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We compared the effectiveness of rifampin-trimethoprim in fixed combination (3.75:1)

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Depts. of ~e d i a~~i o m e t r~' 0~o~a r~n q o l o q v a n d Laboratory Medicine, University of ~i n n e s b t a , ~i n k a i o l i i : ~i d d l ee a r effusions o f t e n p e r s i s t in children with serous and mucoid o t i t i s media d e s p i t e medical therapy. Residual bacterial colonization of effusion may contribute t o t h e pathogenesis of these conditions and was investigated by examining middle e a r effusion f o r bacteria by c u l t u r e and gram s t a i n , and f o r c e l l u l a r i t y by Papanicolaou s t a i n . Effusion was obtained a t t h e time of myringotomy and tympanostomy tube i n s e r t i o n from 509 ears of 317 children age 1 t o 11 years; 362 effusions were mucoid, 79were serous, and 60 were purulent. Mucoid o t i t i s media was found most frequently In younger children, while serous o t i t i s media predominated in older children. Bacteria were cultured from 30% of e a r s and included H. indluenzae (15%), S . epidemddin (6%). N. cohv~~lzaeis ( 6 % ) , S. pneumoniae ( 4 % ) and o t h e r s ( 3 % ) . An equal percentage of mucoid, serous and purulent effusions yielded bacteria by c u l t u r e o r gram s t a i n . Bacteria were observed by gram s t a i n in 16% of t h e s t e r i l e effusions, and t h e majority of t h e organisms were gram p o s i t i v e cocci. Phagocytes were noted on Papanicolaou stained smears in 37% of c u l t u r e p o s i t i v e e f f u s i o n s , but were l e s s frequent (23%) in s t e r i l e effusions. These r e s u l t s suggest t h a t bacteria which a r e known pathogens in acute o t i t i s media, p e r s i s t in many chronic serous, mucoid and purulent middle e a r effusions. The presence of bacteria a s well a s phagocytes i n these effusions i n d i c a t e s chronic inflammatory stimulation which may c o n t r i b u t e t o t h e pathogenesis of chronic o t i t i s media with effusion. Although a v i r a l etiology f o r b i l i a r y atresia(B.A.) has been suspected, no v i r a l i s o l a t e s o r antibody responses have been cons i s t e n t l y c o r r e l a t e d with t h e disease. Because our s t u d i e s on the hepatobiliary i n j u r y i n mice inoculated with reovirus type 3 (Reo 3) have shown t h a t many s t a g e s of t h e human and rodent microscopic pathology a r e s i m i l a r (Bangaru,et a l , Lab.Invest.g,456,1980), we have studied Re0 3 antibody responses i n 15 i n f a n t s with B.A. When n e u t r a l i z a t i o n t e s t s were used, t h e s e r a from 2 babies demo n s t r a t e d r i s i n g antibody t i t e r s t o Reo 3 . When antibodies were measured by i n d i r e c t immunofluorescence using Re0 3 infected L c e l l s a s antigen i n a coded protocol, 8 of 15 (53%) of babies with B.A. had Reo 3 antibodies. Some of these p o s i t i v e s e r a were shown t o contain v i r a l s p e c i f i c IgM. Only 1 of 18 (6%) of t h e c o n t r o l s had s i m i l a r antibody (P<.001). Neutralization t e s t s measure response t o only 1 of 10 Re0 3 p r o t e i n s ; however, fluor e s c e n t antibodies proba...