Moraxella catarrhalis infection

Category: Illness or disabilities

Type

Involuntary

Introduction and description

Moraxella catarrhalis is a large, kidney-shaped, Gram-negative diplococcus.  [A diplococcus (plural diplococci) is a round bacterium (a coccus) that typically occurs in the form of two joined cells] .

M. catarrhalis was previously placed in a separate genus named Branhamella, as such you may find that the name Branhamella catarrhalis is used as well, especially in older papers.  It can be cultured on blood and chocolate agar plates after an aerobic incubation at 37 °C for 24 hours. Cultures revealed grey-white hemispheric colonies about 1 mm in diameter. 

They can cause infections of the respiratory system, middle ear, eye, central nervous system, and joints of humans.  Moraxella is named after Victor Morax, a Swiss ophthalmologist who first described this genus of bacteria. Catarrhalis is derived from catarrh, from the Greek meaning "to flow down" (cata- implies down; -rrh implies flow), describing the profuse discharge from eyes and nose typical of infection with this bacteria.

M. catarrhalis is now accepted as the third commonest pathogen of the respiratory tract after Streptococcus pneumoniae and Haemophilus influenza.   Incidence of M. catarrhalis infection is high in children and in the elderly.

Approximately 90% of strains are now β-lactamase positive.  The significance of this is that antibiotic resistance is achieved via the enzyme β-lactamase.  The bacteria has so far become resistant to the antibiotics penicillin, ampicillin, and amoxicillin.   Resistance to trimethoprim, trimethoprim-sulfamethoxazole (TMP-SMX), clindamycin, and tetracycline have also been reported.

Given that the first such strain was reported in 1976, this represents a dramatic increase in frequency over the last 20 years which has not been paralleled in any other species.  Indications are that it might lose susceptibility to fluoroquinolones, most second- and third-generation cephalosporins, erythromycin, and amoxicillin-clavulanate.

Symptoms

M. catarrhalis is an opportunistic pulmonary invader, and causes harm especially in patients who have compromised immune systems or any underlying chronic disease.  It is a significant cause of lower respiratory tract infections in adults, especially those with underlying chest disease.

Otitis media

Sinusitis

M. catarrhalis is a significant cause of sinusitis in children, both acute sinusitis, and maxillary sinusitis.

Bacteremia

M. catarrhalis is an important cause in bacteremia [the presence of bacteria in the blood].  M. catarrhalis infection can range in severity from a slight fever to lethal sepsis and an associated respiratory tract infection is usually also identified. Bacteremia infections caused by M. catarrhalis have a 21% mortality rate among patients.

Meningitis

M. catarrhalis is an important cause in meningitis:

Asthma

Neonates with airways colonized by Haemophilus influenzae, Streptococcus pneumoniae or Moraxella catarrhalis can exhibit symptoms - a recurrent wheeze - which may resemble asthma early in life.

COPD

Moraxella catarrhalis is implicated in the pathogenesis of some COPD patients.

Laryngitis

Subglottic laryngitis (pseudocroup) is one of the acute children's diseases, directly caused by a violently growing oedema of the subglottic area.  The symptoms are: “dry barking cough, stridor, inspiratory dyspnoea with the participation of auxiliary respiratory muscles, agitation and change of colour of skin”.

M. catarrhalis is also an important cause of acute laryngitis in adults.

Pharyngitis

Pharyngitis is inflammation of the pharynx, which is in the back of the throat. It is most often referred to simply as “sore throat.” Pharyngitis can also cause scratchiness in the throat and difficulty swallowing

Conjunctivitis

Bacterial croup

Bacterial croup may be divided into laryngeal diphtheria, bacterial tracheitis, laryngotracheobronchitis, and laryngotracheobronchopneumonitis. Laryngeal diphtheria is due to Corynebacterium diphtheriae while bacterial tracheitis, laryngotracheobronchitis, and laryngotracheobronchopneumonitis are usually due to a primary viral infection with secondary bacterial growth. The most common bacteria implicated are Staphylococcus aureus, Streptococcus pneumoniae, Hemophilus influenzae, and Moraxella catarrhalis

Bacterial bronchitis

Protracted bacterial bronchitis is usually caused by Streptococcus pneumoniae.  The other bacteria implicated in causing bronchitis include:

• Mycoplasma pneumoniae,
• Chlamydophila pneumoniae,
• Bordetella pertussis
• Haemophilus influenzae
• Moraxella catarrhalis and
• Pseudomonas aeruginosa

M. catarrhalis is an important cause in acute purulent irritation of chronic bronchitis

Mastoiditis

Mastoiditis is an infection of mastoid process, the portion of the temporal bone of the skull that is behind the ear which contains open, air-containing spaces.  Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus, Haemophillus influenzae, and Moraxella catarrhalis are the most common organisms causing acute mastoiditis.

Pneumonia

Gram-negative bacteria cause pneumonia less frequently than gram-positive bacteria. Some of the gram-negative bacteria that cause pneumonia include Haemophilus influenzae, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa and Moraxella catarrhalis. These bacteria often live in the stomach or intestines and may enter the lungs if vomit is inhaled.

Elderly patients and long-term heavy smokers with chronic obstructive pulmonary disease should be aware that M. catarrhalis is associated with bronchopneumonia, as well as exacerbations of existing chronic obstructive pulmonary disease.

The peak rate of colonisation by M. catarrhalis appears to occur around 2 years of age, with a striking difference in colonization rates between children and adults (very high to very low).

Septic arthritis

M. catarrhalis has been linked with septic arthritis in conjunction with bacteremia. Although cases of bacteremia caused by M. catarrhalis have been reported before, this was the first instance in which bacteremia caused by M. catarrhalis was also associated with septic arthritis.

Urethritis

Urine samples from men attending sexually transmitted disease clinics have identified a whole host of bacteria associated with urethritis-  Chlamydia trachomatis, Mycoplasma genitalium, Trichomonas vaginalis, Ureaplasma urealyticum, U. parvum, adenovirus, herpes simplex virus, Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae.  In general the number of lifetime sexual partners is negatively associated with bacterial load and the use of anal sex or other sexually abnormal approaches.[PMID: 26658669]

M. catarrhalis however, is an important but frequently overlooked cause of urethritis.

Cause

Moraxella catarrhalis is a fastidious, nonmotile, Gram-negative, aerobic, oxidase-positive diplococcus.  It causes the infection of the host cell by sticking to the host cell using trimeric autotransporter adhesins.  Current research priorities involve determining factors involved with virulence.  According to medical literature this bacteria shows “complement resistance”.  The complement system is part of the immune system.  But does it?

Suppressed immune system - If one looks at the papers on this bacteria, one finds some common factors amongst those who appear to be suffering most from the disease:

• In babies, they are often already sickly with a low body weight, and their immune system is not functioning correctly
• In others, there is a Low white blood cell count - in other words their immune system is not functioning correctly

M. catarrhalis bacteremia - There are other changes that are significant. M. catarrhalis is now being found all over the body.  Many chronic diseases in patients with M. catarrhalis bacteremia can be linked to those patients with immune defects or respiratory debility.

Infection of high-grade bacteremia has been linked with the development of endocarditis – heart disease and as we have seen above it is associated with meningitis and arthritis. 

So we have two main causes for the increased disease incidences of this bacteria:

•  A suppressed immune system
• Entry of the bacteria into the blood, as opposed to its normal confinement in the gastrointestinal tract

Stress and Pharmaceuticals – the role of immunosuppressants

The suppression of the immune system can be caused by stress and indeed one cannot find a more stressful or terrifying, noisy, hostile or unhelpful place for a baby, child or an adult to be than a hospital or that oxymoron of the hospital system the Intensive Care Unit.

But we also have the one pharmaceutical given to patients without thought or understanding of the effects – the immunosuppressant – given to suppress symptoms but which as a consequence suppresses the one system the body has to fight disease -  the immune system

Glucocorticoids are immunosuppressants.  Those receiving treatment for leukemia have acquired the infection

So we can say that the main cause of the increase in severity, frequency and incidence of infection with this bacteria are the medical profession. As Wikipedia say “Nosocomial [originating in a hospital] spread of infection, especially within respiratory wards, has been reported”.

Hospital equipment

How does the bacteria get into the blood?  It appears that the principle mechanism is hospital equipment.  Haemodialysis equipment for example:

And trans nasal devices. 

Nasal administration is a route of administration in which drugs are insufflated through the nose. It can be a form of either topical administration or systemic administration.  “The nasal cavity is covered by a thin mucosa which is well vascularised. Therefore, a drug molecule can be transferred quickly across the single epithelial cell layer directly to the systemic blood circulation without first-pass hepatic and intestinal metabolism.”

Treatment

Treatment should always be of the cause and not the symptom, as such given the cause is the combination of the bacteria and the medical profession and its procedures and equipment one might be wise to address the latter.

References and further reading

• Bacteremia and Septic Arthritis Caused by Moraxella catarrhalis  - Philipp R. Melendez Royce H. Johnson Reviews of Infectious Diseases, Volume 13, Issue 3, 1 May 1991, Pages 428–429, https://doi.org/10.1093/clinids/13.3.428  Published:  01 May 1991
• Otolaryngol Head Neck Surg. 2018 Nov 27:194599818815109. doi: 10.1177/0194599818815109. [Epub ahead of print]  The Microbiology of Complicated Acute Sinusitis among Pediatric Patients: A Case Series. Mulvey CL1, Kiell EP2, Rizzi MD3, Buzi A3.
• J Chin Med Assoc. 2016 Aug;79(8):440-4. doi: 10.1016/j.jcma.2016.03.002. Epub 2016 Jun 6.  Detection of Streptococcus pneumoniae and Moraxella catarrhalis in patients with paranasal chronic sinusitis by polymerase chain reaction method.  Farajzadeh Sheikh A1, Ahmadi K2, Nikakhlagh S3.
• Ann Trop Paediatr. 1996 Sep;16(3):199-201.  Neonatal meningitis due to Moraxella catarrhalis and review of the literature.   Daoud A1, Abuekteish F, Masaadeh H. 1  Department of Paediatrics, Jordan University of Science and Technology, Irbid, Jordan
• Int J STD AIDS. 2007 Aug;18(8):579-80.  Moraxella catarrhalis associated with acute urethritis imitating gonorrhoea acquired by oral-genital contact.  Abdolrasouli A1, Amin A, Baharsefat M, Roushan A, Hemmati Y.  Microbiology Department, Pathology Centre, Hammersmith Hospital NHS Trust, Du Cane Road, London, UK. AAbdolrasouli@hhnt.nhs.uk DOI: 10.1258/095646207781439775
• PLoS One. 2011;6(11):e27913. doi: 10.1371/journal.pone.0027913. Epub 2011 Nov 29.  Wheeze in preschool age is associated with pulmonary bacterial infection and resolves after antibiotic therapy.  Schwerk N1, Brinkmann F, Soudah B, Kabesch M, Hansen G. PMCID: PMC3226624
• Int J Chron Obstruct Pulmon Dis. 2018 Nov 8;13:3663-3667. doi: 10.2147/COPD.S180961. eCollection 2018.  Sputum Moraxella catarrhalis strains exhibit diversity within and between COPD subjects.  George LM1, Haigh RD1, Mistry V1, Haldar K1, Barer MR1, Oggioni MR2, Brightling CE1.

Related observations

Healing observations

• Activity of Aristolochia bracteolata against Moraxella catarrhalis 027929
• Antibacterial activities of plants from Central Africa used traditionally by the Bakola pygmies for treating respiratory and tuberculosis-related symptoms 027927

Hallucination

• Moraxella catarrhalis bacteraemia and prosthetic valve endocarditis 027928
• Respiratory infections: clinical experiences with the new quinolones 019058

Other observations

• Hiding in Plain Sight: Contaminated Ice Machines Are a Potential Source for Dissemination of Gram-Negative Bacteria and Candida Species in Healthcare Facilities 027931
• Moraxella catarrhalis - pathogen or commensal 027930
• The problem of antibiotic resistance in bacteria 027933