Relationship between Nasopharyngeal Colonization and the Development of Otitis Media in Children

Abstract

Streptococcus pneumoniae, nontypeable Haemophilus influenzae, and Moraxella catarrhalis are the predominant bacteria associated with otitis media. A cohort of 306 infants was followed from birth through 12 months to determine frequency and duration of colonization and risk of acute otitis media (AOM) and otitis media with effusion (OME). M. catarrhalis was the most common bacterium isolated. Infants colonized at < or = 3 months of age were at increased risk of AOM and OME. Early colonization with M. catarrhalis revealed the greatest risk (relative risk [RR] = 1.24), especially for OME (RR = 1.57). There was a strong relationship between the frequency of colonization and OM (r = .37, P < .001,) for each pathogen. Although S. pneumoniae, nontypeable H. influenzae, and M. catarrhalis are part of the normal nasopharyngeal flora during infancy, an increased rate of colonization may identify a subpopulation of children that is at increased risk of OM.

Exclusive Breastfeeding Protects Against Bacterial Colonization and Day Care Exposure to Otitis Media

“…The strong correlation (r ϭ .37, P Ͻ .001) between pathogen colonization rates and frequency of OM episodes found in the cohort is described more fully in a recent microbiology report by the coauthors (HF, LD, RW, et al). 14 Early age at colonization (Յ3 months) with middle-ear pathogens correlated with onset of OM episodes in infants Ͻ6 months of age. Alternatively, although our own extensive studies provide evidence that human milk has immunologic and nonimmunologic protective properties, 13,18 data from our laboratories and elsewhere do not conclusively show whether breast milk is protective or whether components of formula-feeding are conducive to onset and recurrence of OM.…”

“…Cumulative incidence of OM episodes and colonization patterns of disease in this present cohort are described in detail in recent reports. [12][13][14] Interim visits after diagnosis of middle-ear disease and recent illnesses were scheduled as necessary. Maternal interviews (family medical history, demographics, prenatal maternal exposures) and physical examinations of eligible infants were completed at study enrollment.…”

Phylogenetic relatedness and diversity of non-typable Haemophilus influenzae in the nasopharynx and middle ear fluid of children with acute otitis media

“…NTHi strains are rarely associated with invasive disease in children, but they are associated with respiratory tract infections in both children and adults (Murphy, 2003;Kyd & Cripps, 1999). NP colonization with NTHi is an important risk factor for developing disease (Faden et al, 1997). Children frequently NP-colonized by NTHi are more likely to develop acute otitis media (AOM) than less frequently colonized children (Faden et al, 1997;Harabuchi et al, 1994).…”

“…NP colonization with NTHi is an important risk factor for developing disease (Faden et al, 1997). Children frequently NP-colonized by NTHi are more likely to develop acute otitis media (AOM) than less frequently colonized children (Faden et al, 1997;Harabuchi et al, 1994). Simultaneous detection of multiple isolates of NTHi from the same sample has been reported among aboriginal children with otitis media (Smith-Vaughan et al, 1996), among otitis-prone children in day care centres (St Sauver et al, 2000) and in cystic fibrosis patients (Bandi et al, 2001;Murphy et al, 1999), which may result from inadequate clearance of colonizing bacteria, exposure to multiple circulating strains or in vivo genetic recombinations in a specific host.…”

B cell mediated priming following pneumococcal colonization

“…The human nasopharynx is the major reservoir of S. pneumoniae, and colonization is often the initial step in pathogenesis [18]. A majority of individuals have been colonized by the pneumococcus, which correlates with the significant levels of anti-PPS specific antibody in adults [6,3,7].…”