Branhamella catarrhalis conjunctivitis

Eleven cases of Branhamella catarrhalis conjunctivitis have been reported. In four recent studies that examine the microbial etiology of ophthalmia neonatorum, B catarrhalis was identified only twice in 1,299 cases. However, diagnosis by Gram stain in some and previous antibiotic therapy in others may have resulted in underdiagnosis of B catarrhalis and inaccurate diagnosis as gonococcal ophthalmia.     

Branhamella catarrhalis infections

Branhamella (Moraxella) catarrhalis is responsible for a significant number of bronchopulmonary infections in adults, as well as otitis media and sinusitis in children. This gram-negative diplococcus is indistinguishable from Neisseria gonorrhoeae on gram-stained smear. Many strains of the organism produce beta-lactamase and are resistant to the penicillins and other beta-lactam antibiotics. When B. catarrhalis is the probable pathogen, a beta-lactamase-resistant antibiotic is the initial drug of choice in both adults and children.     

Infection and Branhamella catarrhalis

Of the Gram-negative cocci found in the nasopharynx to which any pathogenic status can be attributed, Neisseria meningitidis and Neisseria (Branhamella) catarrhalis have gained significant notoriety. Traditionally, B. catarrhalis is regarded as a nasopharyngeal commensal and thus there is, in general, considerable reluctance to accept that B. catarrhalis may be a pathogen when it is seen. Hence, it is under-reported or totally ignored though there is more awareness regarding its pathogenic potential, particularly as an increasingly high incidence of beta lactamase producing strains is being reported from many countries. The importance of this development concerns the choice of routine antibiotic therapy as ampicillin, to which this organism was previously sensitive, may no longer be effective.     

Branhamella catarrhalis pneumonia with bacteremia

A woman with diabetes mellitus and coronary artery disease developed pneumonia and bacteremia from Branhamella catarrhalis. This is only the fifth reported case of pneumonia with bacteremia due to this organism, which was previously considered normal upper airway flora.     

Branhamella catarrhalis: antibiotic sensitivities and beta-lactamases

Twenty-eight strains of Branhamella catarrhalis, isolated from patients with acute exacerbations of chronic bronchitis, were tested both for beta-lactamase production and for sensitivity to a wide range of antimicrobial agents. A microtitre broth dilution technique was used for the latter and the MIC50, MIC90, and geometric mean MIC values were all calculated. Eleven strains were found to produce beta-lactamases. Isoelectric focusing in polyacrylamide gels showed four different band patterns, of which the most common was identical with that of the Ravasio type enzyme. Substrate profiles of the four types of branhamella beta-lactamases differed from each other although one was again similar to the Ravasio enzyme profile. Most of these beta-lactamases were readily inhibited by clavulanic acid (with I50 values of 0.01-0.08 mg/l) but were less readily inhibited by oxacillin. Attempts to isolate extrachromosomal DNA were unsuccessful. These results suggest that at least five possible different beta-lactamases can be demonstrated in Bran. catarrhalis strains, and that they are chromosomally determined.     

The penetration of trimethoprim and sulphamethoxazole into synovial fluid

A group of six patients with non-infected synovial effusions requiring diagnostic or therapeutic aspiration, were given a short oral course of 'Septrin' (two tablets bd for two doses, each tablet containing 80 mg of trimethoprim plus 400 mg of sulphamethoxazole). Serum and synovial fluid (SF) were sampled frequently following antibiotic administration. It was found that concentrations of trimethoprim in SF approached serum levels after a short lag time (about 3 h) and thereafter approximated to the serum levels, whereas sulphamethoxazole did not as readily penetrate into SF. With the regimens used MIC levels for trimethoprim were achieved in SF, which suggests that this drug could be usefully prescribed in normal doses for the treatment of septic arthritis due to bacterial infection.     

Branhamella catarrhalis endocarditis in a patient receiving hemodialysis

While Branhamella catarrhalis is now recognized as an important pathogen, this is only the fifth reported case of endocarditis caused by it. The production of beta-lactamase by many strains and its resistance to vancomycin and clindamycin complicate the choice of antibiotic therapy.     

Branhamella catarrhalis pneumonia in patients with immunoglobulin abnormalities

The importance of Branhamella catarrhalis pneumonia has only recently been appreciated. Predisposing underlying illness associated with this organism have not yet been clarified. We report five cases of Branhamella catarrhalis pneumonia occurring in patients with diseases associated with documented quantitative immunoglobulin deficiencies. Normal immunoglobulins appear to be important host defense mechanisms in preventing infection with this organism.     

Susceptibility of enterococci to trimethoprim and trimethoprim-sulfamethoxazole.

The in vitro activities of trimethoprim (TMP), alone and in combination with sulfamethoxazole (SMX), against 131 clinical isolates of enterococci, 126 Streptococcus faecalis isolates, and 5 Streptococcus faecium isolates were determined by a broth microdilution method with Mueller-Hinton broth that was substantially free of inhibitory substances. The geometric mean MIC of TMP for strains of S. faecalis was 0.164 micrograms/ml (range, 0.03 to 8 micrograms/ml), with a geometric mean MBC of 0.298 micrograms/ml (range, 0.063 to 8 micrograms/ml). Although all strains were resistant to the sulfonamide alone, the inhibitory and bactericidal activities of TMP against strains of S. faecalis were markedly potentiated when TMP was combined in a fixed ratio of 1:19 with SMX; the geometric mean MIC of TMP was reduced to 0.016 micrograms/ml (range, 0.002 to 0.25 micrograms/ml), with a geometric mean MBC of 0.031 micrograms/ml (range, 0.004 to 0.25 micrograms/ml). The combination had no synergistic effect against strains of S. faecium; the geometric mean MICs and MBCs of both agents were ca. 0.06 micrograms/ml. The MBC/MIC ratios for TMP and TMP-SMX were less than or equal to 16 for all 131 strains. MICs and MBCs for TMP-SMX were unchanged, and for TMP they decreased when performed in broth supplemented with 50% heat-inactivated pooled human serum. For TMP and TMP-SMX, the susceptibilities of isolates with high-level resistance to gentamicin or streptomycin were the same as those of isolates susceptible to less than or equal to 2,000 micrograms of aminoglycoside per ml. These results suggest that TMP-SMX and TMP alone could prove useful in the treatment of serious enterococcal infections, including infections by strains with high-level resistance to aminoglycosides.     

Antimicrobial susceptibility of Branhamella catarrhalis isolates from bronchopulmonary infections

Fifty-four clinical isolates of Branhamella catarrhalis from patients with bronchopulmonary infections were studied. The MICs for 50 and 90% of the isolates and the geometric mean MICs were determined for 11 antimicrobial agents. All the strains were resistant to trimethoprim but were susceptible to clavulanate-potentiated amoxicillin (Augmentin; Beecham Research Laboratories, London), chloramphenicol, co-trimoxazole, erythromycin, cefotaxime, and cefuroxime. Beta-lactamase-negative strains were uniformly susceptible to penicillin and ampicillin.