Moraxella Catarrhalis

Microbiology

Moraxella Catarrhalis (Previously Known as Branhamella Catarrhalis) is a Member of the Moraxella Genus (within the Moraxellaceae Family) (see Moraxella)

Moraxella Catarrhalis is an Aerobic, Nonmotile, Gram-Negative Diplococci
Most Strains of Moraxella Catarrhalis Produce β-Lactamase
Moraxella Catarrhalis is Exclusively a Human Pathogen
- Ecological Reservoir Appears to Be the Human Upper Respiratory Tract
Multiple Moraxella Catarrhalis Strains Exist
- Virulence Factors and Pathogenic Potential Vary Among the Strains

Physiology

Colonization

Colonization with Moraxella Catarrhalis is a Predisposing Factor for Infection

Prevalence of Moraxella Catarrhalis Colonization is Highly Dependent on Age
- In Infants, Nasopharyngeal Moraxella Catarrhalis Colonization is Common, with Reported Prevalence Ranging from 30-100%
- By Adulthood, Nasopharyngeal Moraxella Catarrhalis Colonization Prevalence Decreases to Approximately 1-5% (J Clin Microbiol, 1990) [MEDLINE]
  - In Adults with Chronic Obstructive Pulmonary Disease (COPD), the Prevalence of Nasopharyngeal Moraxella Catarrhalis Colonization is Higher than in Other Patients (Although Precise Prevalence Rates Have Not Been Reported) (Am J Respir Crit Care Med, 2005) Chronic Obstructive Pulmonary Disease MEDLINE
- In All Age Groups, Nasopharyngeal Moraxella Catarrhalis Colonization Appears to Be Episodic, with Different Moraxella Catarrhalis Strains Colonizing the Upper Respiratory Tract Over Time

Use of Pneumococcal Vaccination Has Increased Nasopharyngeal Moraxella Catarrhalis Colonization Rates

Rates of Moraxella Catarrhalis Colonization (and Infection) are Increasing Due to the Widespread Use of Pneumococcal Vaccination (Which Alters the Respiratory Tract Microbiome)
- With Pneumococcal Vaccination, Colonization with Vaccine Serotypes of Streptococcus Pneumoniae Decreases, While Colonization with Other Organisms (Moraxella Catarrhalis, Haemophilus Influenzae, and Non-Vaccine Streptococcus Pneumoniae Serotypes) Increases (J Infect Chemother, 2014) [MEDLINE] (Vaccine, 2016) [MEDLINE] (Pediatrics, 2017) [MEDLINE] (Vaccine, 2017) [MEDLINE]

Transmission

Moraxella Catarrhalis is Transmitted Person-to-Person, Likely Via Respiratory Droplets and Fomites (Intern Med, 2009) [MEDLINE]

Clusters of Cases Have Been Reported in Hospital Settings, in Daycare Centers, and in Family Members (Drugs, 1986) [MEDLINE] (J Hosp Infect, 1993) [MEDLINE] (J Clin Microbiol, 2000) [MEDLINE] (Microbiol Immunol, 2003) [MEDLINE] (Int J Med Microbiol, 2005) [MEDLINE] (Intern Med, 2009) [MEDLINE] (Microbiol Immunol, 2011) [MEDLINE]

Clinical Manifestations

Otolaryngologic Manifestations

Acute Otitis Media

Epidemiology
- Most Acute Otitis Media Cases Due to Moraxella Catarrhalis Occur in the Late Fall to Early Spring (Coinciding with the Incidence of Viral Respiratory Tract Infections
- Moraxella Catarrhalis is One of the Top Three Etiologies of Otitis Media in Children
- Moraxella Catarrhalis Accounts for Approximately 10-20% of Acute Otitis Media Cases in Children
  - Highest Rates are Observed in Children <2 y/o
  - Moraxella Catarrhalis is Also Increasingly Recognized as an Etiology of Recurrent/Chronic Otitis Media in Children
- Acute Otitis Media Due to Moraxella Catarrhalis is Rare in Adults
Clinical
- General Comments
  - Clinical Features of Acute Bacterial Otitis Media Due to Moraxella Catarrhalis are Indistinguishable from Other Bacterial Etiologies of Acute Otitis Media
  - Acute Otitis Media Due to Moraxella Catarrhalis is Typically Preceded by a Viral Upper Respiratory Tract Infection
  - Moraxella Catarrhalis is Generally Considered to Be Less Virulent than Other Common Bacterial Pathogens of Otitis Media (Such as Streptococcus Pneumoniae and Haemophilus Influenzae), with Fewer Complications Such as Tympanic Membrane Perforation and Mastoiditis
- Bulging Tympanic Membrane
- Ear Pain (see Ear Pain)
- Fever (see Fever)

Acute (Bacterial) Rhinosinusitis (see Acute Rhinosinusitis)

Epidemiology
- Most Cases of Acute Rhinosinusitis are Due to Viruses
  - Bacteria Account for Only 0.5-2% of Acute Rhinosinusitis Cases (Rhinology, 2007) [MEDLINE]
    - Of the Acute Bacterial Rhinosinusitis Cases, Moraxella Catarrhalis Accounts for Approximately 2-10% of These Cases (Laryngoscope, 2010) [MEDLINE] (Otolaryngol Head Neck Surg, 2015) [MEDLINE]
Clinical
- General Comments
  - Clinical Features of Acute Bacterial Rhinosinusitis Due to Moraxella Catarrhalis are Indistinguishable from Other Bacterial Etiologies of Acute Rhinosinusitis
- Facial Pain
- Fever (see Fever)
- Headache (see Headache)
- Nasal Onstruction
- Purulent Nasal Discharge

Pulmonary Manifestations

Chronic Obstructive Pulmonary Disease (COPD) Exacerbation (see Chronic Obstructive Pulmonary Disease)

Epidemiology
- In Adults with Chronic Obstructive Pulmonary Disease (COPD), the Prevalence of Nasopharyngeal Moraxella Catarrhalis Colonization is Higher than in Other Patients (Although Precise Prevalence Rates Have Not Been Reported) (Am J Respir Crit Care Med, 2005) [MEDLINE]
  - New Moraxella Catarrhalis Strains are Acquired and Cleared from the Sputum Frequently
  - In Approximately 50% of Cases, Acquisition of a New Moraxella Catarrhalis Strain Results in a Clinical Chronic Obstructive Pulmonary Disease Exacerbation (NEJM, 2002) [MEDLINE] (Am J Respir Crit Care Med, 2005) [MEDLINE] (Thorax, 2017) [MEDLINE]
- Approximately 10-20% of Acute COPD Exacerbations are Caused by Moraxella Catarrhalis (Am J Respir Crit Care Med, 2005) [MEDLINE] (Thorax, 2017) [MEDLINE]
- Chronic Obstructive Pulmonary Disease Exacerbations Due to Moraxella Catarrhalis Occur Throughout the Year, But More Cases Tend to Occur in Late Fall to Early Spring (Thorax, 2017) [MEDLINE]
Clinical
- Cough (see Cough)
- Dyspnea (Increased from Baseline) (see Dyspnea)
- Sputum Production/Change in Sputum Color/Sputum Purulence

Community-Acquired Pneumonia (CAP) (see Community-Acquired Pneumonia)

Epidemiology
- Moraxella Catarrhalis is an Infrequent Etiology of Community-Acquired Pneumonia (J Med Assoc Thai, 2009) [MEDLINE]
- Moraxella Catarrhalis Community-Acquired Pneumonia Most Commonly Occurs in Older Adults, Patients with Cardiopulmonary Disease, Patients with Diabetes Mellitus, and/or Patients with an Immunocompromised State (Semin Respir Infect, 1989) [MEDLINE] (Case Rep Pulmonol, 2016) [MEDLINE] (BMC Infect Dis, 2020) [MEDLINE]

Other Invasive Manifestations

General Comments

Invasive Moraxella Catarrhalis Infections are Considered Rare
- However, Invasive Moraxella Catarrhalis Infections Have Been Reported in All Age Groups and in Both Immunocompetent/Immunocompromised Patients (Pediatr Infect Dis J, 2008) [MEDLINE]

Bacteremia (see Bacteremia)

Epidemiology
- Moraxella Catarrhalis is an Infrequent Etiology of Bacteremia (Clin Infect Dis, 1995) [MEDLINE] (J Med Assoc Thai, 2009) [MEDLINE]
  - Moraxella Catarrhalis Bacteremia May Occur in Association with Pneumonia (Particularly in Patients with Underlying Lung Disease) (Clin Infect Dis, 1995) [MEDLINE]
  - Moraxella Catarrhalis Bacteremia May Occur in Association with Ear Infection in Immunocompetent Hosts (Clin Infect Dis, 1995) [MEDLINE]
- Neutropenic Cases of Moraxella Catarrhalis Bacteremia Frequently Do Not Have an Obvious Primary Focus of Infection (Clin Infect Dis, 1995) [MEDLINE]
- Transnasal Devices (Nasogastric Tubes, etc) Have Been Reported to Increase the Risk of Moraxella Catarrhalis Bacteremia in Children (BMC Infect Dis, 2016) [MEDLINE]

Endocarditis (see Endocarditis)

Epidemiology
- Moraxella Catarrhalis Bacteremia Cases Have Been Associated with Prosthetic Valve Endocarditis (BMJ Case Rep, 2015) [MEDLINE]

Neonatal Meningitis (see Bacterial Meningitis)

Epidemiology
- Cases Have Been Reported

Preseptal (Periorbital) Cellulitis (see Preseptal Cellulitis)

Epidemiology
- Cases Have Been Reported

Septic Arthritis (see Septic Arthritis)

Epidemiology
- Cases Have Been Reported

Vascular Graft Infection

Epidemiology
- Moraxella Catarrhalis Bacteremia Cases Have Been Associated with Vascular Graft Infection (J Med Microbiol, 2010) [MEDLINE]

Treatment

General Comments

Nearly All Strains of Moraxella Catarrhalis Produce β-Lactamase and are Resistant to Penicillin/Ampicillin/Amoxicillin
Moraxella Catarrhalis is Resistant to Clindamycin and Vancomycin

Amoxicillin-Clavulanic Acid (Augmentin) (see Amoxicillin-Clavulanic Acid)

Acceptable Agent
- While Moraxella Catarrhalis is Susceptible to Piperacillin/Ticarcillin/Aminoglycosides, Moraxella Catarrhalis Generally Do Not Require Treatment with Intravenous Antibiotics

Sulfamethoxazole-Trimethoprim (Bactrim, Septra) (see Sulfamethoxazole-Trimethoprim)

Acceptable Agent

Cephalosporins (see Cephalosporins)

Acceptable Agents

Macrolides (see Macrolides)

Acceptable Agents
- Moraxella Catarrhalis Resistance to Macrolides Has Been Reported in Asia

Tetracyclines (see Tetracyclines)

Acceptable Agents
- Moraxella Catarrhalis Resistance to Macrolides Has Been Reported in Asia

Fluoroquinolones (see Fluoroquinolones)

Acceptable Agents

References

Pneumonia due to Moraxella (Branhamella) catarrhalis. Semin Respir Infect. 1989 Mar;4(1):40-6 [MEDLINE]
The incidence and antibiotic susceptibility of Branhamella catarrhalis in respiratory infections. Drugs. 1986;31 Suppl 3:11 [MEDLINE]
Respiratory tract carrier rates of Moraxella (Branhamella) catarrhalis in adults and children and interpretation of the isolation of M. catarrhalis from sputum. J Clin Microbiol. 1990;28(12):2674 [MEDLINE]
A prospective study of isolation of Moraxella catarrhalis in a hospital during the winter months. J Hosp Infect. 1993;25(1):7 [MEDLINE]
Spectrum and significance of bacteremia due to Moraxella catarrhalis. Clin Infect Dis. 1995;21(2):390 [MEDLINE]
Pulsed-field gel electrophoresis analysis of nasopharyngeal flora in children attending a day care center. J Clin Microbiol. 2000;38(2):625 [MEDLINE]
New strains of bacteria and exacerbations of chronic obstructive pulmonary disease. N Engl J Med. 2002;347(7):465 [MEDLINE]
Possible relationship of PFGE patterns of Moraxella catarrhalis between hospital- and community-acquired respiratory infections in a community hospital. Microbiol Immunol. 2003;47(6):379-85 [MEDLINE]
Moraxella catarrhalis in chronic obstructive pulmonary disease: burden of disease and immune response. Am J Respir Crit Care Med. 2005;172(2):195 [MEDLINE]
Molecular analysis of intrafamiliar transmission of Moraxella catarrhalis. Int J Med Microbiol. 2005;295(3):187 [MEDLINE]
Detection of 12 respiratory viruses with two-set multiplex reverse transcriptase-PCR assay using a dual priming oligonucleotide system. Korean J Lab Med. 2007;38:420 [MEDLINE]
EP3OS 2007: European position paper on rhinosinusitis and nasal polyps 2007. A summary for otorhinolaryngologists. Rhinology. 2007 Jun;45(2):97-101 [MEDLINE]
Clinical and laboratory aspects of Moraxella catarrhalis bacteremia in children. Pediatr Infect Dis J. 2008;27(5):459 [MEDLINE]
Molecular epidemiological study of Moraxella catarrhalis isolated from nosocomial respiratory infection patients in a community hospital in Japan. Intern Med. 2009;48(10):797 [MEDLINE]
Moraxella catarrhalis pneumonia in an AIDS patient: a case report. J Med Assoc Thai. 2009;92(2):284 [MEDLINE]
Moraxella catarrhalis bacteraemia associated with prosthetic vascular graft infection. J Med Microbiol. 2010;59(Pt 2):245 [MEDLINE]
Moxifloxacin five-day therapy versus placebo in acute bacterial rhinosinusitis. Laryngoscope. 2010 May;120(5):1057-62. doi: 10.1002/lary.20878 [MEDLINE]
A prospective study of intrafamilial transmission and antimicrobial susceptibility of Moraxella catarrhalis. Microbiol Immunol. 2011;55(9):599 [MEDLINE]
Changes in nasopharyngeal carriage of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis among healthy children attending a day-care centre before and after official financial support for the 7-valent pneumococcal conjugate vaccine and H. influenzae type b vaccine in Japan. J Infect Chemother. 2014;20(2):146 [MEDLINE]
Moraxella catarrhalis bacteraemia and prosthetic valve endocarditis. BMJ Case Rep. 2015;2015 [MEDLINE]
Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg. 2015 Apr;152(2 Suppl):S1-S39. doi: 10.1177/0194599815572097 [MEDLINE]
Community-Acquired Moraxella catarrhalis Bacteremic Pneumonia: Two Case Reports and Review of the Literature. Case Rep Pulmonol. 2016;2016:5134969 [MEDLINE]
Nasopharyngeal carriage of Streptococcus pneumoniae and other bacteria in the 7th year after implementation of the pneumococcal conjugate vaccine in the Netherlands. Vaccine. 2016;34(4):531 [MEDLINE]
10-valent pneumococcal conjugate vaccine (PCV10) decreases metabolic activity but not nasopharyngeal carriage of Streptococcus pneumoniae and Haemophilus influenzae. Vaccine. 2017;35(33):4105 [MEDLINE]
A prospective, observational cohort study of the seasonal dynamics of airway pathogens in the aetiology of exacerbations in COPD. Thorax. 2017;72(10):919 [MEDLINE]
Epidemiology of Acute Otitis Media in the Postpneumococcal Conjugate Vaccine Era. Pediatrics. 2017;140(3) [MEDLINE]
Clinical characteristics of the patients with bacteremia due to Moraxella catarrhalis in children: a case-control study. BMC Infect Dis. 2016;16:73 [MEDLINE]
Clinical characteristics of community-acquired pneumonia due to Moraxella catarrhalis in adults: a retrospective single-centre study. BMC Infect Dis. 2020;20(1):821 [MEDLINE]