Microbiology of Acute Otitis Media in Children with Tympanostomy Tubes: Prevalences of Bacteria and Viruses

Ruohola, Aino; Meurman, Olli; Nikkari, Simo; Skottman, Tuukka; Salmi, A Kiani; Waris, Matti; Österback, Riikka; Eerola, Erkki; Allander, Tobias; Niesters, Hubert G. M.; Heikkinen, Terho; Ruuskanen, Olli

doi:10.1086/509332

Cited by 178 publications

(150 citation statements)

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“…However, M. catarrhalis commonly causes otitis media in children (15-20% cases) and acute exacerbations in adults with chronic obstructive pulmonary disease (COPD) (6,7). M. catarrhalis can also cause symptomatic infections in the upper and lower respiratory tract, as well as infections in the bone and joint tissue in rare cases (8).…”

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confidence: 99%

Moraxella catarrhalis Evades Host Innate Immunity via Targeting Cartilage Oligomeric Matrix Protein

Liu

Gradstedt

Ermert

et al. 2016

The Journal of Immunology

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Moraxella catarrhalis is a respiratory tract pathogen commonly causing otitis media in children and acute exacerbations in patients suffering from chronic obstructive pulmonary disease. Cartilage oligomeric matrix protein (COMP) functions as a structural component in cartilage, as well as a regulator of complement activity. Importantly, COMP is detected in resident macrophages and monocytes, alveolar fluid, and the endothelium of blood vessels in lung tissue. We show that the majority of clinical isolates of M. catarrhalis (n = 49), but not other tested bacterial pathogens, bind large amounts of COMP. COMP interacts directly with the ubiquitous surface protein A2 of M. catarrhalis. Binding of COMP correlates with survival of M. catarrhalis in human serum by inhibiting bactericidal activity of the complement membrane attack complex. Moreover, COMP inhibits phagocytic killing of M. catarrhalis by human neutrophils. We further observed that COMP reduces bacterial adhesion and uptake by human lung epithelial cells, thus protecting M. catarrhalis from intracellular killing by epithelial cells. Taken together, our findings uncover a novel mechanism that M. catarrhalis uses to evade host innate immunity.

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confidence: 99%

Moraxella catarrhalis Evades Host Innate Immunity via Targeting Cartilage Oligomeric Matrix Protein

Liu

Gradstedt

Ermert

et al. 2016

The Journal of Immunology

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“…Viral URI increases the risk of bacterial AOM by promoting the replication of bacteria and increasing inflammation in the nasopharynx and Eustachian tube, which subsequently facilitates bacterial entry into the middle ear space (4). Respiratory viruses can coinfect the middle ear with bacterial AOM pathogens and have been identified as the sole causative agent of AOM (19,29). Viral URI is a major risk factor for AOM; however, specific viruses differ in their propensity to cause disease (10,21).…”

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confidence: 99%

“…Human bocavirus (hBOV) is a parvovirus that was first described in 2005 (1). Several studies have detected hBOV in nasal samples from children with URI and in middle ear fluid samples from children with AOM (5,14,29,30). However, the role of hBOV as a causative URI pathogen has been debated (3,23,25).…”

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Viral-Bacterial Interactions and Risk of Acute Otitis Media Complicating Upper Respiratory Tract Infection

et al. 2011

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Acute otitis media (AOM) is a common complication of upper respiratory tract infection whose pathogenesis involves both viruses and bacteria. We examined risks of acute otitis media associated with specific combinations of respiratory viruses and acute otitis media bacterial pathogens. Data were from a prospective study of children ages 6 to 36 months and included viral and bacterial culture and quantitative PCR for respiratory syncytial virus (RSV), human bocavirus, and human metapneumovirus. Repeated-measure logistic regression was used to assess the relationship between specific viruses, bacteria, and the risk of acute otitis media complicating upper respiratory tract infection. In unadjusted analyses of data from 194 children, adenovirus, bocavirus, Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis were significantly associated with AOM (P < 0.05 by 2 test

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“…Intercurrent respiratory viral infections may render the middle ear susceptible to symptomatic infection with bacteria that normally colonize the nasopharynx. Ruohola et al suggest that the majority of acute middle-ear infections in children are due to bacterial and viral coinfection (4).…”

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confidence: 99%

“…More than one bacterial species can simultaneously infect the middle ear in AOM (1,4). Multibacterial species biofilm formation may be involved in chronic recurrent otitis media pathogenesis, perhaps explaining the demonstrated effectiveness of conjugate pneumococcal vaccines against AOM but not recurrent disease (5).…”

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Multiple Streptococcus pneumoniae Serotypes in Aural Discharge Samples from Children with Acute Otitis Media with Spontaneous Otorrhea

et al. 2013

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e Among 55 children with cultures positive for acute otitis media with spontaneous otorrhea, 28 (51%) had cultures positive for aural Streptococcus pneumoniae, and in 10 of these, two distinct strains were detected, in which 5 had pairs of strains that were both capsule-bearing serotypes. Such cases were more likely to have cultures positive for other otopathogens than those with only one pneumococcus present. The most common bacteria causing acute otitis media (AOM) in children are Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pyogenes. Spontaneous otorrhea can complicate AOM, and S. pyogenes may be found in higher percentages and H. influenzae and M. catarrhalis in lower percentages among such patients than among those with AOM and intact tympanic membranes (1).Nasopharyngeal colonization by potential middle-ear pathogens is presumed to precede AOM. There is an association between nasal bacterial load and the presence and severity of ear disease (2), and aural S. pneumoniae shows a close genetic relatedness with its nasopharyngeal counterpart (3).Understanding of the etiopathogenesis of AOM is increasing. Viral and bacterial causation are no longer seen as alternatives. Intercurrent respiratory viral infections may render the middle ear susceptible to symptomatic infection with bacteria that normally colonize the nasopharynx. Ruohola et al. suggest that the majority of acute middle-ear infections in children are due to bacterial and viral coinfection (4).More than one bacterial species can simultaneously infect the middle ear in AOM (1, 4). Multibacterial species biofilm formation may be involved in chronic recurrent otitis media pathogenesis, perhaps explaining the demonstrated effectiveness of conjugate pneumococcal vaccines against AOM but not recurrent disease (5).Conventional S. pneumoniae culture and serotyping methodologies underestimate multiple-serotype carriage. Molecular serotyping improves detection of multiple serotypes and determines the relative abundance of each (6, 7) but has not previously been applied to the middle ear.The pneumococcal conjugate vaccine (PCV) became available in Portugal in 2001 but has not been included in the national immunization program. Coverage from private market sales data was around 65% in 2011, following a peak of around 79% in 2007 (oral communication, Pfizer). Since 2010, 13-valent PCV (PCV13) has been used predominantly.Tympanocentesis is not routinely performed in the investigation and management of AOM in Portugal. To obtain data on the etiology of AOM, we studied children with AOM with spontaneous otorrhea (AOMSO). We hypothesized that just as simultaneous nasal colonization with multiple pneumococcal serotypes and strains occurs (7), this may also be the case in the ear.The study was conducted at Coimbra Children's Hospital, a 120-bed tertiary care center in central Portugal, with more than 60,000 emergency service (ES) visits each year. It was approved by the hospital ethics committee. Parents or guardians provid...

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Microbiology of Acute Otitis Media in Children with Tympanostomy Tubes: Prevalences of Bacteria and Viruses

Abstract: In the great majority of children, AOM is a coinfection with bacteria and viruses. The patent tympanostomy tube does not change the spectrum of causative agents in AOM. A microbiological etiology can be established in practically all cases.

Cited by 178 publications

References 43 publications

Moraxella catarrhalis Evades Host Innate Immunity via Targeting Cartilage Oligomeric Matrix Protein

Moraxella catarrhalis Evades Host Innate Immunity via Targeting Cartilage Oligomeric Matrix Protein

Viral-Bacterial Interactions and Risk of Acute Otitis Media Complicating Upper Respiratory Tract Infection

Multiple Streptococcus pneumoniae Serotypes in Aural Discharge Samples from Children with Acute Otitis Media with Spontaneous Otorrhea

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