Chlamydia pneumoniae in acute otitis media

Block, Stan L.; Hammerschlag, Margaret R.; Hedrick, James; Tyler, Ron; Smith, Alan; Roblin, Patricia M.; Gaydos, Charlotte A.; Pham, Dien G.; Quinn, Thomas C.; Palmér, Robert; McCarty, James

doi:10.1097/00006454-199709000-00008

Cited by 56 publications

(28 citation statements)

References 24 publications

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“…It has been suggested that a PCR which is positive for C. pneumoniae in respiratory samples does not always indicate acute C. pneumoniae infections because there may be transient carriage of C. pneumoniae in the [3][4][5][6][7][8][9][10] The presence of only C. pneumoniae DNA in upper respiratory tract specimens, as demonstrated by the PCR, without a concomitant serological response, may indicate prolonged, harmless colonization of the respiratory tract rather than the agent causing respiratory tract infections. Therefore, conventional PCR assays cannot differentiate between acute C. pneumoniae infections and persistent ones or nasopharyngeal carriage.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 The PCR assays have detected persistent infections of C. pneumoniae, indicating that the majority of C. pneumoniae infections are asymptomatic. [3][4][5][6][7][8][9][10] Transient carriage without serological response seems to be a common phenomenon in younger children. These fi ndings indicate that PCR assays cannot differentiate between acute C. pneumoniae infections and persistent ones or nasopharyngeal carriage.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the diagnostic usefulness of real-time PCR for detection of Chlamydophila pneumoniae in acute respiratory infections

Miyashita

Obase

Fukuda

et al. 2007

Journal of Infection and Chemotherapy

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of the diagnostic usefulness of real-time PCR for detection of Chlamydophila pneumoniae in acute respiratory infections

Miyashita

Obase

Fukuda

et al. 2007

Journal of Infection and Chemotherapy

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“…Both clinical data [20] and personal clinical experience with tympanocentesis show that bullous myringitis is not caused by M. pneumoniae, even when MEE are tested with more sensitive PCR assays for that pathogen (0 of 50 patients). In contrast, Block et al [41] have isolated Chlamydia pneumoniae from a small but significant percentage (8% of 101 children) with AOM. Five of the children with this pathogen were very young (8 to 17 months old) and 3 had refractory AOM.…”

Section: Other Pathogens Of Aommentioning

confidence: 92%

Management of Acute Otitis Media in the 1990s

Block

1999

Pediatric Drugs

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Acute otitis media (AOM) has become increasingly difficult to treat in the 1990s, the decade of drug-resistant pneumococcus. Throughout the world, drug-resistant strains of this pathogen are being recovered from 20 to 50% of cases of initial untreated AOM, and from 45 to 90% of refractory AOM. Almost as alarming is that beta-lactamase-producing strains of Haemophilus influenzae are currently being isolated in 40 to 50% of cases of AOM in the US. Clinicians can no longer expect 'Pollyanna-like' high rates of clinical resolution for this disease. It is now imperative that they become aware of the regional prevalence of these drug-resistant bacteria and, just as importantly, their patterns of antibacterial resistance. Although some authors would hold that any antibacterial, or even placebo, should be adequate for most cases of AOM, clinical practice appears to suggest otherwise. Amoxicillin, still the first-line therapeutic choice for initial nonrefractory AOM, will often fail. The real dilemma begins when clinicians search for clinical data to select an antibacterial for therapeutic failures--few data are available. Thus, to give optimal treatment to a child who has failed antibacterial therapy--the true actual indication for all second-line antibacterials--they must instead become familiar with the following in vivo and in vitro data: 1. 'In vivo sensitivity data': otherwise known as bacteriological efficacy, in which repeat tympanocentesis is performed in mid-therapy. This reveals the bacterial 'Achilles heel' or weakness for the individual antibacterial agents. 2. Clinical efficacy data: analysis of rates of clinical resolution after therapy in comparative trials which use a single tympanocentesis initially and a 'gold standard' comparator antibacterial. 3. 'Bug to drug' data: comparison of reported middle ear concentrations for each individual antibacterial agent relative to the respective minimum inhibitory concentrations of isolates, particularly drug-resistant pneumococcus and H. influenzae (if possible, obtained from the paediatric respiratory tract). The selection of an antibacterial agent for AOM in any particular case should not be merely a random process. It involves awareness of the pathogens most likely to be observed: with co-infections; after failure with a particular antibacterial (the bacterial 'Achilles heel' of the drug); and at different points in time, whether initially or after therapeutic failures (e.g. first-line versus fourth-line failure).

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“…In contrast, Block et al [9] recovered C. pneumoniae from the middle-ear fluids of eight of 101 (8%) children (3 months to 14 years of age) with AOM. None of the children, five of whom were younger than 16 months of age, had C. pneumoniae recovered from their nasopharyngeal culture.…”

Section: Otitis Mediamentioning

confidence: 94%

The role of Chlamydia in upper respiratory tract infections

Hammerschlag

2000

Curr Infect Dis Rep

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Although Chlamydia pneumoniae and Chlamydia psittaci are well-established causes of community-acquired pneumonia, little is known about the role of Chlamydia species in upper respiratory tract infections. C. pneumoniae may play a role in the pathogenesis of acute otitis media. Although C. pneumoniae has been isolated from the middle-ear fluid of children with otitis, children in whom the organism was isolated from middle-ear fluid improved despite being treated with antibiotics that are not active against C. pneumoniae. Although many patients with community-acquired pneumonia caused by C. pneumoniae have symptoms suggestive of sinusitis, there is only one report of isolation of the organism from the maxillary sinus of a patient with sinusitis. Studies of the association with pharyngitis are all based on serology, which often has a poor correlation with isolation of the organism by culture.

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Chlamydia pneumoniae in acute otitis media

Abstract: This is the first study to report the isolation of C. pneumoniae in middle ear fluid of children with AOM.

Cited by 56 publications

References 24 publications

Evaluation of the diagnostic usefulness of real-time PCR for detection of Chlamydophila pneumoniae in acute respiratory infections

Evaluation of the diagnostic usefulness of real-time PCR for detection of Chlamydophila pneumoniae in acute respiratory infections

Management of Acute Otitis Media in the 1990s

The role of Chlamydia in upper respiratory tract infections

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