Viral–Bacterial Interactions in Acute Otitis Media

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Abstract

Acute otitis media (AOM) is a polymicrobial disease, which usually occurs as a complication of viral upper respiratory tract infection (URI). While respiratory viruses alone may cause viral AOM, they increase the risk of bacterial middle ear infection and worsen clinical outcomes of bacterial AOM. URI viruses alter Eustachian tube (ET) function via decreased mucociliary action, altered mucus secretion and increased expression of inflammatory mediators among other mechanisms. Transient reduction in protective functions of the ET allows colonizing bacteria of the nasopharynx to ascend into the middle ear and cause AOM. Advances in research help us to better understand the host responses to viral URI, the mechanisms of viral–bacterial interactions in the nasopharynx and the development of AOM. In this review, we present current knowledge regarding viral–bacterial interactions in the pathogenesis and clinical course of AOM. We focus on the common respiratory viruses and their established role in AOM.

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Live attenuated versus inactivated influenza vaccine in infants and young children.

Robert Belshe, Kathryn Edwards, Timo Vesikari … (2007)

Universal vaccination of children 6 to 59 months of age with trivalent inactivated influenza vaccine has recently been recommended by U.S. advisory bodies. To evaluate alternative vaccine approaches, we compared the safety and efficacy of intranasally administered live attenuated influenza vaccine with those of inactivated vaccine in infants and young children. Children 6 to 59 months of age, without a recent episode of wheezing illness or severe asthma, were randomly assigned in a 1:1 ratio to receive either cold-adapted trivalent live attenuated influenza vaccine (a refrigeration-stable formulation of live attenuated intranasally administered influenza vaccine) or trivalent inactivated vaccine in a double-blind manner. Influenza-like illness was monitored with cultures throughout the 2004-2005 influenza season. Safety data were available for 8352 children, and 7852 children completed the study according to the protocol. There were 54.9% fewer cases of cultured-confirmed influenza in the group that received live attenuated vaccine than in the group that received inactivated vaccine (153 vs. 338 cases, P<0.001). The superior efficacy of live attenuated vaccine, as compared with inactivated vaccine, was observed for both antigenically well-matched and drifted viruses. Among previously unvaccinated children, wheezing within 42 days after the administration of dose 1 was more common with live attenuated vaccine than with inactivated vaccine, primarily among children 6 to 11 months of age; in this age group, 12 more episodes of wheezing were noted within 42 days after receipt of dose 1 among recipients of live attenuated vaccine (3.8%) than among recipients of inactivated vaccine (2.1%, P=0.076). Rates of hospitalization for any cause during the 180 days after vaccination were higher among the recipients of live attenuated vaccine who were 6 to 11 months of age (6.1%) than among the recipients of inactivated vaccine in this age group (2.6%, P=0.002). Among young children, live attenuated vaccine had significantly better efficacy than inactivated vaccine. An evaluation of the risks and benefits indicates that live attenuated vaccine should be a highly effective, safe vaccine for children 12 to 59 months of age who do not have a history of asthma or wheezing. (ClinicalTrials.gov number, NCT00128167 [ClinicalTrials.gov].). Copyright 2007 Massachusetts Medical Society.

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Evidence of human coronavirus HKU1 and human bocavirus in Australian children

Theo Sloots, Peter McErlean, David J Speicher … (2005)

Undiagnosed cases of respiratory tract disease suspected of an infectious aetiology peak during the winter months. Since studies applying molecular diagnostic assays usually report reductions in the number of undiagnosed cases of infectious disease compared to traditional techniques, we applied PCR assays to investigate the role of two recently described viruses, namely human coronavirus (HCoV) HKU1 and human bocavirus (HBoV), in a hospital-based paediatric population. Both viruses were found among Australia children with upper or lower respiratory tract disease during the autumn and winter of 2004, contributing to 21.1% of all microbial diagnoses, with individual incidences of 3.1% (HCoV-HKU1) and 5.6% (HBoV) among 324 specimens. HBoV was found to coincide with another virus in more than half of all instances and displayed a single genetic lineage, whilst HCoV-HKU1 was more likely to occur in the absence of another microbe and strains could be divided into two genetic lineages which we propose be termed HCoV-HKU1 type A and type B. Children under the age of 2 years were most at risk of infection by these viruses which contribute significantly to the microbial burden among patients with respiratory tract disease during the colder months.

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Diagnosis and management of acute otitis media.

(2004)

This evidence-based clinical practice guideline provides recommendations to primary care clinicians for the management of children from 2 months through 12 years of age with uncomplicated acute otitis media (AOM). The American Academy of Pediatrics and American Academy of Family Physicians convened a committee composed of primary care physicians and experts in the fields of otolaryngology, epidemiology, and infectious disease. The subcommittee partnered with the Agency for Healthcare Research and Quality and the Southern California Evidence-Based Practice Center to develop a comprehensive review of the evidence-based literature related to AOM. The resulting evidence report and other sources of data were used to formulate the practice guideline recommendations. The focus of this practice guideline is the appropriate diagnosis and initial treatment of a child presenting with AOM. The guideline provides a specific definition of AOM. It addresses pain management, initial observation versus antibacterial treatment, appropriate choices of antibacterials, and preventive measures. Decisions were made based on a systematic grading of the quality of evidence and strength of recommendations, as well as expert consensus when definitive data were not available. The practice guideline underwent comprehensive peer review before formal approval by the partnering organizations. This clinical practice guideline is not intended as a sole source of guidance in the management of children with AOM. Rather, it is intended to assist primary care clinicians by providing a framework for clinical decision-making. It is not intended to replace clinical judgment or establish a protocol for all children with this condition. These recommendations may not provide the only appropriate approach to the management of this problem.

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Author and article information

Contributors

Tasnee Chonmaitree: +1-409-7724876 , +1-409-7471753 , tchonmai@utmb.edu

Journal

Journal ID (nlm-ta): Curr Allergy Asthma Rep

Journal ID (iso-abbrev): Curr Allergy Asthma Rep

Title: Current Allergy and Asthma Reports

Publisher: Current Science Inc. (New York )

ISSN (Print): 1529-7322

ISSN (Electronic): 1534-6315

Publication date (Electronic): 12 September 2012

Publication date (Print): 2012

Volume: 12

Issue: 6

Pages: 551-558

Affiliations

[1 ]GRID grid.176731.5, ISNI 0000000115479964, Division of Infectious Diseases, Department of Pediatrics, , University of Texas Medical Branch, ; 301 University Boulevard, Galveston, TX 77555-0371 USA

[2 ]GRID grid.15485.3d, ISNI 0000000099505666, Department of Otorhinolaryngology, , Helsinki University Central Hospital, ; P.O. Box 220, 00290 Helsinki, Finland

Article

Publisher ID: 303

DOI: 10.1007/s11882-012-0303-2

PMC ID: 3493715

PubMed ID: 22968233

SO-VID: 15b2c060-ae12-4132-bffd-5ffff38fcbb7

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This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

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ScienceOpen disciplines: Immunology

Keywords: eustachian tube,upper respiratory tract infection,middle ear fluid,respiratory viruses,vaccine,influenza,adenovirus,rhinovirus,respiratory syncytial virus

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ScienceOpen disciplines: Immunology

Keywords: eustachian tube, upper respiratory tract infection, middle ear fluid, respiratory viruses, vaccine, influenza, adenovirus, rhinovirus, respiratory syncytial virus

Viral–Bacterial Interactions in Acute Otitis Media

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Most cited references 93

Live attenuated versus inactivated influenza vaccine in infants and young children.

Evidence of human coronavirus HKU1 and human bocavirus in Australian children

Diagnosis and management of acute otitis media.

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