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
• References

Section I: Infectious agent

Name: Haemophilus parainfluenzae
Agent type: Bacteria

Taxonomy

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 length^{Footnote 1}. They are opportunistic pathogens that occur in the oral cavity, pharynx, and lower genital tract^{Footnote 1Footnote 2}.

Haemophilus species can be cultured on blood agar; addition of bacitracin prevents growth of most other bacteria found in the oral cavity^{Footnote 1}. X factor is not required for growth of H. parainfluenzae; V factor is required for most strains^{Footnote 1,Footnote 3}. Strains of H. parainfluenzae are genetically diverse and phenotypically heterogenous for many of the enzymes typically used to classify bacteria^{Footnote 1,Footnote 3,Footnote 4}. Eight biotypes of H. parainfluenzae have been identified, which are based on production of tryptophanase, urease, and ornithine decarboxylase^{Footnote 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 hours^{Footnote 5}.

Section II: Hazard identification

Pathogenicity/toxicity: H. parainfluenzae is of low pathogenicity but is occasionally implicated in cases of systemic infection^{Footnote 1}. It is also responsible for about 1-3% of infective endocarditis cases^{Footnote 3,Footnote 6}. Symptoms associated with infective endocarditis include presence of a new regurgitant murmur and fever^{Footnote 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 meningitis^{Footnote 6,Footnote 10}, respiratory tract infections, bacteremia^{Footnote 5} neonatal sepsis^{Footnote 11,Footnote 12}, osteomyelitis^{Footnote 13}, pneumonia, and genitourinary tract infections^{Footnote 1,Footnote 14}.

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

H. parainfluenzae is not known to cause disease in animals, as the host range is restricted to humans^{Footnote 3}.

Communicability: Vertical transmission of H. parainfluenzae resulting in neonatal infections has been reported^{Footnote 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 contact^{Footnote 16,Footnote 17}.

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

Host range: Humans^{Footnote 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 cefuroxime^{Footnote 13,Footnote 19}; meropenem^{Footnote 13,Footnote 19}; aminoglycosides, such as gentamicin^{Footnote 9}; amoxicillin-clavulanic acid; and levofloxacin^{Footnote 19}.

Drug resistance: Resistance profiles are highly variable; multidrug resistant isolates have been reported^{Footnote 5,Footnote 20,Footnote 21}. Some isolates are not susceptible to beta-lactams, such as ampicillin^{Footnote 2,Footnote 5}; cephalosporins, such as ceftazidime and cefazoline^{Footnote 5}; quinolones such as ciprofloxacin^{Footnote 13,Footnote 20}; macrolides such as clarithromycin^{Footnote 20,Footnote 22}; azalides^{Footnote 20}; ketolides^{Footnote 20}; licoasamides^{Footnote 20}; or streptogramins^{Footnote 20}. Resistance has also been reported to tetracycline^{Footnote 5}, chloramphenicol^{Footnote 21,Footnote 23}, and trimethoprim/sulphametoxazole^{Footnote 5}.

Susceptibility to disinfectants: Chloramine-T^{Footnote 24}, 60-90% ethanol and isopropanol^{Footnote 24}, sodium hypochlorite^{Footnote 24}, chlorhexidine digluconate^{Footnote 24}, povidone-iodine solutions^{Footnote 24}, quaternary ammonium compound formulations^{Footnote 24}, and hydrogen peroxide^{Footnote 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 light^{Footnote 26}, microwave radiation^{Footnote 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 hours^{Footnote 29}.

Section V: First aid and medical

Surveillance: Monitor for symptoms. Specimens (e.g., throat swabs, blood) are cultured on chocolate agar with bacitracin^{Footnote 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 species^{Footnote 3,Footnote 30,Footnote 31,}. H. parainfluenzae can be identified using 16S rRNA sequencing or MALDI-TOF mass spectrometry^{Footnote 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 prescribed^{Footnote 8,Footnote 32}. Duration of antibiotic therapy depends on the infection^{Footnote 13}. In 40% of infective endocarditis cases caused by H. parainfluenzae, the treatment is surgical valve replacement^{Footnote 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 specimens^{Footnote 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 pathogen^{Footnote 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 cultures^{Footnote 34}.

Protective clothing: The applicable Containment Level 2 requirements for personal protective equipment and clothing outlined in the CBS should be followed^{Footnote 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 possible^{Footnote 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 up^{Footnote 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 decontamination^{Footnote 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 access^{Footnote 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:

• Human Pathogen and Toxins Act and Regulations
• Transportation of Dangerous Goods Regulations

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

References