Japanese Journal of Ophthalmology

, Volume 63, Issue 4, pp 328–336 | Cite as

Moraxella species: infectious microbes identified by use of time-of-flight mass spectrometry

  • Shunsuke Takahashi
  • Kazuhiro Murata
  • Kenji Ozawa
  • Hiroki Yamada
  • Hideaki KawakamiEmail author
  • Asami Nakayama
  • Yuko Asano
  • Kiyofumi Mochizuki
  • Hiroshige Mikamo
Clinical Investigation



To report the clinical manifestations, identification, antimicrobial susceptibilities, and treatment outcomes of ocular infections caused by Moraxella species.

Study design

Retrospective study.

Patients and methods

The medical records of all patients treated at the Departments of Ophthalmology of the Ogaki Municipal Hospital and the Gifu University Graduate School of Medicine for ocular infections caused by Moraxella species between January 2011 and June 2017 were examined. The stored Moraxella species isolated from ocular samples were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), molecular identification, and the biochemical properties.


Sixteen eyes of 16 patients were treated for Moraxella ocular infections. The patients’ median age was 72 years. A predisposing systemic or ocular condition was identified in 15 of the patients. Nine of the patients developed keratitis; four, conjunctivitis; and three, blebitis. M lacunata (6 eyes), M catarrhalis (6), M nonliquefaciens (3), and M osloensis (1) were identified by MALDI-TOF MS. All isolates were sensitive to levofloxacin, tobramycin, ceftazidime, ceftriaxone, and cefazolin. Twelve patients with keratitis or blebitis were treated with various topical antimicrobial combinations, and systemic antibiotics were used in 10 of the 12 patients. The mean time for the complete closure of the epithelial defects with keratitis was 24 days. The visual outcomes after treatment were favorable except in 1 keratitis patient who underwent enucleation.


The use of duo-therapy with a combination of fluoroquinolone and cefmenoxime should be considered in cases nonresponsive to monotherapy, such as keratitis and bleb-associated infections. MALDI-TOF MS is useful for the identification of Moraxella to the species level.


Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry Moraxella species Ocular infection 



We would like to express our gratitude to Mr Haruki Sawamura, PhD, for scientific advice.

Conflicts of interest

S. Takahashi, None; K. Murata, None; K. Ozawa, None; H. Yamada, None; H. Kawakami, None; A. Nakayama, None; Y. Asano, None; K. Mochizuki, None; H. Mikamo, None.


  1. 1.
    Berrocal AM, Scott IU, Miller D, Flynn HW Jr. Endophthalmitis caused by Moraxella species. Am J Ophthalmol. 2001;132:788–90.CrossRefGoogle Scholar
  2. 2.
    Schaefer F, Bruttin O, Zografos L, Guex-Crosier Y. Bacterial keratitis: a prospective clinical and microbiological study. Br J Ophthalmol. 2001;85:842–7.CrossRefGoogle Scholar
  3. 3.
    Berrocal AM, Scott IU, Miller D, Flynn HW Jr. Endophthalmitis caused by Moraxella osloensis. Graefes Arch Clin Exp Ophthalmol. 2002;240:329–30.CrossRefGoogle Scholar
  4. 4.
    Das S, Constantinou M, Daniell M, Taylor HR. Moraxella keratitis: predisposing factors and clinical review of 95 cases. Br J Ophthalmol. 2006;90:1236–8.CrossRefGoogle Scholar
  5. 5.
    Inoue H, Suzuki T, Inoue T, Hattori T, Nejima R, Todokoro D, et al. Clinical characteristics and bacteriological profile of Moraxella keratitis. Cornea. 2015;34:110–9.CrossRefGoogle Scholar
  6. 6.
    Tobimatsu Y, Inada N, Shoji J, Yamagami S. Clinical characteristics of 17 patients with Moraxella keratitis. Semin Ophthalmol. 2018;33:726–32.CrossRefGoogle Scholar
  7. 7.
    Leung AK, Hon KL, Wong AHC, Wong AS. Bacterial conjunctivitis in childhood: etiology, clinical manifestations, diagnosis, and management. Recent Pat Inflamm Allergy Drug Discov. 2018. Scholar
  8. 8.
    Varaprasathan G, Miller K, Lietman T, Whitcher JP, Cevallos V, Okumoto M, et al. Trends in the etiology of infectious corneal ulcers at the F. I. Proctor Foundation. Cornea. 2004;23:360–4.CrossRefGoogle Scholar
  9. 9.
    Cornut PL, Chiquet C, Bron A, Romanet JP, Lina G, Lafontaine PO, FRIENDS Group, et al. Microbiologic identification of bleb-related delayed-onset endophthalmitis caused by Moraxella species. J Glaucoma. 2008;7:541–5.CrossRefGoogle Scholar
  10. 10.
    Jacobs DJ, Leng T, Flynn HW Jr, Shi W, Miller D, Gedde SJ. Delayed-onset bleb-associated endophthalmitis: presentation and outcome by culture result. Clin Ophthalmol. 2011;5:739–44.CrossRefGoogle Scholar
  11. 11.
    Takahashi H, Fujimura S, Ubukata S, Sato E, Shoji M, Utagawa M, et al. Pneumonia after earthquake, Japan, 2011. Emerg Infect Dis. 2012;18:1909–11.CrossRefGoogle Scholar
  12. 12.
    Dingle TC, Butler-Wu SM. Maldi-tof mass spectrometry for microorganism identification. Clin Lab Med. 2013;33:589–609.CrossRefGoogle Scholar
  13. 13.
    Jabs DA. Improving the reporting of clinical case series. Am J Ophthalmol. 2005;139:900–5.CrossRefGoogle Scholar
  14. 14.
    Masaki T, Ohkusu K, Ezaki T, Miyamoto H. Nocardia elegans infection involving purulent arthritis in humans. J Infect Chemother. 2012;18:386–9.CrossRefGoogle Scholar
  15. 15.
    Pettersson B, Kodjo A, Ronaghi M, Uhlén M, Tønjum T. Phylogeny of the family Moraxellaceae by 16S rDNA sequence analysis, with special emphasis on differentiation of Moraxella species. Int J Syst Bacteriol. 1998;48:75–89.CrossRefGoogle Scholar
  16. 16.
    Orlans HO, Hornby SJ, Bowler IC. In vitro antibiotic susceptibility patterns of bacterial keratitis isolates in Oxford, UK: a 10-year review. Eye (Lond). 2011;25:489–93.CrossRefGoogle Scholar
  17. 17.
    National Surveillance of Infectious Keratitis in Japan. National Surveillance of Infectious Keratitis in Japan: current status of isolates, patient background, and treatment. Nippon Ganka Gakkai Zasshi. 2006;110:961–72 (in Japanese).Google Scholar
  18. 18.
    Tan SZ, Walkden A, Au L, Fullwood C, Hamilton A, Qamruddin A, et al. Twelve-year analysis of microbial keratitis trends at a UK tertiary hospital. Eye (Lond). 2017;31:1229–36.CrossRefGoogle Scholar
  19. 19.
    Mian SI, Malta JB. Moraxella keratitis: risk factors, presentation, and management. Acta Ophthalmol. 2011;89:e208–9.CrossRefGoogle Scholar
  20. 20.
    Barash A, Chou TY. Moraxella atlantae keratitis presenting with an infectious ring ulcer. Am J Ophthalmol Case Rep. 2017;7:62–5.CrossRefGoogle Scholar
  21. 21.
    Morax V. Note sur un diplobacille pathogène pour la conjonctivite humaine. Ann Inst Pasteur. 1896;10:337–45.Google Scholar
  22. 22.
    Axenfeld T. Über die chronische Diplobacille conjunctivitis. Zentralbl Bakteriol. 1897;21:1–9.Google Scholar
  23. 23.
    Cobo LM, Coster DJ, Peacock J. Moraxella keratitis in a nonalcoholic population. Br J Ophthalmol. 1981;65:683–6.CrossRefGoogle Scholar
  24. 24.
    Shah SS, Ruth A, Coffin SE. Infection due to Moraxella osloensis: case report and review of the literature. Clin Infect Dis. 2000;30:179–81.CrossRefGoogle Scholar
  25. 25.
    Dalmon C, Porco TC, Lietman TM, Prajna NV, Prajna L, Das MR, et al. The clinical differentiation of bacterial and fungal keratitis: a photographic survey. Invest Ophthalmol Vis Sci. 2012;53:1787–91.CrossRefGoogle Scholar
  26. 26.
    Garg P, Mathur U, Athmanathan S, Rao GN. Treatment outcome of Moraxella keratitis: our experience with 18 cases: a retrospective review. Cornea. 1999;18:176–81.CrossRefGoogle Scholar
  27. 27.
    Suzuki T, Ohashi Y. Combination effect of antibiotics against bacteria isolated from keratitis using fractional inhibitory concentration index. Cornea. 2013;32:e156–60.CrossRefGoogle Scholar
  28. 28.
    Laukeland H, Bergh K, Bevanger L. Posttrabeculectomy endophthalmitis caused by Moraxella nonliquefaciens. J Clin Microbiol. 2002;40:2668–770.CrossRefGoogle Scholar
  29. 29.
    Song A, Scott IU, Flynn HW Jr, Budenz DL. Delayed-onset bleb-associated endophthalmitis: clinical features and visual acuity outcomes. Ophthalmology. 2002;109:985–91.CrossRefGoogle Scholar
  30. 30.
    Busbee BG, Recchia FM, Kaiser R, Nagra P, Rosenblatt B, Pearlman RB. Bleb-associated endophthalmitis: clinical characteristics and visual outcomes. Ophthalmology. 2004;111:1495–503.CrossRefGoogle Scholar
  31. 31.
    Yamamoto T. Bleb-related infection: clinical features and management. Taiwan J Ophthalmol. 2012;2:2–5.CrossRefGoogle Scholar
  32. 32.
    Hori N, Mochizuki K, Ishida K, Yamamoto T, Mikamo H. Clinical characteristics and risk factors of glaucoma filtering bleb infections. Nippon Ganka Gakkai Zasshi. 2009;113:951–63 (in Japanese).Google Scholar
  33. 33.
    Nihonyanagi S, Wada T, Adachi Y, Fujimura H, Munekata S, Kanoh Y, et al. Trends in the occurrence and antibiotic susceptibility of Moraxella catarrhalis from 2009 to 2014. Jpn J Med Technol. 2016;65:268–74.Google Scholar
  34. 34.
    Stull TL, Stanford EJ. Pseudogonococcal ophthalmia neonatorum caused by Branhamella catarrhalis. Pediatr Infect Dis. 1986;5:104–5.CrossRefGoogle Scholar
  35. 35.
    Maruyama Y, Shigemura T, Aoyama K, Nagano N, Nakazawa Y. Bacteremia due to Moraxella osloensis: a case report and literature review. Braz J Infect Dis. 2018;22:60–2.CrossRefGoogle Scholar
  36. 36.
    Hansen W, Butzler JP, Fuglesang JE, Henriksen SD. Isolation of penicillin and streptomycin resistant strains of Moraxella osloensis. Acta Pathol Microbiol Scand B Microbiol Immunol. 1974;82:318–22.Google Scholar

Copyright information

© Japanese Ophthalmological Society 2019

Authors and Affiliations

  • Shunsuke Takahashi
    • 1
  • Kazuhiro Murata
    • 1
  • Kenji Ozawa
    • 1
  • Hiroki Yamada
    • 2
  • Hideaki Kawakami
    • 3
    Email author
  • Asami Nakayama
    • 4
  • Yuko Asano
    • 5
  • Kiyofumi Mochizuki
    • 1
  • Hiroshige Mikamo
    • 6
  1. 1.Department of OphthalmologyGifu University Graduate School of MedicineGifuJapan
  2. 2.Department of OphthalmologyOgaki Municipal HospitalGifuJapan
  3. 3.Department of OphthalmologyGifu Municipal HospitalGifuJapan
  4. 4.Department of Clinical LaboratoryGifu University Graduate School of MedicineGifuJapan
  5. 5.Department of Clinical LaboratoryOgaki Municipal HospitalGifuJapan
  6. 6.Department of Clinical Infectious DiseasesAichi Medical UniversityAichiJapan

Personalised recommendations