Scandinavian Journal of Infectious Diseases
ISSN: 0036-5548 (Print) 1651-1980 (Online) Journal homepage: http://www.tandfonline.com/loi/infd19
Branhamella catarrhalis septicemia in an immunocompetent adult Annette Alaeus & Göuran Stiernstedt To cite this article: Annette Alaeus & Göuran Stiernstedt (1991) Branhamella catarrhalis septicemia in an immunocompetent adult, Scandinavian Journal of Infectious Diseases, 23:1, 115-116 To link to this article: http://dx.doi.org/10.3109/00365549109023384
Published online: 08 Jul 2009.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=infd19 Download by: [University of California, San Diego]
Date: 15 December 2015, At: 05:25
Scand J Infect Dis 23: 115-1 16, 1991
CASE REPORT
Branhamella catarrhalis Septicemia in an lmmunocompetent Adult ANNETTE ALAEUS and GORAN STIERNSTEDT
Downloaded by [University of California, San Diego] at 05:25 15 December 2015
From the Department of Infectious Diseases, Karolinska I n ~ l r l i t f r , Danderyd Hospital, Stockholm, Sweden
A 68-year-old man with otitis media developed signs of disseminated intravasal coagulation (DIC) and shock. Beta-lactamase positive Branhamella catarrhalis grew in all blood cultures and in secretion from the middle ear. The patient was immunocompetent and previously healthy. Severe B. catarrhalis septicemia has so far mainly been described in immunocompromised patients, mostly children, but this report shows that it may occasionally occur in immunocompetent adults. A. Alaeus, MD, Department of Infectious Diseases, Danderyd Hospital, 918.2 88 Danderyd, Sweden
INTRODUCTION The human nasal cavity of man is considered to be the main natural habitat of Branhamella (Moraxella) catarrhalis ( 1). Branhamella has long been regarded as an occasional non-pathogenic inhabitant of the respiratory tract. However, during the last few decades its importance as a pathogen i n both acute upper and lower respiratory tract infections has become evident (3, 4). It has been isolated from inflammatory secretions of the middle ear, maxillary sinuses and from bronchial aspirate in bronchitis and pneumonia (1, 3, 4). Few reports have been published on septicemia due to B. catarrhalis (2, 5 , 6, 7). The majority of patients in these reports are immunocompromised adults with preexisting diseases (2,8,9) or small children (5, 6). CASE REPORT The patient was a 68-year-old male, who was previously healthy, except for a history of mild angina pectoris. After a common cold more than 6 months before admission he had suffered now and then from right sided otalgia, and had been treated with bilateral paracentesis. This condition was regarded as otosalpingitis and the symptoms diminished. He had received no antibiotic treatment. At the time of admission the patient had been suffering for 24 h from high fever, chills, nausea, vomiting, cough and severe pain from his right ear. His temperature was 39.5”C and he was slightly confused. On inspection the left ear was normal, while on the right side an acute suppurative otitis media was seen. The white blood cell count was 44xlO’II (84% neutrophils). ESR 12 inrnfh and C-reactive protein 128 mgil. Cultures were obtained and the patient received benzylpenicillin 3 g t.i.d. on the suspicion of a penumococcai infection. A few hours after admission the systolic blood pressure declined t o 80 mmHg and the patient was transferred to the intensive care unit. There were also laboratory signs of disseminated intravasal ~ prothrombin complex 24%. activated partial thromboplascoagulation (DIC) like platelet count 3 5 109/1, tin time (APTT) 42 sec; fibrin degradation products 40-100 mg/l; antithrombin 45%. Therapy with antithrombin and heparin was initiated. Lumbar puncture was normal as was chest X-ray. Sinus X-ray revealed swollen mucouos membranes in the right maxillary sinus. After transferral to the intensive care unit, therapy was changed t o cefuroxime 1.5 g t.i.d. and a single dose of 120 mg gentamicin was given intravenously. After 24 h in the intensive care unit the patient’s condition had improved and he was transferred back to the ward. A paracentesis of the right ear was done, revealing mucopurulent secretion under pressure. All 3 blood cultures and cultures from nasopharynx and the middle ear yielded B. catarrhalis which produced beta-lactamase.
116 A . Alaezis and G. Stiernstedt
S a n d J Infect Dis 23 (1991)
After 4 days the patient became afebrile and all other acute symptoms resolved except for the middle ear secretion which continued but slowly diminished during treatment. After 8 days, treatment was changed to oral erythromycin 500 mg t.i.d. for another 10 days. After 12 days at hospital the patient was discharged. Outpatient surveillance during 6 months revealed no signs of malignancy, but the patient is still under control because of a small ear-drum perforation.
Downloaded by [University of California, San Diego] at 05:25 15 December 2015
DISCUSSION This report presents a patient with B. catarrhalis bacteremia originating from an otitis media. Positive blood cultures in patients with bacterial respiratory tract infection might be explained by transient bacteremia. However, we believe that the decline in blood pressure and laboratory signs of DIC in this patient indicate a severe septicemia. Previous reports have remarked upon a link between immunodeficiency and the occurrence of serious B. catarrhalis disease ( 5 , 6 , 8 ) . This report shows that it may occasionally occur also in adult immunocompetent patients, a finding which may have implications in the choice of antibiotic treatment in severe life-threatening respiratory tract infections. REFERENCES 1. Bsvre K. Gram-negative aerobic rods and cocci: Family Neisseriaceae. In: Krieg NR, Holt IG, eds. Bergey’s Manual of systematic bacteriology, vol. 1 . BaltimorelLondon: Williams & Wilkins, 302, 1984. 2. Guthrie R, Bakenhaster K, Nelson K, Woskobnick R. Branhamella catarrhalis sepsis: A case report and review of the literature. J Infect Dis 4 0 907-908, 1988. 3. Hager H, Verghese A, Alvarez S,Berk SL. Branhamella catarrhalis respiratory infections. Rev Infect Dis 6: 1140-1149, 1987. 4. SchalCn L, Christensen P, Kamme C, Miorner H, Pettersson K-I, Schalen C. High isolation rate of Branhamella catarrhalis from the nasopharynx in adults with acute laryngitis. Scand J Infect Dis 12: 277-280, 1980. 5. Cimolai N, Adderley RJ. Branhamella catarrhalis bacteremia in children. Acta Pediatr Scand 78: 465-468, 1989. 6. Bonadio WA. Branhamella catarrhalis bacteremia in children. Pediatr Infect Dis J 10: 738-739, 1988. 7. Wong VK, Ross LA. Branhamella catarrhalis septicemia in an infant with AIDS, Scand J Infect Dis 20: 559-560, 1988. 8. Bannatyne RM, Kolodej V. Branhamella catarrhalis bacteremia and immunosuppression-part of a larger problem? Diagn Microbiol Infect Dis 3: 65-67, 1985. 9. Kostiala AAE, Honkanen T. Branhamella catarrhalis as a cause of acute purulent pericarditis. J Infect Dis 3: 291-292, 1989.
ISSN: 0036-5548 (Print) 1651-1980 (Online) Journal homepage: http://www.tandfonline.com/loi/infd19
Branhamella catarrhalis septicemia in an immunocompetent adult Annette Alaeus & Göuran Stiernstedt To cite this article: Annette Alaeus & Göuran Stiernstedt (1991) Branhamella catarrhalis septicemia in an immunocompetent adult, Scandinavian Journal of Infectious Diseases, 23:1, 115-116 To link to this article: http://dx.doi.org/10.3109/00365549109023384
Published online: 08 Jul 2009.
Submit your article to this journal
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=infd19 Download by: [University of California, San Diego]
Date: 15 December 2015, At: 05:25
Scand J Infect Dis 23: 115-1 16, 1991
CASE REPORT
Branhamella catarrhalis Septicemia in an lmmunocompetent Adult ANNETTE ALAEUS and GORAN STIERNSTEDT
Downloaded by [University of California, San Diego] at 05:25 15 December 2015
From the Department of Infectious Diseases, Karolinska I n ~ l r l i t f r , Danderyd Hospital, Stockholm, Sweden
A 68-year-old man with otitis media developed signs of disseminated intravasal coagulation (DIC) and shock. Beta-lactamase positive Branhamella catarrhalis grew in all blood cultures and in secretion from the middle ear. The patient was immunocompetent and previously healthy. Severe B. catarrhalis septicemia has so far mainly been described in immunocompromised patients, mostly children, but this report shows that it may occasionally occur in immunocompetent adults. A. Alaeus, MD, Department of Infectious Diseases, Danderyd Hospital, 918.2 88 Danderyd, Sweden
INTRODUCTION The human nasal cavity of man is considered to be the main natural habitat of Branhamella (Moraxella) catarrhalis ( 1). Branhamella has long been regarded as an occasional non-pathogenic inhabitant of the respiratory tract. However, during the last few decades its importance as a pathogen i n both acute upper and lower respiratory tract infections has become evident (3, 4). It has been isolated from inflammatory secretions of the middle ear, maxillary sinuses and from bronchial aspirate in bronchitis and pneumonia (1, 3, 4). Few reports have been published on septicemia due to B. catarrhalis (2, 5 , 6, 7). The majority of patients in these reports are immunocompromised adults with preexisting diseases (2,8,9) or small children (5, 6). CASE REPORT The patient was a 68-year-old male, who was previously healthy, except for a history of mild angina pectoris. After a common cold more than 6 months before admission he had suffered now and then from right sided otalgia, and had been treated with bilateral paracentesis. This condition was regarded as otosalpingitis and the symptoms diminished. He had received no antibiotic treatment. At the time of admission the patient had been suffering for 24 h from high fever, chills, nausea, vomiting, cough and severe pain from his right ear. His temperature was 39.5”C and he was slightly confused. On inspection the left ear was normal, while on the right side an acute suppurative otitis media was seen. The white blood cell count was 44xlO’II (84% neutrophils). ESR 12 inrnfh and C-reactive protein 128 mgil. Cultures were obtained and the patient received benzylpenicillin 3 g t.i.d. on the suspicion of a penumococcai infection. A few hours after admission the systolic blood pressure declined t o 80 mmHg and the patient was transferred to the intensive care unit. There were also laboratory signs of disseminated intravasal ~ prothrombin complex 24%. activated partial thromboplascoagulation (DIC) like platelet count 3 5 109/1, tin time (APTT) 42 sec; fibrin degradation products 40-100 mg/l; antithrombin 45%. Therapy with antithrombin and heparin was initiated. Lumbar puncture was normal as was chest X-ray. Sinus X-ray revealed swollen mucouos membranes in the right maxillary sinus. After transferral to the intensive care unit, therapy was changed t o cefuroxime 1.5 g t.i.d. and a single dose of 120 mg gentamicin was given intravenously. After 24 h in the intensive care unit the patient’s condition had improved and he was transferred back to the ward. A paracentesis of the right ear was done, revealing mucopurulent secretion under pressure. All 3 blood cultures and cultures from nasopharynx and the middle ear yielded B. catarrhalis which produced beta-lactamase.
116 A . Alaezis and G. Stiernstedt
S a n d J Infect Dis 23 (1991)
After 4 days the patient became afebrile and all other acute symptoms resolved except for the middle ear secretion which continued but slowly diminished during treatment. After 8 days, treatment was changed to oral erythromycin 500 mg t.i.d. for another 10 days. After 12 days at hospital the patient was discharged. Outpatient surveillance during 6 months revealed no signs of malignancy, but the patient is still under control because of a small ear-drum perforation.
Downloaded by [University of California, San Diego] at 05:25 15 December 2015
DISCUSSION This report presents a patient with B. catarrhalis bacteremia originating from an otitis media. Positive blood cultures in patients with bacterial respiratory tract infection might be explained by transient bacteremia. However, we believe that the decline in blood pressure and laboratory signs of DIC in this patient indicate a severe septicemia. Previous reports have remarked upon a link between immunodeficiency and the occurrence of serious B. catarrhalis disease ( 5 , 6 , 8 ) . This report shows that it may occasionally occur also in adult immunocompetent patients, a finding which may have implications in the choice of antibiotic treatment in severe life-threatening respiratory tract infections. REFERENCES 1. Bsvre K. Gram-negative aerobic rods and cocci: Family Neisseriaceae. In: Krieg NR, Holt IG, eds. Bergey’s Manual of systematic bacteriology, vol. 1 . BaltimorelLondon: Williams & Wilkins, 302, 1984. 2. Guthrie R, Bakenhaster K, Nelson K, Woskobnick R. Branhamella catarrhalis sepsis: A case report and review of the literature. J Infect Dis 4 0 907-908, 1988. 3. Hager H, Verghese A, Alvarez S,Berk SL. Branhamella catarrhalis respiratory infections. Rev Infect Dis 6: 1140-1149, 1987. 4. SchalCn L, Christensen P, Kamme C, Miorner H, Pettersson K-I, Schalen C. High isolation rate of Branhamella catarrhalis from the nasopharynx in adults with acute laryngitis. Scand J Infect Dis 12: 277-280, 1980. 5. Cimolai N, Adderley RJ. Branhamella catarrhalis bacteremia in children. Acta Pediatr Scand 78: 465-468, 1989. 6. Bonadio WA. Branhamella catarrhalis bacteremia in children. Pediatr Infect Dis J 10: 738-739, 1988. 7. Wong VK, Ross LA. Branhamella catarrhalis septicemia in an infant with AIDS, Scand J Infect Dis 20: 559-560, 1988. 8. Bannatyne RM, Kolodej V. Branhamella catarrhalis bacteremia and immunosuppression-part of a larger problem? Diagn Microbiol Infect Dis 3: 65-67, 1985. 9. Kostiala AAE, Honkanen T. Branhamella catarrhalis as a cause of acute purulent pericarditis. J Infect Dis 3: 291-292, 1989.
