TAILIEUCHUNG - Chapter 138. Moraxella Infections (Part 2)

Other Syndromes Local extension causing empyema is very uncommon, and—as might be inferred from the low rate of bacteremia—metastatic complications of M. catarrhalis pneumonia, such as septic arthritis, are exceedingly rare. As of 1995, 58 cases of bacteremic infection due to M. catarrhalis had been reported, mainly in children 60 years old; most of these patients had severe underlying lung disease and/or were immunocompromised. The syndromes reported have included bacteremia with no apparent focus, pneumonia, endocarditis, and meningitis. A petechial or purpuric rash, reminiscent of that observed in meningococcal sepsis and associated with disseminated intravascular coagulation, has been described in. | Chapter 138. Moraxella Infections Part 2 Other Syndromes Local extension causing empyema is very uncommon and as might be inferred from the low rate of bacteremia metastatic complications of M. catarrhalis pneumonia such as septic arthritis are exceedingly rare. As of 1995 58 cases of bacteremic infection due to M. catarrhalis had been reported mainly in children 10 years old or adults 60 years old most of these patients had severe underlying lung disease and or were immunocompromised. The syndromes reported have included bacteremia with no apparent focus pneumonia endocarditis and meningitis. A petechial or purpuric rash reminiscent of that observed in meningococcal sepsis and associated with disseminated intravascular coagulation has been described in a few cases. Diagnosis Microscopic examination of Gram-stained sputum yields characteristic findings Fig. 138-1 . The presence of many polymorphonuclear leukocytes without epithelial cells indicates that the sputum sample is of good quality since most patients with Moraxella infection have chronic lung disease it is usually not difficult to obtain an acceptable specimen. Large numbers of Moraxella organisms are seen as gram-negative cocci often lining up side by side and thus resembling pairs of kidneys. Moraxella Infections Treatment M. catarrhalis is widely susceptible to most antibiotics used to treat lower respiratory tract infection Table 138-1 . Penicillin resistance first appeared in isolated strains in the mid-1970s and is now found in 94 of clinical isolates. This resistance is mediated by two closely related P-lactamases BRO-1 and BRO-2. These enzymes are active against penicillin ampicillin and amoxicillin but less so against cephalosporins especially third-generation cephalosporins they also bind avidly to clavulanic acid and sulbactam. Thus a p-lactam p-lactamase inhibitor combination such as amoxicillin clavulanate offers excellent treatment. Second-and third-generation cephalosporins are effective .

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