Yale University

Viral-bacterial interactions and risk of acute otitis media complicating upper respiratory tract infection.

TitleViral-bacterial interactions and risk of acute otitis media complicating upper respiratory tract infection.
Publication TypeJournal Article
Year of Publication2011
AuthorsPettigrew, Melinda M., Janneane F. Gent, Richard B. Pyles, Aaron L. Miller, Johanna Nokso-Koivisto, and Tasnee Chonmaitree
JournalJournal of clinical microbiology
Date Published2011 Nov
KeywordsChild, Preschool, Cohort Studies, Comorbidity, Haemophilus influenzae, Human bocavirus, Humans, Infant, Metapneumovirus, Microbial Interactions, Moraxella (Branhamella) catarrhalis, Otitis Media, Polymerase Chain Reaction, Prospective Studies, Respiratory Syncytial Viruses, Respiratory Tract Infections, Risk Assessment, Streptococcus pneumoniae
AbstractAcute 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 χ(2) test). Children with high respiratory syncytial virus loads (≥3.16 × 10(7) copies/ml) experienced increased acute otitis media risk. Higher viral loads of bocavirus and metapneumovirus were not significantly associated with acute otitis media. In adjusted models controlling for the presence of key viruses, bacteria, and acute otitis media risk factors, acute otitis media risk was independently associated with high RSV viral load with Streptococcus pneumoniae (odds ratio [OR], 4.40; 95% confidence interval [CI], 1.90 and 10.19) and Haemophilus influenzae (OR, 2.04; 95% CI, 1.38 and 3.02). The risk was higher for the presence of bocavirus and H. influenzae together (OR, 3.61; 95% CI, 1.90 and 6.86). Acute otitis media risk differs by the specific viruses and bacteria involved. Acute otitis media prevention efforts should consider methods for reducing infections caused by respiratory syncytial virus, bocavirus, and adenovirus in addition to acute otitis media bacterial pathogens.
Alternate JournalJ. Clin. Microbiol.

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