Background: The association of SARS-CoV-2 with acute otitis media (AOM) in children is poorly understood. Methods: Cases were identified as a subpopulation within the NO TEARS prospective AOM study in Denver, CO from March to December 2020. Children enrolled were 6 to 35 months of age with uncomplicated AOM; those with AOM and SARS-CoV-2 were included. Data was obtained from electronic medical records and research case report forms. Results: A total of 108 patients enrolled in the NO TEARS study from May 2019 through December 2020 (all subsequently tested for SARS CoV-2). During the COVID-19 pandemic study period (March-December 2020), 16 patients enrolled, and 7 (43.6%) were identified with AOM/COVID-19 co-infection. Fever was present in 3 of 7 children (29%). Four children (57%) attended daycare. Only 2 children (29%) had SARS CoV-2 testing as part of their clinical workup. Mean AOM-SOS© scores were similar among SARS CoV-2 positive and negative patients with no statistical significance with two-sided t-tests: 13.6 (±4.5) versus 14.2 (±4.9) at enrollment, 1.4 (±1.8) versus 4.2 (±4.9) on Day 5, and 0.6 (±0.9) versus 2.5 (±6.1) on Day 14. Among the 7 cases, no child had an AOM treatment failure or recurrence within 3 to 14 or 15 to 30 days respectively. Of the 6 patients with completed bacterial and viral testing, a bacterial pathogen was identified in all 6, and a viral pathogen in 3 (50%). Conclusions: COVID-19 and AOM can co-exist. Providers should maintain a high index of suspicion for COVID-19 even in patients with clinical AOM and should not use a diagnosis of AOM to exclude COVID-19.
Background Among children with acute otitis media (AOM) S.pneumoniae, H.influenzae, and M.catarrhalis are the predominant bacterial otopathogens. There is a high correlation between nasopharyngeal (NP) and middle ear fluid (MEF) organisms during AOM. Thus, NP samples could serve as a surrogate for detection of otopathogens and are more easily collected in a typical practice environment than MEF. Though culture is considered the gold standard for detection, it is time-consuming, which can limit its diagnostic utility to guide clinical care. We aimed to determine the sensitivity, specificity, positive (PPV) and negative predictive value (NPV) for NP qualitative PCR for bacterial otopathogens compared to NP culture. Methods Patients age 6-35 months with uncomplicated AOM who were prospectively enrolled in an AOM study in Denver, CO from Jan 2019-Dec 2020 were included. All patients had an NP flocked swab (Eswab®, Copan Diagnostics) at enrollment. Otopathogen culture was completed using standard techniques. Nucleic acids were extracted using the NucliSENS® easyMAG® system (Quidel, San Diego, CA) per manufacturer’s instructions. Multiplex RT-PCR for S.pneumoniae, H.influenzae, and M.catarrhalis was completed using Lyra® (Quidel, San Diego, CA) and AnDiaTec® assay kits (Quidel Germany GmbH, Kornwestheim, Germany). Nucleic acid amplification and detection was completed on the Applied Biosystems® (ABI) 7500 Fast Dx Real-Time PCR Instrument. Results Of the 80 children included, 18 (22.5%) had no organism detected on culture, 31 (38.8%) had one and 31 (38.8%) had multiple organisms detected. The most commonly identified organisms on culture were M.catarrhalis (42, 52.5%), followed by S.pneumoniae (30, 37.5%), and H.influenzae (17, 21.3%). Of H.influenzae isolates 8 (47.1%) produced beta-lactamase. The sensitivity of PCR was high ( >94%) for all organisms whereas the specificity was lower (50.0-77.8%) and varied by organism (Table). NPV were high ( >96%) for all otopathogens, whereas, PPV ranged from 53.3 to 68.9%. PCR detected 1.6 times more organisms than culture (149 vs. 96). Sensitivity, specificity, positive and negative predictive value of PCR compared to culture for otopathogens. Conclusion NP PCR has a high predictive value for excluding otopathogens and warrants further exploration as a diagnostic tool to evaluate for otopathogens in children. Disclosures Andreas Bress, PhD, Quidel Laboratories- Germany (Employee) Richard Egan, PhD, Quidel Laboratories (Employee) Samuel R. Dominguez, MD, PhD, BioFire Diagnostics (Consultant, Research Grant or Support)DiaSorin Molecular (Consultant)Pfizer (Grant/Research Support) Samuel R. Dominguez, MD, PhD, BioFire (Individual(s) Involved: Self): Consultant, Research Grant or Support; DiaSorin Molecular (Individual(s) Involved: Self): Consultant; Pfizer (Individual(s) Involved: Self): Grant/Research Support
Background Acute infectious conjunctivitis (AIC) is a common pediatric infection affecting one in eight children annually. The etiology of AIC is poorly understood but important to inform treatment and return to school recommendations. Additionally, the association of bacteria isolated from the conjunctiva with the development of clinical AIC is not well defined. We aimed to determine the bacterial and viral causes of AIC in children. Methods Patients age 6 months-18 years with AIC at Denver Health (Denver, CO) and Marshfield Clinic (Marshfield, WI) from 2019-2021 were included. Age-matched healthy and upper respiratory infection (URI) controls without conjunctivitis were enrolled within 30 days of each case. Patients had a conjunctival flocked swab (Eswab®, Copan Diagnostics) obtained. Nucleic acids were extracted using the NucliSENS® easyMAG® system (Quidel, San Diego, CA) per manufacturer’s instructions. Multiplex RT-PCR for S.pneumoniae, H.influenzae, M.catarrhalis, S.aureus , and 11 respiratory viruses were completed using Lyra® (Quidel, San Diego, CA) and AnDiaTec® assay kits (Quidel Germany GmbH, Kornwestheim, Germany, Table). Nucleic acid amplification and detection was completed on the Applied Biosystems® (ABI) 7500 Fast Dx Real-Time PCR Instrument. Odds ratios were computed for each organism. Results A total of 78 cases and 71 controls (33 healthy, 38 URI) were included (Table). Bacteria were detected in 59 (75.6%) cases and 36 (50.7%) of controls (OR 14.3; 4.7,33.7). Respiratory viruses were infrequently detected (cases 2, 2.6%; controls 6, 8.5%), including in the pre-pandemic period. Of bacteria detected in cases, H.influenzae was the most common (56.4%) and had the highest association with conjunctivitis (OR 11.8; 4.8, 29.1) followed by M.catarrhalis (35.9% cases, OR 2.5; 1.2, 5.3). S.pneumoniae was detected more often in controls than cases (33.8% v 26.9%). Conclusion H.influenzae is likely the most important pathogen associated with AIC in children. Though data have suggested marginal benefit of antibiotic treat for conjunctivitis overall, studies specifically looking at benefit by organism would advance the field. A rapid diagnostic test for H.influenzae and possibly M.catarrhalis could help direct antibiotic treatment to children most likely to benefit. Disclosures Samuel R. Dominguez, MD PhD, Biofire DIagnostics: Advisor/Consultant|Biofire DIagnostics: Grant/Research Support|DiaSorin Molecular: Advisor/Consultant|Karius: Advisor/Consultant|Pfizer: Grant/Research Support.
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