Transcript Branhamella catarrhalis

Branhamella catarrhalis
Made by :Huda M. N. Hanyia
Presented to:Dr Abdelraouf A.
Elmanama
Introduction
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Branhamella catarrhalis is classified with genera Neisseria,
Moraxella and Acinetobacter in the family Neisseria.
The taxonomic position of B. catarrhalis be assigned to the
genus Moraxella (M. catarrhalis) in the family Moraxella, or to
its own genus
Moraxellae are closely related to the Neisseriae. Like
Neisseriae, they synthesize the unusual type 4 pili that are
involved in both adherence and motility. Some of the other
organisms that synthesize type 4 pili also synthesize a variety
of hydrolytic enzymes that may be involved in pathogenesis,
but these have yet to be identified in Moraxella.
In the clinical laboratory , isolates of B . Catarrhalis must be
distinguished from Neisseria
The Branhamella catarrhalis was consider as a saprophyte of
the upper respiratory tarct with no siginficant pathogenic.
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Although the commensal status of Branhamella
catarrhalis in the nasopharynx is still accepected , the
organism is common cause of Otitis media and sinusitis ,
laryngitis.
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The Branhamella catarrhalis Bacteremia especially in
patients who are immunocompromised.
Bacteremia can be complicated by local infection such as
osteomyelitis or septic arthritis.
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Branhamella catarrhalis is also associated with
nosocomial infections.
Normal human habitat:
 It is a part of the normal in human cavity and mucosa
and nasopharynx
Sources/specimens:
 nasopharyngeal specimen, blood, cerebrospinal fluid
 Reservoir : human
 Zoonosis: none
 vector: none
Mode of Transmission:
 By direct contact with droplets and discharges
from nose and throat of infected persons ;
 nosocomial transmission is being increasingly
documented
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Lab studies:
CBC count : increased WBC count with netrophilia
may be present in branhallema catarrhalis.
Gram stain: Gram-negative diplococcus culture
result are found ;strict adherence to the staining is
required
Confirmation of diagnosis of branhallema
catarrhalis is based on isolation of the organism in
culture.
culture can be taken from middle ear effusion, the
nasopharynx, sputum, blood ,wound, urine .
colonies are 0.2 cm in diameter, opaque, and no
hemolytic after incubation on C.A,or B.A for 48hrs
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characteristically , colonies can be pushed along the
surface of the agar like hockey puck
with standard methods of identification , branhallema
catarrhalis can be difference from Neisseria species
by not using sucrose ,glucose. Because Neisseria
cineria has the same reaction pattern, the superoxol
test must be added.
for definitive identification Dnase and nitrate
reduction are performed ; branhallema catarrhalis
Dnase and nitrate and nitrite levels
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several rapid confirmy tests are available to identify
branhallema catarrhalis , and they are all based on the
ability of branhallema catarrhalis to hydrolyze
tributyrin. This provides immediate identification
and separation from human Neisseria species
Neisseria species, which do not hydrolyze tributyrin
serological tes for branhallema catarrhalis are not
widely used : cross-reactively with Neisseria species
in the detection of complent fixation Ab by
immunoelectrophoresis has been demonstrated.
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Serum Ab to whole cell protein, to lipooligosaccharides, and to outer membrane Ag have
proved useful in the diagnosis of branhallema
catarrhalis infection.
Other lab studies may be needed , depending on the
site of the infection and underlying condition
Imaging studies:
Imaging studies may be needed, depending of the
site of infection:
Paranasal sinus radiographs or CT scans.
2- chest radiographs
3- abdominal radiographs: obtain a 3-way peritonitis is
a possibility.
Pathogenicity;
Infection in adult:
A-The M. catarrhalis is manifest itself as a pathogen in
the nosocomial setting .a rare but very serous and
frequently lethal infection with M. catarrhalis
appear to be endocarditic
B- laryngitis
C- bronchitis and pneumonia
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Infection in the children:
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Meningitis
Media Otitis
Pneumonia
Bronchitis
Bacteremia
complication: recurrence, Bacteremia, meningitis,
mastoidotis, hearing loss, pleural effusion, shock, death
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Nosocomial infection: outbreaks of infection
with branhallema catarrhalis have reported,
mostly involving pulmonary units or pediatric
intensive care units. Increased length of
hospitalized has been correlated with the
presence of branhallema catarrhalis
Bacteremia : no primary site infection was
found in 46% of patient with branhallema
catarrhalis bacterima .
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Deterrence/prevention:
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universal precaution, good hand hashing and
sterilization of instruments and tubes used
intubations , aspiration, or invasive produced may
reduce or prevent the nosocomial infection caused
by branhallema catarrhalis
prognosis :prognosis is poor for hospitalized
patients with underlying conditions, especially the
following;
Patients hospitalized for prolonged periods
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2- Patients in pulmonary units or pediatric
intensive care units
3- Patients of advanced age.
Patients education:
Hand washing, smoking cessation, and good heath
habits (e.g, proper rest, diet, exercise) are helpful
both the treatment process and in prevention of any
infection.
Characteristic of B. catarrhalis
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Gram stain: Gram-negative diplococcus
Colony morphology :
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Pigmentation:
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Oxidase test:
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Acid production
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Production of deoxyribonucleas(DNase):
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Polysaccharide from sucrose:
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Superoxol test (reaction with 30% hydrogen
peroxide)
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Catalase test (reaction with 3%
hydrogen peroxide);
When performed on clear base
medium without Hb , the
Catalase reaction of B.
catarrhalis may vigorously, but
very rapid and then become
negative , persistent bubbles
may not be observed . Thus , the
reaction should be watched to
observe a positive Catalase
reaction
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Colistin resistance:
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Nitrate reduction ; positive
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MEDIA OF CHOICE:
Modified oxidation-fermentation medium was
developed as a practical medium for highly and
specific detection of acid production from
carbohydrates by Neisseria spp. and B catarrhalis.
Neisseria spp and B. catarrhalis were tested in this
medium , in which the protein concentration was
reduced relative to the carbohydrate concentration ,
phenol red was substituted for bromthymol blue at
low conc. and the PH is 7.2 .
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Sugar utilization patterns were consistent with
published result and other cultural and
biochemical characteristics for these species.
The reaction obtained using this medium were
qualitative better and more reproducible than
those obtained in cystine- Trypticase agar .
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To study effect of various commonly used
media on the growth of Branhamella :
New York city medium (MNYC) containing
the selective agent trimethoprim lactate
Modified Thayer Martin medium containing
vancomycin
Mac agar
4- crystal violet blood agar , bilayer ;lower contain
colum blood agar, the upper blood agar contain
crystal violet
5- N.A
6- semiselective media for Branhamella allow all
Neisseria ssp and further differentiation is necessary.
 The plate incubated at 22c and 37c aerobically and
37c anaerobically on NA
 Cultured were read after overnight and read as light,
moderate or heavy growth
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The result :
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The Branhamella have no ability to grow on MNYC
or MTM media
All the strain of Branhamella failed to grow on the
MAC agar and blood agar
All strain grow on the N.A at 22c and 37c
None of the strain of Branhamella grew under the
anaerobic condition
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because the morphological similarities and
biochemical variation among Neisseria ssp.and
Branhamella may cause confusion and result
in error delayed in their recognition
Dnase is test high specificity it can be used as
confirmatory test and also superoxol test.
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Risk factor:
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This bacteria cause more than 70%of patient
that have neutropenia, malignancy,
respiratory impairment.
This bacteria cause infection in most patient
older than 65 year and 90%to 95%of patient
have underlying cardiopulmonary disease.
A large % are smoker
Men appear to be greater risk than women
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Virulence of M. catarrhalis:
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Adherence:
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Study M. catarrhalis was show to specifically
attach to the mucin molecules from thenasopharynx
and middle ear but not to mucin the saliva and
trancheobronchial mucin.
The interaction such as these represent the first
steps in the process of bacterial colonization and
infection.
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The presence or absence of fimbria did not influence
the capacity of the bacterium to adhere or to cause
haemagglutination .
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The bacteria and epithelial cell are both negatively
charged, interaction between the negatively charged
surface of M. catarrhalis cells and positively charge
domain s called microplica on pharyngeal epithelial
cells was found.
2- Tissue culture adherence and haemagglutination
characteristics of M.catarrhalis
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The haemagglutination and tissue culture adherence
properties of 20 isolates of Moraxella catarrhalis
obtained from the sputum of elderly patient with
lower respiration tract infection were compared with
those 20 isolation of Moraxella obtained from the
nasopharynx of elderly persons colonized by the
organism .
Eighty percent of isolate from the infected group as
opposed to 5% of isolate from the colonized group
hameagglutinin human erythrocyte .
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The indicating that the hameagglutinin might
be a marker of Pathogenicity for catarrhalis.
Animal Models:
 the low virulence of M .catarrhalis in laboratory
animals has hampered protection experiment and
Pathogenicity studies in rats and mice
 one study on the model was presented by lee etal,
who were able to isolate live M .catarrhalis from
specific mouse strain, suspended in BHIB were
inoculalated via interaperitoneal route .
 infection resulted in high mortality and
facilitated antibiotic efficacy studies.
 in another study murine model designed to
study phagocyte response and clearance
mechanism after endotarcheal challenge with
M .catarrhalis , high influx of PMN
leukocytes into the lung
 bacteria were cleared from the lung within
24-48hr, and the animal remained healthy
 Enhanced clearance of bacteria from the lungs was
observed , correlating with higher levels of specific
IgA and IgG in serum and bronchoalveolar lavage
fluid
 the clearance of M .catarrhalis from the lungs is
rapid within 6-24 h , result of low virulence of M
.catarrhalis for animal models.
 passive and active immunization studies in this
animal model documented improved pulmonary.
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Complement resistance:
 complement resistance strain appeared to activate
complement to the same extent as , or even slightly.
 the resistance strain do not inhibit classical or
alternative complement pathway activation but
interfere with complement at the level of attack
complex formation
Treatment:
Amoxicillin-clavulanate,second and third generation
oral cephalosporin and trimethoprim-sulfamethoazole
are the most recommended agent. Alternatively,
azithromycin, diithromycin can be used . All other
agents listed below are also effective
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