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Bacteria, respiratory viruses play key role in pediatric AOM
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Respiratory viruses and pathogenic bacteria figured significantly in the development of acute otitis media, irrespective of HIV status, in South African children, according to study results.
“Acute otitis media causes significant morbidity in children and is the most common reason for outpatient antibiotic therapy,” Shabir A. Madhi, PhD, MBBCh, of the Respiratory and Meningeal Pathogens Research Unit at the University of the Witwatersrand in Johannesburg, South Africa, and colleagues wrote. “Children with HIV are known to be at greater risk for bacterial and viral infections, including AOM. There are limited data from developing countries on the etiology of uncomplicated AOM and generally limited global data on the association of respiratory viral bacterial coinfections in AOM.”
The study, conducted from May 2009 to April 2010, included children aged 3 months to 5 years with AOM and HIV, those without HIV and patients exposed to HIV but clinically asymptomatic for infection. All children underwent antibacterial susceptibility and serotyping for Streptococcus pneumoniae and Haemophilus influenzae. Middle ear fluid samples were cultured for bacteria, and nasopharyngeal aspirates were assessed for respiratory viruses with PCR and immunofluorescence assay.
There were 260 episodes of AOM: 15 occurred in children with HIV, 182 occurred in children without HIV, and 63 occurred in children who were HIV-exposed clinically but asymptomatic for infection. Bacteria were identified in 54.6%, of which 30.8% were H. influenzae (98.8% were nontypeable [NTHi]); 20.4% were S. pneumoniae; 15.8% were S. aureus; 5% were Moraxella catarrhalis; and 1.5% were S. pyogenes. There was an overall 64.2% rate for the nonsusceptibility of S. pneumoniae to penicillin.
Of the 74.2% of cases with respiratory viruses, 37.7% were human rhinoviruses, 14.2% were adenovirus, and 11.5% were human bocavirus, regardless of HIV status.
In addition, researchers identified respiratory viruses in 72% of episodes negative for any bacteria, as well as in 63.4% of S. aureus cases and in 76.9% to 78.8% of S. pneumoniae, H. influenzae and M. catarrhalis cases.
“The results of our study suggest that bacteria and respiratory viruses may play an important role in the development of AOM in children,” the investigators wrote. “Vaccines targeting both NTHi and S. pneumoniae may be an important tool in reducing the burden of AOM in South Africa.” – by Jennifer Southall
Disclosure: Madhi reports his institution received grants to conduct trials from the GlaxoSmithKline group of companies/various pharmaceutical companies; and he has undertaken consultancy and received payment for lectures, including service on speakers bureaus for various pharmaceutical companies. Please see the full study for a list of all other authors’ relevant financial disclosures.
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