HACEK GROUP

BAUSIN, HANNA ISABELA S.

BELTRAN, FRANCHETTE LORRAINE M.

LAYLAY, MA. ERICKA ANNE R.

 HACEK GROUP
• Haemophilus spp.
- Aggregatibacter aphrophilus (previously Haemophilus aphrophilus)
- Haemophilus paraphropilus
• Aggregatibacter spp.
- Aggregatibacter actinomycetemcomitans (previously Actinobacillus
actinomycetemcomitans)
GENERAL CHARACTERISTICS
• Gram (-) rods
• Capnophilic
• Non-motile
• Fastidious
• More dysgonic- slower or poorer growing (Except Haemophilus spp.)
• Endocarditis - involved in heart valves
• Nonfermentative
• Normal biota of the oral cavity
• Opportunistic and required a compromised host
HAEMOPHILUS SPP

• small, pleomorphic gram (-) coccobacilli

• positive for cytochrome oxidase
• No growth in MacConkey agar
• Growth in culture requires exogenous hemin (oxidized
ferroprotoporphyrin) (X factor) and/or nicotinamide
adenine dinucleotide (NAD) (V factor)
• sheep blood contains NADase, a V factor-destroying
enzyme, and consequently clinical strains of
Haemophilus do not grow on standard 5% sheep blood
agar
• Heating sheep blood agar at 80oC denatures NADase
and heat-lysis of red cells releases free NAD (chocolate
agar)
• Growth of Haemophilus on chocolate agra in the
presence of 5-10% CO2
• Contemporary chocolate agar is a synthetic "mix" of
NAD, hemoglobin, vitamins (cobalamin, thiamine,
hydrochloride), minerals (iron, magnesium), cysteine,
glutamine and glucose
MOST COMMON SPECIES OF
HAEMOPHILUS

•Haemophilus influenzae
•Haemophilus parainfluenzae
•Haemophilus aphrophilus
•Haemophilus ducreyi
HAEMOPHILUS: NATURAL HABITAT

• Natural inhabitant of the upper respiratory, gastrointestinal,

and genital tracts of humans except H. ducreyi

• H. ducreyi found only in humans during disease (not normal

microbial flora)
MODES OF INFECTION

• Encapsulated strains of H. influenzae associated with invasive

infection by person-to-person spread of H. influenzae due to
inhalation of infectious respiratory droplets

• Type b H. influenzae was most commonly associated with

disease prior to conjugate vaccine but prevalence has declined
with advent of vaccination
 PATHOGENICITY

Organism Disease and Infection

Haemophilus influenza Encapsulated strains: Meningitis, Epiglottitis
Cellulitis with bacteremia, Septic arthritis
Pneumonia
Nonencapsulated strains
Localized infections: Otitis media, Sinusitis
Conjunctivitis
Immunocompromised patients: Chronic bronchitis, Pneumonia, Bacteremia
Haemophilus ducreyi Chancroid; genital lesions progress from tender papules (i.e.,
small bumps) to painful ulcers with several satellite lesions;
regional lymphadenitis is common
Other Haemophilus spp. Associated with wide variety of infections similar to H. influenzae;
and Aggregatibacter spp. A. aphrophilus is an uncommon cause of endocarditis and is
the H member of the HACEK group of bacteria associated with
slowly progressive (subacute) bacterial endocarditis
 AGGREGATIBACTER APHROPHILUS

• Foaming lover or needing high • CLINICAL FEATURES:

[CO2] • Fever

• Most prevalent species in the • Heart murmur

group producing endocarditis • Congestive heart failure

• H. aphrophilus and H. • Embolism

paraphrophilus have been recently

reclassified as a single specie
• Contains V factor in/dependent
 AGGREGATIBACTER ACTINOCETEMCOMITANS

• Formely known as ACTINOBACILLUS • Virulence Factor:

• Small bacilli to coccid gram-negative Collagenase-toxic to polymorphonuclear
bacilli cells
• 6 serotype (a-f) Leukotoxin monocytes
- A, B & C are the most common
• Normal oral microbiota
• Subacute bacterial endocarditis
Cultural Characteristics
• Ferments glucose, maltose,
mannitol & xylose
• Catalase +
• “Star shape with 4-6 points” in
the center of the colonies
• Very small cocobacillus in
Gram stain
• Small colonies that adhere
to agar
• Culture media:
• Brain Heart Infusion
• Trypticase soy agar
 DISEASE ACQIURED

- MODE OF TRANSMISSION:
• Enters in deeper tissue by minor trauma to mouth, such as during dental procedures
- DISEASE:
• Causative agent of SUBACUTE BACTERIAL
• ENDOCARDITIS with an insidious and protracted presentation, usually treated by
penicillin.
• PERIODONTITIS- “inflammation around the tooth and gum
SENSITIVITY TO PENICILLIN

- ISOLATES ARE SUSCEPTIBLE TO:

• Aminoglycosides
• Cephalosporins
• Quinolones
• Chloramphenicol
• Tetracycline

• * RESISTANCE TO VANCOMYCIN AND ERYTHROMYCIN

KINGELLA
GENERAL CHARACTERISTICS
• Cocobacilli “short bacilli with squared ends that occur in pairs or short chain”
• They tend to resist decolorization in the gram staining
Note: if the isolate does not pit the agar as many strains do can resemble
Neisseria gonorrhoeae.
• They are tend nutritionally fastidious
• Fermenters of glucose and other sugar with no gas
• Oxidase positive
• Catalase negative
Cultural morphology Infection
• may grow on Neisseria • They colonize the upper
selective agar(Thayer respiratory tract
Martin Medium) specially the tonsils
• usually susceptible to • Poor dental hygiene or
most agents , including oral surgery associated
PENICILLIN with infection
Kingella kingae
• Are recognized as an important pathogen in the pediatric population.
• Weakly ferments glucose and maltose but negative in sucrose
• Produces yellow brown pigments
Two types of colony morphology
• Spreading corroding colony or smooth convex and ß-hemolytic colony
• The hemolysis may appear beneath the colony or in close proximity after
24hrs and after 48hrs of incubation
• It is major gram negative bacterium isolated from denigrative joint and
bone infection (osteoarthritis)
Kingella denitrificans
• positive for glucose fermentation and nitrate reduction and might grow at 46°C
• both catalase and superoxol are negative.
• It is negative for urease and indole esculin gelatin citrate
• Does not grow on MAC agar
Two types of colonies morphology
• smooth and convex type and Spreading corroding type
• this spp. is rarely isolated as a pathogen but has been associated with bacteremia
Kingella oralis
• newly described species in the human oral cavity
• The mean percentage of K. oralis in total microbiota in the dental plaque
ranged from 0.40% in the periodontally healthy group to 4.60% in localized
juvenile periodontitis subjects. The organism was a significant species in a
few periodontitis sites, constituting > 5% of the total microbiota.
Periodontitis-Most common disease because
of HACEK bacteria

“inflammation around the tooth"

it is a serious gum infection that damages
the soft tissue and bone that supports the tooth.
 Organism

catalase

maltose
sucrose
oxidase
glucose

lactose
Gram Colony
COMMENTS
staining Morphology

A. Aphrophilus - V + + + + Small Raised, convex,

granular,
coccobacillus yellowish

A. + V + + - -
Very small Small colonies
actinomycetemc coccobacillus that adhere to
omitans agar

C. Hominis - + + + + - Smooth,
Straight bacillis, opaque,
spindle, rosettes adherent to
Indole (+)
agar
Eikenella - + - - - - Smell like
Usually pits the
corrodens Straight rods agar
bleach
Ornithine (+)
Kingella kingae - + + + - - Coccoid to 2 types: spreading
straight bacili, & corroiding or
chains and smooth & convex Nitrate (-)
pairs beta hemolysis