Etiology of Acute Otitis Media in Children Less Than 5 Years of Age

Dyke, Melissa K. Van; Pirçon, Jean‐Yves; Cohen, Robert; Madhi, Shabir А.; Rosenblüt, Andrés; Macías-Parra, Mercedes; Al-Mazrou, Khalid A.; Grevers, Gerhard; López, Pío; Naranjo, Laura; Pumarola, Felix; Sonsuwan, Nuntigar; Hausdorff, William P.

doi:10.1097/inf.0000000000001420

Cited by 43 publications

(23 citation statements)

References 41 publications

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“…This is a positive result, albeit not completely surprising, as S. pneumoniae is most often associated with increased recurrence and severity of infection [20••, 106]. …”

Section: Vaccinesmentioning

confidence: 99%

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Streptococcus pneumoniae Otitis Media Pathogenesis and How It Informs Our Understanding of Vaccine Strategies

Bergenfelz

Håkansson

2017

Curr Otorhinolaryngol Rep

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Purpose of ReviewThis study aimed to review the literature regarding the mechanisms of transition from asymptomatic colonization to induction of otitis media and how the insight into the pathogenesis of otitis media has the potential to help design future otitis media-directed vaccines.Recent FindingsRespiratory viruses have long been shown to predispose individuals to bacterial respiratory infections, such as otitis media. Recent information suggests that Streptococcus pneumoniae, which colonize the nasopharynx asymptomatically, can sense potentially “threatening” changes in the nasopharyngeal environment caused by virus infection by upregulating specific sets of genes involved in biofilm release, dissemination from the nasopharynx to other sites, and protection against the host immune system. Furthermore, an understanding of the transcriptional and proteomic changes occurring in bacteria during transition to infection has led to identification of novel vaccine targets that are disease-specific and will not affect asymptomatic colonization. This approach will avoid major changes in the delicate balance of microorganisms in the respiratory tract microbiome due to elimination of S. pneumoniae.SummaryOur recent findings are reviewed in the context of the current literature on the epidemiology and pathogenesis of otitis media. We also discuss how other otopathogens, such as Haemophilus influenzae and Moraxella catarrhalis, as well as the normal respiratory microbiome, can modulate the ability of pneumococci to cause infection. Furthermore, the unsatisfactory protection offered by the pneumococcal conjugate vaccines is highlighted and we review potential future strategies emerging to confer a more specific protection against otitis media.

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“…This is a positive result, albeit not completely surprising, as S. pneumoniae is most often associated with increased recurrence and severity of infection [20••, 106]. …”

Section: Vaccinesmentioning

confidence: 99%

“…S. pneumoniae is also an especially important pathogen in OM, as it is the main cause of recurrent infections as well as postinfectious complications, including ventilation tube insertion (myringostomy) [19••, 20••].…”

Section: Otitis Media: Definitions and Complicationsmentioning

confidence: 99%

Streptococcus pneumoniae Otitis Media Pathogenesis and How It Informs Our Understanding of Vaccine Strategies

Bergenfelz

Håkansson

2017

Curr Otorhinolaryngol Rep

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“…Indeed, the causative role of Staphylococcus aureus , Pseudomonas aeruginosa or Turicella otitidis in AOM is doubtful because these are normal inhabitants of the external auditory canal [13]. Therefore, only otopathogens such as Streptococcus pneumoniae (Sp), non-typable Haemophilus influenzae (NTHi), Moraxella catharalis and group A Streptococcus (GAS) must be considered if they grow in otorrhea samples [7, 9, 13, 14].…”

Section: Introductionmentioning

confidence: 99%

Bacterial causes of otitis media with spontaneous perforation of the tympanic membrane in the era of 13 valent pneumococcal conjugate vaccine

Lévy¹,

Varon²,

Ouldali³

et al. 2019

PLoS ONE

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After pneumococcal conjugate vaccine (PCV) implementation, the number of acute otitis media (AOM) episodes has decreased, but AOM still remains among the most common diagnoses in childhood. From 2% to 17% of cases of AOM feature spontaneous perforation of the tympanic membrane (SPTM). The aim of this study was to describe the bacteriological causes of SPTM 5 to 8 years years after PCV13 implementation, in 2010. From 2015 to 2018, children with SPTM were prospectively enrolled by 41 pediatricians. Middle ear fluid was obtained by sampling spontaneous discharge. Among the 470 children with SPTM (median age 20.8 months), no otopathogen was isolated for 251 (53.4% [95% CI 48.8%;58.0%]): 47.1% of infants and toddlers, 68.3% older children (p<0.001). Among children with isolated bacterial otopathogens (n = 219), non-typable Haemophilus influenzae (NTHi) was the most frequent otopathogen isolated (n = 106, 48.4% [95% CI 41.6%;55.2%]), followed by Streptoccocus pyogenes (group A streptococcus [GAS]) (n = 76, 34.7% [95% CI 28.4%;41.4%]) and Streptococcus pneumoniae (Sp) (n = 61, 27.9% [95% Ci 22.0%;34.3%]). NTHi was frequently isolated in infants and toddlers (53.1%), whereas the main otopathogen in older children was GAS (52.3%). In cases of co-infection with at least two otopathogens (16.9%, n = 37/219), NTHi was frequently involved (78.4%, n = 29/37). When Sp was isolated, PCV13 serotypes accounted for 32.1% of cases, with serotype 3 the main serotype (16.1%). Among Sp strains, 29.5% were penicillin-intermediate and among NTHi strains, 16.0% were β-lactamase–producers. More than 5 years after PCV13 implementation, the leading bacterial species recovered from AOM with SPTM was NTHi for infants and toddlers and GAS for older children. In both age groups, Sp was the third most frequent pathogen and vaccine serotypes still played an important role. No resistant Sp strains were isolated, and the frequency of β-lactamase–producing NTHi did not exceed 16%.

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“…Streptococcus pneumoniae (S. pneumoniae) accounts for 30%-50% of all OM cases, translating to approximately 300 million OM cases worldwide annually (20). Reduced susceptibility or resistance to β-lactam and macrolide antibiotics is prevalent among isolates of S. pneumoniae (21,22). The minimum inhibitory concentration (MIC) of S. pneumoniae is at least 50 times greater than that of NTHi (the MIC of ciprofloxacin against certain strains of S. pneumoniae is 0.5-4 μg/ml, compared with less than 0.01 μg/ml for NTHi; refs.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Streptococcus pneumoniae otitis media in a chinchilla model by transtympanic delivery of antibiotics

Yang¹,

Sabharwal²,

Shlykova³

et al. 2018

JCI Insight

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Etiology of Acute Otitis Media in Children Less Than 5 Years of Age

Abstract: Supplemental Digital Content is available in the text.

Cited by 43 publications

References 41 publications

Streptococcus pneumoniae Otitis Media Pathogenesis and How It Informs Our Understanding of Vaccine Strategies

Streptococcus pneumoniae Otitis Media Pathogenesis and How It Informs Our Understanding of Vaccine Strategies

Bacterial causes of otitis media with spontaneous perforation of the tympanic membrane in the era of 13 valent pneumococcal conjugate vaccine

Treatment of Streptococcus pneumoniae otitis media in a chinchilla model by transtympanic delivery of antibiotics

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