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Efforts to reduce organic sulfur in coal are taken through biodesulfurization by using desulfurization bacteria to release covalently-bound sulfur from the coal matrix. Coal is a complex hydrocarbon material that requires collaboration from more than one type of bacteria in a consortium for desulfurization. The current study shows how the individual members of a bacterial consortium obtained directly from coal samples grew on the coal. Mineral medium containing sub-bituminous coal with a concentration of 10%, 15%, and 20% served as a carbon source and the only sulfur to support the consortium's growth. The examination included growth patterns, concentrations of dibenzothiophene as an organic sulfur representative, pH, and sulfate concentration as the sulfur product released into the medium. The growth of individual members of the consortium was observed for 336 h. The consortium grew in all three coal concentrations with slightly different cell growth patterns and the release of dibenzothiophene. Members of the consortium grew alternately and overlapped, which showed possible linkages or dependence on products and existence from the growth of other members. The existence of the primary strain Moraxella osloensis COK1 indicated that they played a role in the activities and growth of other members. The alternating growth is discussed to produce a hypothetical illustration of how several other members play in using sulfur in a well-known desulfurization pathway. In conclusion, this study provides a deeper insight into the value of consortium members individually but growing together while swarming coal as a complex resource to become low-sulfur coal.

Background The gram-negative aerobic bacterium Moraxella osloensis is an opportunistic pathogen in brain tissues. Case summary The gram-negative aerobic bacterium Moraxella osloensis was isolated from a patient's brain tissue during a stereotactic biopsy. Conclusion This is the first report of a brain tissue infection with Moraxella osloensis possibly causing brain gliomatosis.

BackgroundThe purpose is to study the metagenomics of the microbes isolated from the lacrimal sac of patients with primary acquired nasolacrimal duct obstruction (PANDO).MethodsA prospective study was performed on ten consecutive lacrimal sac samples obtained for the metagenomic analysis from the patients with PANDO, who underwent endoscopic dacryocystorhinostomy at a tertiary care Dacryology service. The samples were collected intraoperatively soon after a full-length lacrimal sac marsupialisation and immediately transported on ice to the laboratory. Following DNA extraction and library preparation, a whole shotgun metagenome sequencing was performed on the Illumina platform. The downstream processing and bioinformatics of the samples were performed using multiple software packaged in the SqueezeMeta pipeline and MG-RAST pipeline.ResultsThe taxonomic hit distribution across the samples showed that bacteria were the most common isolates (mean—97.56%), followed by viruses (mean—0.29%), archaea (0.04%) and others. The five major phyla identified across the samples of PANDO were proteobacteria, Bacteroidetes, Fusobacteria, Actinobacteria and Firmicutes. The prevalent organisms includeAcinetobacter johnsonii, Porphyromonas catoniae, Cutibacterium acnes, Pseudomonas alcaliphila, Escherichia coli, Haemophilus influenzae, Enhydrobacter aerosaccus, Fusobacterium nucleatum, Moraxella osloensis, Butyricimonas virosaandVariovorax paradoxus,among few others. The alpha diversity of the ten sample datasets ranged from 60 to 175 species.ConclusionThis is the first whole metagenome sequencing of the lacrimal sac contents from PANDO patients. Lacrimal sacs harbour diverse microbial communities, including bacteria, viruses, and archaea. Further Lacriome studies may provide clues for a better understanding of the disease aetiopathogenesis.

Background Moraxella osloensis rarely causes infection in humans, and most of the reported cases are not fatal. It is often difficult to identify M. osloensis using conventional biochemical methods. Methods Here, we report a bacteremia case caused by M. osloensis in a patient with advanced lung cancer who initially presented symptoms of fever. Results Blood culture revealed growth of a gram-negative bacterium, which was identified as M. osloensis through 16S rRNA gene sequencing and MALDI-TOF analyses. The patient could not recover from sepsis with empirical treatment. Conclusions As M. osloensis can cause serious infections in immunocompromised patients, its prompt identification is important.

Moraxella osloensis has been reported in the literature as a human pathogen, particularly among immunocompromised adults. In contrast to the adult population, most pediatric cases are among patients with no underlying immunological defect; however, no patient underwent further investigation and no data about the long-term follow-up are available. We report the case of a 2-month-old previously healthy girl infected with Moraxella osloensis. Here, we review case reports and case series of children and adults with Moraxella osloensis infection and compare them with our experience. On the basis of our findings, we recommend further investigations (immunological or other underlying diseases) when a child is found to be infected with these bacteria.

A-26-year-old man was admitted to our hospital with diffuse abdominal pain, nausea, and vomiting. He had a history of malignant nephrosclerosis, for which he had been receiving peritoneal dialysis (PD) for the past 14 months. His PD effluent was cloudy and turbid (white blood cell count, 10,528/μL; neutrophils 95.2%). A Gram-negative coccobacillus was isolated from peritoneal fluid culture. However, the organism could not be identified by matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) (Vitek MS, bioMerieux), but was identified as Moraxella osloensis by the 16S rRNA gene sequencing. He was successfully treated with intraperitoneal cefazolin therapy for 3 weeks without removing the intra-abdominal catheter. A literature review revealed three previous case reports all of which were diagnosed by MALDI Biotyper (Bruker Daltonics), suggesting that the identification of M. osloensis may vary depending on the type of MALDI-TOF MS system. In conclusion, we experienced a case of M. osloensis infection in a PD patient, which was successfully treated by antibiotic treatment, without removing the PD catheter.

application/pdf, A three-year-old spayed domestic short-haired cat presented for evaluation of weight loss, cardiomegaly and pleural effusion. Echocardiographic examination demonstrated a thickened pericardium with mild pericardial effusion and a large volume of pleural effusion characterized by exudate. Although the cat was treated with antibiotics, the clinical symptoms did not improve. The cat developed dyspnea and died on day 7. Necropsy revealed a large amount of modified transudates ascites, pleural effusion and markedly dilated pericardium. Histopathological examination revealed severe exudation of fibrin and granulation tissue in a thick layer of the epicardium. The cat was diagnosed with fibrinous pericarditis secondary to bacterial infection.

Peritonitis is a very serious complication encountered in patients undergoing peritoneal dialysis and healthcare providers involved in the management should be very vigilant. Gram-positive organisms are the frequent cause of peritonitis compared to gram-negative organisms. There has been recognition of peritonitis caused by uncommon organisms because of improved microbiological detection techniques. We report a case of peritonitis caused by Moraxella osloensis (M. osloensis), which is an unusual cause of infections in humans. A 68-year-old male, who has been on peritoneal dialysis for 2 years, presented with abdominal pain and cloudy effluent. Peritoneal fluid analysis was consistent with peritonitis and peritoneal fluid culture grew gram-negative bacteria. M. osloensis was identified by 16 S PCR phenotypic and sequencing techniques. Patient responded well to the treatment, with intraperitoneal cephalosporin, and repeat peritoneal fluid culture yielded no growth. M. osloensis rarely causes infection in humans and responds well to treatment, as reported in literature.

Moraxella osloensis has been reported in the literature as a rare cause of sepsis, central nervous system infection, chest infection, and endophthalmitis. In the present case, the organism was isolated from the blood of an 8-year-old immunocompetent boy. It could not be identified with VITEK-2 and API-20NE (bioMerieux SA, Marcy-l'Etoile, France). Latex-based bacterial antigen test (BD Directigen Meningitis Combo Test; Becton, Dickinson and Company, Sparks, Maryland, United States) was positive for Neisseria meningitidis A/Y. It was identified as M. osloensis using matrix-associated laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF) (Vitek MS, bioMerieux, Marcy-l'Etoile) (confidence level 99.9%) and 16S rRNA gene sequencing (99% sequence identity). The child responded well to ampicillin, and was discharged home after 4 days, on oral amoxicillin–clavulanic acid for the next 7 days. M. osloensis is a rare cause of bacteremia. It may masquerade as N. meningitidis in the routine tests performed in the routine microbiology laboratories. It is imperative to confirm the identification with MALDI-TOF or a molecular method to remove the false positive diagnosis of N. meningitidis, and to avoid the unnecessary use of prophylaxis with rifampicin or ciprofloxacin.

OBJECTIVE To compare the microbial flora of cholesteatoma and normal middle ears using gene-based sequencing analysis. STUDY DESIGN Controlled ex vivo human study. SETTING Academic, tertiary medical center. SUBJECTS AND METHODS Brush, swab, and tissue samples were each taken from cholesteatoma matrix and uninvolved tissue in patients with previously untreated, acquired cholesteatoma (n = 19) or middle ear mucosa from patients undergoing cochlear implantation with no history of cholesteatoma or previous middle ear surgery (control; n = 12). DNA was isolated from specimens then 16S rRNA gene sequencing was performed. RESULTS There was no difference in microbial yield between the sampling methods. Cholesteatoma specimens had lower relative abundance of 14 bacterial species compared with controls including Acidovorax sp., Bacillus sp., Masillia sp., Moraxella osloensis, Phenylobacterium conjunctum, Sphingomonas sp., and Staphylococcus epidermidis (all p

Background Etiological diagnosis is a key to therapeutic adaptation and improved prognosis, particularly for infections such as endocarditis. In blood culture–negative endocarditis (BCNE), 22% of cases remain undiagnosed despite an updated comprehensive syndromic approach. This prompted us to develop a new diagnostic approach. Methods Eleven valves from 10 BCNE patients were analyzed using a method that combines human RNA bait-depletion with phi29 DNA polymerase-based multiple displacement amplification and shotgun DNA sequencing. An additional case in which a microbe was serendipitously visualized by immunofluorescence was analyzed using the same method, but after laser capture microdissection. Results Background DNA prevented any diagnosis in cases analyzed without microdissection because the majority of sequences were contaminants. Moraxella sequences were dramatically enriched in the stained microdissected region of the additional case. A consensus genome sequence of 2.4 Mbp covering more than 94% of the Moraxella osloensis KSH reference genome was reconstructed with 234X average coverage. Several antibiotic-resistance genes were observed. Etiological diagnosis was confirmed using Western blot and specific polymerase chain reaction with sequencing on a different valve sample. Conclusions Microdissection could be a key to the metagenomic diagnosis of infectious diseases when a microbe is visualized but remains unidentified despite an updated optimal approach. Moraxella osloensis should be tested in blood culture–negative endocarditis.

Herein we report the case of a 10-year-old boy with an autosomal mosaic mutation who developed bacteremia. The causative agent was identified as Moraxella osloensis by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and 16S rRNA gene sequencing. In the pediatric population, there have been 13 case reports of infection attributed to M. osloensis and this is the fifth reported case of pediatric bacteremia due to M. osloensis. After Moraxella species infection was confirmed, the patient recovered with appropriate antimicrobial therapy. It is important to consider that M. osloensis can cause serious infections, such as bacteremia, in otherwise healthy children. Keywords: Moraxella osloensis, Bacteremia, MALDI-TOF MS, 16S rRNA gene sequencing

This is a case report of infective endocarditis due toMoraxella osloensis. This study would be the fourth since the two latest episodes were described in 2015. The patient of this exposition is different from those previously described in the literature because it was a young adult, under 50 years of age, immunocompetent, with no comorbidities and no obvious focus of infection.

Highlights • Moraxella osloensis is a gram-negative coccobacillus, which part of normal flora in human skin and mucus. • Moraxella osloensis rarely causes infections in human, especially in immunocompromised. • Proper microbiologic investigation is important to diagnose Moraxella osloensis. • Accurate diagnosis and proper treatment are crucial for the resolution of infections caused by Moraxella osloensis., Introduction Moraxella osloensis is a gram-negative coccobacillus, that is saprophytic on skin and mucosa, and rarely causing human infections. Reported cases of human infections usually occur in immunocompromised patients. Presentation of case We report the second case of M. osloensis-caused-osteomyelitis in literature, occurring in a young healthy man. The organism was identified by sequencing analysis of the 16S ribosomal RNA gene. Our patient was treated successfully with surgical debridement and intravenous third-generation cephalosporins. Discussion M. osloensis has been rarely reported to cause local or invasive infections. Our case report is the second case in literature and it is different from the previously reported case in that our patient has no chronic medical problems, no history of trauma, with unique presentation and features on the MRI and intraoperative finding. Conclusion Proper diagnosis is essential for appropriate treatment of osteomyelitis. RNA gene sequence analysis is the primary method of M. osloensis diagnosis. M. osloensis is usually susceptible to simple antibiotics.

Introduction The aim of the present study was to analyze the microbiota of primary and secondary/persistent endodontic infections of patients undergoing endodontic treatment with respect to clinical and radiographic findings. Methods Samples from the root canals of 21 German patients were taken using 3 sequential sterile paper points. In the case of a root canal filling, gutta-percha was removed with sterile files, and samples were taken using sterile paper points. The samples were plated, and microorganisms were then isolated and identified morphologically by biochemical analysis and sequencing the 16S rRNA genes of isolated microorganisms. Results In 12 of 21 root canals, 33 different species could be isolated. Six (50%) of the cases with isolated microorganisms were primary, and 6 (50%) cases were endodontic infections associated with root-filled teeth. Twelve of the isolated species were facultative anaerobic and 21 obligate anaerobic. Monomicrobial infections were found for Enterococcus faecalis and Actinomyces viscosus . E. faecalis was most frequently isolated in secondary endodontic infections (33%). Moraxella osloensis was isolated from a secondary endodontic infection that had an insufficient root canal filling accompanied by a mild sensation of pain. A new bacterial composition compromising Atopobium rimae , Anaerococcus prevotii , Pseudoramibacter alactolyticus , Dialister invisus , and Fusobacterium nucleatum was recovered from teeth with chronic apical abscesses. Conclusions New bacterial combinations were found and correlated to clinical and radiographic findings, particularly to chronic apical abscesses. M. osloensis was detected in root canals for the second time and only in German patients.

Moraxella osloensis is an aerobic, gram-negative coccobacillus infrequently isolated from clinical specimens. There is little published related to risk factors and treatment of Moraxella osloensis infections in the paediatric population. We report the first case of Moraxella bacteremia in a preterm newborn infant successfully treated and a review of bacteremia cases in children.

The genus Moraxella comprises approximately 20 species of aerobic, non-motile, oxidase-positive, and gram-negative coccobacilli. Besides M. catarrhalis, a well-known pathogen, M. atlantae, M. canis, M. lacunata, M. lincolnii, M. nonliquefaciens, and M. osloensis are also occasionally isolated from clinical samples [1]. M. osloensis is a commensal microorganism in the human respiratory tract, but has also been reported as a rare causative pathogen in human infections [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12]. Here, we report a case of M. osloensis bacteremia in a patient with a hematologic malignancy. To our knowledge, this is the first report of M. osloensis bacteremia in Korea. A 66-yr-old man with acute myeloid leukemia (AML) was admitted to our hospital for consolidation chemotherapy. Two months prior to this hospitalization, the patient was diagnosed with AML, not otherwise specified, according to the 2008 WHO classification system [13], and he subsequently received cytarabine and idarubicin chemotherapy. After 1 month, follow-up bone marrow examination was performed, and he achieved complete remission. On admission, the patient presented with symptoms of an upper respiratory infection including coughing and chills. He had a temperature of 37.2℃, a blood pressure of 117/57 mmHg, a pulse of 106/min, and a respiration rate of 20 breaths/min. The results of the laboratory investigation were as follows: Hb, 11.7 g/dL; leukocyte count, 5.7×109/L; platelet count, 177×109/L; C-reactive protein level, 6.48 mg/dL; blood urea nitrogen (BUN)/creatinine, 15/1.2 mg/dL; and total protein/albumin, 6.8/3.6 g/dL. A total of four blood culture sets were collected from two separate peripheral veins and central venous catheter. There were no abnormalities in the chest radiographic images, but paranasal sinus radiographic imaging indicated a suspected maxillary sinusitis. Therefore, empirical antibiotic therapy with intravenous ampicillin-sulbactam was administered. Bacterial growth was detected in an aerobic culture bottle that contained the blood from the central venous catheter after 1 day of incubation, and in the other 3 aerobic culture bottles after 2 days of incubation (Fig. 1A). The broths from positive culture bottles were inoculated onto blood agar plates (BAPs) and MacConkey agar plates (MACs) that were subsequently incubated for 24 hr at 35℃ in a 5% CO2 atmosphere. Whereas no colony was observed on the MACs, grey-white colored, non-hemolytic colonies grew on the BAPs (Fig. 1B) and gram-negative coccobacilli were observed from gram stain smear preparations (Fig. 1C). The isolates were oxidase-positive and indole-negative. Fig. 1 Colonial and microscopic morphology of Moraxella osloensis. (A) Gram-negative coccobacilli from positive aerobic blood culture smear preparations (Gram stain, ×1,000). (B) Grey-white colored colonies on blood agar plate. (C) Gram-negative coccobacilli ... Using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS; Bruker Daltonik GmbH, Bremen, Germany) and Vitek2 GN system (bioMerieux, Marcy l'Etoile, France), the organism was suboptimally identified as M. osloensis, with a score of 1.885 in the Bruker system and with a 50% probability in the Vitek2 system. To confirm the identity of the isolate, 16S rRNA sequence analysis was performed on the MicroSeq 500 system (Applied Biosystems, Foster City, CA, USA), using PCR and sequencing kits with universal primers designed to cover all bacteria. The sequences were analyzed with an ABI PRISM 3730 Series DNA Analyzer (Applied Biosystems). The first 500 bp of the 16S rRNA gene sequence from the isolate shared 99.6% identity with the GenBank sequence {"type":"entrez-nucleotide","attrs":{"text":"AY043376","term_id":"21844518","term_text":"AY043376"}}AY043376 (M. osloensis) and 99.0% identity with the GenBank sequence {"type":"entrez-nucleotide","attrs":{"text":"KC494325","term_id":"456371510","term_text":"KC494325"}}KC494325 (Enhydrobacter aerosaccus). Antimicrobial susceptibility was tested with the AST-N222 card from the Vitek 2 system (bioMerieux). Using the CLSI breakpoints for other non-Enterobacteriaceae for the interpretation [14], the isolate was determined susceptible to aztreonam, cefepime, ceftazidime, ciprofloxacin, gentamicin, imipenem, meropenem, piperacillin, and trimethoprim-sulfamethoxazole. Intravenous ampicillin-sulbactam treatment was maintained, and follow-up blood cultures from the peripheral veins and central venous catheter on day 3 were negative. The patient was successfully treated with a 10-day course of intravenous ampicillin-sulbactam and subsequently began consolidation chemotherapy for AML. Despite the unique biochemical characteristics of M. osloensis, which include acetate alkalinization, ethylene glycol acidification, and desferrioxamine resistance, species-level biochemical identification is difficult because of the overall lack of biochemical differences among the Moraxella species [1]. Although only 2 reported isolates besides the present case have been identified by MALDI-TOF MS, this method suboptimally identified M. osloensis; one isolate was identified as M. osloensis with a score of

We report two cases of endocarditis due to Moraxella osloensis. Only one previous case of such infection has been described. These infections occurred in immunocompromised patients (B-cell chronic lymphocytic leukaemia and kidney graft associated with Hodgkin's disease) and both patients had a favourable outcome with a complete cure of their infectious endocarditis. This bacterium could be an emerging pathogen revealed by MALDI-TOF. Indeed, its characterisation within the Moraxella group by use of biochemistry-based methods is difficult. Moreover, this strain could be particularly involved in immunocompromised patients.

Moraxella osloensis, a gram-negative bacterium that is saprophytic on skin and mucosa, rarely causes infections. Moreover, infections in patients with cancer have not been reported. We describe 10 cases of M. osloensis blood or catheter infections that occurred during anticancer chemotherapy with or without preexisting neutropenia. The organism was identified definitively by sequencing analysis of the 16S ribosomal RNA gene. Fever (up to 39.7 degrees C) with substantial neutrophilia characterized these infections. The infections were monomicrobic for 3 patients and polymicrobic for 7 patients. Nine patients acquired the infection through central venous catheter colonization. The likely sources of the organism were sinusitis (3 cases), bronchitis (1 case), presumed subclinical mucositis from anticancer therapy (4 cases), and cutaneous graft-vs-host disease (2 cases). The infections resolved, without catheter removal, after antibiotic therapy with cell wall-active agents, to which all strains were shown to be susceptible. The M. osloensis strains exhibited significant morphologic variations on gram stain, and sheep blood agar was the preferred culture medium for 9 strains.

To evaluate the ability of the EmulSiv™ filter (EF) to remove extrinsic microbial contaminants from propofol. Aliquots of Staphylococcus aureus (S. aureus), Candida albicans (C. albicans), Klebsiella pneumoniae (K. pneumoniae), Moraxella osloensis (M. osloensis), Enterobacter agglomerans (E. agglomerans), Escherichia coli (E. coli), Serratia marcescens (S. marcescens), Moraxella catarrhalis (M. catarrhalis), Haemophilus influenzae (H. influenzae) and Campylobacter jejuni (C. jejuni) were inoculated into vials containing 20 mL of sterile propofol. The unfiltered inoculated propofol solutions served as controls. Ten millilitres and 20 mL samples of the inoculated propofol were filtered through the EF. All solutions were then subplated onto three culture plates using a precision 1 μL calibrated platinum loop and incubated. The number of colony forming units (CFU) were counted. Data were analyzed using a one-sample t test, and a P value of less than 0.05 was selected as the level of statistical significance. The EF was able to completely remove CFU of S. aureus, C. albicans, K. pneumoniae, M. osloensis, E. agglomerans, E. coli, S. marcescens, and M. catarrhalis (P < 0.05). A small number of H. influenzae CFU were able to evade filtration in both the 10 mL and 20 mL samples. C. jejuni CFU were able to evade filtration in only the 10 mL sample. The EF removes the majority of microbial contaminates from propofol with the exception of H. influenzae and C. jejuni. Although the EF is capable of removing most of the microbial contamination produced by H. influenzae and C. jejuni, a few CFU are capable of evading filtration. Consequently, even the use of a filter capable of removing microbial contaminants is not a substitute for meticulous aseptic technique and prompt administration when propofol is used.

The authors report a rare case of diarrhea caused by Moraxella osloensis in a pediatric child with Hemolytic Uremic Syndrome/Acute Renal Failure (HUS/ARF). A 6-y-old boy was referred to the Pediatric Unit with a 3 d history of bloody diarrhea with mucus and fever and decreased urine output for 6 d. Microbiological investigations were done as per CLSI guidelines. His diarrhea, and the subsequent renal failure resolved with appropriate treatment. To the best of authors' knowledge and pubmed search, this is the first case of M. osloensis causing diarrhea in a HUS/ARF pediatric patient reported from India-Manipal.

We present an unusual case of septic arthritis of the ankle due to Moraxella osloensis . The implications of a diplococcus culture are discussed, including notification of the disease, the suggestion of sexual impropriety and drug-induced side effects for the treating doctors and other contacts. The case is of a 56-year-old man presenting with a past medical history of gout (great hallux) and increasing pain in his ankle. Systemic examination revealed a low-grade pyrexia and lateral malleolar swelling with evidence of an effusion. Initial gram stain revealed a raised WBC. Laboratory evaluation showed a raised CRP, ESR and urate. The patient was commenced on intravenous antibiotics. Initial blood cultures suggested a possibility of Neisseria meningitidis and primary contacts were commenced on rifampicin. The cultures were later confirmed as the rather unusual penicillin sensitive, gram-negative, aerobic Moraxella oseloensis . Antibiotics were discontinued at 6 weeks and the patient discharged at 3 months. The recognition of septic arthritis, obtaining systemic blood cultures, joint aspirates followed by prompt treatment with a suitable antibiotic regime will reduce morbidity and mortality. Recognition of any potential pathogens that may be harmful to health professionals or other close contacts is also of vital importance.

Nongroupable meningococci or bacteria related to the genus Neisseria rarely cause meningitis. Complement deficiency has been identified as a major predisposing factor for meningococcal disease. To assess whether patients with meningitis due to such strains have a complement deficiency, we studied 12 persons. Six patients had meningitis due to nongroupable strains of meningococci, and six patients had meningitis due to Moraxella species or Acinetobacter species. Inherited complement component C7 or C8 deficiency was found in two persons who had had meningitis due to nongroupable meningococci, and one C8-deficient person had had meningitis caused by Moraxella osloensis. Hypocomplementemia resulting from CSF drain-associated shunt nephritis was found in one person with meningitis due to Moraxella nonliquefaciens and in one person with meningitis due to Acinetobacter lwoffi. This rather high frequency of inherited or acquired complement deficiencies among patients with meningitis due to nongroupable meningococci, Moraxella species, and Acinetobacter species justifies the recommendation that such patients must be studied for complement deficiency.

We encountered a pediatric case of bacteremia and possible cholecystitis due to Moraxella osloensis that was treated successfully. We confirmed the diagnosis with the presence of a high serum titer of the antibody to the organism. Furthermore, 16S rRNA sequencing was performed to identify the bacteria.

We report the first case of a central venous catheter infection caused by Moraxella osloensis, which was successfully treated without catheter removal. The isolation, identification, and pathogenesis of this species are discussed. It is recommended that Moraxella isolates be identified to species in order to determine the relative pathogenic and opportunistic roles of the various Moraxella species. Our case also demonstrates that catheter sepsis caused by some Gram-negative organisms may be amenable to systemic antibiotic therapy without the necessity of catheter removal.

PURPOSE: To report the incidence, clinical presentation, antibiotic sensitivities, and treatment outcomes for endophthalmitis caused by Moraxella species. METHODS: Consecutive interventional case series. Medical records were reviewed of all patients treated at Bascom Palmer Eye Institute between 1991 and 2000 for endophthalmitis caused by Moraxella species. RESULTS: Moraxella species were recovered from 9 patients (10 eyes), or 1.3% (10 of 757) of all culture-proven bacterial endophthalmitis cases; Moraxella catarrhalis was recovered from 7 eyes and Moraxella osloensis from 3. Endophthalmitis was delayed-onset (5 months to 10 years postoperatively) and bleb-associated in 9 eyes and trauma-related in 1. All isolates were sensitive to ceftazidime, ciprofloxacin, and the aminoglycosides, and they were resistant to vancomycin; resistance to ampicillin and trimethoprim/sulfa was 11%. Although presenting vision was hand motion or worse in 7 of 10 eyes, all but 3 regained baseline visual acuity (including two eyes in which the post-treatment course was complicated by retinal detachment and one eye with coexistent traumatic injuries). CONCLUSION: Endophthalmitis caused by Moraxella species is usually delayed-onset and bleb-associated. Although patients usually present with a profound decrease in vision, the organisms are sensitive to most antibiotics and, unlike most series of delayed-onset bleb-associated endophthalmitis, visual outcomes are generally good unless coexistent ocular morbidities exist.

We report a case of septicaemia with prolonged, refractory hypotension related toMoraxella osloensisisolated in a non-immunocompromised paediatric patient.

From 1953 to 1980 the Centers for Disease Control received 933 isolates of bacteria belonging to species of the genus Moraxella, Moraxella-like Moraxella urethralis, now renamed Oligella urethralis, unnamed groups M-5 and M-6, and Kingella kingae. Ordinarily sterile sites were the source of 233 isolates. Moraxella nonliquefaciens, the most common isolate (356 strains), was recovered from upper respiratory or ocular sites in 208 (58%) of the cases. Moraxella osloensis was next most common (199 strains) but was the most frequent blood isolate (44 cases). K. kingae appeared especially invasive, with 58 of 78 isolates from blood, bone, or joint. Of the K. kingae strains, 75% were recovered from children under 6 years, compared with 23% of the other strains from that age group (P less than .01). Of the 74 isolates of group M-5, 53 were from wounds caused by dog bites; no other organism in this series was recovered from such wounds. Sixteen of the 28 M. urethralis isolates were from urine. Cases occurred as single infections, with no evidence of clusters. Of patients with infection of ordinarily sterile sites, 9.3% died; only bacteremia, meningitis, and empyema caused fatalities. Most referring laboratories (98%) had not identified the organisms to species, and only 30% had identified them to correct genus. Susceptibility testing by broth dilution revealed low MICs of penicillin (mean, 0.3; 64% less than 1 micrograms/mL). Moraxella, M. urethralis, M-5, M-6, and Kingella are important but frequently misidentified pathogens for humans; penicillin appears to be the treatment of choice.

We report the first case of early-onset systemic neonatal infection associated with Moraxella osloensis bacteriemia in a full term baby. The genus Moraxella is constituted by a group of pleomorphic bacteria obligate aerobes, Gram-negative, oxidase positive and indole negative infrequently isolated from clinical specimens. The organism is rarely reported in the literature as the causative agent of infection in humans, mostly in immunocompromised patients. Only 12 cases of M. osloensis-related infections during childhood have been reported in the literature so far. This unique report of M. osloensis infection, during the neonatal period, concerns the isolation of the bacteria in purulent secretions from the eyes of a 3-week-old baby with opthalmia. In our patient, the precocity of the onset of symptoms allows us to hypothesize a vertical transmission of the bacteria.

Introduction Neonatal meningitis causes substantial morbidity and mortality and is commonly caused by GBS. Moraxella osloensis is an aerobic, gram-negative coccobacillus infrequently isolated from CSF. There is little published related to risk factors of M. osloensis infections in the paediatric population. We report a case of Moraxella meningitis a neonate and review of cases in children. Case report A 2 day old neonate was referred for jaundice and bilirubin check. He was noted to be jaundiced and lethargic. He was born at term complicated with maternal pyrexia and raised maternal inflammatory markers. He was discharged on day1 following 12 h of satisfactory observation. A full septic screen was performed on the baby in-view of risk factor for sepsis. The biochemical work-up was suggestive of meningitis. The blood and CSF culture were negative; however the CSF PCR was positive for Moraxella Oslonesis. He was treated with 3 week course of IV cefotaxime and discharged without any acute complications. Discussion A PubMed search yielded 4 published cases of M. osloensis meningitis but none of them presented in the neonatal period. There was 1 published case of neonatal septicemia without meningitis, however there was no specific risk factor identified in any of these patients. In conclusion, although M. osloensis meningitis is rare it may cause severe CNS infection in children we were able to definitely identify the species of the isolates only by using 16S rRNA gene sequencing and extended PCR must be performed on all babies presenting with possible meningitis.

A previously healthy 6-y-old girl presented with a disease very similar to pneumococcal pneumonia. However, Moraxella osloensis was isolated by lung tap. The patient responded well to a course of parenteral penicillin. This is probably the first documented case of community-acquired pneumonia associated with this agent. Clinical isolates of M. osloensis are rare and its pathogenesis has not been delineated; however, a literature review suggests that the organism is more common than is generally recognized.

Purpose: To report the clinical presentation, antibiotic sensitivities, and treatment outcomes of endophthalmitis caused by Moraxella osloensis. Methods: Case series: retrospective review of the medical records of all patients treated for endophthalmitis at Bascom Palmer Eye Institute between 1 January 1991 and 31 December 2000. Results: During the study interval, 757 eyes were treated for endophthalmitis. Moraxella osloensis was isolated from three eyes of two patients (3/757, or 0.39%). In all three eyes, the endophthalmitis was delayed-onset and bleb-associated; Moraxella osloensis was isolated on chocolate agar and 5% sheep's blood agar using a RapNH commercial Kit (by Remel) through an automated system (Vitek). Like most gram-negative organisms, Moraxella was sensitive to ceftazidime, ciprofloxacin, and the aminoglycosides. Although vision at presentation was poor, both patients regained baseline vision after treatment with pars plana vitrectomy and injection of intravitreal antibiotics. Conclusions: To our knowledge, this is the first report of endophthalmitis caused by Moraxella osloensis. Unlike most series of delayed-onset, bleb-associated endophthalmitis the visual prognosis following treatment for endophthalmitis caused by Moraxella osloensis appears to be generally favorable.

Propofol, 2,6 diisopropylphenol, in an emulsion formulation (Diprivan), has been associated with postsurgical infections caused by Staphylococcus aureus, Moraxella osloensis and Candida albicans. These organisms were individually inoculated into each of the following media: (1) the emulsion preparation of propofol, (2) Intralipid 10%, (3) pure 2,6 diisopropylphenol, and (4) trypticase soy broth (TSB). The organisms were incubated and subcultured hourly for eight hours at room temperature. Propofol supported the growth of all three organisms, but for S. aureus and M. osloenis, the growth rate was slower in propofol than in TSB (P less than 0.05). There was no difference between the growth rate of any organism in propofol than in Intralipid 10%. The authors conclude that propofol, in the emulsion formulation, supports bacterial growth and, therefore, must be prepared for administration in an aseptic manner. Also, by administering propofol soon after preparation, the risk of introduction of a significant inoculum to the patient will be reduced.

We describe the successful treatment of Moraxella osloensis bacteremia in a 2-year-old boy who presented with fever, petechial rash, and exacerbation of reactive airway disease. We also review the 12 cases previously reported in the literature.

To the Editor: Moraxella osloensis is an aerobic, gram-negative, lactose-nonfermenting coccobacillus. It is a commensal of the human upper respiratory tract and occasionally of the skin and urogenital tract (1). Unlike M. catarrhalis, M. osloensis is rarely pathogenic in humans. However, several cases of serious infections caused by this organism have been documented (2–6). While cases of nongonococcal, nonchlamydial, neonatal ophthalmia have been reported in which the causative agent was M. catarrhalis (7,8), to our knowledge, this case is the first report of neonatal ophthalmia due to M. osloensis. A 3-week-old, previously healthy boy was seen at the emergency department with a 48-hour history of yellow drainage from and swelling in both eyes. One day before admission, the drainage increased; the child could not open his eyes spontaneously. He had been eating well and was normally active. Aside from mild fussiness, no other symptoms were noted. The child was born full-term without complications to a gravida 6, para 5–6 mother. He received normal newborn care, including topical erythromycin ointment to the eyes. Aside from some mild jaundice at 6 days of age, he had been healthy. The mother denied any history of sexually transmitted disease. On examination, the infant's temperature was 38°C rectally, heart rate 144 beats/min, respirations 26/min, and blood pressure 94/60 mm Hg. The child appeared well developed and was fussy but showed no symptoms of toxicity. Both eyelids were markedly swollen and erythematous, and a yellow, purulent discharge was noted bilaterally. The sclera and conjunctivae were injected bilaterally. An ophthalmologist recorded that the red reflex was intact bilaterally and the corneas were clear. Intravenous cefotaxime, oral erythromycin, and topical erythromycin ointment to the eyes were recommended. The leukocyte count was 11,400 cells/mm3 with a normal differential. Hemoglobin level, hematocrit, platelet count, and bilirubin level were all within normal range. Urinalysis results as well as urine, blood, and cerebrospinal fluid cultures were negative. Secretions from the eyes were collected and sent for Gram stain and bacterial culture as well as chlamydial culture. Gram stain showed few gram-variable cocci. The child's eyes were flushed with copious amounts of normal saline, and a dose of intravenous cefotaxime and ampicillin was administered in the emergency department. He was admitted to the hospital for presumed ophthalmia neonatorum. The following day, decreased lid swelling, erythema, and eye discharge were observed, with trace conjunctival injection and minimal chemosis. The child's condition improved markedly during the next 24–48 hours. Cultures of the secretions obtained from the eye grew presumed Neisseria species as a pure culture. The isolate was sent to the Allegheny County Health Department for further testing and speciation. It was first tested with a fluorescein-conjugated antibody for Neisseria gonorrhoeae; results were negative. A RapID NH panel (Remel, Lenexa, KS, USA) was performed that identified the isolate as M. osloensis with a 99.7% probability. Ideally, the isolate would have undergone more comprehensive genotypic and phenotypic characterization. However, as a presumed Neisseria species, it was subjected to the usual testing protocol at the health department. Chlamydial culture was performed by using buffalo green monkey kidney cells (Viromed, Minnetonka, MN, USA) grown under standard conditions. No viral inclusions were seen, and the culture did not react with chlamydial antibodies (Trinity Biotech, Bray, Ireland). Because the child responded rapidly to antimicrobial drug treatment, no further workup of the bacterial isolate was considered. The child was healthy 3 days later and was discharged to his home with topical erythromycin and instructions to his parents to follow up with his primary care physician. Neonatal ophthalmia is a potentially serious, sight-threatening infection that may be caused by sexually transmitted pathogens. Accordingly, this clinical presentation warrants prompt diagnosis and appropriate therapy. At the same time, suspicion of a sexually transmitted disease causes immense social turmoil. Specific bacterial cultures are essential for precise microbiologic diagnosis and treatment. Cultures of conjunctival specimens from our patient grew M. osloensis. Clinically, this patient's infection was indistinguishable from other causes of neonatal ophthalmia. The differential diagnosis includes other agents such as N. gonorrhoeae, Chlamydia trachomatis, M. catarrhalis, Staphylococcus aureus, Haemophilus influenzae, and Streptococcus pneumoniae. Rarely, gram-negative enteric organisms may be implicated (9). Viruses, such as adenovirus or herpesvirus, are also a potential cause but were unlikely in this case. Finally, social issues must be considered. When an infant is seen with neonatal ophthalmia, a physician will often presume it to be gonococcal or chlamydial and assume the mother is positive for these infections. Recognizing that Moraxella species, including M. osloensis, may produce an identical clinical picture should limit presumptions regarding sexually transmitted diseases until a precise microbiologic diagnosis is made.

A case of left subclavian artery aneurysm with thrombus from which Moraxella group was recovered on culture is described. Patient had presented with life threatening hemoptysis, which on computed tomography (CT) scan evaluation of the chest, revealed a fistulous communication between aneurysm from the origin of left subclavian artery and segmental left upper lobe bronchus. Biochemically on the Vitek system and by growth characteristics organism present was identified as Moraxella osloensis. It was highly sensitive to all antibiotics tested. Cocci with exactly the same morphology could be seen in the Gram stain of a sputum sample from the patient. Postoperative antibiotics eradicated the bacteria and so no growth occurred on culture of the sputum. To our knowledge, this is the first ever time Moraxella species has been isolated from an arterial thrombus, particularly so from a person with normal heart valves.

Moraxella osloensis is a rare causative organism of infections in humans, with most cases reported in cancer patients. We report the case of a 67-year-old Japanese man with advanced cancer of the pancreatic head and multiple liver metastases who developed fever with chills. Blood culture was found to be positive for Gram-negative bacilli that were aerobic, oxidase-positive, and catalase-positive. M. osloensis was identified by 16 rRNA gene sequencing. Prompt control of the infection was achieved by treatment with cefepime for 14 days, without the need for removal of the central venous catheter.

Es wird uber einen Fall von eitriger Meningitis durchMoraxella osloensis bei einem 4 1/4jahrigen Jungen berichtet. Trotz der geringen Empfindlichkeit des Erregers wurde das Kind mit Penicillin (und anschliesend Chloramphenicol) komplikationslos geheilt. Fur die bakteriologische Diagnose der Meningitis ist die Bestimmung der biochemischen Eigenschaften des Erregers unerlaslich; der Nachweis gramnegativer, oxidasepositiver Diplokokken reicht dafur nicht aus.

Moraxella osloensis pyarthrosis of the knee joint is an unusual infection. The diagnosis can be quite difficult since the organism is fastidious in its growth characteristics. This case report presents an adult with M. osloensis sepsis of the knee, which could only be diagnosed by arthroscopic synovial biopsy and culture. Moreover, arthroscopy played a critical role in the definitive therapy.

We report a case of a 31 year old male with extensive subclinical sinusitis leading to erosion in the cribriform plate and subsequent meningitis caused by the organism Moraxella osloensis. The patient presented to the emergency department with rapid onset confusion, neck stiffness and headache. Inflammatory markers, renal and liver function, and a chest radiograph were all normal. CT Head showed extensive polyp disease in the paranasal sinuses with expansion of the left frontal sinus and CT Sinuses revealed an area of low attenuation in the cribriform plate consistent with bony erosion. MRI Head showed thick loculated sinus inflammation. Lumbar puncture yielded CSF with a high white cell count of predominantly mononuclear cells, no visible organisms and an elevated protein. CSF microscopy, culture and viral PCR were not diagnostic, and so the CSF was sent for 16S rDNA PCR screening, which identified the rDNA of Moraxella osloensis. Moraxella osloensis is a rare cause of bacterial meningitis, with only a few reported cases. This case illustrates that sinusitis, while a common condition, when severe can predispose to intracranial infection with atypical and low virulence organisms such as Moraxella species, which do not commonly cause invasive CNS disease. This case represents the first case of Moraxella osloensis meningitis reported from the United Kingdom.

A case of septicemia caused by Moraxella osloensis is described. A 4-year old girl fell ill with symptoms similar to those described in cases of septicemia caused by Neisseria meningitidis. Two days after the commencement of treatment with penicillins, however, Moraxella osloensis could be isolated from cerebral fluid, which contained only a small number of cells. It is assumed that the delayed recovery of the child was directly related to the diminished susceptibility of this Moraxella strain to penicillins. Since Moraxella strains may be resistant to these antibiotics, it is necessary to distinguish between Moraxella and N. meningitidis by means of laboratory tests. The symptoms elicited by Moraxella are similar to those in septicaemia caused by N. meningitidis, but are considerably milder in character.

Summary The first case of septic arthritis associated with vaginal discharge in a young child caused by Moraxella osloensis is reported. The similarity of clinical appearance to gonococcal disease and of microscopic morphology of the organism to Neisseria gonococcus emphasize the necessity for confirming a suspected clinical diagnosis with careful laboratory studies.

FOR years, the sine qua non of gonococcal infection in the male patient has been a thick, purulent urethral discharge and evidence of Gramnegative intracellular diplococci on smear examination. Indeed, these findings are used for presumptively diagnosing gonorrhea in males. Similarly for the female patient, an oxidase-positive colony that shows Gram-negative diplococci by microscopic examination is often accepted as a gonococcus without further investigation. As early as 1939, attention was drawn to microorganisms that could invalidate the diagnosis of gonorrhea by the smear method. DeBord 1 indicated such for Mima polymorpha (Moraxella osloensis) , and in 1942 Carpenter and Charles 2 reported the isolation of Neisseria meningitidis from gonococcal-like discharge in seven male patients. Little attention has been paid to N meningitidis until recent years. Since 1971, there have been reports of 80 patients in whom N meningitidis was isolated from the urethra, cervix, or anal canal. 3,4 This article reports