We measured concentrations of Haemophilus influenzae type b (Hib)
polysaccharide antigen by ELISA in urine samples from 81 healthy North American children with positive or negative throat cultures for Hib, to investigate the possibility that asymptomatic carriers may have antigenuria. For comparison, we determined the concentrations of Hib
polysaccharide antigen in urine samples from 56 patients with proven Haemophilus disease, including 13 children with lower
respiratory infections who resided in developing countries. Among the healthy children,
antigen was detected in the urine of seven of 19 (37%) carriers of Hib compared with one of 62 (2%) children with negative throat cultures (p less than 0.001). Among the patients with invasive
Haemophilus infections, 93% had
antigen detected. Although there was overlap in the concentrations of
antigen in the positive urines from the asymptomatic carriers and those of the ill patients, the concentrations of the ill patients were higher than those of the carriers. The respective geometric means of the positive patients were: American patients with
meningitis, 42.5 ng/mL (range 1.7-9800 ng/mL); American patients with
infections not involving the CNS, 5.8 ng/mL (range: 1.0-96 ng/mL); patients from developing countries with lower
respiratory infections, 29.6 ng/mL (range: 0.9-5290), and American asymptomatic carriers, 1.9 ng/mL (range: 0.6-16.7 ng/mL). Thus, antigenuria is present in a high proportion of healthy children with positive throat cultures for Hib, and the
antigen concentrations of the carriers overlap those of ill patients. These results suggest that either mucosal colonization itself is sufficient to produce
antigen-uria, or asymptomatic carriers may be experiencing asymptomatic invasive
Hib infection.