Moraxella catarrhalis Infection Workup: Laboratory Studies, Imaging Studies

Laboratory Studies

A complete blood count (CBC) should be obtained. An increased white blood cell (WBC) count with neutrophilia may be present.

Gram-negative diplococci are found on Gram staining of cultures. Strict adherence to the staining protocol is required. The accuracy of Gram staining for isolation of Neisseria or Moraxella species has been reported to agree perfectly with identification by culture.

Confirmation of the diagnosis of M catarrhalis infection is based on isolation of the organism in culture. Cultures can be taken from middle ear effusion, the nasopharynx, sputum, sinus aspirates, transtracheal or transbronchial aspirates, blood, peritoneal fluid, wounds, or urine. Colonies are approximately 0.2 cm in diameter, opaque, and nonhemolytic after incubation on chocolate or blood agar for 48 hours. Characteristically, colonies can be pushed along the surface of the agar like a hockey puck.

With standard methods of identification, M catarrhalis can be differentiated from Neisseria species by not using sucrose, glucose, maltose, and lactose. Because Neisseria cinerea exhibits the same reaction pattern, the Superoxyl test must be added. For definitive identification, deoxyribonuclease (DNase) and nitrate reduction tests are performed; M catarrhalis produces DNase and reduces nitrate and nitrite levels.

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

Serologic tests for infections with M catarrhalis are not widely used; cross-reactivity with Neisseria species in the detection of complement fixation antibodies by immunoelectrophoresis has been demonstrated. Serum antibodies to whole-cell proteins, to lipo-oligosaccharides, and to outer-membrane antigens have proved useful in the diagnosis of M catarrhalis infection. Other laboratory studies may be needed, depending on the site of infection and underlying conditions.

Imaging Studies

Imaging studies (eg, plain radiography or computed tomography [CT]) may be needed, depending on the site of infection.

Paranasal sinus radiography or CT scanning may be helpful. Chest radiography is often performed. If peritonitis is a possibility, abdominal radiography using a 3-way view is indicated.

Treatment & Management



Michael Constantinescu, MD Staff Pathologist, Overton Brooks Veterans Affairs Medical Center

Michael Constantinescu, MD is a member of the following medical societies: American Society for Clinical Pathology, College of American Pathologists, United States and Canadian Academy of Pathology

Coauthor(s)

James D Cotelingam, MBBS, MD Head of Hematopathology, Director of Clinical Laboratories, Professor, Department of Pathology, Louisiana State University School of Medicine in Shreveport

James D Cotelingam, MBBS, MD is a member of the following medical societies: American Association for Physician Leadership, American Society for Clinical Pathology, Association of Military Surgeons of the US, College of American Pathologists, New York Academy of Sciences

Ronald Silberman, PhD Director of Clinical Microbiology Laboratory, Louisiana State University Hospital; Professor, Department of Pathology, Louisiana State University School of Medicine in Shreveport

Joseph A Bocchini, Jr, MD Medical Director of Children's Hospital; Member, Pediatric Infectious Disease Section, Chairman, Professor, Department of Pediatrics, Louisiana State University School of Medicine in Shreveport

Joseph A Bocchini, Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Southern Society for Pediatric Research

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, Oklahoma State Medical Association, Southern Society for Clinical Investigation, Association of Professors of Medicine, American College of Physicians, Infectious Diseases Society of America

Acknowledgements

Joseph F John Jr, MD, FACP, FIDSA, FSHEA Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina College of Medicine; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center

Disclosure: Nothing to disclose.

Maria D Mileno, MD Associate Professor of Medicine, Division of Infectious Diseases, The Warren Alpert Medical School of Brown University

Maria D Mileno, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, International Society of Travel Medicine, and Sigma Xi

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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