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Otitis Media-associated Bacterial Meningitis in Children in a Low-income Country

Lempinen, Laura MD*; Karppinen, Mariia MD; Pelkonen, Tuula MD, PhD†,‡; Laulajainen-Hongisto, Anu MD, PhD*; Aarnisalo, Antti A. MD, PhD*; Sinkkonen, Saku T. MD, PhD*; Bernardino, Luis MD; Peltola, Heikki MD; Pitkäranta, Anne MD*; Jero, Jussi MD§

The Pediatric Infectious Disease Journal: August 2019 - Volume 38 - Issue 8 - p 791–797
doi: 10.1097/INF.0000000000002335
Original Studies

Background: Otitis media (OM) is a common childhood infection that may result in bacterial meningitis (BM). However, OM-associated BM remains poorly characterized. We aimed to study the occurrence, clinical presentation and outcome of this type of childhood BM in Luanda, Angola.

Methods: Five hundred twelve children from our previous clinical BM trial, with the ear meticulously examined, were analyzed whether they had or not OM, and according to their age, ≤12 month old and >12 month old. Prospectively collected clinical data, laboratory test results and outcome for these groups were assessed.

Results: Sixty-two children (12%) had OM-associated BM, of whom 39 had otorrhea. Ear discharge was more common in older children (median age 45 months old vs. 12 months old; P < 0.001). Children with OM often showed an additional infectious focus (n = 20, 32% vs. n = 82, 18%; P = 0.016), were dehydrated (n = 16, 26% vs. n = 66, 15%; P = 0.04), and showed higher odds of complicated clinical course or death (odds ratios 2.27, 95% CI: 1.004–5.15, P = 0.049) compared with children without OM. The >12-month-old children with OM often arrived in poor clinical condition with coma and/or ptosis. Otorrhea was associated with HIV positivity. Infants with otorrhea frequently lived under poor socioeconomic conditions.

Conclusions: Children with OM-associated BM were prone to many problems, such as being especially ill at presentation, undergoing a difficult clinical course and showing a higher risk of complicated or fatal outcome. HIV infection and malnutrition were common in children with otorrhea, which was also associated with low socioeconomic status.

From the *Department of Otorhinolaryngology, Helsinki University Hospital

Department of Pediatrics, University of Helsinki, Helsinki, Finland

Department of Pediatrics, Hospital Pediátrico David Bernardino, Luanda, Angola

§Department of Otorhinolaryngology and Head and Neck Surgery, University of Turku, Turku, Finland.

Accepted for publication February 13, 2019.

Supported by the Päivikki and Sakari Sohlberg Foundation, the Sigrid Juselius Foundation, the Paediatric Research Foundation and the daily newspaper Helsingin Sanomat. The writing of this manuscript was supported by a grant from the Sigrid Juselius Foundation, Päivikki and Sakari Sohlberg Foundation, the Paediatric Reasearche Foundation, the Finnish Association of Otorhinolaryngology and Head and Neck Surgery and Finland’s State Funding for University-level Health Research.

T.P. has received funding for another research project from Sanofi Pasteur. The other authors have no conflicts of interest to disclose.

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Address for correspondence: Laura Lempinen, MD, Department of Otorhinolaryngology, Helsinki University Hospital, Kasarmikatu 11–13, P.O. Box 220, FIN-00029 HUS, Finland. E-mail:

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