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  Table of Contents    
ORIGINAL ARTICLE  
Year : 2011  |  Volume : 54  |  Issue : 4  |  Page : 769-771
Moraxella catarrhalis as a respiratory pathogen


1 Zoonotic divison, National Center For Disease Control, Delhi, India
2 Department of Microbiology, Apollo Hospital, Delhi, India
3 Medical Officer, Delhi Government, Delhi, India

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Date of Web Publication6-Jan-2012
 

   Abstract 

Background: Moraxella catarrhalis is gaining significance as a pathogen over few decades because of increased rate of isolation in respiratory specimens and due to emergence of multidrug resistant strains. Therefore, appropriate antimicrobial agents are required for eradication and prevention of spread of the organism. Material and Methods: -The study was conducted over 1-year period inpatients of lower respiratory tract infections (L.R.T.I.) in P.G.I.M.S. Rohtak (Haryana) . Assessment of clinical significance of M.catarrhalis was ascertained on the basis of preformed criteria. Results: A total of 63 clinically significant M. catarrhalis were isolated from a tertiary care hospital. The isolates showed maximum resistance to cotrimoxazole (82.5%), pencillin (77.7%), and ampicillin (71.4%) while susceptibility was maximum to cefotaxime (87.3%) followed by tetracycline (85.7%) ciprofloxacin (84.1%), erythromycin (80.9%) amikacin (79.3%), gentamycin (77.7%), and cefazolin (76.2%). Multidrug resistance to >3 antimicrobials was seen in 22 (34.9%) of cases. Conclusions: Predominant or pure growth of M.catarrhalis in throat swabs from cases of L.R.T.I. should be reported and treated by microbiologist and clinician respectively. Antibiotic therapy should be decided based on sensitivity report for rapid respose and recovery of patients.

Keywords: Moraxella catarrhalis , opportunistic pathogens, respiratory pathogens

How to cite this article:
Gupta N, Arora S, Kundra S. Moraxella catarrhalis as a respiratory pathogen. Indian J Pathol Microbiol 2011;54:769-71

How to cite this URL:
Gupta N, Arora S, Kundra S. Moraxella catarrhalis as a respiratory pathogen. Indian J Pathol Microbiol [serial online] 2011 [cited 2019 Apr 23];54:769-71. Available from: http://www.ijpmonline.org/text.asp?2011/54/4/769/91496



   Introduction Top


 Moraxella More Details catarrhalis (Branhamella catarrhalis) , an aerobic gram negative diplococcus is frequently found as a commensal of upper respiratory tract. [1] But over the last -two to three decades the bacterium has emerged as a genuine pathogen and is now considered as important cause of upper respiratory tract infections in otherwise healthy children and elderly people and lower respiratory tract infections particularly in patients with chronic obstructive pulmonary disease (COPD). [2] Studies have shown that M. catarrhalis binds to the major basement membrane glycoprotein that is thickened in airways of smokers. M. catarrhalis is currently recognized as the third most frequent cause of acute otitis media and acute sinusitis in young children. [3],[4],[5] M. catarrhalis along with Haemophilus influenzae has been recognized as important cause of community acquired respiratory infections including community acquired pneumonia, acute exacerbation of chronic bronchitis, acute sinusitis, and acute otitis media. [6]

Recently, increased isolation as well as rise in the drug resistant strains of M. catarrhalis has renewed our interest to assess the role of M. catarrhalis in respiratory-tract infections and its antibiotic profile which is absolutely essential for determining effective therapy.


   Materials and Methods Top


All the patients presenting during the 1-year period with one or more clinical findings suggestive of respiratory tract infection such as wheezing, stridor, rales or crackles, tachypnea, thoracic retractions, or decreased breath sounds constituted the study group. Early morning samples were plated on 5% sheep blood agar and MacConkey medium. The isolated M. catarrhalis were identified by gram stain, colony morphology, lack of pigmentation of colony on blood agar, oxidase production, failure to produce acid from glucose, maltose, lactose, and sucrose, growth at 22°C on nutrient agar and finally reduction of nitrate to nitrite. [1]

Assessment of pathogenic significance of isolates of M. catarrhalis was based on four predetermined criteria (1) clinical examination of respiratory infection based on history, examination, and chest X-ray, (2) isolation of M. catarrhalis as the sole potential pathogen, (3) Absence of antibiotic treatment in the previous two weeks, and (4) subsequent clinical response to an antibiotic to which the isolate was sensitive. Isolates were considered to be of pathogenic significance when all four criteria were satisfied.


   Results Top


A total of 63 M. catarrhalis of pathogenic significance were isolated in pure growth. Out of 63 cases 49 (77.7%) were males and 14 (22.2%) females [Table 1]. The isolates showed maximum resistance to cotrimoxazole (82.5%), penicillin (77.7%), and ampicillin (71.4%) while susceptibility was maximum to cefotaxime (87.3%) followed by tetracycline (85.7%) ciprofloxacin (84.1%), erythromycin (80.9%) amikacin (79.3%), gentamycin (77.7%), and cefazolin (76.2%) [Table 2].
Table 1: Age and sex distribution of Moraxella catarrhalis cases

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Table 2: Antibiotic sensitivity pattern of Moraxella catarrhalis (n=63)

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Multidrug resistance to >3 antimicrobials was seen in 22 (34.9%) of cases [Table 3].
Table 3: Drug resistance in Moraxella catarrhalis (n=63)

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   Discussion Top


Clinical interest in M. catarrhalis is recently recognized, still majority of laboratories do not report M. catarrhalis as a pathogen, especially when a well-recognized pathogen (e.g., Streptococcus pneumoniae or H. influenzae) is present in the clinical specimen. In addition, the isolation of M. catarrhalis from sputum is complicated by the presence of nonpathogenic  Neisseria More Detailse. [1] It is extremely important to realize that the M. catarrhalis carriage rate in children is high (up to 75%). [7],[8],[9] In contrast, the carriage rate of M. catarrhalis in healthy adults is very low (about 1% to 3%). [10] Interestingly, nasopharyngeal carriage rates are significantly higher in winter and autumn than in spring and summer. [8]

M. catarrhalis is now considered an important pathogen in respiratory tract infections, both in children and in adults with underlying COPD. Local factors such as mucociliary clearance, aerodynamics, alveolar macrophage activity, complement-mediated killing, and surfactant activity play an important role in host defense against oropharyngeal pathogens. [11] In COPD patients, local host defense against respiratory pathogens is relatively poor, and since M. catarrhalis is not a normal inhabitant of the upper respiratory tract in adults infections caused by M. catarrhalis are frequent in these patients. [10] Similarly in our study >50% of clinically significant Moraxellae was isolated from more than 50 years age group.

In our study, out of 63 patients from which M. catarrhalis was isolated 77.7% were males and 22.25% were females. Others, have reported that in respiratory tract infections 60% of M. catarrhalis were isolated from males and 40% from females. [12]

In our study, resistance to penicillin was 77.7%. This penicillin resistance is due to two types of ß-lactamases: The BRO-1 and BRO- 2 types. Both are membrane associated, and they differ by only a single amino acid. These enzymes are encoded by chromosomal genes and these genes can be relatively easily transferred from cell to cell by conjugation. [13],[14] These ß-Lactamases from M. catarrhalis not only protects the bacteria, but also inactivate penicillin therapy of concomitant infections by serious airway pathogens such as S. pneumoniae and/or nontypeable H. influenzae.[15],[16],[17],[18] Recent studies from Australia, Europe, and the United States have reported ß-lactamase production in over 90% of isolates. [19],[20],[21],[22],[23],[24],[25]

In our study, we only focused on pure isolates; however, in clinical microbiology practice it is important to realize that an additional important organism can also be isolated in about 40% to 50% of sputum cultures like S. pneumoniae or H. influenzae. [5],[26],[27],[ 28] It is important to define the role of M. catarrhalis in such mixed infections, particularly with respect to the adequate management of patients with specific antibiotic therapy.

In our study, resistance to cotrimoxazole is 82.5%, which practically excludes it as therapeutic option; on the other hand sensitivity to tetracycline seems to be good (85.7%). However, because of frequent side effects and various other options available like cephalosporins, macrolides and fluoroquinolones, tetyracyclines are rarely used. In our study resistance to ciprofloxacin is 16.8% while others have reported 0-1% resistance. [29],[30] Overall, in our study 34.9% M. catarrhalis are multidrug resistant as shown in [Table 3], which indeed warrants reporting clinically significant M. catarrhalis. Therefore, we emphasize the ignorance of M. catarrhalis as a pathogen in respiratory tract and advice laboratories and clinicians to recognize report and treat it appropriately with antibiotics based on sensitivity to avoid therapeutic failure and serious consequences.

 
   References Top

1.Verduin CM, Hol C, Fleer A, Dijak HJ, Berkum AV. Moraxella catarrhalis from emerging to established pathogen. Clin Microbiol Rev 2002;15:125-44.  Back to cited text no. 1
    
2.Karalus R, Campagnari A. Moraxella catarrhalis: A review of an important mucosal pathogen. Microbes Infect 2000;2:547-9.  Back to cited text no. 2
    
3.Tan TT, Forsgreen A, Riesbeck K. The respiratory pathogen Moraxella catarrhalis binds to laminin via ubiquitous surface proteins A1 and A2. J Infect Dis 2006;194:493-7.  Back to cited text no. 3
    
4.Catlin BW. Branhamella catarrhalis: An organism gaining respect as a pathogen. Clin Microbiol Rev 1990;3:293-320.  Back to cited text no. 4
    
5.Hager H, Verghese A, Alvarez S, Berk SL. Branhamella catarrhalis respiratory infections. Rev Infect Dis 1987;9:1140-9.  Back to cited text no. 5
    
6.Zhanel GG, Palatnick L, Nichol KA, Low DE, Hoban DJ. Antimicrobial resistance in Haemophilus influenzae and Moraxella catarrhalis respiratory tract isolates: Results of Canadian respiratory organism susceptibility study, 1997 to 2002. Antimicrob Agents Chemother 2003;47:1875-81.  Back to cited text no. 6
    
7.Fade H, Harabuchi Y, Hong JJ. Epidemiology of Moraxella catarrhalis in children during the first 2 years of life: Relationship to otitis media. J Infect Dis 1994;169:1312-7.  Back to cited text no. 7
    
8.Van Hare GF, Shurin PA, Marchant CD, Cartelli NA, Johnson CE, Fulton D, et al. Acute otitis media caused by Branhamella catarrhalis: Biology and therapy. Rev Infect Dis 1987;9:16-27.  Back to cited text no. 8
    
9.Varon E, Levy C, De La Rocque F, Boucherat M, Deforche D, Podglajen I, 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 2000;31:477-81.  Back to cited text no. 9
    
10.DiGiovanni C, Riley TV, Hoyne GF, Yeo R, Cooksey P. Respiratory tract infections due to Branhamella catarrhalis: Epidemiological data from Western Australia. Epidemiol Infect 1987;99:445-53.  Back to cited text no. 10
    
11.Toews GB, Hansen EJ, Strieter RM. Pulmonary host defenses and oropharyngeal pathogens. Am J Med 1990;88:Supp 1:20-4  Back to cited text no. 11
    
12.Boyle FM, Goerghiou RR, Tilse MH, McCormack JG. Branhamella (Moraxella) catarrhalis: Pathogenic significance in respiratory infections. Med J Aust 1991;154:592-6.  Back to cited text no. 12
    
13.McGregor KB, Chang J, Mee BJ, Riley TV. Moraxella catarrhalis: Clinical significance, antimicrobial susceptibility and BRO beta-lactamases. Eur J Clin Microbiol Infect Dis 1998;17:219-34.  Back to cited text no. 13
    
14.Wallace RJ Jr, Steingrube VA, Nash DR, Hollis DG, Flanagan C, Brown BA, et al. BRO-beta-lactamases of Branhamella catarrhalis and Moraxella subgenus Moraxella, including evidence for chromosomal ß-lactamase transfer by conjugation in B. catarrhalis, M. nonliquefaciens, and M. lacunata. Antimicrob Agents Chemother 1989;33:1845-54.  Back to cited text no. 14
    
15.Brook I. Direct and indirect pathogenicity of Branhamella catarrhalis. Drugs 1986; 31Suppl3:97-102.  Back to cited text no. 15
    
16.Brook I. In vitro susceptibility vs. in vivo efficacy of various antimicrobial agents against the Bacteroides fragilis group. Rev Infect Dis 1991;13:1170-80.  Back to cited text no. 16
    
17.Budhani RK, Struthers JK. Interaction of Streptococcus pneumoniae and Moraxella catarrhalis: Investigation of the indirect pathogenic role of beta-lactamase-producing moraxellae by use of a continuous-culture biofilm system. Antimicrob Agents Chemother 1998;42:2521-6.  Back to cited text no. 17
    
18.Hol C, Van Dijke EE, Verduin CM, Verhoef J, Van Dijk H. Experimental evidence for Moraxella-induced penicillin neutralization in pneumococcal pneumonia. J Infect Dis 1994;170:1613-6.  Back to cited text no. 18
    
19.Doern GV, Jones RN, Pfaller MA, Kugler K. Haemophilus influenzae and Moraxella catarrhalis from patients with community-acquired respiratory tract infections: Antimicrobial susceptibility patterns from the SENTRY antimicrobial Surveillance Program (United States and Canada, 1997). Antimicrob Agents Chemother 1999;43:385-9.  Back to cited text no. 19
    
20.Fluit AC, Schmitz FJ, Jones ME, Acar J, Gupta R, Verhoef J. Antimicrobial resistance among community-acquired pneumonia isolates in Europe: First results from the SENTRY antimicrobial surveillance program 1997. Sentry Participants Group. Int J Infect Dis 1999;3:153-6.  Back to cited text no. 20
    
21.Manninen R, Huovinen P, Nissinen A. Increasing antimicrobial resistance in Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis in Finland. J Antimicrob Chemother 1997;40:387-92.  Back to cited text no. 21
    
22.Thornsberry C, Jones ME, Hickey ML, Mauriz Y, Kahn J, Sahm DF. Resistance surveillance of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis isolated in the United States, 1997- 1998. J Antimicrob Chemother 1999;44:749-59.  Back to cited text no. 22
    
23.Varon E, Levy C, De La Rocque F, Boucherat M, Deforche D, Podglajen I, 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 2000;31:477-81.  Back to cited text no. 23
    
24.Walker ES, Neal CL, Laffan E, Kalbfleisch JH, Berk SL, Levy F. Long-term trends in susceptibility of Moraxella catarrhalis: A population analysis. J Antimicrob Chemother 2000;45:175-82.  Back to cited text no. 24
    
25.Wood GM, Johnson BC, McCormack JG. Moraxella catarrhalis: Pathogenic significance in respiratory tract infections treated by community practitioners. Clin Infect Dis 1996,22:632-6.  Back to cited text no. 25
    
26.Barreiro B, Esteban L, Prats E, Verdaguer E, Dorca J, Manresa F. Branhamella catarrhalis respiratory infections. Eur Respir J 1992;5:675-9.  Back to cited text no. 26
    
27.Nicotra B, Rivera M, Luman JI, Wallace RJ. Branhamella catarrhalis as a lower respiratory tract pathogen in patients with chronic lung disease. Arch Intern Med 1986;146:890-3.  Back to cited text no. 27
    
28.Pollard JA, Wallace RJ, Nash DR, Luman JI, Wilson RW. Incidence of Branhamella catarrhalis in the sputa of patients with chronic lung disease. Drugs 1986; 31Suppl 3:103-8.  Back to cited text no. 28
    
29.Powell M, Mcvey D, Kassim MH, Chen HY, Williams JD. Antimicrobial susceptibility of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella (Branhamella) catarrhalis isolates in U.K. from sputa. J Antimicrob Chemother 1991;28:249-59.  Back to cited text no. 29
    
30.Mickucka A, Janicka G, Krawiecka D, Kochanowska J. Antibiotic sensitivity of Moraxella catarrhalis isolated from clinical materials in 1997-1998. Medica Science Monitor 2000;6:300-4.  Back to cited text no. 30
    

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Correspondence Address:
Naveen Gupta
Deputy Director, Zoonosis Divison, National Center for Disease Control (NCDC), 22 Shamnath Marg, Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.91496

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