The effect of serum bactericidal antibody on colonization with NTHI was studied in 26 children. Serum bactericidal antibody did not prevent colonization with NTHI in the nasopharynx. Antibody was detected in 53% before, 91% during, and 100% after documented colonization. The log titer of antibody was significantly higher during (1.18 +/- 0.56), p less than 0.002; and after (1.31 +/- 0.29), p greater than 0.001 compared to before colonization (0.49 +/- 0.51). The roles of secretory IgA and normal nasopharyngeal flora in inhibiting pathogenic bacteria are discussed.

Nasopharyngeal colonization by nontypeable Hemophilus influenzae in children: the effect of serum bactericidal antibody.

Saffer M, Neto JFL, Piltcher OB, Petrillo VF. Chronic secretory otitis media: negative bacteriology. Acta Otolaryngol (Stockh) 1996; 116: 836-839.There is disagreement on the role of bacteria in the genesis and maintenance of chronic secretory otitis media (CSOM). Extensive studies from other countries report up to 40% of middle ear cultures with bacterial growth. For the present study, material was collected from 94 ears of children with both clinical and tympanometric diagnoses of CSOM. the samples were sent for bacteriological analysis, in there it was stained according to Gram's method and put into growing media: MacConkey (for gram-negative bacteria) and blood agar (for gram-positive bacteria) for 24 h, at 37°C. If germs were identified by Gram's method, antibiograms would be carried out as well, with the Mueller Hington medium. No cultures were made for anaerobes. Only one ear had grown bacteria (Staphylococcus epidermidis), which was deemed contamination. No other ear studied bore bacteria. the pos...

Chronic secretory otitis media: negative bacteriology.

Children with acute otitis media as the result of nontypable Haemophilus influenzae often develop serum bactericidal and/or opsonic IgG antibodies to this organism during convalescence. Outer membrane proteins appear to be the principal targets for such antibodies. In this study we characterized the IgG subclass responses to major outer membrane proteins of nontypable H. influenzae in otitis-prone children in whom this organism had colonized. Three of the major outer membrane proteins (P2, P5, and P6) were isolated from the homologous nontypable H. influenzae strain recovered from the middle ear at the time of acute infection. Sera were obtained during the acute phase and at 1 and 6 months thereafter. The outer membrane proteins, which were isolated by preparative sodium dodecylsulfate–polyacrylamide gel electrophoresis, were used as test antigens in a quantitative IgG subclass enzyme immunoassay. The results of this analysis indicate that the temporal characteristics and distribution of IgG subclass antibodies were found to differ for each of the outer membrane proteins. Moreover, substantial variation between patients was observed with respect to both temporal characteristics and subclass distribution of the IgG response to the three outer membrane proteins. Significantly, sera from two of three otitis-prone subjects contained detectable levels of IgG antibody to the conserved P6 outer membrane protein at the time of acute infection, with serum from one subject also containing detectable levels of IgG
 3 antibody to this same protein. Nevertheless, the organism persisted in the middle ears of these patients. The results of this study indicate that otitis-prone children manifest a highly variable IgG subclass response to both conserved (P6) and variable (P2) outer membrane proteins of nontypable H. influenzae . Further study is required to ascertain whether these IgG subclass antibodies are biologically efficacious and whether otitis-prone children possess the immunologic maturity to respond to nontypable H. influenzae outer membrane protein–based vaccines in a predictable manner. (Otolaryngol Head Neck Surg 1997;116:363-71.)

Immunoglobulin G subclass response to major outer membrane proteins of nontypable Haemophilus influenzae in children with acute otitis media

DR REYNOLDS: Sam is a 15-month-old child who has recurrent otitis media. He lives near Boston with his mother, father, and a healthy older brother, aged 2 years 9 months. Sam is cared for at home while his parents are at work. Born at term in October 2000 by elective repeat cesarean delivery to a healthy 37-year-old gravida 2, para 2 mother after an uncomplicated pregnancy, Sam had a normal hearing screen at birth. At the age of 5 months he had his first episode of acute otitis media, manifested by spontaneous perforation and draining of pus from the left ear. He was treated with amoxicillin, 80 mg/kg per day, and his eardrum was found intact at a subsequent visit. In May, June (twice), August, September, and November of 2001, Sam had 6 more episodes of acute otitis without perforation. His pediatrician, Dr T, noted that the diagnoses were made based on pneumatic otoscopy showing pus behind an immobile tympanic membrane when the patient was symptomatic with cold symptoms, irritability, and/or fever. Sam was treated with amoxicillin, azithromycin, and amoxicillin-clavulanate. Revisits showed a normal tympanic membrane between each episode. In early December 2001, Dr T discussed the relative merits and risks of watchful waiting, prophylactic antibiotics, and tympanostomy tube placement with Sam’s parents. At the time of the interview, Mrs G, Sam’s mother, reported that he had been taking prophylactic amoxicillin, 250 mg/d, for 1 month and had not had another acute otitis media episode. Sam’s past medical history is significant for a buckle fracture of his right radius and ulna. He has had normal growth and has achieved appropriate developmental milestones. His immunizations are up to date, including pneumococcal conjugate vaccine. His only medication is amoxicillin; he has no known drug allergies. He is not exposed to cigarette smoke. Family history is significant for first cousins on his paternal side with recurrent otitis media. Physical examination showed a healthy 15-month-old boy. His weight was 22 lb 14 oz (25th percentile), length 31.5 in (50th percentile), and head circumference 19.75 in (95th percentile). His ear examination results were normal by pneumatic otoscopy bilaterally. Sam has not had a hearing test since birth. His IgG level was borderline low when tested in September 2001 at 288 mg/dL (normal for age, 300-1500 mg/dL); his IgA level was also at the lower limit of normal. His parents are frustrated by his recurrent ear infections and hope that the prophylactic antibiotics prevent future infections.

https://jamanetwork.com/journals/jama/articlepdf/195564/JXR20005.pdf

A 15-month-old child with recurrent otitis media.

Moraxella (Branhaomella) catarrhalis is frequently present in the nasopharyngeal microflora of small children, especially during episodes of acute otitis media . By means of ribotyping (restriction endonuclease analysis of chromosomal DNA combined with rRNA probing), we studied the genetic heterogeneity of 78 cultures of M. catarrhalis obtained from different localities in the nasopharynx of nine young children with secretory otitis media. Using HindIII and PstI as endonucleases, five different ribotypes were recognized, representing at least five different genotypes of M. catarrhalis. The distribution of these types was found to be almost identical to the distribution among 16 M. catarrhalis strains cultured from middle ear exudates of 16 children with acute otitis media. Ribotype HAPA was found in two-thirds of all the cultures investigated, and 44% of the children harboured more than one ribotype in the nasopharynx at the same time. The vast majority of the nasopharyngeal M. catarrhalis cultures were beta-lactamase positive. One child had both a HAPA ribotype, beta-lactamase-negative strain in the nasopharyngeal secretions, and HAPA ribotype, beta-lactamase-positive strains at the entrance of the eustachian tube, the nasopharyngeal tonsils, the folds of the nasopharyngeal tonsils and the oropharynx. All except one of the M. catarrhalis strains cultured from middle ear exudates were beta-lactamase positive.

Ribotyping of Strains of Moraxella (Branhamella) Catarrhalis Cultured from the Nasopharynx and Middle Ear of Children with Otitis Media

During 1983-87, tympanostomy tubes were inserted in a total of 4952 ears of 2575 children remitted to the ENT Department of our hospital because of chronic or recurrent otitis media problems. The children were included in a prospective study and referred to one of three groups for comparison of findings. Group 1 included all 6- to 12-month-old infants undergoing primary tube treatment; group 2, all children 1 year or older who had their first ventilation tube(s) inserted in connection with adenoidectomy; and group 3, all children in whom tympanostomy had been performed one or more times previously. Middle ear effusion was aspirated from 2392 ears (48%); 67.6% of all ears were negative for bacteria and 22.1% of the ears with effusion grew pathogenic bacteria. S. pneumoniae was the most frequently cultured pathogen among the 6 to 12 month olds in group 1, but in groups 2 and 3 H. influenzae occurred more frequently than S. pneumoniae. Beta-lactamase-producing strains of pathogenic bacteria were formed in only 4% of all ears with effusion: H. influenzae in 1.2% and B. catarrhalis in 2.8%. Compared with figures from the United states, the frequency of beta-lactamase-producing strains is low in the present series. This is probably explained by differences in antimicrobial treatment practices; in Finland and the Scandinavian countries, penicillin V is the primary drug for acute otitis media. In light of present results, it seems well-suited for treatment of otitis media in young children.

Bacterial findings in middle ear effusion in children.

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Bacterial findings in middle ear effusion in children.