Moraxella catarrhalis - Pathogen or Commensal?

Moraxella catarrhalis is an exclusively human commensal and mucosal pathogen. Its role as a disease-causing organism has long been questioned. Today, it is recognized as one of the major causes of acute otitis media in children, and its relative frequency of isolation from both the nasopharynx and the middle ear cavity has increased since the introduction of the heptavalent pneumococcal conjugate vaccine, which is associated with a shift in the composition of the nasopharyngeal flora in infants and young children. Although otitis media caused by M. catarrhalis is generally believed to be mild in comparison with pneumococcal disease, numerous putative virulence factors have now been identified and it has been shown that several surface components of M. catarrhalis induce mucosal inflammation. In adults with chronic obstructive pulmonary disease (COPD), M. catarrhalis is now a well-established trigger of approximately 10% of acute inflammatory exacerbations. Although the so-called cold shock response is a well-described bacterial stress response in species such as Escherichia coli, Bacillus subtilis or - more recently - Staphylococcus aureus, M. catarrhalis is the only typical nasopharyngeal pathogen in which this response has been investigated. Indeed, a 3-h 26 degrees C cold shock, which may occur physiologically, when humans inspire cold air for prolonged periods of time, increases epithelial cell adherence and enhances proinflammatory host responses and may thus contribute to the symptoms referred to as common cold, which typically are attributed to viral infections.