Pathogen Safety Data Sheet: Infectious Substances - Haemophilus parainfluenzae
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- Section I: Infectious agent
- Section II: Hazard identification
- Section III: Dissemination
- Section IV: Stability and viability
- Section V: First aid and medical
- Section VI: Laboratory hazards
- Section VII: Exposure controls and personal protection
- Section VIII: Handling and storage
- Section IX: Regulatory and other information
Section I: Infectious agent
Name: Haemophilus parainfluenzae
Agent type: Bacteria
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
Zoonosis/Reverse zoonosis: 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.
Note: More information on the medical surveillance program can be found in the CBH, and by consulting the Canadian Immunization Guide.
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
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- Footnote 15
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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.
- Footnote 18
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- Footnote 19
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- Footnote 20
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- Footnote 21
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- Footnote 28
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- Footnote 33
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- Footnote 35
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