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Moraxella catarrhalis Infection

By Larry M. Bush, MD, Affiliate Professor of Clinical Biomedical Sciences; Affiliate Associate Professor of Medicine, Charles E. Schmidt College of Medicine, Florida Atlantic University; University of Miami-Miller School of Medicine ; Maria T. Perez, MD, Associate Pathologist, Department of Pathology and Laboratory Medicine, Wellington Regional Medical Center, West Palm Beach

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Moraxella catarrhalis causes ear and upper and lower respiratory infections.

Previously classified as Micrococcus, then Neisseria, and also known asBranhamella catarrhalis, this organism is a frequent cause of otitis media in children, acute and chronic sinusitis at all ages, and lower respiratory infection in adults with chronic lung disease. It is the 2nd most common bacterial cause of COPD exacerbations after nontypeable Haemophilus influenzae. M. catarrhalis pneumonia resembles pneumococcal pneumonia. Although bacteremia is rare, half of patients die within 3 mo because of intercurrent diseases.

The prevalence of M. catarrhalis colonization depends on age. About 1 to 5% of healthy adults have upper respiratory tract colonization. Nasopharyngeal colonization with M. catarrhalis is common throughout infancy, may be increased during winter months, and is a risk factor for acute otitis media; early colonization is a risk factor for recurrent otitis media. Substantial regional differences in colonization rates occur. Living conditions, hygiene, environmental factors (eg, household smoking), genetic characteristics of the populations, host factors, and other factors may contribute to these differences.

The organism appears to spread contiguously from its colonizing position in the respiratory tract to the infection site.

There is no pathognomonic feature of M. catarrhalis otitis media, acute or chronic sinusitis, or pneumonia. In lower respiratory disease, patients experience increased cough, purulent sputum production, and increased dyspnea.

These gram-negative cocci resemble Neisseria sp but can be readily distinguished by routine biochemical tests after culture isolation from infected fluids or tissues.

All strains now produce beta-lactamase. The organism is generally susceptible to beta-lactam/beta-lactamase inhibitors, sulfamethoxazole, tetracyclines, extended-spectrum oral cephalosporins, aminoglycosides, macrolides, and fluoroquinolones.