Bacteremia Due to Moraxella atlantae in a Cancer Patient

Abstract

A gram-negative alkaline phosphatase-and pyrrolidone peptidase-positive rod-shaped bacterium (CCUG 45702) was isolated from two aerobic blood cultures from a female cancer patient. No identification could be reached using phenotypic techniques. Amplification of the tRNA intergenic spacers revealed fragments with lengths of 116, 133, and 270 bp, but no such pattern was present in our reference library. Sequencing of the 16S rRNA gene revealed its identity as Moraxella atlantae, a species isolated only rarely and published only once as causing infection. In retrospect, the phenotypic characteristics fit the identification as M. atlantae (formerly known as CDC group M-3). Comparative 16S rRNA sequence analysis indicates that M. atlantae, M. lincolnii, and M. osloensis might constitute three separate genera within the Moraxellaceae. After treatment with amoxicillin-clavulanic acid for 2 days, fever subsided and the patient was dismissed. CASE REPORTIn April 2001 a 31-year-old female patient was admitted to the oncology department with a history of intermittent fever for more than 1 week and with complaints of right hypochondrial pain and rectal cramps. The patient had a rectal adenocarcinoma that was diagnosed 1 year previously, with recent massive liver metastasis which had been treated with an anterior resection and with palliative chemotherapy (irinotecan and 5-fluorouracil) for 10 months. Clinical examination revealed a relapse of the rectal cancer at the anastomosis and a hepatomegaly of 8 cm. X-ray examination of the thorax revealed no infiltrates. Three pairs of blood cultures and a urine culture were carried out, with the latter being negative. Streptococci of the viridans group were isolated from one aerobically incubated culture bottle. A gram-negative rod, susceptible to all antibiotics tested and later identified as Moraxella atlantae (CCUG 45702), was isolated from the two other aerobic bottles. The anaerobic cultures remained negative. The patient was treated with amoxicillin-clavulanic acid (875 mg) two times a day, resulting in the disappearance of the fever after 2 days, whereafter the patient was dismissed. A computed tomography of the abdomen 7 days later showed an abscess around the rectum, which was drained with evacuation of 100 ml of serous fluid. Culture of this fluid remained negative. The patient died 4 months later as a result of her underlying disease.The blood culture bottles (FA aerobic and SN anaerobic bottles; Organon Teknika, Boxtel, The Netherlands) were inoculated with 10 ml of blood and incubated in the Bact/Alert 3D system (Organon Teknika). Gram staining showed short, plump, rod-shaped to coccoid gram-negative rods. On tryptic soy agar plus 5% sheep blood (Becton Dickinson, Erembodegem, Belgium), colonies were small and grayish, with twitching motility and corroding activity. The isolate grew well on MacConkey agar, in contrast to most other Moraxella sp. It was nonmotile. Catalase and oxidase were positive. No sugars were acidified, either fermentatively or oxidatively. No grow...

Acinetobacter , Chryseobacterium , Moraxella , and Other Nonfermentative Gram-Negative Rods

“…Moraxella species are rare agents of infections (conjunctivitis, keratitis, meningitis, septicemia, endocarditis, arthritis, and otolaryngologic infections) (54,122,191,223), but M. catarrhalis has been reported to cause sinusitis and otitis media by contiguous spread of the organisms from a colonizing focus in the respiratory tract (122). However, isolation of M. catarrhalis from the upper respiratory tract (i.e., a throat culture) of children with otitis media or sinusitis does not provide evidence that the isolate is the cause of these infections, because M. catarrhalis is present frequently as a commensal of the upper respiratory tract in children (232).…”

The First Report of Diversity Analyses of Skin Microbiome In Indonesian Leprosy Patient

“…Acinetobacter johnsonii, Micrococcus luteus, Moraxella atlantae, and Pseudomonas stutzeri have been reported previously as a pathogen bacteria that can cause some diseases, such as meningitis (Acinetobacter johnsonii, Micrococcus luteus, Pseudomonas stutzeri), bacteriemia in adenocarcinoma patient (Moraxella atlantae), and ecthyma gangrenosum (Pseudomonas stutzeri). [25][26][27][28] Factors that cause the four species mentioned above are found to be more in the leprous skin lesions than healthy individuals is not known, but it is possibly due to autonomic nerve damage in leprous skin lesions which causes dry skin and impaired protective role of the skin. 1 In contrast to the four previous species, Ensifer adhaerens was higher in healthy individuals compared to leprous skin lesions.…”

Moraxella atlantae keratitis presenting with an infectious ring ulcer

“… 1 To date, this species has been described in only two other patients, both bacteremic: one with lupus 9 and one with metastatic rectal adenocarcinoma. 8 Neither had ocular involvement. Since Moraxella isolates are often considered non-pathogenic or contaminants, 1 there is the possibility that microbiology labs may not always speciate Moraxella infections.…”

“… 5 M. catarrhalis, previously categorized under genuses Neisseria and later Branhamella, has occasionally been implicated in conjunctivitis, ulcerative keratitis, pseudomembrane, and endophthalmitis. 6 , 7 Moraxella atlantae is an uncommon opportunistic pathogen 8 -- of all Moraxella eye infections cultured and sent to the CDC from 1953 to 1980, only one percent were due to M . atlantae .…”