title: Viral-bacterial interactions and risk of acute otitis media complicating upper respiratory tract infection.
abstract: Acute otitis media (AOM) is a common complication of upper respiratory tract infection whose pathogenesis involves both viruses and bacteria. We examined risks of acute otitis media associated with specific combinations of respiratory viruses and acute otitis media bacterial pathogens. Data were from a prospective study of children ages 6 to 36 months and included viral and bacterial culture and quantitative PCR for respiratory syncytial virus (RSV), human bocavirus, and human metapneumovirus. Repeated-measure logistic regression was used to assess the relationship between specific viruses, bacteria, and the risk of acute otitis media complicating upper respiratory tract infection. In unadjusted analyses of data from 194 children, adenovirus, bocavirus, Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis were significantly associated with AOM (P < 0.05 by χ(2) test). Children with high respiratory syncytial virus loads (≥3.16 × 10(7) copies/ml) experienced increased acute otitis media risk. Higher viral loads of bocavirus and metapneumovirus were not significantly associated with acute otitis media. In adjusted models controlling for the presence of key viruses, bacteria, and acute otitis media risk factors, acute otitis media risk was independently associated with high RSV viral load with Streptococcus pneumoniae (odds ratio [OR], 4.40; 95% confidence interval [CI], 1.90 and 10.19) and Haemophilus influenzae (OR, 2.04; 95% CI, 1.38 and 3.02). The risk was higher for the presence of bocavirus and H. influenzae together (OR, 3.61; 95% CI, 1.90 and 6.86). Acute otitis media risk differs by the specific viruses and bacteria involved. Acute otitis media prevention efforts should consider methods for reducing infections caused by respiratory syncytial virus, bocavirus, and adenovirus in addition to acute otitis media bacterial pathogens.
authors: Yale School of Public Health, Yale School of Medicine, New Haven, CT 06520-8034, USA. melinda.pettigrew@yale.edu
authors: Melinda M
authors: MM
authors: Pettigrew
authors: Janneane F
authors: JF
authors: Gent
authors: Richard B
authors: RB
authors: Pyles
authors: Aaron L
authors: AL
authors: Miller
authors: Johanna
authors: J
authors: Nokso-Koivisto
authors: Tasnee
authors: T
authors: Chonmaitree
mesh_terms: D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D006193:Haemophilus influenzae / Q000302:isolation & purification; D056661:Human bocavirus / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D029121:Metapneumovirus / Q000302:isolation & purification; D056265:Microbial Interactions; D001936:Moraxella catarrhalis / Q000302:isolation & purification; D010033:Otitis Media / Q000453:epidemiology / Q000382:microbiology* / Q000821:virology*; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012136:Respiratory Syncytial Viruses / Q000302:isolation & purification; D012141:Respiratory Tract Infections / Q000150:complications* / Q000382:microbiology / Q000821:virology; D018570:Risk Assessment; D013296:Streptococcus pneumoniae / Q000302:isolation & purification