title: Association of clinical signs and symptoms with bacterial findings in acute otitis media.
abstract: In acute otitis media (AOM), a means of prediction of the bacterial pathogen based on symptoms and signs would be valuable in selecting appropriate antimicrobial treatment. Children in the control arm (n=831) in the Finnish Otitis Media Vaccine Trial were prospectively observed in a study clinic setting from the age of 2 to 24 months. In patients with AOM, myringotomy with aspiration was performed, and middle ear fluid samples were cultured for bacterial pathogens. Symptoms and signs of respiratory infections were thoroughly recorded. Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus influenzae were the most common bacterial pathogens. Pneumococcal AOM was associated with more-severe AOM characterized by fever and earache. AOM due to H. influenzae was associated with eye symptoms and findings. Accurate prediction of a bacterial cause of infection based on symptoms and signs of AOM was not possible, but a specific cause was predicted in some situations, with a high probability of applicability to clinical practice.
authors.affiliation: National Public Health Institute, Helsinki, Finland. arto.palmu@ktl.fi
authors.forename: Arto A I
authors.initials: AA
authors.lastname: Palmu
authors.forename: Elja
authors.initials: E
authors.lastname: Herva
authors.forename: Heljä
authors.initials: H
authors.lastname: Savolainen
authors.forename: Pekka
authors.initials: P
authors.lastname: Karma
authors.forename: P Helena
authors.initials: PH
authors.lastname: Mäkelä
authors.forename: Terhi M
authors.initials: TM
authors.lastname: Kilpi
mesh_terms: D000208:Acute Disease; D002648:Child; D005260:Female; D006193:Haemophilus influenzae; D017325:Hepatitis B Vaccines / Q000008:administration & dosage; D006801:Humans; D008297:Male; D001936:Moraxella catarrhalis; D010033:Otitis Media / Q000382:microbiology* / Q000503:physiopathology / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000008:administration & dosage; D011237:Predictive Value of Tests; D013296:Streptococcus pneumoniae
chemical_list: D017325:Hepatitis B Vaccines; D022242:Pneumococcal Vaccines