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Comprehensive Detection of Respiratory Bacterial and Viral Pathogens in the Middle Ear Fluid and Nasopharynx of Pediatric Patients With Acute Otitis Media

Sawada, Shoichi MD*; Okutani, Fumino MD; Kobayashi, Taisuke MD

The Pediatric Infectious Disease Journal: December 2019 - Volume 38 - Issue 12 - p 1199–1203
doi: 10.1097/INF.0000000000002486
Original Studies

Background: Acute otitis media (AOM) is a common ear infection caused by respiratory viruses and bacteria of the nasopharynx. The present study aimed to detect various respiratory viruses and bacteria in middle ear fluid (MEF) and nasopharyngeal aspirates (NPA) using polymerase chain reaction (PCR).

Methods: We collected MEF and NPA samples from 122 pediatric patients with AOM. Real-time PCR detected 11 types of respiratory viruses (respiratory syncytial virus A/B, parainfluenza virus 1/2/3, human metapneumovirus, influenza virus A/B, adenovirus, human bocavirus and rhino virus) and 7 types of bacteria (Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydia pneumoniae, Streptococcus pyogenes, Legionella pneumophila and Moraxella catarrhalis). MEF specimens were also examined using bacterial culture.

Results: At least 1 respiratory viral or bacterial pathogen was detected in MEF of 120 cases (98%) by viral and bacterial PCR and of 93 cases (76%) by viral PCR and bacterial culture. Respiratory viruses were detected in NPA of 84 cases (69%) and MEF of 67 cases (55%). The most common virus detected in MEF was respiratory syncytial virus (21%), followed by parainfluenza virus (15%). All the viruses present in MEF were also detected in NPA specimens. Bacteria were detected by PCR in MEF of 109 cases (89%); H. influenzae was the most frequently detected (65%).

Conclusions: In many cases, pediatric AOM was found to constitute a respiratory polymicrobial infection. Multiplex PCR was useful to detect multiple respiratory viruses and bacteria in AOM. To understand intractable AOM, further studies regarding the clinical features of each viral and bacterial coinfection are required.

From the *Sawada Eye and Ear Clinic, Kochi City, Kochi, Japan

Graduate School of Health and Nursing Sciences

Department of Otolaryngology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan.

Accepted for publication August 19, 2019.

The authors have no funding or conflicts of interest to disclose.

Address for correspondence: Shoichi Sawada, MD, Sawada Eye and Ear Clinic, 1734-5 Fukuicho, Kochi City, Kochi 780-0965, Japan. E-mail:

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.