The role of chronic infection in children with otitis media with effusion: evidence for intracellular persistence of bacteria.
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.
Coates
Harvey
H
Department of ENT Surgery, Princess Margaret Hospital for Children, Perth, Western Australia. harveyc@cyllene.uwa.edu.au
Thornton
Ruth
R
Langlands
Jennifer
J
Filion
Pierre
P
Keil
Anthony D
AD
Vijayasekaran
Shyan
S
Richmond
Peter
P
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