Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Mar;66(3):247-54.
doi: 10.1016/j.jinf.2012.12.002. Epub 2012 Dec 22.

Bacterial and Viral Interactions Within the Nasopharynx Contribute to the Risk of Acute Otitis Media

Affiliations
Free PMC article

Bacterial and Viral Interactions Within the Nasopharynx Contribute to the Risk of Acute Otitis Media

Aino Ruohola et al. J Infect. .
Free PMC article

Abstract

Objectives: To understand relationships between microbes in pathogenesis of acute otitis media during respiratory tract infections, we compared nasopharyngeal bacteria and respiratory viruses in symptomatic children with and without AOM.

Methods: We enrolled children (6-35 months) with acute symptoms suggestive of AOM and analyzed their nasopharyngeal samples for bacteria by culture and for 15 respiratory viruses by PCR. Non-AOM group had no abnormal otoscopic signs or only middle ear effusion, while AOM group showed middle ear effusion and acute inflammatory signs in pneumatic otoscopy along with acute symptoms.

Results: Of 505 children, the non-AOM group included 187 and the AOM group 318. One or more bacterial AOM pathogen (Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis) was detected in 78% and 96% of the non-AOM and AOM group, respectively (P < .001). Colonization with S. pneumoniae and H. influenzae, each alone, increased risk of AOM (odds ratio (OR) 2.92; 95% confidence interval (CI), .91-9.38, and 5.13; 1.36-19.50, respectively) and co-colonization with M. catarrhalis further increased risk (OR 4.36; 1.46-12.97, and 9.00; 2.05-39.49, respectively). Respiratory viruses were detected in 90% and 87% of the non-AOM and AOM group, respectively. RSV was significantly associated with risk of AOM without colonization by bacterial AOM pathogens (OR 6.50; 1.21-34.85).

Conclusions: Co-colonization by M. catarrhalis seems to increase risk of AOM and RSV may contribute to AOM pathogenesis even without nasopharyngeal bacterial colonization.

Figures

Figure 1
Figure 1
Occurrence of nasopharyngeal bacteria in children without acute otitis media (non-AOM group) and in children with acute otitis media (AOM group). NPAHS stands for non-pneumococcal alpha-hemolytic streptococci. Below the bars, n is the numerator (i.e. number of positive findings) and N is the denominator (i.e. number of samples analyzed). Proportions have been compared by Chi-square test.
Figure 2
Figure 2
Occurrence of nasopharyngeal bacteria alone and in combinations in children without acute otitis media (non-AOM group) and in children with acute otitis media (AOM group). The risk of acute otitis media related to each finding according to logistic regression multivariate model. Diamonds indicate odds ratio (OR), lines 95% confidence intervals (95% CI), arrows are added when CI is beyond the scale.
Figure 3
Figure 3
Occurrence of respiratory viruses in children without acute otitis media (non-AOM group) and in children with acute otitis media (AOM group). Parainfluenza virus types 1–3 are grouped together, as well as coronaviruses (229E/NL63 and OC43/HKU1) and influenza A and B viruses. Below the bars, n is the numerator (i.e. number of positive findings) and N is the denominator (i.e. number of samples analyzed). Proportions have been compared by Chi-square test.
Figure 4
Figure 4
Occurrence of respiratory viruses in children without acute otitis media (non-AOM group) and in children with acute otitis media (AOM group) when at least one of the bacterial AOM pathogen (S. pneumoniae, H. influenzae, or M. catarrhalis) is detected (panel A) and when no bacterial AOM pathogen is detected (panel B). Parainfluenza virus types 1–3 are grouped together, as well as coronaviruses (229E/NL63 and OC43/HKU1) and influenza A and B viruses. Below the bars, n is the numerator (i.e. number of positive findings) and N is the denominator (i.e. number of samples analyzed). Proportions have been compared by Chi-square test.

Similar articles

See all similar articles

Cited by 32 articles

See all "Cited by" articles

References

    1. Winther B., Alper C.M., Mandel E.M., Doyle W.J., Hendley J.O. Temporal relationships between colds, upper respiratory viruses detected by polymerase chain reaction, and otitis media in young children followed through a typical cold season. Pediatrics. 2007;119:1069–1075. - PubMed
    1. Vergison A., Dagan R., Arguedas A., Bonhoeffer J., Cohen R., Dhooge I. Otitis media and its consequences: beyond the earache. Lancet Infect Dis. 2010;10:195–203. - PubMed
    1. Teele D.W., Klein J.O., Rosner B. Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective cohort study. J Infect Dis. 1989;160:83–94. - PubMed
    1. Casey J.R., Adlowitz D.G., Pichichero M.E. New patterns in the otopathogens causing acute otitis media six to eight years after introduction of pneumococcal conjugate vaccine. Pediatr Infect Dis J. 2010;29:304. - PMC - PubMed
    1. Broides A., Dagan R., Greenberg D., Givon-Lavi N., Leibovitz E. Acute otitis media caused by Moraxella catarrhalis: epidemiologic and clinical characteristics. Clin Infect Dis. 2009;49:1641–1647. - PubMed

Publication types

MeSH terms

Feedback