Nasopharyngeal colonization of otopathogens in South Indian children with acute otitis media - A case control pilot study
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M Napolean1, V Rosemol2, M John1
1Department of ENT, Christian Medical College, Vellore, Tamil Nadu, India.
Insights
Nasopharyngeal bacteria like Streptococcus pneumoniae and Haemophilus influenzae significantly increase the risk of acute otitis media (AOM) in young children. Co-colonization further elevates this risk, highlighting the importance of these pathogens in AOM development.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Acute otitis media (AOM) is a common childhood illness causing significant morbidity.
- Identifying risk factors, particularly nasopharyngeal otopathogens, is crucial for understanding AOM in South Indian children.
Purpose of the Study:
- To investigate the role of nasopharyngeal otopathogens as risk factors for AOM in children under six.
- To determine the prevalence of specific bacterial pathogens and their serotypes in children with AOM.
Main Methods:
- A prospective case-control pilot study involving 50 AOM cases and 45 controls.
- Nasopharyngeal swabs analyzed for bacterial culture and Streptococcus pneumoniae carriage using CDC enrichment and serotyping methods.
- Statistical analysis to identify significant risk factors for AOM.
Main Results:
- Streptococcus pneumoniae (55%) and Haemophilus influenzae (29%) were the most common otopathogens.
- Nasopharyngeal colonization with S. pneumoniae (OR 6.57) and H. influenzae (OR 14.18) were significant risk factors.
- Co-colonization significantly increased AOM risk (OR 13.89).
Conclusions:
- Nasopharyngeal otopathogen colonization is a significant risk factor for AOM, amplified by co-colonization.
- S. pneumoniae, particularly serotypes 11A and 19F, is the primary otopathogen in this population.
Background:
Acute otitis media (AOM) is an inflammatory disease of the middle ear causing significant morbidity in early childhood. A pilot study was undertaken to identify the role of various risk factors South Indian children with AOM, especially the role of nasopharyngeal otopathogens.
Methodology:
A prospective case control pilot study was conducted in children aged below six years, presenting to a single tertiary care from 2018 to 2019. Fifty cases with AOM and 45 age and gender matched controls were recruited. Two nasopharyngeal swabs were collected, one was processed for bacterial culture. The other swab was processed according to the CDC recommended broth enrichment method to identify carriage of S. pneumoniae. Subsequent serotyping was done by Quellung method and conventional sequential multiplex PCR.
Result:
Otalgia was the major presentation seen in 92% of the children with AOM. None of the clinical and demographic characteristics were found to be statistically significant between the cases and controls. The most common otopathogen was S. pneumoniae (55%) followed by H. influenza (29%). The common S. pneumoniae serotypes encountered were 11A and 19F.Nasopharyngeal colonization with S. pneumoniae [OR 6.57, p < 0.003] and H. influenzae [OR14.18, p < 0.003] were significant risk factors for AOM in children. The risk increased with co-colonization (OR 13.89,p < 0.003).
Conclusion:
This study strengthens the significant association between nasopharyngeal colonization of otopathogens and AOM as a risk factor that is enhanced by co-colonization.S. pneumoniae was the main otopathogen in this population, serotypes 11A and 19F being the most common.
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