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Invasive Nontypeable Haemophilus influenzae Infection Among Adults With HIV in Metropolitan Atlanta, Georgia, 2008-2018
JAMA ( IF 63.1 ) Pub Date : 2019-12-24 , DOI: 10.1001/jama.2019.18800
Lauren F Collins 1, 2 , Fiona P Havers 3, 4 , Amy Tunali 1, 2 , Stephanie Thomas 1, 2 , Julie A Clennon 5 , Zanthia Wiley 1 , Melissa Tobin-D'Angelo 2, 6 , Tonia Parrott 2, 6 , Timothy D Read 1, 2 , Sarah W Satola 1, 2 , Robert A Petit 1, 2 , Monica M Farley 1, 2, 4
Affiliation  

Importance Invasive nontypeable Haemophilus influenzae (NTHi) infection among adults is typically associated with bacteremic pneumonia. Nontypeable H influenzae is genetically diverse and clusters of infection are uncommon. Objective To evaluate an increase in invasive NTHi infection from 2017-2018 among HIV-infected men who have sex with men in metropolitan Atlanta, Georgia. Design, Setting, and Participants A population-based surveillance study with a cohort substudy and descriptive epidemiological analysis identified adults aged 18 years or older with invasive NTHi infection (isolation of NTHi from a normally sterile site) between January 1, 2008, and December 31, 2018 (final date of follow-up). Exposures Time period, HIV status, and genetic relatedness (ie, cluster status) of available NTHi isolates. Main Outcomes and Measures The primary outcome was incidence of invasive NTHi infection (from 2008-2016 and 2017-2018) among persons with HIV and compared with NTHi infection from 2008-2018 among those without HIV. The secondary outcomes were assessed among those aged 18 to 55 years with invasive NTHi infection and included epidemiological, clinical, and geographic comparisons by cluster status. Results Among 553 adults with invasive NTHi infection (median age, 66 years [Q1-Q3, 48-78 years]; 52% male; and 38% black), 60 cases occurred among persons with HIV. Incidence of invasive NTHi infection from 2017-2018 among persons with HIV (41.7 cases per 100 000) was significantly greater than from 2008-2016 among those with HIV (9.6 per 100 000; P < .001) and from 2008-2018 among those without HIV (1.1 per 100 000; P < .001). Among adults aged 18 to 55 years with invasive NTHi infections from 2017-2018 (n = 179), persons with HIV (n = 31) were significantly more likely than those from 2008-2018 without HIV (n = 124) to be male (94% vs 49%, respectively; P < .001), black (100% vs 53%; P < .001), and have septic arthritis (35% vs 1%; P < .001). Persons with HIV who had invasive NTHi infection from 2017-2018 (n = 31) were more likely than persons with HIV who had invasive NTHi infection from 2008-2016 (n = 24) to have septic arthritis (35% vs 4%, respectively; P = .01). Pulsed-field gel electrophoresis of 174 of 179 NTHi isolates from 18- to 55-year-olds identified 2 genetically distinct clonal groups: cluster 1 (C1; n = 24) and cluster 2 (C2; n = 23). Whole-genome sequencing confirmed 2 clonal lineages of NTHi infection and revealed all C1 isolates (but none of the C2 isolates) carried IS1016 (an insertion sequence associated with H influenzae capsule genes). Persons with HIV were significantly more likely to have C1 or C2 invasive NTHi infection from 2017-2018 (28/31 [90%]) compared with from 2008-2016 among persons with HIV (10/24 [42%]; P < .001) and compared with from 2008-2018 among those without HIV (9/119 [8%]; P < .001). Among persons with C1 or C2 invasive NTHi infection who had HIV (n = 38) (median age, 34.5 years; 100% male; 100% black; 82% men who have sex with men), 32 (84%) lived in 2 urban counties and an area of significant spatial aggregation was identified compared with those without C1 or C2 invasive NTHi infection. Conclusions and Relevance Among persons with HIV in Atlanta, the incidence of invasive nontypeable H influenzae infection increased significantly from 2017-2018 compared with 2008-2016. Two unique but genetically related clonal strains were identified and were associated with septic arthritis among black men who have sex with men and who lived in geographic proximity.

中文翻译:

2008-2018 年佐治亚州亚特兰大市成年 HIV 感染者的侵袭性不可分型流感嗜血杆菌感染

重要性 成人中侵袭性不可分型流感嗜血杆菌 (NTHi) 感染通常与菌血症性肺炎有关。不可分型的流感嗜血杆菌具有遗传多样性,感染群并不常见。目的 评估 2017 年至 2018 年在佐治亚州亚特兰大市的男男性行为 HIV 感染者中侵袭性 NTHi 感染的增加情况。设计、设置和参与者 一项基于人群的监测研究,包括队列亚研究和描述性流行病学分析,确定了 2008 年 1 月 1 日至 12 月 31 日期间 18 岁或以上的成人侵袭性 NTHi 感染(从正常无菌部位分离 NTHi) , 2018 年(随访的最后日期)。暴露可用 NTHi 分离株的时间段、HIV 状态和遗传相关性(即集群状态)。主要结果和措施 主要结果是 HIV 感染者的侵袭性 NTHi 感染发生率(2008-2016 年和 2017-2018 年),并与 2008-2018 年非 HIV 感染者的 NTHi 感染率进行了比较。次要结果在 18 至 55 岁的侵袭性 NTHi 感染患者中进行评估,包括按集群状态进行的流行病学、临床和地理比较。结果 在 553 名患有侵袭性 NTHi 感染的成年人中(中位年龄,66 岁 [Q1-Q3,48-78 岁];52% 为男性;38% 为黑人),其中 60 例发生在 HIV 感染者中。2017-2018 年 HIV 感染者的侵袭性 NTHi 感染发生率(每 10 万人 41.7 例)显着高于 2008-2016 年 HIV 感染者(每 10 万人 9.6 例;P < .001)和 2008-2018 年没有 HIV(每 100 000 人中有 1.1 人;P < .001)。在 2017 年至 2018 年感染 NTHi 的 18 至 55 岁成年人(n = 179)中,艾滋病毒感染者(n = 31)明显高于 2008 年至 2018 年未感染艾滋病毒的人(n = 124)为男性(分别为 94% 对 49%;P < .001)、黑人(100% 对 53%;P < .001)和感染性关节炎(35% 对 1%;P < .001)。2017-2018 年感染 NTHi 的 HIV 感染者 (n = 31) 比 2008-2016 年感染 NTHi 的 HIV 感染者 (n = 24) 更容易患化脓性关节炎(分别为 35% 和 4% ; P = .01)。对来自 18 至 55 岁人群的 179 个 NTHi 分离株中的 174 个进行脉冲场凝胶电泳鉴定了 2 个遗传上不同的克隆群:簇 1 (C1; n = 24) 和簇 2 (C2; n = 23)。全基因组测序证实了 NTHi 感染的 2 个克隆谱系,并显示所有 C1 分离株(但没有一个 C2 分离株)携带 IS1016(与流感嗜血杆菌荚膜基因相关的插入序列)。与 2008 年至 2016 年期间的 HIV 感染者相比,HIV 感染者在 2017 年至 2018 年期间感染 C1 或 C2 侵袭性 NTHi 的可能性显着高于 2008 年至 2016 年(10/24 [42%];P < . 001) 并与 2008-2018 年未感染 HIV 的人群进行比较 (9/119 [8%]; P < .001)。在感染 HIV 的 C1 或 C2 侵袭性 NTHi 感染者(n = 38)(中位年龄,34.5 岁;100% 男性;100% 黑人;82% 男男性行为者)中,32 人(84%)生活在 2与没有 C1 或 C2 侵袭性 NTHi 感染的县相比,确定了城市县和显着空间聚集区域。结论和相关性 在亚特兰大 HIV 感染者中,与 2008-2016 年相比,2017-2018 年侵袭性不可分型 H 流感病毒感染的发生率显着增加。在与男性发生性关系且居住在地理上接近的黑人男性中,发现了两种独特但与遗传相关的克隆菌株,并与脓毒性关节炎有关。
更新日期:2019-12-24
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