eMedicine Specialties > Infectious Diseases > Bacterial Infections

Moraxella Catarrhalis Infections

Author: Michael Constantinescu, MD, Staff Pathologist, Christus St Frances Cabrini Hospital
Coauthor(s): Joseph A Bocchini, Jr, MD, Medical Director of Children's Hospital, Director of Clinical Virology Laboratory, Chairman, Professor, Chief of Infectious Disease Section, Department of Pediatrics, Louisiana State University at Shreveport; Ronald Silberman, PhD, Director of Clinical Microbiology Laboratory, Louisiana State University Hospital; Professor, Department of Pathology, Louisiana State University Medical Center at Shreveport; James D Cotelingam, MBBS, MD, Head of Hematopathology, Director of Clinical Laboratories, Professor, Department of Pathology, Louisiana State University at Shreveport
Contributor Information and Disclosures

Updated: Nov 17, 2009

Introduction

Background

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. For most of the 20th century, M catarrhalis was considered a saprophyte of the upper respiratory tract associated with no significant pathogenic consequences.

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.

Pathophysiology

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

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.

Frequency

United States

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.

Mortality/Morbidity

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

Sex

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

Age

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.

Clinical

History

  • Common cold: In 29% of common-cold episodes due to bacterial pathogens (including M catarrhalis), affected children continued to be symptomatic 10 days after the first appearance of symptoms.1
  • Otitis media: A clinical history of acute otitis media and otitis media with effusion with symptoms includes otalgia, fever, and hearing loss. Otitis media is a very common condition, especially in children. Approximately 70% of children have at least one episode of otitis media during childhood. M catarrhalis has been isolated in 3%-17.3% of middle ear exudates in children with otitis media.2,3
  • Sinusitis: Clinical history commonly includes headache, pain in the maxillary or frontal area, fever, and cough. Young children present with persistent nasal discharge (lasting >2 wk) and cough, especially at night. M catarrhalis has been isolated in 22% of maxillary sinus aspirates in children as a single pathogen and in 72% of aspirates in combination with other organisms such as S pneumoniae and/or H influenzae.4
  • Lower respiratory tract infections
    • Adult patients with a history of conditions such as chronic obstructive pulmonary disease (COPD), pneumoconiosis, asthma, malignancies, or immunosuppression, with findings characteristic of bronchitis or pneumonia or exacerbations of their underlying condition, may have an M catarrhalis infection. Lower respiratory tract infections with M catarrhalis were also associated with smoking in 77% of patients in a meta-analysis. M catarrhalis was isolated from sputum and transtracheal aspirate specimens at rates of 0.2%-8.1%. In more than 30% of cases, H influenzae and/or S pneumoniae was isolated in addition to M catarrhalis.5,6,7,8
    • In children, lower respiratory tract infections have been associated with a history of recent respiratory syncytial virus or cytomegalovirus infection or with more debilitating conditions such as bronchopulmonary dysplasia, ventricular septal defect, leukemia, Arnold-Chiari syndrome, prematurity, or HIV infection.9,10
  • Nosocomial infections: Outbreaks of infections with M catarrhalis have been reported, mostly involving pulmonary units or pediatric intensive care units.
  • Bacteremia: No primary site of infection was found in 46% of patients with M catarrhalis bacteremia. Bacteremia is rare with M catarrhalis community-acquired pneumonia.11 The following conditions have been found to predispose to M catarrhalis bacteremia:
  • Endocarditis: M catarrhalis endocarditis has been described in patients with previous history of valvular conditions or prosthesis, as well as in patients who were previously healthy. It has also been described as a complication of balloon angioplasty.12,13
  • Sporadic cases of other infections with M catarrhalis include the following:
    • Meningitis
    • Neonatal ophthalmia
    • Septic arthritis
    • Keratitis
    • Urinary tract infection
    • Wound infection
    • Peritonitis in patients on dialysis
    • Conjunctivitis
    • Periorbital cellulitis14
    • Acute urethritis resembling gonorrhea15

Physical

Physical findings in M catarrhalis infections are similar to findings of infections with other organisms in the same location.

More on Moraxella Catarrhalis Infections

Overview: Moraxella Catarrhalis Infections
Differential Diagnoses & Workup: Moraxella Catarrhalis Infections
Treatment & Medication: Moraxella Catarrhalis Infections
Follow-up: Moraxella Catarrhalis Infections
References
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References

  1. Pappas DE, Hendley JO, Hayden FG, et al. Symptom profile of common colds in school-aged children. Pediatr Infect Dis J. Jan 2008;27(1):8-11. [Medline].

  2. Gehanno P, Panajotopoulos A, Barry B, et al. Microbiology of otitis media in the Paris, France, area from 1987 to 1997. Pediatr Infect Dis J. Jun 2001;20(6):570-3. [Medline].

  3. Li WC, Chiu NC, Hsu CH, et al. Pathogens in the middle ear effusion of children with persistent otitis media: implications of drug resistance and complications. J Microbiol Immunol Infect. Sep 2001;34(3):190-4. [Medline].

  4. Wald ER. Microbiology of acute and chronic sinusitis in children and adults. Am J Med Sci. Jul 1998;316(1):13-20. [Medline].

  5. Hunter MH, King DE. COPD: management of acute exacerbations and chronic stable disease. Am Fam Physician. Aug 15 2001;64(4):603-12. [Medline].

  6. Lieberman D, Lieberman D, Ben-Yaakov M, et al. Infectious etiologies in acute exacerbation of COPD. Diagn Microbiol Infect Dis. Jul 2001;40(3):95-102. [Medline].

  7. Sethi S, Murphy TF. Bacterial infection in chronic obstructive pulmonary disease in 2000: a state-of-the-art review. Clin Microbiol Rev. Apr 2001;14(2):336-63. [Medline]. [Full Text].

  8. Soler N, Torres A, Ewig S, et al. Bronchial microbial patterns in severe exacerbations of chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation. Am J Respir Crit Care Med. May 1998;157(5 Pt 1):1498-505. [Medline].

  9. Aronovitz G. Treatment of upper and lower respiratory tract infections: clinical trials with cefprozil. Pediatr Infect Dis J. Aug 1998;17(8 Suppl):S83-8. [Medline].

  10. Manfredi R, Nanetti A, Valentini R, et al. Moraxella catarrhalis pneumonia during HIV disease. J Chemother. Oct 2000;12(5):406-11. [Medline].

  11. Thórsson B, Haraldsdóttir V, Kristjánsson M. Moraxella catarrhalis bacteraemia. A report on 3 cases and a review of the literature. Scand J Infect Dis. 1998;30(2):105-9. [Medline].

  12. Neumayer U, Schmidt HK, Mellwig KP, et al. Moraxella catarrhalis endocarditis: report of a case and literature review. J Heart Valve Dis. Jan 1999;8(1):114-7. [Medline].

  13. Stefanou J, Agelopoulou AV, Sipsas NV, et al. Moraxella catarrhalis endocarditis: case report and review of the literature. Scand J Infect Dis. 2000;32(2):217-8. [Medline].

  14. Tritton D, Watts T, Sieratzki JS. Peri-orbital cellulitis and sepsis by Branhamella catarrhalis. Eur J Pediatr. Jul 1998;157(7):611-2. [Medline].

  15. Abdolrasouli A, Amin A, Baharsefat M, et al. Moraxella catarrhalis associated with acute urethritis imitating gonorrhoea acquired by oral-genital contact. Int J STD AIDS. Aug 2007;18(8):579-80. [Medline].

  16. Uehara Y, Yagoshi M, Tanimichi Y, Yamada H, Shimoguchi K, Yamamoto S, et al. Impact of reporting gram stain results from blood culture bottles on the selection of antimicrobial agents. Am J Clin Pathol. Jul 2009;132(1):18-25. [Medline]. [Full Text].

  17. Roland PS, Kreisler LS, Reese B, et al. Topical ciprofloxacin/dexamethasone otic suspension is superior to ofloxacin otic solution in the treatment of children with acute otitis media with otorrhea through tympanostomy tubes. Pediatrics. Jan 2004;113(1 Pt 1):e40-6. [Medline]. [Full Text].

  18. Swanson RN, Lainez-Ventosilla A, De Salvo MC, et al. Once-daily azithromycin for 3 days compared with clarithromycin for 10 days for acute exacerbation of chronic bronchitis: a multicenter, double-blind, randomized study. Treat Respir Med. 2005;4(1):31-9. [Medline].

  19. Sethi S, Anzueto A, Farrell DJ. Antibiotic activity of telithromycin and comparators against bacterial pathogens isolated from 3,043 patients with acute exacerbation of chronic bronchitis. Ann Clin Microbiol Antimicrob. Mar 8 2005;4:5. [Medline].

  20. Dore DD, DiBello JR, Lapane KL. Telithromycin use and spontaneous reports of hepatotoxicity. Drug Saf. 2007;30(8):697-703. [Medline].

  21. Hwang PH. A 51-year-old woman with acute onset of facial pressure, rhinorrhea, and tooth pain: review of acute rhinosinusitis. JAMA. May 6 2009;301(17):1798-807. [Medline].

  22. McMichael JC. Progress toward the development of a vaccine to prevent Moraxella (Branhamella) catarrhalis infections. Microbes Infect. Apr 2000;2(5):561-8. [Medline].

  23. McMichael JC. Vaccines for Moraxella catarrhalis. Vaccine. Dec 8 2000;19 Suppl 1:S101-7. [Medline].

  24. O'Brien MA, Prosser LA, Paradise JL, Ray GT, Kulldorff M, Kurs-Lasky M, et al. New vaccines against otitis media: projected benefits and cost-effectiveness. Pediatrics. Jun 2009;123(6):1452-63. [Medline].

  25. Abuhammour WM, Abdel-Haq NM, Asmar BI, et al. Moraxella catarrhalis bacteremia: a 10-year experience. South Med J. Nov 1999;92(11):1071-4. [Medline].

  26. Bitnun A, Allen UD. Medical therapy of otitis media: use, abuse, efficacy, and morbidity. J Otolaryngol. 1998;27 Suppl 2:26-36. [Medline].

  27. Bootsma HJ, van Dijk H, Vauterin P, et al. Genesis of BRO beta-lactamase-producing Moraxella catarrhalis: evidence for transformation-mediated horizontal transfer. Mol Microbiol. Apr 2000;36(1):93-104. [Medline].

  28. Christensen JJ. Moraxella (Branhamella) catarrhalis: clinical, microbiological and immunological features in lower respiratory tract infections. APMIS Suppl. 1999;88:1-36. [Medline].

  29. de Lalla F. Cefixime in the treatment of upper respiratory tract infections and otitis media. Chemotherapy. Sep 1998;44 Suppl 1:19-23. [Medline].

  30. Enright MC, McKenzie H. Moraxella (Branhamella) catarrhalis--clinical and molecular aspects of a rediscovered pathogen. J Med Microbiol. May 1997;46(5):360-71. [Medline].

  31. Gunnarsson RK, Holm SE, Söderström M. The prevalence of potential pathogenic bacteria in nasopharyngeal samples from healthy children and adults. Scand J Prim Health Care. Mar 1998;16(1):13-7. [Medline].

  32. Johnson DM, Biedenbach DJ, Beach ML, et al. Antimicrobial activity and in vitro susceptibility test development for cefditoren against Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus species. Diagn Microbiol Infect Dis. Jun 2000;37(2):99-105. [Medline].

  33. Karalus R, Campagnari A. Moraxella catarrhalis: a review of an important human mucosal pathogen. Microbes Infect. Apr 2000;2(5):547-59. [Medline].

  34. McGregor K, Chang BJ, Mee BJ, et al. Moraxella catarrhalis: clinical significance, antimicrobial susceptibility and BRO beta-lactamases. Eur J Clin Microbiol Infect Dis. Apr 1998;17(4):219-34. [Medline].

  35. Mikucka A, Janicka G, Krawiecka D, et al. Antibiotic-sensitivity of Moraxella catarrhalis isolated from clinical materials in 1997-1998. Med Sci Monit. Mar-Apr 2000;6(2):300-4. [Medline].

  36. Miravitlles M, Espinosa C, Fernandez-Laso E, et al. Relationship between bacterial flora in sputum and functional impairment in patients with acute exacerbations of COPD. Study Group of Bacterial Infection in COPD. Chest. Jul 1999;116(1):40-6. [Medline].

  37. Murphy TF. Lung infections. 2. Branhamella catarrhalis: epidemiological and clinical aspects of a human respiratory tract pathogen. Thorax. Feb 1998;53(2):124-8. [Medline].

  38. Cunha BA. Pneumonia Essentials. 2nd Ed. Royal Oak, MI: Physicians Press; 2008.

  39. Principi N. Oral cephalosporins in the treatment of acute otitis media. Clin Microbiol Infect. 2000;6 Suppl 3:61-3. [Medline].

  40. Pérez JL, Pulido A, Pantozzi F, et al. Butyrate esterase (4-methylumbelliferyl butyrate) spot test, a simple method for immediate identification of Moraxella (Branhamella) catarrhalis [corrected]. J Clin Microbiol. Oct 1990;28(10):2347-8. [Medline].

  41. Traub WH, Leonhard B. Susceptibility of Moraxella catarrhalis to 21 antimicrobial drugs: validity of current NCCLS criteria for the interpretation of agar disk diffusion antibiograms. Chemotherapy. May-Jun 1997;43(3):159-67. [Medline].

  42. Varon E, Levy C, De La Rocque F, et al. Impact of antimicrobial therapy on nasopharyngeal carriage of Streptococcus pneumoniae, Haemophilus influenzae, and Branhamella catarrhalis in children with respiratory tract infections. Clin Infect Dis. Aug 2000;31(2):477-81. [Medline].

  43. Walker ES, Neal CL, Laffan E, et al. Long-term trends in susceptibility of Moraxella catarrhalis: a population analysis. J Antimicrob Chemother. Feb 2000;45(2):175-82. [Medline].

  44. Wise R, Andrews JM. A comparison of the activity of ciprofloxacin and levofloxacin with other agents against respiratory tract pathogens. J Chemother. Aug 1998;10(4):276-9. [Medline].

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Further Reading

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Keywords

Moraxella catarrhalis, Neisseria catarrhalis, N catarrhalis, Micrococcus catarrhalis, M catarrhalis, Branhamella catarrhalis, B catarrhalis, upper respiratory tract infections, lower respiratory tract infections, otitis media, sinusitis, chronic obstructive pulmonary disease, COPD, pneumonia, Moraxella catarrhalis infection, M catarrhalis infection, M catarrhalis endocarditis, M catarrhalis pneumonia, M catarrhalis otitis media, M catarrhalis sinusitis, M catarrhalis bacteremia, Moraxella catarrhalis endocarditis , Moraxella catarrhalis pneumonia , Moraxella catarrhalis otitis media , Moraxella catarrhalis sinusitis , Moraxella catarrhalis bacteremia

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Contributor Information and Disclosures

Author

Michael Constantinescu, MD, Staff Pathologist, Christus St Frances Cabrini Hospital
Michael Constantinescu, MD is a member of the following medical societies: American Society for Clinical Pathology, College of American Pathologists, and United States and Canadian Academy of Pathology
Disclosure: Nothing to disclose.

Coauthor(s)

Joseph A Bocchini, Jr, MD, Medical Director of Children's Hospital, Director of Clinical Virology Laboratory, Chairman, Professor, Chief of Infectious Disease Section, Department of Pediatrics, Louisiana State University at 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, and 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 Medical Center at Shreveport
Ronald Silberman, PhD is a member of the following medical societies: American Society for Microbiology
Disclosure: Nothing to disclose.

James D Cotelingam, MBBS, MD, Head of Hematopathology, Director of Clinical Laboratories, Professor, Department of Pathology, Louisiana State University at Shreveport
James D Cotelingam, MBBS, MD is a member of the following medical societies: American College of Physician Executives, American Society for Clinical Pathology, Association of Military Surgeons of the US, College of American Pathologists, and New York Academy of Sciences
Disclosure: Nothing to disclose.

Medical Editor

Maria D Mileno, MD, Assistant Professor, Department of Internal Medicine, Division of Infectious Diseases, 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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Joseph F John Jr, MD, FACP, FIDSA, FSHEA, Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center
Disclosure: BioMerieux Honoraria Review panel membership; Cubist Honoraria Review panel membership; Pfizer Honoraria Speaking and teaching; Merck Stock dividends stock holdings

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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