bNonhemolytic variants of Haemophilus haemolyticus are difficult to differentiate from Haemophilus influenzae despite a wide difference in pathogenic potential. A previous investigation characterized a challenging set of 60 clinical strains using multiple PCRs for marker genes and described strains that could not be unequivocally identified as either species. We have analyzed the same set of strains by multilocus sequence analysis (MLSA) and near-full-length 16S rRNA gene sequencing. MLSA unambiguously allocated all study strains to either of the two species, while identification by 16S rRNA sequence was inconclusive for three strains. Notably, the two methods yielded conflicting identifications for two strains. Most of the "fuzzy species" strains were identified as H. influenzae that had undergone complete deletion of the fucose operon. Such strains, which are untypeable by the H. influenzae multilocus sequence type (MLST) scheme, have sporadically been reported and predominantly belong to a single branch of H. influenzae MLSA phylogenetic group II. We also found evidence of interspecies recombination between H. influenzae and H. haemolyticus within the 16S rRNA genes. Establishing an accurate method for rapid and inexpensive identification of H. influenzae is important for disease surveillance and treatment.
Haemophilus influenzae is an important human pathogen involved in respiratory tract infections, such as sinusitis, acute otitis media, pneumonia, and exacerbations in chronic obstructive pulmonary disease (1-5). The majority of these infections are caused by unencapsulated H. influenzae, traditionally designated nontypeable H. influenzae (NTHi). Haemophilus haemolyticus is a close relative of H. influenzae, and the two species colonize the upper respiratory tract of humans. Although H. haemolyticus has, on rare occasion, been isolated from invasive infections (6), several lines of evidence indicate that the pathogenicity of H. haemolyticus is much reduced compared with H. influenzae. While up to 20% of presumptive H. influenzae nasopharyngeal isolates can be identified as H. haemolyticus by molecular characterization (7-9), H. haemolyticus is rarely cultured from middle ear fluid (10, 11), supporting the view that H. haemolyticus, in contrast to NTHi, is a respiratory commensal infrequently associated with otitis media. Reinvestigation of presumptive H. influenzae isolates, cultured from lower respiratory tract samples from cystic fibrosis patients (12) or from unselected clinical samples submitted to the laboratory on suspicion of lower respiratory tract infection (13), detected that Ͻ1% were misidentified strains, further supporting a minor pathogenic role for H. haemolyticus.H. haemolyticus was traditionally identified by its hemolytic action on erythrocytes, but it has become clear that a large proportion of H. haemolyticus strains is nonhemolytic (10,14). Such strains, which are designated as nonhemolytic H. haemolyticus, can only be differentiated from H. influenzae by DNA sequencing or extended phen...