Comprehensive Detection of Respiratory Bacterial and Viral Pathogens in the Middle Ear Fluid and Nasopharynx of Pediatric Patients With Acute Otitis Media

Abstract

Background: Acute otitis media (AOM) is a common ear infection caused by respiratory viruses and bacteria of the nasopharynx. The present study aimed to detect various respiratory viruses and bacteria in middle ear fluid (MEF) and nasopharyngeal aspirates (NPA) using polymerase chain reaction (PCR). Methods: We collected MEF and NPA samples from 122 pediatric patients with AOM. Real-time PCR detected 11 types of respiratory viruses (respiratory syncytial virus A/B, parainfluenza virus 1/2/3, human metapneumovirus, influenza virus A/B, adenovirus, human bocavirus and rhino virus) and 7 types of bacteria (Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydia pneumoniae, Streptococcus pyogenes, Legionella pneumophila and Moraxella catarrhalis). MEF specimens were also examined using bacterial culture. Results: At least 1 respiratory viral or bacterial pathogen was detected in MEF of 120 cases (98%) by viral and bacterial PCR and of 93 cases (76%) by viral PCR and bacterial culture. Respiratory viruses were detected in NPA of 84 cases (69%) and MEF of 67 cases (55%). The most common virus detected in MEF was respiratory syncytial virus (21%), followed by parainfluenza virus (15%). All the viruses present in MEF were also detected in NPA specimens. Bacteria were detected by PCR in MEF of 109 cases (89%); H. influenzae was the most frequently detected (65%). Conclusions: In many cases, pediatric AOM was found to constitute a respiratory polymicrobial infection. Multiplex PCR was useful to detect multiple respiratory viruses and bacteria in AOM. To understand intractable AOM, further studies regarding the clinical features of each viral and bacterial coinfection are required.

A Commentary on Safety Precautions for Otologic Surgery during the COVID‐19 Pandemic

“…Respiratory viruses have been identified by polymerase chain reaction (PCR) in middle ear effusions in 55% of cases. 3 Viral pathogens have been also found to cause AOM even without nasopharyngeal bacterial colonization. 4 Certain viruses respiratory viruses, including respiratory syncytial virus (RSV) and rhinovirus, are commonly isolated from the middle ear during URIs across studies, and there is high concordance (82%-98%) of PCR viral results from the middle ear and naxopharynx.…”

Nontypeable Haemophilus influenzae Responds to Virus-Infected Cells with a Significant Increase in Type IV Pilus Expression

“…Coinfection with RSV and NTHI is associated with bronchiolitis and subsequent wheezing in children (49), and RV infection facilitates the development of both rhinosinusitis (33) and NTHI-induced exacerbations of COPD (59,60). Infection with RSV, AV, or RV is associated with increased risk of acute OM in children (32,47,61). Moreover, URT virus infection increases the rate of exacerbation due to NTHI in patients with cystic fibrosis (62).…”

“…Many respiratory tract infections are polymicrobial (30)(31)(32)(33), and viral upper respiratory tract (URT) infection frequently precedes bacterial coinfection (34)(35)(36). URT virus infection induces many alterations in the host epithelium, some of which favor bacterial adherence and colonization (37).…”

Bacterial Spectrum of Spontaneously Ruptured Otitis Media in a 7-Year, Longitudinal, Multicenter, Epidemiological Cross-Sectional Study in Germany

“…M. catarrhalis showed high, although fluctuating, carriage percentages. The fact that M. catarrhalis was frequently carried, but rarely isolated from MEF, indicates the minor role of this pathogen in severe, spontaneously ruptured otitis media (25)(26)(27). The increase of S. pyogenes as pathogen in severe AOM is worrisome and has been reported from several other countries (28,29).…”