote 8

Darras-Joly, C., O. Lortholary, J. L. Mainardi, J. Etienne, L. Guillevin, and J. Acar. 1997. Haemophilus endocarditis: report of 42 cases in adults and review. Haemophilus Endocarditis Study Group. Clin. Infect. Dis. 24:1087-1094.

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Footnote 9

Chambers, S. T., D. Murdoch, A. Morris, D. Holland, P. Pappas, M. Almela, N. Fernández-Hidalgo, B. Almirante, E. Bouza, D. Forno, A. del Rio, M. M. Hannan, J. Harkness, Z. A. Kanafani, T. Lalani, S. Lang, N. Raymond, K. Read, T. Vinogradova, C. W. Woods, D. Wray, G. R. Corey, V. H. Chu, and International Collaboration on Endocarditis Prospective Cohort Study (ICE-PCS) Investigators. 2013. HACEK Infective Endocarditis: Characteristics and Outcomes from a Large, Multi-National Cohort. PLoS One. 8:e63181.

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Footnote 10

Watson, K. C., J. Grimstone, and A. E. O'Hare. 1981. Meningitis due to Haemophilus parainfluenzae. Journal of Infection. 3:380-384.

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Footnote 11

Govind, B., B. Veeraraghavan, S. Anandan, and N. Thomas. 2012. Haemophilus parainfluenzae: report of an unusual cause of neonatal sepsis and a literature review. J. Infect. Dev. Ctries. 6:748-750.

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Footnote 12

Rele, M., M. Giles, and A. J. Daley. 2006. Invasive Haemophilus parainfluenzae maternal-infant infections: an Australasian perspective and case report. Aust. N. Z. J. Obstet. Gynaecol. 46:258-260.

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Footnote 13

O'Neil, C. R., E. Wilson, and B. Missaghi. 2016. Bone and Joint Infections due to Haemophilus parainfluenzae: Case Report and Review of the Literature. Can. J. Infect. Dis. Med. Microbiol. 2016:4503025.

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Footnote 14

Hansson, S., A. Svedhem, M. Wennerstrom, and U. Jodal. 2007. Urinary tract infection caused by Haemophilus influenzae and Haemophilus parainfluenzae in children. Pediatr. Nephrol. 22:1321-1325.

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Footnote 15

Pollard, A., F. St Michael, L. Connor, W. Nichols, and A. Cox. 2008. Structural characterization of Haemophilus parainfluenzae lipooligosaccharide and elucidation of its role in adherence using an outer core mutant. Can. J. Microbiol. 54:906-917.

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Footnote 16

Hasan, N. A., B. A. Young, A. T. Minard-Smith, K. Saeed, H. Li, E. M. Heizer, N. J. McMillan, R. Isom, A. S. Abdullah, D. M. Bornman, S. A. Faith, S. Y. Choi, M. L. Dickens, T. A. Cebula, and R. R. Colwell. 2014. Microbial Community Profiling of Human Saliva Using Shotgun Metagenomic Sequencing. PLoS One. 9:e97699.

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Footnote 17

Houang, E., M. Philippou, and Z. Ahmet. 1989. Comparison of genital and respiratory carriage of Haemophilus parainfluenzae in men. J. Med. Microbiol. 28:119-123.

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Footnote 18

Souder, E., and J. Vodzak. 2018. Other Haemophilus Species and Aggregatibacter Species, p. 932. In S. S. Long, C. G. Prober, and M. Fischer (eds.), Principles and Practice of Pediatric Infectious Diseases, 5th Edition. Elsevier, Philadelphia, PA.

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Footnote 19

Coburn, B., B. Toye, P. Rawte, F. B. Jamieson, D. J. Farrell, and S. N. Patel. 2013. Antimicrobial susceptibilities of clinical isolates of HACEK organisms. Antimicrob. Agents Chemother. 57:1989-1991.

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Footnote 20

Abotsi, R. E., U. Govinden, and S. Y. Essack. 2017. Mechanisms of antibiotic resistance in Haemophilus parainfluenzae. Southern African Journal of Infectious Diseases. 32:111-114.

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Footnote 21

Tinguely, R., S. N. Seiffert, H. Furrer, V. Perreten, S. Droz, and A. Endimiani. 2013. Emergence of Extensively Drug-Resistant Haemophilus parainfluenzae in Switzerland. Antimicrob. Agents Chemother. 57:2867-2869.

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Footnote 22

Rubin, L. G. 2012. Other Gram-Negative Coccobacilli, p. 967. In S. S. Long, L. K. Pickering, and C. G. Prober (eds.), Principles and practice of pediatric infectious diseases. Elsevier Churchill Livingstone, Edinburgh; New York.

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Footnote 23

Cavanagh, P., C. A. Morris, and N. J. Mitchell. 1975. Chloramphenicol Resistance in Haemophilus Species. The Lancet. 305:696.

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Footnote 24

Rodriguez Ferri, E. F., S. Martinez, R. Frandoloso, S. Yubero, and C. B. Gutierrez Martin. 2010. Comparative efficacy of several disinfectants in suspension and carrier tests against Haemophilus parasuis serovars 1 and 5. Res. Vet. Sci. 88:385-389.

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Footnote 25

Miyasaki, K. T., R. J. Genco, and M. E. Wilson. 1986. Antimicrobial properties of hydrogen peroxide and sodium bicarbonate individually and in combination against selected oral, gram-negative, facultative bacteria. J. Dent. Res. 65:1142-1148.

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Footnote 26

Katara, G., N. Hemvani, S. Chitnis, V. Chitnis, and D. S. Chitnis. 2008. Surface disinfection by exposure to germicidal UV light. Indian. J. Med. Microbiol. 26:241-242.

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Footnote 27

Kakita, Y., M. Funatsu, F. Miake, and K. Watanabe. 1999. Effects of microwave irradiation on bacteria attached to the hospital white coats. Int. J. Occup. Med. Environ. Health. 12:123-126.

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Footnote 28

Hancock, C. O. 2013. Heat Sterilization, p. 277-293. In A. P. Fraise, P. A. Lambert, and J. Y. Maillard (eds.), Russell, Hugo & Ayliffe's: Principles and Practice of Disinfection, Preservation and Sterilization, Fifth Edition. Wiley-Blackwell.

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Footnote 29

Murphy, T. V., J. F. Clements, M. Petroni, S. Coury, and L. Stetler. 1989. Haemophilus influenzae type b in respiratory secretions. Pediatr. Infect. Dis. J. 8:148-151.

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Footnote 30

Lau, S. K. P., P. C. Y. Woo, M. Mok, J. L. L. Teng, V. K. P. Tam, K. K. H. Chan, and K. Yuen. 2004. Characterization of Haemophilus segnis, an Important Cause of Bacteremia, by 16S rRNA Gene Sequencing. J. Clin. Microbiol. 42:877-880.

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Footnote 31

Rennie, R. P., C. Brosnikoff, S. Shokoples, L. B. Reller, S. Mirrett, W. Janda, K. Ristow, and A. Krilcich. 2008. Multicenter evaluation of the new Vitek 2 Neisseria-Haemophilus identification card. J. Clin. Microbiol. 46:2681-2685.

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Footnote 32

Revest, M., G. Egmann, V. Cattoir, and P. Tattevin. 2016. HACEK endocarditis: state-of-the-art. Expert Rev. Anti Infect. Ther. 14:523-530.

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Footnote 33

Public Health Agency of Canada. 2015. Human Pathogens and Toxins Act (HPTA), Ottawa, Canada.

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Footnote 34

Government of Canada. 2015. Canadian Biosafety Standard, Ottawa, Canada.

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Footnote 35

Government of Canada. 2016. Canadian Biosafety Handbook, 2nd edition, Ottawa, Canada.

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