Moraxella catarrhalis Infection Workup
- Author: Michael Constantinescu, MD; Chief Editor: Michael Stuart Bronze, MD more...
A complete blood count (CBC) should be obtained. An increased white blood cell (WBC) count with neutrophilia may be present.
Gram-negative diplococci are found on Gram staining of cultures. Strict adherence to the staining protocol is required. The accuracy of Gram staining for isolation of Neisseria or Moraxella species has been reported to agree perfectly with identification by culture.
Confirmation of the diagnosis of M catarrhalis infection is based on isolation of the organism in culture. Cultures can be taken from middle ear effusion, the nasopharynx, sputum, sinus aspirates, transtracheal or transbronchial aspirates, blood, peritoneal fluid, wounds, or urine. Colonies are approximately 0.2 cm in diameter, opaque, and nonhemolytic after incubation on chocolate or blood agar for 48 hours. Characteristically, colonies can be pushed along the surface of the agar like a hockey puck.
With standard methods of identification, M catarrhalis can be differentiated from Neisseria species by not using sucrose, glucose, maltose, and lactose. Because Neisseria cinerea exhibits the same reaction pattern, the Superoxyl test must be added. For definitive identification, deoxyribonuclease (DNase) and nitrate reduction tests are performed; M catarrhalis produces DNase and reduces nitrate and nitrite levels.
Several rapid confirmatory tests are available to identify M catarrhalis, and they are all based on the ability of M catarrhalis to hydrolyze tributyrin. This provides immediate identification and separation from human Neisseria species, which do not hydrolyze tributyrin.
Serologic tests for infections with M catarrhalis are not widely used; cross-reactivity with Neisseria species in the detection of complement fixation antibodies by immunoelectrophoresis has been demonstrated. Serum antibodies to whole-cell proteins, to lipo-oligosaccharides, and to outer-membrane antigens have proved useful in the diagnosis of M catarrhalis infection. Other laboratory studies may be needed, depending on the site of infection and underlying conditions.
Imaging studies (eg, plain radiography or computed tomography [CT]) may be needed, depending on the site of infection.
Paranasal sinus radiography or CT scanning may be helpful. Chest radiography is often performed. If peritonitis is a possibility, abdominal radiography using a 3-way view is indicated.
Aebi C. Moraxella catarrhalis - pathogen or commensal?. Adv Exp Med Biol. 2011. 697:107-16. [Medline].
Wright PW, Wallace RJ Jr, Shepherd JR. A descriptive study of 42 cases of Branhamella catarrhalis pneumonia. Am J Med. 1990 May 14. 88(5A):2S-8S. [Medline].
Pappas DE, Hendley JO, Hayden FG, Winther B. Symptom profile of common colds in school-aged children. Pediatr Infect Dis J. 2008 Jan. 27(1):8-11. [Medline].
Gehanno P, Panajotopoulos A, Barry B, Nguyen L, Levy D, Bingen E, et al. Microbiology of otitis media in the Paris, France, area from 1987 to 1997. Pediatr Infect Dis J. 2001 Jun. 20(6):570-3. [Medline].
Li WC, Chiu NC, Hsu CH, Lee KS, Hwang HK, Huang FY. Pathogens in the middle ear effusion of children with persistent otitis media: implications of drug resistance and complications. J Microbiol Immunol Infect. 2001 Sep. 34(3):190-4. [Medline].
Wald ER. Microbiology of acute and chronic sinusitis in children and adults. Am J Med Sci. 1998 Jul. 316(1):13-20. [Medline].
Hunter MH, King DE. COPD: management of acute exacerbations and chronic stable disease. Am Fam Physician. 2001 Aug 15. 64(4):603-12. [Medline].
Lieberman D, Lieberman D, Ben-Yaakov M, et al. Infectious etiologies in acute exacerbation of COPD. Diagn Microbiol Infect Dis. 2001 Jul. 40(3):95-102. [Medline].
Sethi S, Murphy TF. Bacterial infection in chronic obstructive pulmonary disease in 2000: a state-of-the-art review. Clin Microbiol Rev. 2001 Apr. 14(2):336-63. [Medline]. [Full Text].
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. 1998 May. 157(5 Pt 1):1498-505. [Medline].
Aronovitz G. Treatment of upper and lower respiratory tract infections: clinical trials with cefprozil. Pediatr Infect Dis J. 1998 Aug. 17(8 Suppl):S83-8. [Medline].
Manfredi R, Nanetti A, Valentini R, Chiodo F. Moraxella catarrhalis pneumonia during HIV disease. J Chemother. 2000 Oct. 12(5):406-11. [Medline].
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].
Neumayer U, Schmidt HK, Mellwig KP, Kleikamp G. Moraxella catarrhalis endocarditis: report of a case and literature review. J Heart Valve Dis. 1999 Jan. 8(1):114-7. [Medline].
Stefanou J, Agelopoulou AV, Sipsas NV, Smilakou N, Avlami A. Moraxella catarrhalis endocarditis: case report and review of the literature. Scand J Infect Dis. 2000. 32(2):217-8. [Medline].
Narinesingh SP, Whitby DJ, Davenport PJ. Moraxella catarrhalis: an unrecognized pathogen of the oral cavity?. Cleft Palate Craniofac J. 2011 Jul. 48(4):462-4. [Medline].
Tritton D, Watts T, Sieratzki JS. Peri-orbital cellulitis and sepsis by Branhamella catarrhalis. Eur J Pediatr. 1998 Jul. 157(7):611-2. [Medline].
Abdolrasouli A, Amin A, Baharsefat M, Roushan A, Hemmati Y. Moraxella catarrhalis associated with acute urethritis imitating gonorrhoea acquired by oral-genital contact. Int J STD AIDS. 2007 Aug. 18(8):579-80. [Medline].
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. 2009 Jul. 132(1):18-25. [Medline]. [Full Text].
Hwang PH. A 51-year-old woman with acute onset of facial pressure, rhinorrhea, and tooth pain: review of acute rhinosinusitis. JAMA. 2009 May 6. 301(17):1798-807. [Medline].
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. 2004 Jan. 113(1 Pt 1):e40-6. [Medline]. [Full Text].
Swanson RN, Lainez-Ventosilla A, De Salvo MC, Dunne MW, Amsden GW. 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].
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. 2005 Mar 8. 4:5. [Medline]. [Full Text].
Dore DD, DiBello JR, Lapane KL. Telithromycin use and spontaneous reports of hepatotoxicity. Drug Saf. 2007. 30(8):697-703. [Medline].
Yoshida K, Okimoto N, Kishimoto M, et al. Efficacy and safety of moxifloxacin for community-acquired bacterial pneumonia based on pharmacokinetic analysis. J Infect Chemother. 2011 Oct. 17(5):678-85. [Medline].
Ren D, Yu S, Gao S, et al. Mutant lipooligosaccharide-based conjugate vaccine demonstrates a broad-spectrum effectiveness against Moraxella catarrhalis. Vaccine. 2011 Jun 6. 29(25):4210-7. [Medline]. [Full Text].
Yang M, Johnson A, Murphy TF. Characterization and evaluation of the Moraxella catarrhalis oligopeptide permease A as a mucosal vaccine antigen. Infect Immun. 2011 Feb. 79(2):846-57. [Medline]. [Full Text].
O'Brien MA, Prosser LA, Paradise JL, et al. New vaccines against otitis media: projected benefits and cost-effectiveness. Pediatrics. 2009 Jun. 123(6):1452-63. [Medline].
Shaikh SB, Ahmed Z, Arsalan SA, Shafiq S. Prevalence and resistance pattern of Moraxella catarrhalis in community-acquired lower respiratory tract infections. Infect Drug Resist. 2015. 8:263-7. [Medline].