Branhamella catarrhalisBranhamella catarrhalis

Made byMade by :Huda M. N. Hanyia:Huda M. N. HanyiaPresentedPresented toto:Dr Abdelraouf A. :Dr Abdelraouf A.

ElmanamaElmanama

IntroductionIntroduction Branhamella catarrhalis is classified with genera Neisseria, Branhamella catarrhalis is classified with genera Neisseria,

Moraxella and Acinetobacter in the family Neisseria.Moraxella and Acinetobacter in the family Neisseria. The taxonomic position of B. catarrhalis be assigned to the The taxonomic position of B. catarrhalis be assigned to the

genus Moraxella (M. catarrhalis) in the family Moraxella, or to genus Moraxella (M. catarrhalis) in the family Moraxella, or to its own genus its own genus

Moraxellae are closely related to the Neisseriae. Like Moraxellae are closely related to the Neisseriae. Like Neisseriae, they synthesize the unusual type 4 pili that are Neisseriae, they synthesize the unusual type 4 pili that are involved in both adherence and motility. Some of the other involved in both adherence and motility. Some of the other organisms that synthesize type 4 pili also synthesize a variety of organisms that synthesize type 4 pili also synthesize a variety of hydrolytic enzymes that may be involved in pathogenesis, but hydrolytic enzymes that may be involved in pathogenesis, but these have yet to be identified in Moraxella.these have yet to be identified in Moraxella.

In the clinical laboratory , isolates of B . Catarrhalis must be In the clinical laboratory , isolates of B . Catarrhalis must be distinguished from Neisseriadistinguished from Neisseria

The Branhamella catarrhalis was consider as a saprophyte of The Branhamella catarrhalis was consider as a saprophyte of the upper respiratory tarct with no siginficant pathogenic.the upper respiratory tarct with no siginficant pathogenic.

Although the commensal status of Although the commensal status of Branhamella Branhamella catarrhaliscatarrhalis in the nasopharynx is still accepected , the in the nasopharynx is still accepected , the organism is common cause of Otitis media and sinusitis , organism is common cause of Otitis media and sinusitis , laryngitis.laryngitis.

The The Branhamella catarrhalisBranhamella catarrhalis Bacteremia especially in Bacteremia especially in patients who are immunocompromised.patients who are immunocompromised.

Bacteremia can be complicated by local infection such as Bacteremia can be complicated by local infection such as osteomyelitis or septic arthritis.osteomyelitis or septic arthritis.

Branhamella catarrhalis Branhamella catarrhalis is also associated with is also associated with nosocomial infections.nosocomial infections.

Normal human habitat:Normal human habitat: It is a part of the normal in human cavity and mucosa It is a part of the normal in human cavity and mucosa

and nasopharynxand nasopharynx

Sources/specimens:Sources/specimens: nasopharyngeal specimen, blood, cerebrospinal fluid nasopharyngeal specimen, blood, cerebrospinal fluid ReservoirReservoir : : human human Zoonosis:Zoonosis: none none vector:vector: none none

Mode of Transmission:Mode of Transmission: By direct contact with droplets and discharges By direct contact with droplets and discharges

from nose and throat of infected persons ; from nose and throat of infected persons ; nosocomial transmission is being increasingly nosocomial transmission is being increasingly

documenteddocumented

Lab studies:Lab studies:

1.1. CBC count : increased WBC count with netrophilia CBC count : increased WBC count with netrophilia may be present in branhallema catarrhalis.may be present in branhallema catarrhalis.

2.2. Gram stain: Gram-negative diplococcus culture Gram stain: Gram-negative diplococcus culture result are found ;strict adherence to the staining is result are found ;strict adherence to the staining is requiredrequired

3.3. Confirmation of diagnosis of branhallema Confirmation of diagnosis of branhallema catarrhalis is based on isolation of the organism in catarrhalis is based on isolation of the organism in culture.culture.

o culture can be taken from middle ear effusion, the culture can be taken from middle ear effusion, the nasopharynx, sputum, blood ,wound, urine .nasopharynx, sputum, blood ,wound, urine .

o colonies are 0.2 cm in diameter, opaque, and no colonies are 0.2 cm in diameter, opaque, and no hemolytic after incubation on C.A,or B.A for 48hrshemolytic after incubation on C.A,or B.A for 48hrs

characteristically , colonies can be pushed along the characteristically , colonies can be pushed along the surface of the agar like hockey pucksurface of the agar like hockey puck

with standard methods of identification , branhallema with standard methods of identification , branhallema catarrhalis can be difference from Neisseria species catarrhalis can be difference from Neisseria species by not using sucrose ,glucose. Because Neisseria by not using sucrose ,glucose. Because Neisseria cineria has the same reaction pattern, the superoxol cineria has the same reaction pattern, the superoxol test must be added.test must be added.

for definitive identification Dnase and nitrate for definitive identification Dnase and nitrate reduction are performed ; branhallema catarrhalis reduction are performed ; branhallema catarrhalis Dnase and nitrate and nitrite levelsDnase and nitrate and nitrite levels

several rapid confirmy tests are available to identify several rapid confirmy tests are available to identify branhallema catarrhalis , and they are all based on the branhallema catarrhalis , and they are all based on the ability of branhallema catarrhalis to hydrolyze ability of branhallema catarrhalis to hydrolyze tributyrin. This provides immediate identification tributyrin. This provides immediate identification and separation from human Neisseria species and separation from human Neisseria species Neisseria species, which do not hydrolyze tributyrinNeisseria species, which do not hydrolyze tributyrin

serological tes for branhallema catarrhalis are not serological tes for branhallema catarrhalis are not widely used : cross-reactively with Neisseria species widely used : cross-reactively with Neisseria species in the detection of complent fixation Ab by in the detection of complent fixation Ab by immunoelectrophoresis has been demonstrated.immunoelectrophoresis has been demonstrated.

Serum Ab to whole cell protein, to lipo-Serum Ab to whole cell protein, to lipo-oligosaccharides, and to outer membrane Ag have oligosaccharides, and to outer membrane Ag have proved useful in the diagnosis of branhallema proved useful in the diagnosis of branhallema catarrhalis infection.catarrhalis infection.

Other lab studies may be needed , depending on the Other lab studies may be needed , depending on the site of the infection and underlying conditionsite of the infection and underlying condition

Imaging studies:Imaging studies: Imaging studiesImaging studies may be needed, depending of the may be needed, depending of the

site of infection:site of infection:

1.1. Paranasal sinus radiographs or CT scans.Paranasal sinus radiographs or CT scans.

2-2- chest radiographs chest radiographs

3-3- abdominal radiographs: obtain a 3-way peritonitis is abdominal radiographs: obtain a 3-way peritonitis is a possibility.a possibility.

Pathogenicity;Pathogenicity;1.1. Infection in adult:Infection in adult:

A-TheA-The M. catarrhalis is manifest itself as a pathogen in M. catarrhalis is manifest itself as a pathogen in the nosocomial setting .a rare but very serous and the nosocomial setting .a rare but very serous and frequently lethal infection with M. catarrhalis frequently lethal infection with M. catarrhalis appear to be endocarditicappear to be endocarditic

B- laryngitis B- laryngitis

C- bronchitis and pneumonia C- bronchitis and pneumonia

Infection in the children:Infection in the children:1.1. MeningitisMeningitis

2.2. Media OtitisMedia Otitis

3.3. PneumoniaPneumonia

4.4. BronchitisBronchitis

5.5. Bacteremia Bacteremia complication:complication: recurrence, Bacteremia, meningitis, recurrence, Bacteremia, meningitis,

mastoidotis, hearing loss, pleural effusion, shock, mastoidotis, hearing loss, pleural effusion, shock, deathdeath

Nosocomial infection: outbreaks of infection Nosocomial infection: outbreaks of infection with branhallema catarrhalis have reported, with branhallema catarrhalis have reported, mostly involving pulmonary units or pediatric mostly involving pulmonary units or pediatric intensive care units. Increased length of intensive care units. Increased length of hospitalized has been correlated with the hospitalized has been correlated with the presence of branhallema catarrhalispresence of branhallema catarrhalis

Bacteremia : no primary site infection was Bacteremia : no primary site infection was found in 46% of patient with branhallema found in 46% of patient with branhallema catarrhalis bacterima .catarrhalis bacterima .

Deterrence/prevention:Deterrence/prevention: universal precaution, good hand hashing and universal precaution, good hand hashing and

sterilization of instruments and tubes used sterilization of instruments and tubes used intubations , aspiration, or invasive produced may intubations , aspiration, or invasive produced may reduce or prevent the nosocomial infection caused reduce or prevent the nosocomial infection caused by branhallema catarrhalisby branhallema catarrhalis

prognosis :prognosis :prognosis is poor for hospitalized prognosis is poor for hospitalized patients with underlying conditions, especially the patients with underlying conditions, especially the following;following;

1.1. Patients hospitalized for prolonged periodsPatients hospitalized for prolonged periods

2- 2- Patients in pulmonary units or pediatric Patients in pulmonary units or pediatric

intensive care unitsintensive care units

3-3- Patients of advanced age Patients of advanced age..

Patients education:Patients education:

Hand washing, smoking cessation, and good heath Hand washing, smoking cessation, and good heath habits (e.g, proper rest, diet, exercise) are helpful habits (e.g, proper rest, diet, exercise) are helpful both the treatment process and in prevention of any both the treatment process and in prevention of any infection.infection.

Characteristic of B. catarrhalisCharacteristic of B. catarrhalis Gram stain: Gram-negative diplococcus Gram stain: Gram-negative diplococcus Colony morphology :Colony morphology :

Pigmentation:Pigmentation:

Oxidase test:Oxidase test:

Acid production Acid production

Production of deoxyribonucleas(DNase):Production of deoxyribonucleas(DNase):

Polysaccharide from sucrose:Polysaccharide from sucrose:

Superoxol test (reaction with 30% hydrogen Superoxol test (reaction with 30% hydrogen peroxide)peroxide)

Catalase test (reaction with 3% Catalase test (reaction with 3% hydrogen peroxide); hydrogen peroxide);

When performed on clear base When performed on clear base medium without medium without Hb , the Hb , the Catalase reaction of B. Catalase reaction of B. catarrhalis may vigorously, but catarrhalis may vigorously, but very rapid and then become very rapid and then become negative , persistent bubbles negative , persistent bubbles may not be observed . Thus , the may not be observed . Thus , the reaction should be watched to reaction should be watched to observe a positive Catalase observe a positive Catalase reactionreaction

Colistin resistance:Colistin resistance:

Nitrate reduction ; positiveNitrate reduction ; positive

MEDIA OF CHOICE:MEDIA OF CHOICE:1.1. Modified Modified oxidation-fermentation medium oxidation-fermentation medium was was

developed as a practical medium for highly and developed as a practical medium for highly and specific detection of acid production from specific detection of acid production from carbohydrates by Neisseria spp. and B catarrhalis.carbohydrates by Neisseria spp. and B catarrhalis.

Neisseria spp and B. catarrhalis were tested in this Neisseria spp and B. catarrhalis were tested in this medium , in which the protein concentration was medium , in which the protein concentration was reduced relative to the carbohydrate concentration , reduced relative to the carbohydrate concentration , phenol red was substituted for bromthymol blue at phenol red was substituted for bromthymol blue at low conc. and the PH is 7.2 .low conc. and the PH is 7.2 .

Sugar utilization patterns were consistent with Sugar utilization patterns were consistent with published result and other cultural and published result and other cultural and biochemical characteristics for these species.biochemical characteristics for these species.

The reaction obtained using this medium were The reaction obtained using this medium were qualitative better and more reproducible than qualitative better and more reproducible than those obtained in cystine- Trypticase agar .those obtained in cystine- Trypticase agar .

To study effect of various commonly used To study effect of various commonly used media on the growth of Branhamella :media on the growth of Branhamella :

1.1. New York city medium (MNYC) containing New York city medium (MNYC) containing the selective agent trimethoprim lactatethe selective agent trimethoprim lactate

2.2. Modified Thayer Martin medium containing Modified Thayer Martin medium containing vancomycinvancomycin

3.3. Mac agarMac agar

4- crystal violet blood agar , bilayer ;lower contain 4- crystal violet blood agar , bilayer ;lower contain colum blood agar, the upper blood agar contain colum blood agar, the upper blood agar contain crystal violet crystal violet

5- N.A5- N.A6- semiselective media for Branhamella allow all 6- semiselective media for Branhamella allow all

Neisseria ssp and further differentiation is necessary.Neisseria ssp and further differentiation is necessary. The plate incubated at 22c and 37c aerobically and The plate incubated at 22c and 37c aerobically and

37c anaerobically on NA37c anaerobically on NA Cultured were read after overnight and read as light, Cultured were read after overnight and read as light,

moderate or heavy growthmoderate or heavy growth

The result :The result : The Branhamella have no ability to grow on MNYC The Branhamella have no ability to grow on MNYC

or MTM mediaor MTM media All the strain of Branhamella failed to grow on the All the strain of Branhamella failed to grow on the

MAC agar and blood agarMAC agar and blood agar All strain grow on the N.A at 22c and 37cAll strain grow on the N.A at 22c and 37c None of the strain of Branhamella grew under the None of the strain of Branhamella grew under the

anaerobic conditionanaerobic condition

because the morphological similarities and because the morphological similarities and biochemical variation among Neisseria ssp.and biochemical variation among Neisseria ssp.and Branhamella may cause confusion and result Branhamella may cause confusion and result in error delayed in their recognitionin error delayed in their recognition

Dnase is test high specificity it can be used as Dnase is test high specificity it can be used as confirmatory test and also superoxol test.confirmatory test and also superoxol test.

Risk factor:Risk factor:1.1. This bacteria cause more than 70%of patient This bacteria cause more than 70%of patient

that have neutropenia, malignancy, that have neutropenia, malignancy, respiratory impairment.respiratory impairment.

2.2. This bacteria cause infection in most patient This bacteria cause infection in most patient older than 65 year and 90%to 95%of patient older than 65 year and 90%to 95%of patient have underlying cardiopulmonary disease.have underlying cardiopulmonary disease.

3.3. A large % are smoker A large % are smoker 4.4. Men appear to be greater risk than womenMen appear to be greater risk than women

Virulence of M. catarrhalis:Virulence of M. catarrhalis:1.1. Adherence:Adherence: Study Study M. catarrhalis M. catarrhalis was show to specifically was show to specifically

attach to the mucin molecules from thenasopharynx attach to the mucin molecules from thenasopharynx and middle ear but not to mucin the saliva and and middle ear but not to mucin the saliva and trancheobronchial mucin.trancheobronchial mucin.

The interaction such as these represent the first The interaction such as these represent the first steps in the process of bacterial colonization and steps in the process of bacterial colonization and infection.infection.

The presence or absence of fimbria did not influence The presence or absence of fimbria did not influence the capacity of the bacterium to adhere or to cause the capacity of the bacterium to adhere or to cause haemagglutination .haemagglutination .

The bacteria and epithelial cell are both negatively The bacteria and epithelial cell are both negatively

charged, interaction between the negatively charged charged, interaction between the negatively charged surface of M. catarrhalis cells and positively charge surface of M. catarrhalis cells and positively charge domain s called microplica on pharyngeal epithelial domain s called microplica on pharyngeal epithelial cells was found.cells was found.

22 - -Tissue culture adherence and haemagglutination Tissue culture adherence and haemagglutination characteristics of M.catarrhalischaracteristics of M.catarrhalis

The haemagglutination and tissue culture adherence The haemagglutination and tissue culture adherence properties of 20 isolates of Moraxella catarrhalis properties of 20 isolates of Moraxella catarrhalis obtained from the sputum of elderly patient with obtained from the sputum of elderly patient with lower respiration tract infection were compared with lower respiration tract infection were compared with those 20 isolation of Moraxella obtained from the those 20 isolation of Moraxella obtained from the nasopharynx of elderly persons colonized by the nasopharynx of elderly persons colonized by the organism .organism .

Eighty percent of isolate from the infected group as Eighty percent of isolate from the infected group as opposed to 5% of isolate from the colonized group opposed to 5% of isolate from the colonized group hameagglutinin human erythrocyte .hameagglutinin human erythrocyte .

The indicating that the hameagglutinin might The indicating that the hameagglutinin might be a marker of Pathogenicity for catarrhalis.be a marker of Pathogenicity for catarrhalis.

Animal Models:Animal Models: the low virulence of M .catarrhalis in laboratory the low virulence of M .catarrhalis in laboratory

animals has hampered protection experiment and animals has hampered protection experiment and Pathogenicity studies in rats and micePathogenicity studies in rats and mice

one study on the model was presented by lee etal, one study on the model was presented by lee etal, who were able to isolate live M .catarrhalis from who were able to isolate live M .catarrhalis from specific mouse strain, suspended in BHIB were specific mouse strain, suspended in BHIB were inoculalated via interaperitoneal route .inoculalated via interaperitoneal route .

infection resulted in high mortality and infection resulted in high mortality and facilitated antibiotic efficacy studies.facilitated antibiotic efficacy studies.

in another study murine model designed to in another study murine model designed to study phagocyte response and clearance study phagocyte response and clearance mechanism after endotarcheal challenge with mechanism after endotarcheal challenge with M .catarrhalis , high influx of PMN M .catarrhalis , high influx of PMN leukocytes into the lung leukocytes into the lung

bacteria were cleared from the lung within 24-bacteria were cleared from the lung within 24-48hr, and the animal remained healthy 48hr, and the animal remained healthy

Enhanced clearance of bacteria from the lungs was Enhanced clearance of bacteria from the lungs was observed , correlating with higher levels of specific observed , correlating with higher levels of specific IgA and IgG in serum and bronchoalveolar lavage IgA and IgG in serum and bronchoalveolar lavage fluidfluid

the clearance of M .catarrhalis from the lungs is the clearance of M .catarrhalis from the lungs is rapid within 6-24 h , result of low virulence of rapid within 6-24 h , result of low virulence of M .catarrhalis for animal models.M .catarrhalis for animal models.

passive and active immunization studies in this passive and active immunization studies in this animal model documented improved pulmonary.animal model documented improved pulmonary.

Complement resistance:Complement resistance: complement resistance strain appeared to activate complement resistance strain appeared to activate

complement to the same extent as , or even slightly.complement to the same extent as , or even slightly. the resistance strain do not inhibit classical or the resistance strain do not inhibit classical or

alternative complement pathway activation but alternative complement pathway activation but interfere with complement at the level of attack interfere with complement at the level of attack complex formationcomplex formation

Treatment:Treatment:

Amoxicillin-clavulanate,second and third generation Amoxicillin-clavulanate,second and third generation oral cephalosporin and trimethoprim-sulfamethoazole oral cephalosporin and trimethoprim-sulfamethoazole are the most recommended agent. Alternatively, are the most recommended agent. Alternatively, azithromycin, diithromycin can be used . All other azithromycin, diithromycin can be used . All other agents listed below are also effective agents listed below are also effective

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