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Etiology of acute otitis media in human immunodeficiency virus-infected children
P Marchisio1, N Principi, S Sorella
1Pediatric Department 4, University of Milan Medical School, Italy.
Background:
Acute otitis media (AOM) is one of the most common infections that are implicated as significant contributors to morbidity in HIV-infected children. To establish the optimal antibiotic therapy tympanocentesis is indicated as the first line diagnostic procedure, because unusual pathogens may play a role in advanced stages of deficient humoral or cellular immunity.
Methods:
The microbiology of 60 episodes of AOM diagnosed in 21 symptomatic HIV-infected children (ages 9 months to 12 years) was compared with that of 121 episodes of AOM occurring in 113 immunocompetent HIV-negative children (ages 6 months to 12 years) in the last 5 years.
Results:
The prevalence of the three most common pathogens (Streptococcus pneumoniae, Haemophilus influenzae and group A beta-hemolytic Streptococcus) was similar in HIV-infected and in normal children (56.5% vs. 54.9% of the ears). Staphylococcus aureus was significantly more frequent in AOM diagnosed in severely immunosuppressed stages. A significantly lower proportion of middle ear effusions obtained in HIV-infected children yielded no bacteria compared with normal children. Beta-lactamase production among isolates of H. influenzae was a rare phenomenon, both in HIV-infected and in normal children. No penicillin-resistant S. pneumoniae was found.
Conclusions:
In HIV-infected children with absent or moderate immunosuppression empiric antibiotic therapy should be based on the recommendations given for immunocompetent children of the same geographic area. In severe immunosuppressed stages, given the possible role of Staph. aureus, extended spectrum antibiotics should be considered.
Insights
Acute otitis media (AOM) in HIV-infected children often involves similar common pathogens as in immunocompetent children. However, Staphylococcus aureus is more frequent in severe immunosuppression, necessitating adjusted antibiotic therapy.
Area of Science:
- Pediatric Infectious Diseases
- HIV/AIDS Research
- Microbiology
Background:
- Acute otitis media (AOM) is a common infection contributing to morbidity in HIV-infected children.
- Tympanocentesis is crucial for identifying pathogens, especially in advanced HIV stages with immune deficiency.
- Understanding AOM microbiology in HIV is vital for effective treatment.
Purpose of the Study:
- To compare the microbiology of AOM in HIV-infected children with that in HIV-negative children.
- To identify differences in causative pathogens and antibiotic resistance patterns.
- To inform optimal antibiotic strategies for AOM in pediatric HIV.
Main Methods:
- A comparative study analyzing middle ear fluid cultures from 60 AOM episodes in HIV-infected children and 121 in HIV-negative children.
- Microbiological analysis included pathogen identification and antibiotic resistance testing.
- Data collected over a 5-year period.
Main Results:
- Prevalence of Streptococcus pneumoniae, Haemophilus influenzae, and group A Streptococcus was similar between groups.
- Staphylococcus aureus was significantly more common in severely immunosuppressed HIV-infected children.
- Fewer sterile middle ear effusions were found in HIV-infected children; no penicillin-resistant S. pneumoniae or significant beta-lactamase production in H. influenzae was observed.
Conclusions:
- For HIV-infected children with mild to moderate immunosuppression, AOM antibiotic therapy can follow general recommendations.
- In severe immunosuppression, consider broader-spectrum antibiotics due to the increased prevalence of Staphylococcus aureus.
- Tailoring AOM treatment based on immune status is essential for pediatric HIV patients.