History and Physical Examination
The history typically suggests the type of infection present (eg, upper respiratory tract infection [URTI], lower respiratory tract infection [LRTI], bacteremia, or endocarditis). Physical findings in M catarrhalis infections are similar to findings of infections with other organisms in the same location.
Common cold
In 29% of common-cold episodes due to bacterial pathogens (including M catarrhalis), affected children continued to be symptomatic 10 days after the first appearance of symptoms. [3]
Otitis media
A clinical history of acute otitis media and otitis media with effusion with symptoms includes otalgia, fever, and hearing loss. Otitis media is a very common condition, especially in children. Approximately 70% of children experience at least 1 episode of otitis media during childhood. M catarrhalis has been isolated in 3-17.3% of middle ear exudates in children with otitis media. [4, 5]
Sinusitis
In a patient with sinusitis, the clinical history commonly includes headache, pain in the maxillary or frontal area, fever, and cough. Young children present with persistent nasal discharge (lasting longer than 2 weeks) and cough, especially at night. M catarrhalis has been isolated in 22% of maxillary sinus aspirates in children as a single pathogen and in 72% of aspirates in combination with other organisms (eg, S pneumoniae or H influenzae). [6]
Lower respiratory tract infection
In adult patients who have a history of conditions such as chronic obstructive pulmonary disease (COPD), pneumoconiosis, asthma, malignancies, or immunosuppression and who show findings characteristic of bronchitis or pneumonia or exacerbations of their underlying condition, M catarrhalis infection is a possibility. M catarrhalis LRTI is also associated with smoking. M catarrhalis is isolated from sputum and transtracheal aspirate specimens at rates of 0.2-8.1%, accompanied by H influenzae and/or S pneumoniae in more than 30% of cases. [7, 8, 9, 10]
In children, LRTIs have been associated with a history of recent respiratory syncytial virus or cytomegalovirus infection or with more debilitating conditions, such as bronchopulmonary dysplasia, ventricular septal defect, leukemia, Arnold-Chiari syndrome, prematurity, or HIV infection. [11, 12]
Nosocomial infections
Outbreaks of nosocomial infections with M catarrhalis have been reported, mostly involving pulmonary units or pediatric intensive care units (PICUs).
Bacteremia
In 46% of patients with M catarrhalis bacteremia, no primary site of infection is found. Bacteremia is rare with M catarrhaliscommunity-acquired pneumonia. [13] The following conditions have been found to predispose to M catarrhalis bacteremia:
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Neutropenia, systemic lupus erythematosus, or leukemia
Endocarditis and other local infections
M catarrhalisendocarditis has been described in patients with a history of valvular conditions or prostheses, as well as in patients who were previously healthy. It has also been described as a complication of balloon angioplasty. [14, 15] M catarrhalis has been identified as a pathogen in cleft palate repairs (resulting in a higher fistula rate). [16] Sporadic cases of other infections with M catarrhalis include the following:
Complications
Complications of M catarrhalis infection may include the following:
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Recurrence
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Bacteremia and sepsis
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Meningitis
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Mastoiditis
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Hearing loss
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Pleural effusion
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Shock
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Death
