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Syrjänen RK, Auranen KJ, Leino TM, Kilpi TM, Mäkelä PH. Pneumococcal acute otitis media in relation to pneumococcal nasopharyngeal carriage. Pediatr Infect Dis J 2005; 24:801-6. [PMID: 16148847 DOI: 10.1097/01.inf.0000178072.83531.4f] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute otitis media (AOM) is closely associated with viral upper respiratory tract infections, but the most common microbial agent found in the middle ear fluid during AOM is Streptococcus pneumoniae (Pnc). Pnc is also a common colonizer of the nasopharynx, and its prevalence is further increased during the viral infection. The aim of this study was to investigate the interplay between viral infection, pneumococcal acquisition and carriage in the development of Pnc AOM. METHODS Pnc carriage was assessed in a longitudinal study of 329 infants at scheduled visits at 3, 6, 9, 12, 15 and 18 months of age (N = 1715). The clinical outcome of the first episode of respiratory infection ("sick visit," N = 774) in the following 3-month period was recorded. The occurrence and timing of Pnc AOM in relation to serotype specific carriage at the start of the observation period were assessed. RESULTS The occurrence, timing and duration of symptoms of the sick visits or the frequency of overall AOM were not associated with preceding pneumococcal carriage. Pnc AOM was in each case associated with concurrent carriage and 3.8 times (95% confidence interval, 1.4-10.0) more often with carriage acquired after the start of the observation period than with carriage already present at the scheduled visit. In all, 79% (55 of 70) of Pnc AOM events were caused by a serotype acquired after the start of the period. CONCLUSION The majority of Pnc AOM events develop in association with newly acquired carriage of pneumococcus.
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Affiliation(s)
- Ritva K Syrjänen
- Department of Vaccines, National Public Health Institute, Helsinki, Finland.
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152
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Kay ES, Ng K, Salmon A, Del Mar C. Influenza vaccine for preventing acute otitis media in infants and children. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2005. [DOI: 10.1002/14651858.cd005438] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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153
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Suzuki A, Watanabe O, Okamoto M, Endo H, Yano H, Suetake M, Nishimura H. Detection of human metapneumovirus from children with acute otitis media. Pediatr Infect Dis J 2005; 24:655-7. [PMID: 15999017 DOI: 10.1097/01.inf.0000168755.01196.49] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nasal and middle ear specimens collected from children with acute otitis media were subjected to viral isolation and bacteria culture. All virus-negative specimens underwent reverse transcription polymerase chain reaction to detect human metapneumovirus. Three of 126 middle ear specimens were positive by this assay.
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Affiliation(s)
- Akira Suzuki
- Virus Research Center, Sendai Medical Center, Sendai, Japan
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154
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Kleemola M, Nokso-Koivisto J, Herva E, Syrjänen R, Lahdenkari M, Kilpi T, Hovi T. Is there any specific association between respiratory viruses and bacteria in acute otitis media of young children? J Infect 2005; 52:181-7. [PMID: 15992930 PMCID: PMC7173109 DOI: 10.1016/j.jinf.2005.05.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2005] [Accepted: 05/11/2005] [Indexed: 11/18/2022]
Abstract
Background Respiratory viral infections are usually preceding or coinciding with acute otitis media (AOM) in children. It is not known if a given viral infection would facilitate invasion of bacterial pathogens into the middle ear in a species-specific way. We reanalysed the microbiological results of the two prospective Finnish Otitis Media (FinOM) studies for this purpose. Methods The children had been followed from 2 months to 2 years of age in specific study clinics and all referred AOM events were analysed. Combined results of virus detection tests from middle ear fluid and nasopharyngeal aspirate and those of bacterial culture from middle ear fluid were cross-tabulated for 529 AOM events in the FinOM Cohort Study and for 364 events in the FinOM Vaccine Trial. Results In both studies the main bacterial pathogens were Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis while the main viruses detected were rhinoviruses and respiratory syncytial virus (plus enteroviruses in the Vaccine Trial). No distinct species-specific associations were observed between the viral and bacterial findings. Conclusion We did not find support to the theory that respiratory infection caused by a given viral species would favour growth of a certain bacterial pathogen in the MEF more than another.
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Affiliation(s)
- Marjaana Kleemola
- Department of Microbiology, National Public Health Institute, Helsinki, Finland
| | - Johanna Nokso-Koivisto
- Department of Microbiology, National Public Health Institute, Helsinki, Finland
- Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki, Finland
| | - Elja Herva
- Department of Microbiology, National Public Health Institute, Oulu, Finland
| | - Ritva Syrjänen
- Department of Vaccines, National Public Health Institute, Helsinki, Finland
| | - Mika Lahdenkari
- Department of Vaccines, National Public Health Institute, Helsinki, Finland
| | - Terhi Kilpi
- Department of Vaccines, National Public Health Institute, Helsinki, Finland
| | - Tapani Hovi
- Department of Microbiology, National Public Health Institute, Helsinki, Finland
- Corresponding author. Address: Department of Viral Diseases and Immunology, National Public Health Institute, Mannerheimintie 166, 00300 Helsinki, Finland. Tel.: +358 9 4744 8321.
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155
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Ortega del Alamo P, Rivera Rodríguez T, Sanz Fernández R. [The effect of AM3 in the resolution of otitis media with effusion (OME) in paediatric patients]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2005; 56:1-5. [PMID: 15747716 DOI: 10.1016/s0001-6519(05)78561-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Otitis media with effusion (OME) is one of the most frequent diseases and the main cause of hearing loss in childhood. The medical treatment for OME includes antibiotics, antihistamine-decongestant combinations, steroids and Eustachian-tube autoinflation as the Valsalva manoeuvre. METHODS A total of 62 children aged 2 to 8 years with a diagnosis of OME were enrolled in a prospective study to assess the resolution of OME. Patients were given antibiotics treatment with or without associated AM3. RESULTS After 2 months of treatment, the rate of complete resolution of OME was greater in AM3 treated group than in the non-AM3 treated group (57.6% vs 27.6%) with a statistically significant difference (p<0.017). CONCLUSIONS These results show that AM3 treatment has a beneficial effect on OME resolution when it is associated to antibiotic treatment.
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Affiliation(s)
- P Ortega del Alamo
- Servicio de Otorrinolaringología, Hospital General de Móstoles, Móstoles, Madrid.
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156
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Murphy TF, Bakaletz LO, Kyd JM, Watson B, Klein DL. Vaccines for otitis media: proposals for overcoming obstacles to progress. Vaccine 2005; 23:2696-702. [PMID: 15780715 DOI: 10.1016/j.vaccine.2004.12.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2004] [Revised: 11/29/2004] [Accepted: 12/02/2004] [Indexed: 11/19/2022]
Abstract
Otitis media is a common problem with enormous morbidity worldwide. The development of vaccines to prevent otitis media would have an important human and economic impact. A striking lack of progress in the development, production and clinical testing of vaccines to prevent otitis media has occurred in the past decade. This review outlines a series of specific proposals intended to advance vaccine development for otitis media.
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Affiliation(s)
- Timothy F Murphy
- Division of Infectious Diseases, Department of Medicine, University at Buffalo, SUNY, USA.
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157
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Abstract
PURPOSE OF REVIEW Otitis media is a disease that is prevalent in the pediatric population, and recent twin and triplet studies have confirmed that there is a strong genetic component to susceptibility. Here, we summarize the status of current efforts to identify the specific genes underlying otitis media susceptibility and presentation. RECENT FINDINGS Recent studies have focused on identifying candidate genes. For example, IFN-gamma polymorphisms, allotypes of the leukocyte IgG (FcgammaR) receptors and certain haplotypes of surfactant genes were linked in pilot studies to otitis media susceptibility. The pattern of gene expression during an episode of otitis media is also being elucidated with the overall goal of providing clues as to which of these modulated genes are polymorphic and thus potentially capable of affecting otitis media susceptibility. Mucin and cathepsin protease genes were shown to exhibit these characteristics. SUMMARY In addition to the simple searches for linkages between known genes and otitis media, work is progressing within the context of genome-wide linkage studies. These efforts promise to answer some of the many questions remaining in otitis media susceptibility and pathogenesis.
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158
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Cianci C, Meanwell N, Krystal M. Antiviral activity and molecular mechanism of an orally active respiratory syncytial virus fusion inhibitor. J Antimicrob Chemother 2005; 55:289-92. [PMID: 15681582 DOI: 10.1093/jac/dkh558] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BMS-433771 is an orally bioavailable respiratory syncytial virus (RSV) inhibitor, functioning through inhibition of viral F protein-induced membrane fusion. The compound is active against both A and B groups of RSV, with an average EC(50) of 20 nM. BMS-433771 is also efficacious against RSV infection in two rodent models when dosed orally prior to infection. The compound possesses good pharmacokinetic properties, while maintaining a favourable toxicity profile. Consequently, BMS-433771 is well suited for further clinical evaluation in humans. Direct affinity labelling studies indicate that the compound binds in a hydrophobic cavity within the trimeric N-terminal heptad repeat. During the fusion process, this heptad repeat associates with a C-terminal heptad repeat to form a six helical coiled-coil bundle (or trimer-of-hairpins), and BMS-433771 presumably interferes with the functional association of these heptad repeats. The fusion protein of many other class 1 fusion viruses, such as HIV and influenza, form similar hairpin structures as a prelude to membrane fusion. The identification of BMS-433771 provides a proof of concept for small molecule inhibitors that target the formation of the six helical coiled-coil structure, which could be a prototype for the development of similar antivirals against other class 1 fusion viruses.
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Affiliation(s)
- Christopher Cianci
- Department of Virology, Bristol-Myers Squibb Pharmaceutical Research Institute, 5 Research Parkway, Wallingford, CT 06492, USA
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159
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Könönen E. Anaerobes in the upper respiratory tract in infancy. Anaerobe 2005; 11:131-6. [PMID: 16701543 DOI: 10.1016/j.anaerobe.2004.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2004] [Accepted: 11/20/2004] [Indexed: 11/18/2022]
Abstract
Development of the indigenous microbiota begins on the surfaces of the human body after birth when infants are exposed to continuous person-to-person and environmental contacts with microbes. Anaerobes constitute a significant part of indigenous bacterial communities at different body sites. Pioneering anaerobic commensals are able to colonize and survive in the oral cavity during the first months of life. After teeth emerge, more attachment sites and potential niches are available for anaerobic bacterial colonization. Specific partner relationships influence the composition and stability of forming multigeneric communities, biofilms, where Fusobacterium nucleatum is of specific interest. In infancy, the oral colonization seems to be rather stable at species level, though not at clonal level. The colonization pattern in the nasopharynx is different from that in the oral cavity; anaerobes are absent from healthy nasopharynges but transiently colonize this anatomical site during infection. The most plausible origin for nasopharyngeal anaerobes is the oral cavity and, conceivably, saliva is the most likely transmission vehicle. Whether anaerobic bacteria colonize the nasopharynx just because of ecological changes favoring their growth or whether they could play an active role in the pathogenesis of respiratory infections is not known.
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Affiliation(s)
- Eija Könönen
- Department of Microbiology, Anaerobe Reference Laboratory, National Public Health Institute (KTL), Mannerheimintie 166, Fin-00300 Helsinki, Finland.
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160
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Abstract
CONTEXT Polymicrobial diseases, caused by combinations of viruses, bacteria, fungi, and parasites, are being recognised with increasing frequency. In these infections, the presence of one micro-organism generates a niche for other pathogenic micro-organisms to colonise, one micro-organism predisposes the host to colonisation by other micro-organisms, or two or more non-pathogenic micro-organisms together cause disease. STARTING POINT Recently, Gili Regev-Yochay (JAMA 2004; 292: 716-20) and Debby Bogaert (Lancet 2004; 363: 1871-72), and their colleagues, suggested another interaction: microbial interference-the ability of Streptococcus pneumoniae carriage to protect against Staphylococcus aureus carriage, and the inverse effect of pneumococcal conjugate vaccination on the increased carriage of Staph aureus and Staph-aureus-related disease. Strep pneumoniae carriage protected against Staph aureus carriage, and the bacterial interference could be disrupted by vaccinating children with pneumococcal conjugate vaccines that reduced nasopharyngeal carriage of vaccine-type Strep pneumoniae. WHERE NEXT The medical community is recognising the significance of polymicrobial diseases and the major types of microbial community interactions associated with human health and disease. Many traditional therapies are just starting to take into account the polymicrobial cause of diseases and the repercussions of treatment and prevention.
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Affiliation(s)
- Kim A Brogden
- Department of Periodontics and Dows Institute for Dental Research, College of Dentistry, University of Iowa, Iowa City, IA 52242, USA.
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161
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Tong HH, Long JP, Li D, DeMaria TF. Alteration of gene expression in human middle ear epithelial cells induced by influenza A virus and its implication for the pathogenesis of otitis media. Microb Pathog 2004; 37:193-204. [PMID: 15458780 DOI: 10.1016/j.micpath.2004.06.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2004] [Accepted: 06/22/2004] [Indexed: 10/26/2022]
Abstract
Influenza A virus infection plays a significant role in the pathogenesis of Streptococcus pneumoniae-induced acute otitis media in children. An understanding of how influenza A virus modulates host cellular responses is critically important in efforts to explore the molecular mechanisms of this synergism. We used microarray technology to characterize the mRNA expression profile in human middle ear epithelial cells induced by influenza A virus. Alterations of mRNA expression in 142 out of approximately 12,600 genes were observed at 24h after virus infection. Of these 142 genes with altered expression, interferon inducible genes, chemokine and cytokine genes, pro- and antiapoptotic genes, signal transduction and transcription factors, cellular immune response, cell cycle and metabolism genes were the most prominent. Our results reveal several previously unknown alterations of host gene expression induced by influenza A virus which may provide new targets for further analysis of its role in this particular host-pathogen interaction.
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Affiliation(s)
- Hua Hua Tong
- Division of Otologic Research, Department of Otolaryngology, College of Medicine and Public Health, The Ohio State University, Room 4331 Cramblett, 456 W. 10th Avenue, Columbus, OH 43210, USA
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162
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Pettigrew MM, Gent JF, Triche EW, Belanger KD, Bracken MB, Leaderer BP. Association of early-onset otitis media in infants and exposure to household mould. Paediatr Perinat Epidemiol 2004; 18:441-7. [PMID: 15535820 DOI: 10.1111/j.1365-3016.2004.00596.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Otitis media is one of the most common infections of early childhood. Children who first experience acute otitis media at an early age (before 6 months) are at increased risk for recurrent otitis media. This prospective study investigated exposure to measured levels of airborne household mould and the risk of early otitis media in the first 6 months of life among a cohort of infants at high risk for asthma. Between September 1996 and December 1998, women were invited to participate if they had at least one other child with physician-diagnosed asthma. Mothers were given a standardised questionnaire within 4 months of their infant's birth. Airborne mould samples were also taken at this time, and culturable fungi were categorised into four levels according to the report of the Commission of European Communities: 0 (undetectable), 1-499 colony forming units (CFU)/m(3) (low), 500-999 CFU/m(3) (medium), > or =1000 CFU/m(3) (high). Infant respiratory symptoms were collected during quarterly telephone interviews at 6, 9 and 12 months of age. Of the 806 children in the study, 27.8% experienced otitis media before six months of age. Household levels of Penicillium and Cladosporium were modestly associated with the number of otitis media episodes (P = 0.056 and 0.081 respectively). After controlling for potential confounders, Penicillium and Cladosporium were not associated with early otitis media. High levels of 'other' mould (defined as total spore count minus counts for Penicillium, Cladosporium, and yeast) were associated with early otitis media (OR 3.49; 95% CI [1.38, 8.79]). We also found associations between day-care outside of the home and birth during the summer or fall season with early otitis media. This study is suggestive of a relationship between otitis media and mould that warrants further study.
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Affiliation(s)
- Melinda M Pettigrew
- Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT 06520-8034, USA.
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Brown G, Jeffree CE, McDonald T, Rixon HWM, Aitken JD, Sugrue RJ. Analysis of the interaction between respiratory syncytial virus and lipid-rafts in Hep2 cells during infection. Virology 2004; 327:175-85. [PMID: 15351205 DOI: 10.1016/j.virol.2004.06.038] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2004] [Accepted: 06/04/2004] [Indexed: 10/26/2022]
Abstract
The assembly of respiratory syncytial virus (RSV) in lipid-rafts was examined in Hep2 cells. Confocal and electron microscopy showed that during RSV assembly, the cellular distribution of the complement regulatory proteins, decay accelerating factor (CD55) and CD59, changes and high levels of these cellular proteins are incorporated into mature virus filaments. The detergent-solubility properties of CD55, CD59, and the RSV fusion (F) protein were found to be consistent with each protein being located predominantly within lipid-raft structures. The levels of these proteins in cell-released virus were examined by immunoelectronmicroscopy and found to account for between 5% and 15% of the virus attachment (G) glycoprotein levels. Collectively, our findings suggest that an intimate association exists between RSV and lipid-raft membranes and that significant levels of these host-derived raft proteins, such as those regulating complement activation, are subsequently incorporated into the envelope of mature virus particles.
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Affiliation(s)
- Gaie Brown
- MRC Virology Unit, Institute of Virology, Glasgow G11 5JR, UK
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164
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Yu KL, Zhang Y, Civiello RL, Trehan AK, Pearce BC, Yin Z, Combrink KD, Gulgeze HB, Wang XA, Kadow KF, Cianci CW, Krystal M, Meanwell NA. Respiratory syncytial virus inhibitors. Part 2: Benzimidazol-2-one derivatives. Bioorg Med Chem Lett 2004; 14:1133-7. [PMID: 14980651 DOI: 10.1016/j.bmcl.2003.12.072] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2003] [Revised: 12/14/2003] [Accepted: 12/18/2003] [Indexed: 11/30/2022]
Abstract
Structure-activity relationships for a series of benzimidazol-2-one-based inhibitors of respiratory syncytial virus are described. These studies focused on structural variation of the benzimidazol-2-one substituent, a vector inaccessible in a series of benzotriazole derivatives on which 2 is based, and revealed a broad tolerance for substituent size and functionality.
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Affiliation(s)
- Kuo-Long Yu
- Department of Chemistry, The Bristol-Myers Squibb Pharmaceutical Research Institute, 5 Research Parkway, Wallingford, CT 06492, USA
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165
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Abstract
BACKGROUND AND METHODS Viral-bacterial coinfections in humans are well-documented. Viral infections often lead to bacterial superinfections. In vitro and animal models for influenza, as well as molecular microbiology study of viruses and bacteria, provide an understanding of the mechanisms that explain how respiratory viruses and bacteria combine to cause disease. This article focuses on viral and bacterial combinations, particularly synergism between influenza and Streptococcus pneumoniae. RESULTS Potential mechanisms for synergism between viruses and bacteria include: virus destruction of respiratory epithelium may increase bacterial adhesion; virus-induced immunosuppression may cause bacterial superinfections; and inflammatory response to viral infection may up-regulate expression of molecules that bacteria utilize as receptors. Influenza and parainfluenza viruses possess neuraminidase (NA) activity, which appears to increase bacterial adherence after viral preincubation. Experimental studies demonstrate that viral NA exposes pneumococcal receptors on host cells by removing terminal sialic acids. Other studies show that inhibition of viral NA activity reduces adherence and invasion of S. pneumoniae, independently of effects on viral replication. Clinical studies reveal that influenza vaccination reduces the incidence of secondary bacterial respiratory tract infections. CONCLUSIONS Detection of viral factors (e.g. high NA activity) that increase the likely potential of epidemic/pandemic influenza strains for causing morbidity and mortality from secondary bacterial infections provides new possibilities for intervention. Additional study is needed to identify the mechanisms for the development of bacterial complications after infections with respiratory syncytial virus and other important respiratory viruses that lack NA activity. Prevention of bacterial superinfection is likely to depend on effective antiviral measures.
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Affiliation(s)
- Ville T Peltola
- Department of Infectious Diseases, St Judes Children's Research Hospital, Memphis, TN, USA
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166
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Abstract
PURPOSE OF REVIEW Otitis media is the most common bacterial infection among children, accounting for as many as 30 million office visits annually. Proper treatment has become critical as offending pathogens become increasingly resistant to antibiotics and the cost of managing the disorder has exceeded 3 billion dollars per year. However, data suggest that many practitioners still struggle with the diagnosis of otitis media and often recommend medical and surgical intervention inappropriately. This article presents recent advances in the otitis media literature and an evidence-based approach to its management. RECENT FINDINGS Recent investigations have resulted in the following findings: (1) bacterial biofilms may account for the persistence of middle ear disease; (2) there is increasing evidence that heredity and reflux are risk factors for otitis media; (3) primary care providers may be receiving poor otitis media training, leading to inadequate diagnostic skills; (4) medical and surgical therapy are of limited utility in the management of acute and recurrent acute otitis media; (5) antibiotics and steroids are of limited value in the treatment of chronic middle ear effusion; (6) delayed management of effusion may not adversely affect development in children; (7) vaccination for pneumococcus may alter the serotypes responsible for otitis media; and (8) vaccine candidates for other middle ear pathogens are under investigation. SUMMARY Management of otitis media is constantly evolving, based on research from a variety of medical subspecialties. It is incumbent on the otolaryngologist and primary care providers treating otitis media to keep pace with and synthesize these findings into a rational approach to treatment.
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Affiliation(s)
- David H Darrow
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, USA
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