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Cytology of middle ear fluid during acute otitis media
Arnon Broides1, Eugene Leibovitz, Ron Dagan
1Pediatric Infectious Disease Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Background:
Limited information is available on the cellular characteristics of the middle ear fluid (MEF) during acute otitis media (AOM).
Objectives:
To determine the white blood cell (WBC) composition of the MEF in AOM before and during antibiotic therapy.
Materials And Methods:
Total WBC and differential counts were determined in the MEF of 96 infants and children (ages 2 weeks to 3 years) with AOM who were receiving antibiotics. WBC counts were reported as number of WBC/mg MEF (mean +/- sd).
Results:
One hundred forty-five MEF samples were obtained by tympanocentesis at enrollment (Day 1), and 36 samples were collected on Days 4 to 5 after initiation of antibiotic therapy. Sixty-one percent of the patients were <1 year of age, and 38% were receiving antibiotic therapy at enrollment. Twenty-eight MEF samples were paired (same ear, Day 1 and Days 4 to 5). One hundred twelve pathogens were isolated from 95 of 145 (66%) culture-positive samples obtained on Day 1: 67 Haemophilus influenzae, 40 Streptococcus pneumoniae and 5 others. MEF WBC counts were lower on Day 1 in patients who had received previous antibiotic therapy than in those who had not (432.4+/- 412.8 vs. 590.5 +/- 436.8, P = 0.03). WBC counts were higher on Day 1 in culture-positive than in culture-negative samples (603.9 +/- 504.9 vs.421.4 +/- 373.4, P = 0.02). WBC counts were higher on Day 1 in MEF samples positive for S. pneumoniae than in those positive for H. influenzae (799.2 +/- 641.5 vs.506.4 +/- 401.9, P = 0.04). There were no differences in the number of neutrophil WBC present in the samples obtained on Day 1 vs. Days 4 to 5 or between samples positive vs.samples negative for bacterial pathogens.
Conclusions:
WBC counts were higher in the MEF of patients with culture-positive AOM than in those with culture-negative AOM and in those with AOM caused by S. pneumoniae.
Insights
White blood cell (WBC) counts in middle ear fluid (MEF) during acute otitis media (AOM) were higher in culture-positive cases, especially those caused by Streptococcus pneumoniae. This finding offers insight into the cellular response during AOM infection.
Area of Science:
- Otolaryngology
- Microbiology
- Pediatrics
Background:
- Limited data exists on middle ear fluid (MEF) cellular characteristics during acute otitis media (AOM).
- Understanding MEF composition is crucial for diagnosing and managing AOM.
Purpose of the Study:
- To analyze the white blood cell (WBC) differential in MEF from pediatric patients with AOM.
- To compare MEF WBC counts before and during antibiotic treatment for AOM.
Main Methods:
- Collected 145 MEF samples from 96 children (2 weeks to 3 years) with AOM.
- Performed total and differential WBC counts on MEF, with some paired samples before and during antibiotic therapy.
- Identified bacterial pathogens in MEF samples.
Main Results:
- WBC counts were higher in culture-positive AOM than culture-negative AOM (603.9 vs. 421.4 cells/mg MEF).
- MEF samples positive for Streptococcus pneumoniae showed higher WBC counts than those positive for Haemophilus influenzae (799.2 vs. 506.4 cells/mg MEF).
- Previous antibiotic therapy correlated with lower Day 1 WBC counts.
Conclusions:
- Higher WBC counts in MEF indicate bacterial infection in AOM.
- Streptococcus pneumoniae infections are associated with a more pronounced WBC response in MEF.
- WBC counts did not significantly change between Day 1 and Days 4-5 of antibiotic therapy.