title: The role of chronic infection in children with otitis media with effusion: evidence for intracellular persistence of bacteria.
abstract: OBJECTIVE
  Demonstrate mucosal bacterial infection in children with otitis media with effusion (OME).
  
  
  METHODS
  Middle ear mucosal biopsies from 11 children with OME were examined for bacteria utilizing transmission electron microscopy. This was correlated with standard culture and polymerase chain reaction (PCR) of middle ear effusions.
  
  
  RESULTS
  Gram-positive coccal bacteria were demonstrated in middle ear mucosal epithelial cells of 4 of 11 (36%) children. Morphological appearance of bacteria and detection of pneumolysin DNA by PCR in middle ear fluid suggests a role for persistent intracellular infection with Streptococcus pneumoniae and other gram-positive cocci in some cases of OME.
  
  
  CONCLUSIONS
  Intracellular bacterial infection of middle ear mucosal epithelial cells in children with OME may be an important mechanism for bacterial persistence, and contribute to inflammation and mucus production in the pathogenesis of this condition.
  
  
  CONCLUSIONS
  Persistent intracellular infection is a novel paradigm for OME pathogenesis in children and may influence antibiotic effectiveness in treatment of this condition.
authors.affiliation: Department of ENT Surgery, Princess Margaret Hospital for Children, Perth, Western Australia. harveyc@cyllene.uwa.edu.au
authors.forename: Harvey
authors.initials: H
authors.lastname: Coates
authors.forename: Ruth
authors.initials: R
authors.lastname: Thornton
authors.forename: Jennifer
authors.initials: J
authors.lastname: Langlands
authors.forename: Pierre
authors.initials: P
authors.lastname: Filion
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Keil
authors.forename: Shyan
authors.initials: S
authors.lastname: Vijayasekaran
authors.forename: Peter
authors.initials: P
authors.lastname: Richmond
mesh_terms: D018441:Biofilms; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D004432:Ear, Middle / Q000382:microbiology / Q000648:ultrastructure; D005260:Female; D006095:Gram-Positive Cocci / Q000302:isolation & purification*; D006801:Humans; D042541:Intracellular Space / Q000382:microbiology* / Q000648:ultrastructure; D008297:Male; D046529:Microscopy, Electron, Transmission; D008876:Middle Ear Ventilation; D009092:Mucous Membrane / Q000382:microbiology / Q000648:ultrastructure; D010034:Otitis Media with Effusion / Q000382:microbiology* / Q000473:pathology* / Q000601:surgery; D010865:Pilot Projects