Moraxella catarrhalis Infection

Moraxella catarrhalis Infection

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Moraxella catarrhalis is a gram-negative, aerobic, oxidase-positive diplococcus that was first described in 1896. The organism has also been known as Micrococcus catarrhalis, Neisseria catarrhalis, and Branhamella catarrhalis; currently, it is considered to belong to the subgenus Branhamella of the genus Moraxella. For most of the 20th century, M catarrhalis was considered a saprophyte of the upper respiratory tract that was associated with no significant pathogenic consequences.

Various diagnostic studies and procedures may be warranted, depending on the site of the infection and underlying conditions. Confirmation of the diagnosis of M catarrhalis infection is based on culture. Any of a number of antimicrobial drugs may be used to treat M catarrhalis infection, depending on the need for use of oral or parenteral medication, the age of the patient, any underlying conditions present, the sensitivity of the organism, and the desired spectrum of coverage.

Studies have shown that M catarrhalis colonizes the upper respiratory tract in 28-100% of humans in the first year of life. In adults, the colonization rate is 1-10.4%. Colonization appears to be an ongoing process with an elimination-colonization turnover of various strains. Transmission is believed to be due to direct contact with contaminated secretions by droplets.

The endotoxin of M catarrhalis, a lipopolysaccharide similar to those found in Neisseria species, may play a role in the disease process. Some strains of M catarrhalis have pili or fimbriae, which may facilitate adherence to the respiratory epithelium. Some strains produce a protein that confers resistance to complement by interfering with the formation of the membrane attack complex. M catarrhalis also expresses specific proteins for iron uptake that act as receptors for transferrin and lactoferrin.

M catarrhalis has been shown to have increased cell adhesion and proinflammatory responses when cold shock (26°C for 3 hours) occurs. Physiologically, this may occur with prolonged exposure to cold air temperatures, resulting in coldlike symptoms. [1]

Humoral responses against M catarrhalis appear to be age-dependent, with the titer of immunoglobulin G (IgG) gradually increasing in children. Antibody responses to outer-membrane proteins have been obtained, predominantly in the IgG3 subclass.

Although the commensal status of M catarrhalis in the nasopharynx is still accepted, the organism is a common cause of otitis media and sinusitis and an occasional cause of laryngitis. M catarrhalis causes bronchitis and pneumonia in children and adults with underlying chronic lung disease and is occasionally a cause of bacteremia and meningitis, especially in immunocompromised persons. Bacteremia can be complicated by local infections, such as osteomyelitis or septic arthritis. M catarrhalis is also associated with nosocomial infections.

M catarrhalis is the third most common cause of otitis media and sinusitis in children (after Streptococcus pneumoniae and Haemophilus influenzae). M catarrhalis is estimated to be responsible for 3-4 million cases of otitis media annually, with an associated health care cost (direct and indirect) of $2 billion each year.

M catarrhalis infections may occur at any age. Although colonization is more common in children, only a small percentage of positive cultures findings have clinical significance in the pediatric population. In one study, 9% of cultures positive for M catarrhalis in children younger than 5 years and 33% of isolates from children aged 6-10 years were found to be clinically significant. However, all cultures positive for M catarrhalis had clinical importance in adults.

In one study involving adult patients, the male-to-female ratio was 1.6:1.

The prognosis of M catarrhalis infection is poor in hospitalized patients with underlying conditions, especially the following:

Patients hospitalized for prolonged periods

Patients in pulmonary units or pediatric intensive care units

Patients of advanced age

The most significant infections caused by M catarrhalis are upper respiratory tract infections (URTIs) such as otitis media and sinusitis in children and lower respiratory tract infections (LRTIs) in adults. Infections with M catarrhalis in adults are more common if underlying conditions are present, especially if the patient is elderly. In a study of 42 cases of pneumonia with M catarrhalis isolated as the single agent in sputum cultures, the mortality rate attributable to the underlying problems within 3 months of pneumonia was 45%. [2]

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Michael Constantinescu, MD Staff Pathologist, Overton Brooks Veterans Affairs Medical Center

Michael Constantinescu, MD is a member of the following medical societies: American Society for Clinical Pathology, College of American Pathologists, United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

Joseph A Bocchini, Jr, MD Medical Director of Children’s Hospital; Member, Pediatric Infectious Disease Section, Chairman, Professor, Department of Pediatrics, Louisiana State University School of Medicine in Shreveport

Joseph A Bocchini, Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Ronald Silberman, PhD Director of Clinical Microbiology Laboratory, Louisiana State University Hospital; Professor, Department of Pathology, Louisiana State University School of Medicine in Shreveport

Disclosure: Nothing to disclose.

James D Cotelingam, MBBS, MD Head of Hematopathology, Director of Clinical Laboratories, Professor, Department of Pathology, Louisiana State University School of Medicine in Shreveport

James D Cotelingam, MBBS, MD is a member of the following medical societies: American Association for Physician Leadership, American Society for Clinical Pathology, Association of Military Surgeons of the US, College of American Pathologists, New York Academy of Sciences

Disclosure: Nothing to disclose.

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Joseph F John Jr, MD, FACP, FIDSA, FSHEA Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina College of Medicine; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center

Disclosure: Nothing to disclose.

Maria D Mileno, MD Associate Professor of Medicine, Division of Infectious Diseases, The Warren Alpert Medical School of Brown University

Maria D Mileno, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, International Society of Travel Medicine, and Sigma Xi

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Moraxella catarrhalis Infection

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