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Prevalence of various respiratory viruses in the middle ear during acute otitis media
T Heikkinen1, M Thint, T Chonmaitree
1Department of Pediatrics, University of Texas Medical Branch, Galveston 77555-0371, USA.
Background:
Vaccines against respiratory viruses may be able to reduce the frequency of acute otitis media. Although the role of respiratory viruses in the pathogenesis of acute otitis media is well established, the relative importance of various viruses is unknown.
Methods:
We determined the prevalence of various respiratory viruses in the middle-ear fluid in 456 children (age, two months to seven years) with acute otitis media. At enrollment and after two to five days of antibiotic therapy, specimens of middle-ear fluid and nasal-wash specimens were obtained for viral and bacterial cultures and the detection of viral antigens. The viral cause of the infections was also assessed by serologic studies of serum samples obtained during the acute illness and convalescence.
Results:
A specific viral cause of the respiratory tract infections was identified in 186 of the 456 children (41 percent). Respiratory syncytial virus was the most common virus identified in middle-ear fluid: it was detected in the middle-ear fluid of 48 of the 65 children (74 percent) infected by this virus (P< or =0.04 for the comparison with any other virus). Parainfluenza viruses (15 of 29 children [52 percent]) and influenzaviruses (10 of 24 children [42 percent]) were detected in the middle-ear fluid significantly more often than enteroviruses (3 of 27 children [11 percent]) or adenoviruses (1 of 23 children [4 percent]) (P< or =0.01 for all comparisons).
Conclusion:
Respiratory syncytial virus is the principal virus invading the middle ear during acute otitis media. An effective vaccine against upper respiratory tract infections caused by respiratory syncytial virus may reduce the incidence of acute otitis media in children.
Insights
Respiratory syncytial virus is the main cause of middle ear infections in children with acute otitis media. Vaccines targeting this virus could potentially lower the occurrence of this common childhood illness.
Area of Science:
- Pediatrics
- Infectious Diseases
- Virology
Background:
- Respiratory viruses are implicated in acute otitis media pathogenesis.
- The specific contribution of each virus to acute otitis media remains unclear.
Purpose of the Study:
- To determine the prevalence of various respiratory viruses in middle-ear fluid of children with acute otitis media.
- To identify the primary viral culprits in acute otitis media.
Main Methods:
- Middle-ear fluid and nasal-wash specimens were collected from 456 children diagnosed with acute otitis media.
- Viral cultures, antigen detection, and serologic studies were performed.
- Specimens were obtained at enrollment and after antibiotic treatment.
Main Results:
- A viral cause was identified in 41% of children.
- Respiratory syncytial virus was the most prevalent virus found in middle-ear fluid (74% of RSV-infected children).
- Parainfluenza and influenza viruses were detected more frequently than enteroviruses or adenoviruses.
Conclusions:
- Respiratory syncytial virus is the leading viral pathogen in acute otitis media.
- Developing vaccines against respiratory syncytial virus may decrease the incidence of acute otitis media in pediatric populations.