Invasive non-type b haemophilus influenzae disease: report of eight cases / Doença invasiva causada por haemophilus influenzae não tipo b: relato de oito casos

ASTRACT Objective: To describe eight cases of invasive non-type b Haemophilus influenzae disease in children admitted to Hospital de Clínicas of Universidade Estadual de Campinas. Cases description: In 2015, there were eight cases of invasive non-type b H. influenzae disease. We tested the ampicillin sensitivity and beta-lactamase production of the strains identified and performed the genotyping. Molecular typing was determined by Pulsed-Field Gel Electrophoresis. Four patients were diagnosed with bacteremia; in two cases, H. influenzae was detected in the pleural fluid, and two patients had meningitis. Patients with comorbidities represented 37.5% of cases. Except for the strain of one patient - not sent to the reference laboratory -, all were ampicillin-sensitive and non-beta-lactamase-producing. Genotyping identified four non-capsular, one type c, and two type a strains. Molecular typing ruled out nosocomial transmission since all serotypes were distinct regarding genotype. Comments: The rise in cases of invasive non-type b H. influenzae infection was real. There was no nosocomial transmission, and we found no justification for the increase. These data indicate the need for surveillance to correctly diagnose, monitor, and understand the spectrum of non-type b H. influenzae disease.

ABSTRACT Objetivo: Descrever oito casos de doença invasiva por Haemophilus influenzae não tipo b em crianças internadas no Hospital de Clínicas da Universidade Estadual de Campinas. Descrição dos casos: Em 2015, ocorreram oito casos de doença invasiva por H. influenzae não tipo b. Nas cepas identificadas, testou-se a sensibilidade à ampicilina e a produção de betalactamase, e realizou-se a genotipagem. A tipagem molecular foi feita por Pulsed Field Gel Electrophoresis. Em quatro pacientes, o diagnóstico foi de bacteremia; em dois casos, H. influenzae foi identificado em líquido pleural, e dois pacientes tiveram meningite. Comorbidades foram encontradas em 37,5% dos pacientes. Com exceção da cepa de um dos pacientes (que não foi enviada ao laboratório de referência), todas eram sensíveis à ampicilina e não produtoras de betalactamase. A genotipagem identificou quatro cepas não capsulares, uma cepa tipo c e duas cepas tipo a. A tipagem molecular descartou a transmissão intra-hospitalar, já que todos os sorotipos eram distintos quanto ao genótipo. Comentários: O aumento dos casos de infecção invasiva por H. influenzae não tipo b foi real. Não houve transmissão intra-hospitalar e não foi encontrada justificativa para o aumento. Esses dados indicam a necessidade de vigilância para diagnosticar corretamente, monitorar e entender o espectro da doença causada por H. influenzae não tipo b.

Meningite por Haemophilus influenzae tipo f / Meningitis due to Haemophilus influenzae type f

Com o declínio da taxa de infecções causadas pelo Haemophilus influenzae tipo b após a ampla introdução da vacina, sorotipos não-b devem ser considerados agentes patogênicos potenciais em crianças menores de 5 anos com doença invasiva. Relatamos um caso de meningite por Haemophilus influenzae tipo f em um lactente imunocompetente de 1 ano. O agente foi identificado em líquido cefalorraquidiano e hemocultura. A sorotipagem foi realizada por testes com soros policlonais e confirmada por reação em cadeia de polimerase. Todas as cepas de Haemophilus influenzae associadas à doença invasiva deveriam ser sorotipadas e notificadas, a fim de possibilitar uma análise adequada das mudanças e tendências na distribuição de sorotipos desta doença.

With the decline in the rate of infections caused by Haemophilus influenzae serotype b since the widespread vaccination, non-b serotypes should be considered as potential pathogenic agents in children with invasive disease younger than 5 years old. We report the case of an immunocompetent 1-year-old boy with Haemophilus influenzae type f meningitis. The agent was identified in cerebrospinal fluid and blood cultures. Serotyping was performed by tests using polyclonal sera and confirmed by polymerase chain reaction. All Haemophilus influenzae isolates associated with invasive disease should be serotyped and notified as a way to evaluate the changes and trends in serotype distribution of this disease.

Multi locus sequence type comparison of invasive and commensal Haemophilus influenzae isolates from Delhi.

Haemophilus influenzae is a major public health concern in the developing world. The most virulent strain is H. influenzae Type b (Hib). Hib also constitutes a major portion of nasopharyngeal commensal flora in otherwise healthy individuals. Through dendogram based on composite gene sequences of seven multi locus sequence type genes, it was observed that invasive and commensal isolates made two completely separate clusters which are indicative of independent evolution of these two groups of H. influenzae in the Indian subcontinent.

Ribotyping, biotyping and capsular typing of Haemophilus influenzae strains isolated from patients in Campinas, southeast Brazil

Forty-five Haemophilus influenzae strains isolated from patients were characterized based on biochemical characteristics. Their capsular types were determined by polymerase chain reaction (PCR); they were compared, using two molecular methods [ribotyping with a specific DNA probe amplified from the 16S rDNA region from H. influenzae and through restriction fragment length polymorphism (RLFP) of an amplified 16S DNA region]. The strains were better discriminated by the ribotyping technique that used the 16S probe and by the combination of both techniques. Biotypes I and IV were the most common, followed by biotypes VI, VIII and III. Biotypes II and VII were not found. Most of the capsular samples were nontypable (89 percent), with capsular types a and b found in 2 and 9 percent of the samples, respectively. We concluded that there is a very close genetic identity among pathogenic and non-pathogenic strains.

Caracterización de aislamientos invasivos de S. pneumoniae, H. influenzae y N. meningitidis en América Latina y el Caribe: SIREVA II, 2000-2005 / Characterization of invasive isolates of S. pneumoniae, H. influenzae, and N. meningitidis in Latin America and the Caribbean: SIREVA II, 2000-2005

OBJETIVOS: Analizar las características fenotípicas y la susceptibilidad a antibióticos de las cepas circulantes de Streptococcus pneumoniae, Haemophilus influenzae y Neisseria meningitidis en América Latina y el Caribe entre 2000 y 2005. Se evaluó la cobertura potencial de las vacunas conjugadas. MÉTODOS: Se estudió por métodos convencionales la distribución de los serotipos o serogrupos de 17 303 cepas de S. pneumoniae, 2 782 cepas de H. influenzae y 6 955 cepas de N. meningitidis aisladas de casos de neumonía, meningitis, sepsis, bacteriemias y otros procesos invasivos. Se evaluó la susceptibilidad a los antibióticos de las cepas estudiadas. Los aislamientos procedían de 453 centros centinelas de 19 países de América Latina y 4 del Caribe, como parte del proyecto SIREVA II. RESULTADOS: El serotipo 14 de S. pneumoniae fue el más frecuentemente aislado (21,1 por ciento), especialmente en niños menores de 6 años (29,1 por ciento). Las coberturas potenciales de las vacunas conjugadas antineumocócicas hepta, nona, deca y tridecavalentes fueron de 59,0 por ciento, 73,4 por ciento, 76,5 por ciento y 85,9 por ciento, respectivamente. De los aislamientos, 63,3 por ciento eran sensibles a la penicilina. El serotipo b de H. influenzae estuvo presente en 72,2 por ciento de los aislamientos en niños menores de 2 años, mientras 8,6 por ciento correspondieron a los serotipos a, c, d, e y f; 19,2 por ciento resultaron no serotipables. La proporción de cepas de H. influenzae productoras de betalactamasa en aislamientos en niños menores de 2 años fue de 16,3 por ciento. Los serogrupos de N. meningitidis más frecuentes fueron el B (69,0 por ciento) y el C (25,7 por ciento); 65,8 por ciento y 99,2 por ciento de las cepas fueron sensibles a la penicilina y a la rifampicina, respectivamente. CONCLUSIONES: Estos resultados resaltan la importancia de la vigilancia epidemiológica integral de S. pneumoniae, H. influenzae y N. meningitidis en América Latina...

OBJECTIVES: To analyze the phenotypical characteristics and the susceptibility to antibiotics of the circulating strains of Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis circulating in Latin America and the Caribbean from 2000-2005. Potential coverage by conjugate vaccines was evaluated. METHODS: Conventional methods were used to study the distribution of the serotypes or serogroups of 17 303 strains of S. pneumoniae, 2 782 strains of H. influenzae, and 6 955 strains of N. meningitidis isolated from cases of pneumonia, meningitis, sepsis, bacteriemias, and other invasive processes. The antimicrobial susceptibilities of the study strains were evaluated. The isolates came from 453 sentinel surveillance sites in 19 countries in Latin America and four in the Caribbean, as part of the SIREVA II (Network Surveillance System for the Bacterial Agents Responsible for Pneumonia and Meningitis) project. RESULTS: S. pneumoniae serotype 14 was the most frequently isolated (21.1 percent), especially in children under 6 years of age (29.1 percent). The potential coverages by hepta-, nona-, deca-, and trideca-valent antipneumonia conjugate vaccines were 59.0 percent, 73.4 percent, 76.5 percent, and 85.9 percent, respectively. Of the isolates, 63.3 percent were sensitive to penicillin. H. influenzae serotype b was present in 72.2 percent of the isolations from children under 2 years of age, whereas 8.6 percent produced serotypes a, c, d, e, and f, and 19.2 percent could not be serotyped. The rate of H. influenzae beta-lactamase-producing strains isolated from children under 2 years of age was 16.3 percent. The most frequent N. meningitidis serogroups were B (69.0 percent) and C (25.7 percent); 65.8 percent and 99.2 percent of the strains were susceptible to penicillin and rifampicin, respectively. CONCLUSIONS: These results highlight the importance of comprehensive epidemiological surveillance of S. pneumoniae, H. influenzae...

Tipificación capsular mediante PCR de aislamientos de Haemophilus influenzae no tipificables por aglutinación / PCR-based capsular typing of Haemophilus influenzae isolates non-typeable by agglutination

Haemophilus influenzae es reconocido como un agente patógeno responsable de infecciones localizadas y sistémicas. Se han descrito 6 tipos de polisacáridos capsulares antigénicamente distintos (a, b, c, d, e, y f ) que se pueden identificar por aglutinación en lámina con antisueros específicos. También existen cepas no capsuladas (NC) fenotípicamente no tipificables (NT). La introducción de la vacuna conjugada produjo una marcada disminución de las enfermedades invasivas causadas por H. influenzae tipo b. En este contexto, la tipificación capsular mediante PCR es el método más apropiado para distinguir las cepas no capsuladas de las mutantes b deficientes en cápsula (b-) y detectar la presencia de cepas pertenecientes a otros serotipos que no puedan ser tipificables por aglutinación. Se determinó el genotipo capsular a 38 aislamientos de Haemophilus influenzae no tipificables por aglutinación, derivados al servicio de Bacteriología Clínica del INEI-ANLIS "Dr. Carlos G. Malbrán" en el período 2002-2004. El 78,9% de los aislamientos provenían de hemocultivos y la mayor parte de ellos estaban asociados a foco respiratorio. El 100% de los aislamientos fueron identificados como H. influenzae no capsulados mediante la técnica de PCR.

Haemophilus influenzae is recognized as a pathogenic agent responsible of localized and systemic infections. Six antigenically different capsular polysaccharide types have been described (a, b, c, d, e, and f ) which can be identified by slide agglutination with specific antisera. Besides there are non capsulated strains that cannot be typed by slide agglutination. The introduction of the conjugated vaccine produced an important reduction of invasive diseases caused by H. influenzae type b. Capsular typing by PCR is the most appropriated method for distinguishing non capsulated strains from capsule deficient type b mutants (b-) and for detecting strains of other serotypes that cannot be detected by slide agglutination. Capsular genotype was studied in 38 isolates of non-typeable Haemophilus influenzae received at INEIANLIS "Dr. Carlos G. Malbrán" between 2002-2004. Of the isolates included in this study 78.9% of them were recovered from blood cultures and most of them were associated with a respiratory focus. By PCR technique 100% of the isolates were identified as non-capsulate H. influenzae and genotype b-was not detected.

Aislamiento de distintos serotipos de Haemophilus influenzae en muestras profundas de pacientes pediátricos / Isolation of Haemophilus influenzae serotypes from sterile sites in sick children

Haemophilus influenzae (Hi) es responsable de diversas enfermedades humanas como sepsis, meningitis, celulitis y osteoartritis. En este trabajo se investigó la recuperación de distintos serotipos de Hi en muestras profundas de pacientes pediátricos. Se estudiaron 179 aislamientos de 146 niños durante el periodo 1996-2002 en el Laboratorio de Microbiología del Hospital de Niños Superiora Sor María Ludovica, Argentina. La distribución de los serotipos fue la siguiente: 1 a, 112 b, 1 c,1 d, 4 e, 3 f y 24 no tipificables. A partir del establecimiento de la estrategia de vacunación universal anti Hi b en 1998 se observa una disminución notable del serotipo b y un aumento relativo de otros y no tipificables.

Haemophilus influenzae (Hi) is the causative agent of several human diseases such as sepsis, meningitis, celulitis, and osteoarthritis. We investigated the isolation of Hi serotypes from sterile sites in sick children. One hundred and seventy nine strains from 146 patients were studied, period 1996-2002, at the Microbiology Laboratory, Hospital de Niños Superiora Sor María Ludovica, Argentina. The serotype distribution was:1 a, 112 b,1 c,1 d, 4 e, 3 f y 24 no typable. Since the beginning of universal Hi b vaccination in 1998, we have observed the fast decrease of serotype b and a relative increase of other serotypes.

Resistance pattern of bacteria isolated from acute respiratory tract infection (ARI) cases.

Out of 350 acute respiratory tract infection (ARI) patients 110 (31.4%) were positive on culture. Among then (35.5%) yielded from upper respiratory tract infection (URI) and 64.5% yielded from lower respiratory tract infection (LRI). Predominant bacterial isolates from URI were Staph aureus (12.4%) and Strepto. pyogen (9.8%) whereas predominant agent from LRI were Strepto. pneumoniae (14.7%) and Haemophilus influenzae (8.6%). Capsular typing by polymerase chain reaction (PCR) and type specific antisera revealed that 64.7% of the isolates were type-b and rest were non-b. The most frequent resistance pattern of H. influenzae was found resistant to penicillin-ampicillin (64.7%) followed by SMX-TMP (14.7%) and tetracycline (5.9%). Among penicillin-ampicillin resistant strains, 81.8% were beta lectamase positive and 18.2% were beta lectamase negative. Among beta lectamase positive strains 66.7% were capsular type-b and 33.3% were non-b, had MICS < or = 8 microgram/ml. and < or = 4 microgram/ml. respectively. 5.9% strains of Strepto. pneumoniae was found resistant to SMX-TMP, 5.9% to penicillin-ampicillin and 2.9% to cephalexin. Common resistance pattern of Staph aureus was penicillin-ampicillin (60%), SMX-TMP (37.2%) and tetracycline-erythromycine-cephalexin (11.4%). Strepto. pyogen was found resistant to tetracycline in 12.2% cases and to SMX-TMP in 8.3% cases.

Serotypes and antimicrobial susceptibility in clinical isolates of Haemophilus influenzae from Korean children in prevaccination era

Fifty-five strains of Haemophilus influenzae recovered at a children's hospital in Korea from 1992 through 1997, were analyzed for serotype and antibiotic resistance. Antimicrobial susceptibility was tested by broth dilution method. Among the 55 strains, 26 were from normally sterile body fluids, of which 17 were from the immunocompetent children. Spectrum in the immunocompetent included meningitis (47%), bacteremic pneumonia (18%), and bacteremia without focus (35%). Three (12%) of 26 invasive infections were caused by non-type b: one type d and two type f. Nine of 29 non-sterile body fluid isolates belonged to one of encapsulted serotypes: four a, two c, one of each of b, d and e. Thirty two (58%) strains were resistant to ampicillin, and all of which produced beta-lactamase. All of the strains were highly susceptible to amoxicillin/clavulanate, cefixime, cefuroxime, azithromycin and ciprofloxacin, while 1 (2%), 7 (13%), 4 (7%) and 4 (7%) strains were intermediate to cefprozil, cefaclor, loracarbef, and clarithromycin, respectively. The serotype distribution of H. influenzae in Korean children is similar to those in developed countries before the introduction of Hib conjugate vaccine, and ampicillin resistance rate is among the highest published to date.

Biotypes and Serotypes of Haemophilus influenzae of clincial isolates from Mexican children

Background. Infectious diseases caused by H. influenzae type b are considered preventable through vaccination with Hib conjugate vaccines. Some countries which follow Hib vaccination programs are close to eradication of the disease. In Mexico in particular, little epidemiological information is available. Methods. In this study, 90 clinical strains of H. influenzae were obtained from Mexican children who were treated in four pediatric hospitals in Puebla City, and were diagnosed with invasive or localized infectious diseases. The strains were identified by standard bacteriological methods. Biotyping was done by Kilian criteria and serotyping by coagglutination. Results. H. influenzae infections were found in children younger than 5 years of age, and 68.6 percent of the children were younger than 24 months. Sixty percent of the isolates belonged to serotype b, 31.1 percent were nontypeable, and 7.7 percent were considerer nontype b. Serotype b was the most frequent isolate associated with invasive infectious diseases; however, nontypeable strains were isolated more frequently froms children with otitis, sinusitis, conjunctivitis, and bronchial secretion. Non-type b serotypes were isolated from invasive and non-invasive infections in few cases. Biotypes I and IV were the most frequent isolates of H. influenzae. Conclusions. This study emphasizes the urgent need for an Hib-conjugated vaccine to achieve immunization in a pediatric population

Caracterización de cepas de haemophilus influenzae mediante fermentación de azúcares / Characterization of Haemophilus influenzae by carbohydrate fermentation

Se caracterizaron 64 cepas de haemophilus influenzae circulantes en Ciudad de la Habana durante 1 a por el método de fermentación de azúcares, por primera vez en Cuba. El patrón fermentativo D fue el más frecuentemente encontrado. Los patrones D y G en conjunto constituyeron el 72 por ciento del total de cepas estudiadas. La combinación de la fermentación de azúcares con el serotipaje y el biotipaje permitió una mayor diferenciación de las cepas (14 grupos). Los patrones A, B, C y F aparecieron en niños mayores de 6 meses y el G en el grupo de 6 a 18 meses. En la meningoencefalitis bacteriana predominan los patrones D y G, existió una mayor heterogeneidad en las cepas aisladas de infecciones respiratorias agudas. Se señalan algunas ventajas de este método de subtipificación de cepas de Haemophilus influenzae como son: la sencillez, facilidad de realizar e interpretar y no requerir de un personal calificado ni de un laboratorio especializado para su ejecución

Characterisation of invasive Haemophilus influenzae isolated in Nagpur, central India.

A total of 14 invasive H. influenzae were isolated from 12 patients by culturing 621 samples of body fluids over a span of one year. Twelve non-replicate isolates were analyzed for their drug susceptibility and serotype distribution. Eight (66.7%) isolates were multiply drug resistant with resistance to ampicillin, chloramphenicol and cotrimoxazole in different combinations. All isolates were susceptible to cefotaxime and erythromycin. Serotype b accounted for 10 (83.3%) isolates while one each were type a and non-typeable respectively. A continuous surveillance of drug susceptibility and serotype distribution is important to determine changes in the behaviour of the organism over time.

Caracterización de las enfermedades por Haemophilus influenzae tipo B en Costa Rica / Caracterization of the diseases due to haemophilus influenzae type B in Costa Rica

Las infecciones por Hib fueron la principal causa de infecciones invasivas en pacientes menores de 5 años en países en vías de desarrollo. Esta diferencia es debido al uso generalizado, desde hace algunos años, de la vacuna contra este agente en los países industrializados, documentándose una disminución anual de más del 90 por ciento en el número de infecciones por Hib.

Upper airway carriage by Haemophilus influenzae and Streptococcus pneumoniae in Australian aboriginal children hospitalised with acute lower respiratory infection.

When nasopharyngeal secretions from 171 Australian Aboriginal children hospitalized with acute lower respiratory tract infections (ALRI) were cultured selectively for Streptococcus pneumoniae and Haemophilus influenzae, 136 (79.5%) and 151 (88.3%) children yielded 166 and 254 isolates of S. pneumoniae and H. influenzae, respectively. In colonized subjects multiple populations of S. pneumoniae (20% of carriage-positive patients) and H. influenzae (55%) were common. Pneumococci belonging to 27 types or groups were identified. H. influenzae serotype b colonized 16.4% of all children studied. More than one half of 152 children tested were excreting antibiotics at the time of admission to hospital. Significantly fewer children with serum antibiotic residues were colonized with S. pneumoniae than were antibiotic free children. Antibiotic usage had no measurable impact on the isolation rate of H. influenzae.

Caracteres biológicos de Hemophilus influenzae aislado de diferentes poblaciones infantiles / Biological characteristics of Haemophilus influenzae isolated from different infantile populations

Las características biológicas de Hemophilus influenzae aisladas de áreas normalmente estériles o de la orofaringe de niños, no han sido descritas en el Uruguay. Esta información tiene importante implicancia en la comprensión de la patogenia de esas infecciones y en los requisitos para lograr una vacuna adecuada. Con tal fin se determinaron los serotipos y biotipos en 54.3 por ciento de las cepas aisladas entre 1986 y 1992. Además en la totalidad de las cepas conservadas (n=311) se investigó la producción de ß lactamasas. Se demostró que la resistecia a los ß lactámicos era poco frecuente (5.9 por ciento ). Las cepas invasivas, recuperadas de la sangre, derrame pleural o LCR, pertenecían en su mayoría, al serotipo b y al biotipo I (83.4 por ciento ). En las infecciones del oído medio predominaron los H. influenzae no tipificables, así como entre las cepas que colonizaban la orofaringe de pacientes y niños sanos, pero en estos casos los biotipos fueron diversos, con 38 por ciento correspondiendo al biotipo II. Las vacunas conjugadas conteniendo polisacárido capsular del serotipo b, prevendrían los cuadros invasivos, pero no se lograría el control de infecciones por otros serotipos y por cepas no tipificables

Haemophilus influenzae tipo b: subtipificacíon de cepas aisladas de infecciones respiratorias mediante los perfiles de proteínas de la membrana externa / Haemophilus influenzae type B: subtyping of strains isolated from respiratory infections using the outer membrane protein profiles

Se utilizó la electroforesis en un gel desnaturalizante de poliacrilamida para separar las proteínas de la membrana externa (pme) obtenidas mediante un micrométodo de extracción. Ello sirvió para subclasificar a H. influenzae b biotipo I en distintos subtipos de acuerdo a los perfiles observados. Se analizaron 37 cepas de H. influenzae b aisladas de niños con infección respiratoria aguda inferior (IRAD) y 3 de las fauces de portadores de igual sexo, edad y nivel socioeconómico, menores de cuatro años y recuperadas con la misma estacionalidad. De ellas, 27 pertenecieron al biotipo I. De acuerdo al perfil de PME, los 27 H. influenzae b biotipo I se subdividieron en 8 subtipos. La probabilidad de que dos aislamientos tomados al azar presenten diferentes subtipos de acuerdo a los perfiles de PME fue de 0.733. El subtipo que presentó mayor frecuencia fue el denominado "a", observándose tanto en las cepas invasivas como en las aisladas de fauces de los casos con IRAI y de las fauces de los niños sanos. El empleo del gel desnaturalizante de poliacrilamida al 14% permitió evidenciar la presencia de la proteína P1 con su característica de presentar distintos pesos moleculares, así como las proteínas presentes en el rango de peso molecular 25-40 KD. La mayoría de los perfiles de PME presentaron la proteína P1 de mayor peso molecular. Las condiciones de crecimiento de las cepas y la adaptación del micrométodo de extracción de PME utilizados en este estudio son procedimientos simples y al alcance de todo laboratorio clínico. Además, requiere menor insumo de tiempo que los métodos clásicos. La combinación de biotipificación, serotipificación, y determinación del perfil de PME, mostró ser un arma epidemiológicamente útil para analizar la infección a H. influenzae b.

Febre purpúrica brasileira. Caracterizaçäo rápida das cepas invasoras de Haemophilus aegyptius / Brazilian purpuric fever. Fast characterization of invasive strains of Haemophilus aegyptius

Cepas de H. aegyptus isoladas em surtos de Febre Purpúrica Brasileira (FPB) no Brasil, foram caracterizadas pelo método de aglutinaçäo em lâmina utilizando um anti-soro produzido com cepa de H. aegyptius isolada de cultura de sangue de paciente com FPB. Através desse método foi possível identificar cepas de H. aegyptius responsáveis por surtos de conjuntivite com características antigênicas iguais às cepas isoladas de FPB. A sensibilidade e especificidade da soroaglutinaçäo em lâmina foi de 97,7% e 89,6% respectivamente, podendo ser utilizado como método de triagem em estudos de conjuntivites purulentas, para detectar cepas invasivas de H. aegyptius associada a FPB, possibilitando assim a implantaçäo de medias que ampliem a eficiência na prevençäo e na vigilância epidemiológica da doença