Moraxella Catarrhalis Infections - An Overview

What Is Moraxella Catarrhalis Infection?

Moraxella catarrhalis is a gram-negative diplococcus that frequently colonizes the upper respiratory system. It is the most common cause of middle ear infections in youngsters, including sudden flare-ups with chronic obstructive pulmonary disease (COPD), including acute bacterial rhinosinusitis (a condition in which the nasal cavity lining becomes inflamed, swollen and produces an excess of mucus due to infection or irritation. The enlarged lining may also hinder mucus drainage).

What Are the Causes?

The following are the causes of the infections:

• Regular Cold: Ten days after the onset of symptoms, children with common cold episodes brought on by bacterial infections still exhibited symptoms.

• Middle Ear Infection: Hearing loss, otalgia, and fever are among the symptoms of severe otitis media and otitis media with accompanying effusion in a patient's clinical history. Particularly in youngsters, otitis media becomes a highly prevalent condition. Children with middle ear otitis media have been shown to have M catarrhalis isolated in their exudates. On pneumatic otoscopy, an enlarged tympanic membrane is typically used to diagnose an acute middle ear infection. Ear discomfort and fever are supporting symptoms for the diagnosis.

• Sinusitis: The clinical history of sinusitis often involves headache, maxillary or frontal pain, fever, and cough. Young children cough and have nasal discharge, especially at night. M. catarrhalis has been identified from children's maxillary sinus aspirates as a single pathogen and in combination with other species.

• Infection of the Lower Respiratory Tract: M. catarrhalis infection may occur in adults with a history of COPD, pneumoconiosis (a collection of lung disorders that occur as a result of the lungs reacting to the inhalation of certain dust particles.), asthma, malignancies, immunosuppression, bronchitis, or pneumonia. Smoking is linked to M. catarrhalis LRTI. LRTIs have been linked to bronchopulmonary dysplasia (a chronic lung illness that primarily affects premature neonates who require oxygen therapy.), ventricular septal defect (a genetic cardiac defect characterized by an abnormal opening in the heart.), leukemia (cancers of the blood cells), Arnold-Chiari syndrome (a collection of abnormalities affecting the brain's white matter, other brain parts, and medulla oblongata in the back of the brain and hindbrain.), preterm birth, HIV infection, and recent respiratory syncytial virus (CMV) infection in infants.

• Nosocomial Pathogens: There have been reports of outbreaks of nosocomial infections caused by M. catarrhalis, primarily in pulmonary and pediatric intensive care units (PICUs).

• Endocarditis and Additional Regional Infections: M. catarrhalis endocarditis has been reported among individuals with previous experiences of valvular disorders (abnormalities or malfunctions of the heart valves.) or prostheses (a prosthetic body component) and also in previously healthy patients. It has also been referred to as a balloon angioplasty complication. In cleft palate correction, M. catarrhalis has been recognized as a pathogen. Other sporadic infections caused by M. catarrhalis involve the following:

1. Meningitis (an infection and inflammation of the cerebrospinal fluid and brain tissue, the protective membranes covering the brain and spinal cord).

2. Newborn ophthalmia (an infection of the eyes that appears during the first thirty days of life. It is acquired during childbirth by coming into contact with a sexually transmitted infection infected by the mother's birth canal).

3. Infectious arthritis.

4. Keratitis (inflammation within the eye).

5. Urinary tract disease.

6. Skin infection.

7. Peritonitis (an inflammation and reddening of the stomach or abdomen lining) in individuals on dialysis.

8. Conjunctival inflammation.

9. Periorbital edema (puffiness of the eyes).

10. Urethritis (inflammation of the urinary tract).

11. Gonorrhea (sexually transmitted infection caused by the bacterium Neisseria gon).

• Bacteremia: There is no primary site of infection among individuals with M. catarrhalis bacteremia. M. catarrhalis community-acquired pneumonia is rarely accompanied by bacteremia. These conditions have been demonstrated to increase the risk of M. catarrhalis bacteremia:

1. Immunodeficiency or chronic respiratory disorders like chronic obstructive pulmonary disease (COPD).

2. Bronchiectasis (a condition characterized by the abnormal dilation of the airways or their branches, which increases the susceptibility to infection).

3. Cystic fibrosis (a pathological condition characterized by the accumulation of viscous mucus in the lungs, digestive system, and several other parts of the body).

4. Leukemia (cancer that originates in the body's blood-forming tissues, such as the bone marrow and the lymphatic system).

5. Systemic lupus erythematosus (an autoimmune disease characterized by the body's immune system erroneously targeting and attacking healthy tissue).

6. Neutropenia (a deficiency of neutrophils, a specific type of white blood cell, in the bloodstream).

What Is the Diagnostic Method?

It is necessary to obtain a complete blood count (CBC). The possible presence of an elevated white blood cell (WBC) count and neutrophilia. Gram staining of cultures will reveal gram-negative diplococci. The staining protocol must be followed to the letter. According to reports, the precision of Gramme staining for isolating Neisseria or Moraxella species coincides precisely with determination by culture. According to the location of the infection and the underlying conditions, it may be necessary to conduct additional laboratory tests.

• History and Physical Assessment: Typically, the patient's medical history indicates the type of infection present, such as an upper respiratory tract infection [URTI], a lower respiratory tract infection [LRTI], a bacterial infection, or endocarditis. The physical manifestations of M. catarrhalis infections are comparable to those of other infections at the same site.

• Imaging Studies: Imaging examinations like plain radiography or computed tomography (CT) could be required if the infection is located in a body part different from what is expected. Radiography of the paranasal sinuses or computerized tomography (CT) scanning might be helpful. Chest radiography is often done. If there is a chance that the patient has peritonitis, an abdominal radiograph that includes a three-way view should be performed.

• Clinical Manifestations: A rise in basal dyspnea, cough, and sputum production identifies acute exacerbations of chronic obstructive pulmonary disease (COPD). Acute rhinosinusitis is distinguished by fever, nose congestion, nasal drainage, facial discomfort, and headache. The existence of persistent symptoms or complaints that initially improve but then deteriorate (double deterioration) increases the probability of a bacterial cause.

What Is the Treatment Method?

The type of medical care needed for an M. catarrhalis infection depends on the infection's site, the individual's age, any underlying diseases, and the severity of the sickness. For those who have an illness that fails to respond to drugs, whether it is broad with M. catarrhalis, whether it is in an unusual location, or if it is in a person with a chronic ailment that makes them unable to work, one should visit an infectious disease specialist. Contacting the individual's primary care physician for follow-up is highly encouraged.

• Prescription Medication: Several antimicrobials can be used to treat M. catarrhalis infection, depending on whether oral or parenteral medicine is required, the patient's age, the presence of any other underlying diseases, the sensitivity to the organism, and the planned spectrum of coverage. Amoxicillin-clavulanate, oral second- and third-generation Cephalosporins, and Trimethoprim-sulfamethoxazole (TMP-SMZ) are the most frequently advised medications. There are many alternatives, like Azithromycin and Clarithromycin.

• Acute Otitis: Topical Ciprofloxacin or Dexamethasone treatment for acute otitis media, including otorrhea, through tympanostomy tubes, was found to be equally efficacious as topical Ofloxacin treatment for M. catarrhalis infections.

• Chronic Bronchitis: Treating an acute aggravation of chronic bronchitis using oral Azithromycin 500 mg once daily for three days was equal to treating the condition with oral Clarithromycin 500 mg twice daily over ten days. Telithromycin, an erythromycin A ketolide derivative, showed good in vitro action against M. catarrhalis in sudden flare-ups of chronic bronchitis. There have been reports linking the use of Telithromycin to serious liver damage.

• Pneumonia: Community-acquired pneumonia caused by M. catarrhalis has been successfully treated with 400 mg of Quinolone Moxifloxacin daily.

What Are the Preventive Measures?

The nosocomial infections triggered by M. catarrhalis may be decreased or prevented by taking general precautions, using excellent hand hygiene practices, and sterilizing the devices and tubes employed in intubations, aspirations, or invasive procedures. Smoking cessation and the avoidance of passive smoking may lower M. catarrhalis infections. Additionally, healthy lifestyle choices are useful. An incorporated pneumococcal-non-typeable H. influenzae-Moraxella vaccine would shield against otitis media.

What Are the Complications?

The following are possible complications of an M. catarrhalis infection:

• Recurrent disease.

• Bacteremia (microorganisms that are alive in the blood) and sepsis (a critical condition that results from an overreaction of the immune system to an infection).

• Meningitis (an inflammatory condition that affects the meninges, which are the protective membranes).

• Mastoiditis (a condition characterized by the inflammation of the bone behind the ear, specifically in the temporal bone process).

• Loss of hearing.

• Effusion (a process by which a gas escapes through a small opening) in the pleura (a thin, double-layered membrane that lines the thoracic cavity).

• Sudden trauma.

• Mortality.

Conclusion

M. catarrhalis has shown significant pathogenicity in recent years. Antibiotics relieve clinical symptoms, but vaccination alone may prevent disease. Vaccinating against M. catarrhalis, one of the three primary infections, could be cost-effective. No clinical studies have been undertaken on several immunization regimens proposed over the years. Early life appears to confer immunity. Vaccination may help children with recurrent M. catarrhalis-induced otitis media. M. catarrhalis genomics should be improved by sequencing the full genome, preferably for enhance-resistant and complement-susceptible isolates, to find immunologically important genes and regulators. M. catarrhalis has evolved from a fledgling pathogen to an established disease during this period. Indeed, lactamase-producing isolates are common and may impact infection treatment, particularly mixed infections.