Seminars in Ophthalmology

ISSN: 0882-0538 (Print) 1744-5205 (Online) Journal homepage: https://www.tandfonline.com/loi/isio20

Clinical Characteristics of 17 Patients with

Moraxella Keratitis

Yui Tobimatsu, Noriko Inada, Jun Shoji & Satoru Yamagami

To cite this article: Yui Tobimatsu, Noriko Inada, Jun Shoji & Satoru Yamagami (2018) Clinical
Characteristics of 17 Patients with Moraxella Keratitis, Seminars in Ophthalmology, 33:5, 726-732,
DOI: 10.1080/08820538.2017.1417454

To link to this article: https://doi.org/10.1080/08820538.2017.1417454

Published online: 08 Jan 2018.

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Seminars in Ophthalmology, 2018; 33(5): 726–732
© Taylor & Francis
ISSN: 0882-0538 print / 1744-5205 online
DOI: https://doi.org/10.1080/08820538.2017.1417454

Clinical Characteristics of 17 Patients with Moraxella

Keratitis
1,2 1 1 1
Yui Tobimatsu , Noriko Inada , Jun Shoji , and Satoru Yamagami

1
Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, Tokyo,
Japan and 2Department of Ophthalmology, Diabetes Centre, Tokyo Women’s Medical University School of
Medicine, Tokyo, Japan

ABSTRACT
Purpose: To retrospectively investigate the clinical characteristics of Moraxella keratitis. Patients and methods: We
reviewed the medical records of 17 patients with Moraxella keratitis. Onset age, sex, predisposing factors, initial
clinical presentations, culture and antimicrobial susceptibility testing, and management and outcome of medical
treatment were investigated.
Result: Moraxella keratitis was more common in patients older than 40 years of age, and its representative initial
presentation was a round-shaped ulcer with endothelial plaque (70.6%) and hypopyon (58.8%). Local predis-
posing factors were significantly more frequent than systemic predisposing factors (P < 0.005). Isolated strains of
Moraxella (M. catarrhalis, M. osloensis, and other Moraxella spp.) were sensitive to all antibiotics tested except
ampicillin. The common disease contraction period was <2 weeks.
Conclusion: Moraxella keratitis (including the first report of M. osloensis keratitis) had local predisposing factors,
high sensitivity to antibiotics, and a tendency to recover within 2 weeks.
Keywords: Antimicrobial susceptibility testing, clinical form, corneal ulcer, endothelial plaque, hypopyon

INTRODUCTION However, the clinical characteristics of Moraxella kera-

Bacterial keratitis is a corneal bacterial infection caused
by trauma of the cornea, ocular surface disease, and
contact lens wear.1,2 Although various strains of cau-
sative organisms are isolated from patients with bac-
terial keratitis, Staphylococcus aureus, coagulase
negative Staphylococcus, Streptococcus pneumoniae, and
Pseudomonas aeruginosa are the representative causative
bacteria with a high-frequent detection ratio in cul-
tures of bacterial keratitis.1,3,4 Streptococcus aureus is a
known representative causative bacteria of a contact
lens-associated infectious keratitis5 and atopic derma-
titis-associated infectious keratitis.6,7 The clinical char-
acteristics of S. pneumoniae keratitis are post-traumatic
infection or infectious keratitis in elderly patients.8,9
Furthermore, P. aeruginosa is regarded as an important
causative organism of a contact lens-associated infec-
tious keratitis and corneal opportunistic infection.10,11
titis are not yet fully understood.
Moraxella spp. are gram-negative coccobacillus; they
are resident flora of the upper respiratory tract, skin, and
urogenital apparatus.12,13 Moraxella spp. are often isolated
from compromised hosts, and the major species detected
in the human organs are M. catarrhalis, M. nonliquefaciens,
M. lacunata, and M. osloensis. Critical causative organisms
of ocular surface infection are M. catarrhalis and M. lacu-
nata. Moraxella catarrhalis is a resident flora of the nasal
cavity and pharynx, and is often isolated from children
with conjunctivitis in addition to bronchitis, otitis media,
and sinusitis.12 Moraxella lacunata is a causative organism
of chronic angular blepharoconjunctivitis,14 and some-
times leads to keratitis.
In this study, we investigated the clinical character-
istics of Moraxella keratitis by examining patient back-
ground at onset, observational characteristics of
keratitis, and bacteriological examination results.

Received 9 May 2017; accepted 25 November 2017; published online 9 January 2018
Correspondence: Satoru Yamagami, Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, 30-1
Oyaguchi-Kamichou, Itabashi-ku, Tokyo 173-8610, Japan. E-mail: yamagami.satoru@nihon-u.ac.jp
Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/ISIO.

726

MATERIALS AND METHODS
This retrospective study was approved by the
Institutional Review Board of the Department of
Ophthalmology, Nihon University Itabashi Hospital
(Protocol no. RK-120511–09), and adhered to the tenets
of the Declaration of Helsinki.
Patients
We included 17 patients (17 eyes) with Moraxella ker-
atitis treated at the Department of Ophthalmology,
Nihon University Itabashi Hospital, Tokyo, Japan,
from February 2001 to January 2015. Moraxella keratitis
was diagnosed based on the clinical features of corneal
ulcers, and isolation of Moraxella spp. from the bacter-
ial culture of corneal ulcer scrapings. Patients with
bacteria isolated from corneal ulcers that were not
Moraxella spp. or culture negative were excluded.
Methods
The medical records of 17 patients with Moraxella keratitis
were reviewed. The following information was identified
for all patients included in the study: (1) age of onset and
sex; (2) documented presence of predisposing factors
including local and systemic predisposing factors (pre-
vious ocular trauma, contact lens wear, previous ocular
surface disease, previous ocular surgery, and systemic
disease such as diabetes mellitus or atopic dermatitis);
(3) initial clinical presentations by slit-lamp examination
involving the lesions of Moraxella keratitis (morphological
characteristics of corneal ulcers and presence of asso-
ciated clinical features including hypopyon and endothe-
lial plaque); (4) results of bacterial culture and
antimicrobial susceptibility testing for Moraxella spp.;
and (5) first-line treatment at initial visit and outcome of
medical treatment.
All ulcers were routinely scraped with the intention
of microbiologic examination and treatment. Corneal
ulcer scraping was performed with a spatula after topi-
cal anesthesia using oxybuprocaine hydrochloride
(Benoxil®, Santen Pharmaceutical, Osaka, Japan), and
inoculated into chocolate agar at the initial visit.
Culture media were then incubated at 25°C for 7 days.
To identify the bacteria isolated as the causative
agent of Moraxella keratitis, biochemical characteriza-
tions of the isolates were carried out with the VITEK
2 system using GN cards (SYSMEX bioMérieux, Tokyo,
Japan) together with ID-test HN20 Rapid Kit (Nissui
Pharmaceutical, Tokyo, Japan). Using this method,
Moraxella spp. were identified as M. catarrhalis, M.
osloensis, and other Moraxella spp.
Antibiotic-susceptible and -resistant strains of iso-
lated Moraxella spp. were identified by the minimum
© 2018 Taylor & Francis
Clinical Characteristics of Moraxella Keratitis 727
inhibitory concentration according to the Performance
Standards for Antimicrobial Susceptibility Testing,
26th Informational Supplement M100-S26 by the
Clinical and Laboratory Standards Institute.15
Statistical analysis
Statistical analysis was performed using StatMate V
(ATMS, Tokyo, Japan). The positive rate of predispos-
ing factors in Moraxella keratitis among systemic and
local factors was evaluated using Fisher’s exact test,
and odds ratios (ORs) were determined. Statistical
significance was accepted as P < 0.05.
RESULTS
Age of onset and sex
The mean age of onset in the 17 patients with
Moraxella keratitis was 56.1 ± 22.5 years (mean ±
standard deviation, range 11–86 years). The onset
of Moraxella keratitis developed in a wide age
range group, but it was more common in patients
over the age of 40 (Figure 1). The patient sample
comprised 12 men and 5 women.
Predisposing factors
The predisposing factors of Moraxella keratitis are shown
in Table 1. Fourteen patients were non-contact lens wear-
ers whereas only three were contact lens wearers.
Predisposing factors of the non-contact lens wearers
comprised local factors including corneal edema and
corneal injury, while systemic factors included atopic
dermatitis and diabetes mellitus. The causative diseases
of the two patients with corneal edema were bullous
keratopathy, and one had neovascularization glaucoma.
Four patients had no possible risk factors.
We calculated the detection rate of local and systemic
predisposing factors in 17 patients with Moraxella kera-
titis, including 3 contact lens wearers and 14 non-con-
tact lens wearers. The detection rates of local
predisposing factors are shown in Table 2. The detec-
tion rate of local predisposing factors was significantly
higher than that of systemic disposing factors
(P = 0.0053, Fisher’ exact test, Table 2).
Initial clinical presentations by slit-lamp
examination
We classified corneal ulcers in patients with
Moraxella keratitis as either round-shaped ulcers
(n = 14) or irregular pattern ulcers (n = 3)
728 Y. Tobimatsu et al.

FIGURE 1. Age distribution of patients with Moraxella keratitis.

Moraxella keratitis is more common in adults, in particular, patients ≥40 years of age.

TABLE 1. Predisposing factors of Moraxella keratitis. shaped ulcer, and speckled forms showed speckled
or ring shaped white opacity. Therefore, initial clin-
Predisposing factors No. of patients (cases) ical presentations of Moraxella keratitis comprised
　Contact lens wearers* 3 nine eyes of round-shaped ulcers with diffuse
　Non-contact lens wearers 14 form opacity, five eyes of round-shaped ulcers
Local predisposing factors with speckled form opacity, and three eyes of irre-
Corneal edema 3 gular pattern ulcers (Figure 3). There was no asso-
Trauma (plant) 3
Others 2
ciation between the shape of the corneal ulcer and
Systemic predisposing factors Moraxella spp. strains isolated from corneal ulcers.
Atopic dermatitis 2 Regarding the clinical findings complicated with a
Diabetes 1 corneal ulcer, endothelial plaque was observed in 12
No possible risk factor 4 eyes (70.6%) and hypopyon in 10 eyes (58.8%). Ratios
*Contact lens wearer with no systemic or local disposing of complicated endothelial plaque and hypopyon in
factors except contact lens wear. each form of corneal opacity are shown in Figure 3.

TABLE 2. Detection rate of systemic and local predisposing

factors.
Predisposing factors*
Yes No
Local 11 6 0.0053
Systemic 3 14
*local predisposing factors include three contact lens wearers.
**Fisher’s exact test.
Bold values are statistically significant (P < 0.05)
(Figure 2). Two of the irregular pattern ulcers
developed in an 11-year-old patient with atopic
dermatitis and in an elderly patient older than
80 years of age. Furthermore, the round ulcers
were divided into the following two subgroups
according to the opacification pattern of the corneal
abscess: diffuse form and speckled form. Diffuse
forms showed diffuse white opacity in the round-
Bacterial culture and antimicrobial
susceptibility testing
Regarding the Moraxella spp. isolated from corneal scrap-
P-value** ings, there were four cases of M. catarrhalis, one case of
M. osloensis, and 12 cases of other Moraxella spp. The
antimicrobial susceptibility testing results are shown in
Table 3. Thirteen strains of Moraxella spp. isolated from
corneal scrapes were resistant to ampicillin hydrate
(ABPC). All strains of Moraxella spp. isolated from cor-
neal scrapes were sensitive to the antimicrobial agent
belonging to beta-lactamase inhibitor combination peni-
cillin, second and third generation of cefem, tetracycline,
aminoglycoside, and fluoroquinolone (Table 3).
Management and outcome of medical
treatment
Moraxella keratitis treatments comprised the administra-
tion of antimicrobial agents in addition to the abrasion of

Seminars in Ophthalmology
 Clinical Characteristics of Moraxella Keratitis 729

FIGURE 2. Morphological characteristic of corneal ulcers in patients with Moraxella keratitis.

Corneal ulcers comprise 14 round-shaped ulcers and three irregular ulcers.

FIGURE 3. Morphological characteristic of corneal opacity in Moraxella keratitis.

Morphological characteristics of corneal abscess and corneal infiltration in patients with Moraxella keratitis comprising nine eyes
with diffuse form, five with speckled form, and three with an irregular pattern. Each form of corneal opacity is complicated with
corneal endothelial plaque and hypopyon at various frequencies, but there is no statistical difference in the frequency of forms.

corneal ulcers. Medical treatment details for the 17
patients are shown in Table 4. The combination of med-
icaments most commonly administered for the treatment
of Moraxella keratitis was ceftazidime intravenous feed-
ing, levofloxacin or aminoglycoside ophthalmic solution,
and ofloxacin ophthalmic ointment. In addition,
cefmetazole intravenous feeding, cefmenoxime ophthal-
mic solution, or tetracycline ophthalmic ointment were
administered in some patients.
We investigated the disease contraction period in
each patient. The healing of a corneal ulcer was deter-
mined when the epithelial defect of the corneal ulcer

© 2018 Taylor & Francis

730 Y. Tobimatsu et al.

TABLE 3. Antimicrobial susceptibility test results. DISCUSSION

Antibiotics Susceptibility rate* Antibiotics Susceptibility rate*
In the 1980s, it was reported that Moraxella keratitis
ABPC 0/13 CAM 8/8 tended to develop in insanitary environments, or in
PIPC 4/4 EM 4/4 patients with alcoholism, malnutrition, and diabetes.-
ABPCST 12/12 MINO 12/12 16,17
Alternatively Das et al. (2006) reported that the
CTM 8/8 AMK 4/4 predisposing factors of Moraxella keratitis in an analy-
CTX 13/13 GM 4/4
CTRX 7/7 CPFX 3/3 sis of 95 patients were corneal transplant, herpes sim-
CAZ 4/4 LVFX 16/16 plex keratitis, and diabetes.18 Furthermore, in Japan,
CFPM 3/3 AZT 3/3 predisposing factors include contact lens wear,
CCL 5/5 IPM 5/5 trauma, and diabetes, as reported by Inoue et al.
CDTRPI 8/8 MEPM 10/10 (2015).19 In the present study, local predisposing fac-
CPDXPR 8/8 ST 11/11
tors in the ocular surface included trauma and corneal
*Susceptibility rate = no. of Moraxella spp. indicating the edema in non-contact lens wearers as well as in contact
antibiotic sensitivity/no. of total Moraxella spp. in the antimi- lens wearers. In contrast, systemic predisposing factors
crobial susceptibility testing.
were infrequent, with only three of the 17 patients
ABPC: Ampicillin, PIPC: Piperacillin, CTM: Cefotiam, CTX:
Cefotaxime, CTRX: Ceftriaxone, CAZ:Ceftazidime, CFPM:
having systemic predisposing factors including atopic
Cefepim, CCL: Cefaclor, CDTRPI: Cefditoren Pivoxil, CPDXPR: dermatitis and diabetes. Considering these previous
Cefpodoxime Proxetil, ABPCST: Ampicillin/Sulbactam, CAM: findings and the present results, local predisposing
Clarithromycin, EM: Erythromycin, MINO: Minomycin, AMK: factors in the ocular surface appear to be critical for
Amikacin, GM: Gentamicin, CPFX: ciprofloxacin, LVFX: the onset of Moraxella keratitis rather than systemic
Levofloxacin, AZT: Aztreonam, IPM: Imipenem, MEPM:
Meropen, ST: ST mixture
disposing factors. Therefore, a corneal-compromised
host may create an environment predisposed to
Moraxella spp. infection.
In contrast to previous studies, atopic dermatitis
was indicated as a systemic risk factor in addition to
TABLE 4. First-line treatment at initial visit.
diabetes in the present study. Patients with atopic
Treatment regimen No. of patients (eyes) dermatitis have been previously reported to be predis-
posed to S. aureus,6 but the mechanisms underlying
Systemic administration the susceptibility of patients to Moraxella spp. are not
Ceftazidime 6
Other 6
fully understood. In patients with atopic keratocon-
Local administration junctivitis, allergic inflammation may weaken the ocu-
Ophthalmic solution Fluoroquinolone 10 lar surface defense mechanisms, which may promote
Aminoglycoside 5 corneal infection by gram-positive bacteria (e.g., S.
Other 4 aureus) and gram-negative bacteria (e.g., Moraxella
Ophthalmic Ofloxacin 11
ointment
spp. and Pseudomonas aeruginosa). Therefore, further
Tetracyclines 2 investigation on Moraxella keratitis is critical in large
numbers of patients with atopic keratoconjunctivitis.
The development of Moraxella keratitis was most com-
had disappeared. The disease contraction period mon in patients over 40 years old and in non-contact lens
results comprised the following three groups: 11 eyes wearers. In support of this finding, older age of onset has
(64.7%) <2 weeks, 3 eyes (17.6%) 2–3 weeks, and 2 eyes been frequently reported in previous studies.7,18
(11.8%) >3 weeks to 1 month (Figure 4). The disease Therefore, in Moraxella keratitis, older age should be
contraction period was unknown for one eye owing to considered a risk factor of Moraxella infection.
study interruption caused by a hospital visit. The typical clinical features of corneal ulceration in
The risk factor analysis for disease contraction eyes with Moraxella keratitis are oval ulceration with
period are calculated by Odds ratio. The highest extensive stromal suppurative infiltration, endothelial
OR of the risk factors was that of systemic treatment, decompensation, and moderate-to-severe anterior
but statistical significance was lacking (P > 0.05). chamber reaction.20 Severe cases of Moraxella keratitis
Overall, among age (OR 1.13), sex (OR 0.19), local may be complicated with hypopyon or corneal per-
predisposing factor (OR 1.20), systemic predisposing foration. Therefore, in this study, we classified
factor (OR 0.88), clinical form (OR 1.80), endothelial Moraxella keratitis in the following three groups
plaque (OR 1.13), hypopyon (OR 1.25), and systemic based on the clinical observations of the corneal
treatment (OR 3.00), there were no statistically sig- ulcer: (1) round-shaped ulcers with diffuse form opa-
nificant risk factors for the disease contraction period city; (2) round-shaped ulcers with speckled form opa-
(P > 0.05). city; and (3) irregular pattern ulcers. Inoue et al.

Seminars in Ophthalmology

FIGURE 4. Distribution of disease contraction period.
Moraxella keratitis is most commonly contracted within 2 weeks.
highlighted that some patients with Moraxella keratitis
developed an amoeba-like or an irregularly shaped
corneal ulcer.7 The authors reported atypical corneal
ulcers thought to be similar to those reported in the
present non-representative Moraxella keratitis patients
who were classified with an irregular ulcer. We recog-
nize that round-shaped ulcers with severe stromal
infiltration, corneal endothelial plaque, and hypopyon
are a common feature in typical Moraxella keratitis.
However, bacteriological examination is vital for diag-
nosis because typical clinical observation is not specific
to Moraxella keratitis.
The isolated causative Moraxella spp. in the present
study included 12 cases of Moraxella spp., four cases of
M. catarrhalis, and one case of M. osloensis. In our culture
results, M. lacunata, which is thought to be the most
frequent causative species of Moraxella keratitis, may
have been one of the strains recorded as Moraxella spp.
Furthermore, M. osloensis, which is a rarely isolated cau-
sative bacterium in ocular infections, was detected in a
female 18-year-old soft contact lens wearer without sys-
temic predisposing factors. Moraxella osloensis is a resi-
dent bacterium of the upper respiratory tract and oral
cavity, and is sometimes reported as the causative agent
of sepsis and meningitis.21,22 In ocular infections, there
have been some reports of endophthalmitis caused by M.
osloensis, but there are no reports of M. osloensis keratitis.
These results show that due to the wide variety of strains
isolated from Moraxella keratitis, antimicrobial suscept-
ibility to isolated Moraxella spp. warrants specific
attention.
Moraxella spp. are characterized by a β-lactamase pro-
duction, and it is reported that approximately 80% of M.
catarrhalis produce β-lactamase.23 Therefore, Moraxella
spp. usually show resistance to penicillin and first-
© 2018 Taylor & Francis
Clinical Characteristics of Moraxella Keratitis 731
generation cefem antimicrobial agent, but are sensitive
to other antimicrobial agents including third generation
cefem, macrolides, tetracyclines, aminoglycosides, fluor-
oquinolones, and carbapenem-based antimicrobial
agents, which are recommended for the medical treat-
ment of Moraxella keratitis. All 13 strains isolated in the
present study were resistant to the penicillin antimicro-
bial agent, ABPC, and 12 of the isolated strains showed
susceptibility to ampicillin/sulbactam, a β-lactamase
inhibitor combination penicillin. Fluoroquinolone-based
and aminoglycoside-based antimicrobial ophthalmic
solution and fluoroquinolone-based antimicrobial
ophthalmic ointment were administered in many
patients with Moraxella keratitis as a first-line treatment
at the initial visit. Based on the results of the antimicro-
bial susceptibility testing, these ophthalmic solutions
and ointments appeared to be useful in treatment of
Moraxella keratitis. Frequent administration of ceftazi-
dime intravenous feeding is sensitive to gram-negative
rods (including Pseudomonas aeruginosa) and M. catarrha-
lis, which was isolated from four patients with Moraxella
keratitis in the present study. Therefore, empirical ther-
apy, which assumed infectious keratitis by gram-nega-
tive rods according to the clinical observation at initial
presentation, was thought to be useful as a first-line
treatment for Moraxella keratitis at the initial visit.
In our study, 11 eyes (64.7%) with Moraxella keratitis
healed within 2 weeks. This result indicates that corneal
scraping combined with effective antibiotic treatment
due to appropriate selection based on initial presentation,
bacterial culture, and antimicrobial susceptibility testing
is an effective treatment approach for Moraxella keratitis.
In conclusion, Moraxella keratitis, including the first
report of M. osloensis keratitis, had local predisposing
factors, high sensitivity to antibiotics, and a tendency to
732 Y. Tobimatsu et al.
recover within 2 weeks. These findings will help us devise
a treatment protocol for Moraxella keratitis based on past
therapeutic experience. A prospective clinical trial is
warranted.
CONFLICT OF INTEREST
The authors have no conflicts of interest to declare.
ORCID
Yui Tobimatsu http://orcid.org/0000-0001-9311-
9008
Noriko Inada http://orcid.org/0000-0003-0486-1230
Jun Shoji http://orcid.org/0000-0001-8957-3312
Satoru Yamagami http://orcid.org/0000-0002-1330-
5386
REFERENCES
1. Green M, Apel A, Stapleton F. Risk factors and causative
organisms in microbial keratitis. Cornea. 2008;27:22–27.
2. Ibrahim YW, Boase DL, Cree IA. Epidemiological character-
istics, predisposing factors and microbiological profiles of
infectious corneal ulcers: the Portsmouth corneal ulcer
study. Br J Ophthalmol. 2009;93:1319–1324.
3. Varaprasathan G, Miller K, Lietman T, et al. Trends in the
etiology of infectious corneal ulcers at the F. I. Proctor
Foundation. Cornea. 2004;23:360–364.
4. Laspina F, Samudio M, Cibils D, et al. Epidemiological
characteristics of microbiological results on patients with
infectious corneal ulcer: a 13-year survey in Paraguay.
Graefes Arch Clin Exp Ophthalmol. 2004;242:204–209.
5. Schaefer F, Bruttin O, Guex-Crosier Y. Bacterial keratitis: a
prospective clinical and microbiological study. Br J
Ophthalmol. 2011;85:842–847.
6. Chen JJ, Applebaum DS, Sun GS, Pflugfelder SC. Atopic kera-
toconjunctivitis: A review. J Am Acad Dermatol. 2014;70:569–575.
7. Inoue Y. Ocular infections in patients with atopic dermati-
tis. Int Ophthalmol Clin. 2002;42:55–69.
8. Kunimoto DY, Sharma S, Garg P, Gopinathan U, Miller D,
Rao GN. Corneal ulceration in the elderly in Hyderabad,
south India. Br J Ophthalmol. 2000;84:54–59.
9. Parmar P, Salman A, Kalavathy CM, Jesudasan CA,
Thomas PA. Pneumococcal keratitis: a clinical profile. Clin
Exp Ophthalmol. 2003;31:44–47.
10. Willcox MD. Pseudomonas aeruginosa infection and
inflammation during contact lens wear: a review. Optom
Vis Sci. 2007;84:273–278.
11. Ormerod LD, Smith RE. Contact lens-associated microbial
keratitis. Arch Ophthalmol. 1986;104:79–83.
12. Catlin BW. Branhamella catarrhalis: an organism
gaining respect as a pathogen. Clin Microbiol Rev.
1990;3:293–320.
13. Vaneechoutte M, Verschraegen G, Claeys G, Weise B, Van
Den Abeele AM. Respiratory tract carrier rates of Moraxella
(Branhamella) catarrhalis in adults and children and inter-
pretation of the isolation of M. catarrhalis from sputum. J
Clin Microbiol. 1990;28:2674–2680.
14. Bharathi MJ, Ramakrishnan R, Shivakumar C, Meenakshi R,
Lionalraj D. Etiology and antibacterial susceptibility pattern
of community-acquired bacterial ocular infections in a ter-
tiary eye care hospital in south India. Indian J Ophthalmol.
2010;58:497–507.
15. Clinical and Laboratory Standards Institute. Performance
Standards for Antimicrobial Susceptibility Testing: 26th
Informational Supplement. Wayne, PA: Clinical &
Laboratory Standards Institute; 2016. CLSI document
M100-S26.
16. Baum J, Fedukowicz HB, Jordan A. A survey of Moraxella
corneal ulcers in a derelict population. Am J Ophthalmol.
1980;90:476–480.
17. Marioneaux SJ, Cohen EJ, Arentsen JJ, Laibson PR.
Moraxella keratitis. Cornea. 1991;10:21–24.
18. Das S, Constantinou M, Daniell M, Taylor HR. Moraxella
keratitis: predisposing factors and clinical review of 95
cases. Br J Opthalmol. 2006;90:1236–1238.
19. Inoue H, Suzuki T, Inoue T, et al. Clinical characteristics
and bacteriological profile of Moraxella keratitis. Cornea.
2015;34:1105–1109.
20. Garg P, Mathur U, Athmanathan S, Rao GN.
Treatment outcome of Moraxella keratitis: our experi-
ence with 18 cases-a retrospective review. Cornea.
1999;18:176–181.
21. Fox-Lewis A, Coltart G, Rice S, Gourtsoyannis Y, Hyare H,
Gupta RK. Extensive subclinical sinusitis leading to
Moraxella osloensis meningitis. ID Cases. 2016;6:
39–42.
22. Lee WS, Hsueh PR, Yu FL, Chen FL, Hsieh TC, Ou TY.
Moraxella osloensis bacteremia complicating with severe
pneumonia in a patient with lung cancer. J
Microbiol Immunol Infect. 2015. doi:10.1016/j.
jmii.2015.03.005.
23. Sheikh SO, Fasih N, Irfan S, Zafar A. β-Lactamase production
and antimicrobial susceptibility pattern of Moraxella catarrhalis
isolates: report from Pakistan. Asian Pac J Trop Med. 2014.
doi:10.1016/S1995-7645(14)60237-6.
Seminars in Ophthalmology