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Henny, F.C.

Lampe, A.S.

Meer, J.W.M. van der

Mulder, C.J.J.

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Branhamella catarrhalis septicemia in a granulocytopenic patient

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Case Report__.____________________________________________ _ _ _ ___ ____
F. C. H enny , Ch. J. J. M ulder, A . S. L am pe, J. W . M. van d e r M eer
Branhamella catarrhalis Septicaemia in a Granulocytopenic Patient
Summary: A patient with acute leukaemia developed a 
maxillary sinusitis and septicaemia with Branhamella 
catarrhalis during the period of bone marrow hypopla­
sia. One blood culture also grew Staphylococcus 
aureus. In the same period, the patient developed 
tender red skin lesions and disseminated intra-vascular 
coagulation. The patient recovered when therapy with 
high dosages of amoxicillin was instituted. At the same 
time, however, the bone marrow recovered.
Zusammenfassung: Branhamella catarrhalis-Septik- 
ämie bei einem granulozytopenischen Patienten. Bei 
einem Patienten mit akuter Leukämie trat während 
der Phase der Knochenmarksdepression eine Sinusitis 
maxillaris und Septikämie durch Branhamella catar­
rhalis auf. In einer Blutkultur wuchs auch Staphylococ- 
cus aureus. In der gleichen Phase entwickelten sich bei 
dem Patienten weiche gerötete Hautläsionen und eine 
disseminierte intravasale Gerinnung. Unter hohen Do­
sen Amoxicillin erholte sich der Patient, gleichzeitig 
regenerierte auch das Knochenmark.
Introduction
Branhamella catarrhalis (former name: Neisseria catar­
rhalis) is a gram-negative diplococcus which occurs as a 
commensal in the upper respiratory tract. The organism 
may cause acute, often mild and self-limiting infections 
such as otitis media, maxillary sinusitis and lower respira­
tory tract infections (1, 2). Recently, however, B. catar­
rhalis has been reported as the etiologic agent of serious 
infections, especially in the immuno and myelo-suppress- 
ed host (3-9). The present paper reports a case of 
septicaemia in a leukaemic patient.
Case Report
A 24-year-old woman was admitted because of acute myeloblas- 
tic leukaemia (AML) in relapse. The AML had been diagnosed 
six months before, and administration of daunorubicine, vincris­
tine and cytosine arabinoside had been followed by a remission. 
On examination there were no abnormalities. Laboratory inves­
tigations: Hb: 8.9 mmol/1; WBC: 37x 109/1 with 4.2xl09/l granu­
locytes and 85% blast cells; platelet count: 7.0xl09/l. Further 
laboratory studies were normal. Chest and sinus radiographs 
were normal. Under protective isolation and oral antibiotic 
prophylaxis consisting of neomycin, polymyxin B, amphotericin 
B and nalidixic acid (SAM regimen) (10), intermediate dose cy­
tosine arabinoside and daunorubicine (11) was started. During 
the period of pancytopenia she developed a temperature of 
39° C. Physical examination revealed only a nasopharyngitis and
Figure 1: Tender red subcutaneous nodules on the legs.
bacteriological investigations showed no abnorm alities. The 
tem perature returned to norm al w ithout systemic antibiotics.
A week later, still pancytopenic, she had a chill after a transfus­
ion and developed diarrhoea. She appeared  ill with a tem pera­
ture of 39° C. T he chest X-ray was norm al, but sinus X -ray films 
disclosed an air fluid level in the right m axillary sinus. B lood cui* 
tures w ere taken  and because septicaem ia was suspected , tre a t­
ment with intravenous tobram ycin and cefam andole (4x1 g) 
was started. D uring the next four days her tem pera tu re  rem ain­
ed around 39° C and repeated  exam inations show ed no  abnor­
malities.
On the fifth day tender red subcutaneous nodules (Figure 1) 
were found on the arms and legs. C ultures from the maxillary si­
nus could not be taken because of dissem inated intravascular 
coagulation (D1C) and profound throm bocytopenia . O n the 
same day three blood cultures w ere reported  to be positive for 
B. catarrhalis, sensitive to amoxicillin and  to cefam andole, in­
term ediate to tobram ycin and resistant to sulfam ethoxazole and 
trim ethoprim  (disk diffusion technique). O ne of the  blood cul­
tures also yielded Staphylococcus aureus, as did one  stool spec­
imen. A ntibiotic trea tm en t was changed to amoxicillin (6 x  2 g) 
and cloxacillin (6 x 1  g) intravenously. W ithin the next five days 
the bone marrow recovered, the skin lesions cleared and the 
tem perature  returned to norm al. A t this tim e an asp irate  from 
the maxillary sinus showed many leucocytes, but no  bacteria in 
the G ram  stain; cultures rem ained sterile. Amoxicillin and clo­
xacillin w ere continued for twelve days. T h e  patient experienced 
ano ther remission and was discharged in good condition.
Received: 19 January 1984/Accepted: 28 March !984
F. C. Henny, M. D., Department of Nephrology, University Hospital 
Leiden, NL-Leiden;
Ch. J. J. Mulder, M. D.. J. IV. M. van der Meer, M. D., Department of 
Infectious Diseases. University Hospital Leiden. NL-Leiden;
A. S. Lampe, M. D., Department of Medical Microbiology, University 
Hospital Leiden. NL-Leiden.
208 / 58 Infection 12 (1984) Nr. 3 © MMV Medizin Verlag GmbH München, München 1984
F. C. Henny et al.: Branhamella catarrhalis Septicaemia
Discussion
This report documents the pathogenicity of B. catarrhalis 
in a compromised host. Previously, this agent was recog­
nised as the cause of otitis media (1), maxillary sinusitis 
(2), pneumonia (3, 7), meningitis with septicaemia (4, 6) 
and endocarditis (8, 9). Our patient had subcutaneous no­
dules giving the impression of a disseminated infection. 
Since the lesions were not punctured for culture, we can­
not prove that they represented metastatic lesions with B. 
catarrhalis. The skin lesions did not resemble the skin le­
sions of meningococcal septicaemia which have also been 
reported in B. catarrhalis meningitis (6). As a gram-ne­
gative microorganism, B. catarrhalis produces endotoxin 
and this might explain the DIC. Although the B. catarrha­
lis strain was sensitive in vitro to cefamandole, our patient 
did not respond until a high dose of amoxicillin was given.
Literature
1. Coffey, J. D.: Otitis media in the practice of pediatrics. Pediatrics 
38 (1966) 25-32.
2. Brorson, J. E., Axelsson, A., Holm, S. E.: Studies on Branhamella 
catarrhalis (Neisseria catarrhalis) with special reference to maxillary 
sinusitis. Scand. J. Infect. Dis. 8 (1976) 151-155.
3. McNeely, D. J., Kitchens, C. S., Kluge, R. M.: Fatal Neisseria 
(Branhamella) catarrhalis pneumonia in an immunodeficient host. 
Am. Rev. Respir. Dis. 14 (1976) 399-402.
4. Pfister, L. E., Gallagher, M. V., Potterfield, T. G., van Brown, D. 
W.: Neisseria catarrhalis bacteremia with meningitis, JAMA 193 
<1965) 399-401.
5. Doern, G. V., Miller, M. J., Winn, R. E.: Branhamella (Neisseria) 
catarrhalis systemic disease in humans. Arch. Intern. Med. 141 
(1981) 1690-1692.
6. Feigin, R. D., San Joaquin, V., Middelkamp, J. N.: Purpura fulmi- 
nans associated with Neisseria catarrhalis septicaemia and meningi­
tis. Pediatrics 44 (1969) 120-123.
At the same time, however, the bone marrow recovered. 
Since organisms like B. catarrhalis are not eradicated with 
the oral non-absorbable antibiotics used (10), infections 
with such microorganisms can occur.
Prophylaxis with co-trimoxazole (12) most probably 
would not have prevented this infection either, since the 
microorganism was co-trimoxazole-resistant. Our case re­
port underlines the experience in previous reports that B 
catarrhalis is an opportunistic pathogen that may cause 
serious systemic infections in the compromised host.
Acknowledgements
We are grateful to Prof. Dr. R. van Furth and Dr. J. M. Dunbar 
for their critical review of the manuscript and to Mrs. A. H. Pi- 
ket for her secretarial help.
7. Srinivasan, G., Raff, M. J., Templeton, YV. C., Givens, S. J., Gra­
ve, R. C., Melo, J. C.: Branhamella catarrhalis pneumonia. Am. 
Rev. Respir. Dis. 123 (1981) 553-555.
8. Pollock, A, A ,, Holzman, R. S.: Neisseria catarrhalis endocarditis. 
Ann. Intern. Med. 85 (1976) 206-207.
9. Douer, D ., Danzíger, Y., Pinkhas, J.: Neisseria catarrhalis endocar­
ditis, Ann. Intern. Med. 86 (1977) 116-119.
10. Guiot, H, F. L., van den Broek, P. J., van der Meer, J. W. M., van 
Furth, R.: Selective antimicrobial modulation of the intestinal flora 
of patients with acute non-lymphocytic leukaemia: A double-blind, 
placebo-controlled study. J. Infect. Dis. 147 (1983) 615-623.
11. Willemze, R., Fibbe, W. E., Zwaan, F. E.: Experience with inter­
mediate and high dose cytosine arabinoside in refractory acute leu­
kaemia. Onkologie 6 (1983) 200-204.
12. Dekker, A. W., Rozeaberg-Arska, M., Sixma, J. J., Verhoef, J.: 
Prevention of infection by trimethoprim-sulfamethoxazole plus am­
photericin B in patients with acute non-lymphocytic leukaemia. 
Ann. Intern. Med. 95 (1981) 555-559.
Infection 12 (1984) Nr. 3 © MMV Medizin Verlag GmbH München, München 1984 591 209


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