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Ruttkay Pereira DR, Pereira MR, Rotta Pereira MB, Costa SS, Mott MP, Cantarelli V. Otopathogens in the middle ear and nasopharynx of children with recurrent acute otitis media. Int J Pediatr Otorhinolaryngol 2023; 169:111552. [PMID: 37120991 DOI: 10.1016/j.ijporl.2023.111552] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/03/2023] [Accepted: 04/09/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE This study aimed to describe the microbiology of the middle ear and nasopharynx, determining the prevalence of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis in a group of children vaccinated with pneumococcal conjugate vaccine (PCV) who underwent ventilation tube insertion for recurrent acute otitis media. METHODS We analyzed 278 middle ear effusion and 139 nasopharyngeal samples obtained from 139 children who underwent myringotomy and ventilation tube insertion for recurrent acute otitis media between June 2017 and June 2021. The children's ages ranged from 9 months to 9 years, 10 months, with a median of 21 months. The patients had no signs of acute otitis media or respiratory tract infection and were not on antibiotic therapy at the time of the procedure. The middle ear effusion and nasopharyngeal samples were collected with an Alden-Senturia aspirator and a swab, respectively. Bacteriological studies and multiplex PCR were performed for the detection of the three pathogens. Direct molecular determination of pneumococcal serotypes was performed by real-time PCR. The chi-square test was used to verify associations between categorical variables and measures of strength of association based on prevalence ratios, considering a 95% confidence interval a 5% significance level. RESULTS Vaccination coverage was 77.7% with the basic regimen plus booster dose and 22.3% with the basic regimen alone. Middle ear effusion culture identified H. influenzae in 27 children (19.4%), S. pneumoniae in 7 (5.0%), and M. catarrhalis in 7 (5.0%). PCR detected H. influenzae in 95 children (68.3%), S. pneumoniae in 52 (37.4%), and M. catarrhalis in 23 (16.5%), a three-to seven-fold increase compared to culture. In the nasopharynx, culture isolated H. influenzae in 28 children (20.1%), S. pneumoniae in 29 (20.9%), and M. catarrhalis in 12 (8.6%). PCR identified H. influenzae in 84 children (60.4%), S. pneumoniae in 58 (41.7%), and M. catarrhalis in 30 (21.5%), a two-to three-fold increase in detection. The most common pneumococcal serotype was 19A, both in the ears and the nasopharynx. In the ears, of the 52 children who had pneumococcus, 24 (46.2%) had serotype 19A. In the nasopharynx, of the 58 patients who had pneumococcus, 37 (63.8%) had serotype 19A. Of all 139 children, 53 (38.1%) had polymicrobial samples (more than 1 of the 3 otopathogens) in the nasopharynx. Of the 53 children who had polymicrobial samples in the nasopharynx, 47 (88.7%) also had 1 of the 3 otopathogens in the middle ear, mainly H. influenzae (40%-75.5%), especially when it was found in the nasopharynx in conjunction with S. pneumoniae. CONCLUSION The prevalence of bacteria in a group of Brazilian children immunized with the PCV who required ventilation tube insertion for recurrent acute otitis media was similar to that reported in other parts of the world after the advent of PCV. H. influenzae was the most frequent bacteria, both in the nasopharynx and the middle ear, while S. pneumoniae serotype 19A was the most common pneumococcus in the nasopharynx and middle ear. Polymicrobial colonization of the nasopharynx was strongly associated with detection of H. influenzae in the middle ear.
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Affiliation(s)
- Denise Rotta Ruttkay Pereira
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), R. Ramiro Barcelos, 2400, 90035003, Porto Alegre, RS, Brazil.
| | - Manuel Ruttkay Pereira
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Av. Ipiranga, 6681, 90619900, Porto Alegre, RS, Brazil.
| | | | - Sady Selaimen Costa
- School of Medicine, UFRGS, R. Ramiro Barcelos, 2400, 90035003, Porto Alegre, RS, Brazil.
| | - Mariana Preussler Mott
- Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, 90035903, Porto Alegre, RS, Brazil.
| | - Vlademir Cantarelli
- Department of Basic Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), R. Sarmento Leite, 245, 90050170, Porto Alegre, RS, Brazil.
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Van Dyke MK, Pirçon JY, Cohen R, Madhi SA, Rosenblüt A, Macias Parra M, Al-Mazrou K, Grevers G, Lopez P, Naranjo L, Pumarola F, Sonsuwan N, Hausdorff WP. Etiology of Acute Otitis Media in Children Less Than 5 Years of Age: A Pooled Analysis of 10 Similarly Designed Observational Studies. Pediatr Infect Dis J 2017; 36:274-281. [PMID: 27918383 PMCID: PMC5312727 DOI: 10.1097/inf.0000000000001420] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute otitis media (AOM) is an important cause of childhood morbidity and antibiotic prescriptions. However, the relative importance of the well-known otopathogens, Streptococcus pneumoniae (Spn) and Haemophilus influenzae (Hflu), remains unclear because of a limited number of tympanocentesis-based studies that vary significantly in populations sampled, case definitions and heptavalent pneumococcal conjugate vaccine use. METHODS We conducted a pooled analysis of results from 10 AOM etiology studies of similar design, the protocols of which were derived from a common protocol and conducted in children 3 months to 5 years of age in different countries. Generalized estimating equations were used to account for within-study correlations. RESULTS The majority, 55.5% (95% confidence interval: 47.0%-65.7%) of 1124 AOM episodes, were bacterial pathogen positive: 29.1% (24.8%-34.1%) yielded Hflu and 23.6% (19.0%-29.2%) Spn. Proportions of Hflu and Spn were higher and lower, respectively, in heptavalent pneumococcal conjugate vaccine-vaccinated children. Hflu and Spn were each isolated from 20% to 35% of children in every 1-year age range. Hflu was less likely to be isolated from first (vs. subsequent) episodes [relative risk (RR): 0.71 (0.60-0.84)]. Spn was more often isolated from sporadic (vs. recurrent) cases [RR: 0.76 (0.61-0.97)]; the opposite was true for Hflu [RR: 1.4 (1.00-1.96)]. Spn cases were more likely to present with severe (vs. mild) symptoms [RR: 1.42 (1.01-2.01)] and Hflu cases with severe tympanic membrane inflammation [RR: 1.35 (1.06-1.71)]. CONCLUSIONS Spn and Hflu remain the leading otopathogens in all populations examined. While associated with overlapping symptoms and severity, they exhibit some differences in their likelihood to cause disease in specific subpopulations.
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Affiliation(s)
- Melissa K. Van Dyke
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Jean-Yves Pirçon
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Robert Cohen
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Shabir A. Madhi
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Andrés Rosenblüt
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Mercedes Macias Parra
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Khalid Al-Mazrou
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Gerhard Grevers
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Pio Lopez
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Laura Naranjo
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Felix Pumarola
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Nuntigar Sonsuwan
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - William P. Hausdorff
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
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