Bacterial and Respiratory Viral Interactions in the Etiology of Acute Otitis Media in HIV-infected and HIV-uninfected South African Children.
BACKGROUND
Bacteria and respiratory viruses are implicated in the pathogenesis of acute otitis media (AOM); however, data from low-middle income countries are sparse. We investigated the etiology of AOM in HIV-infected (HIV+), HIV-uninfected (HIV-) and HIV-exposed clinically asymptomatic for HIV-infection (HEU) South African children.


METHODS
Children ≥3 months to <5 years of age with AOM were enrolled between May 2009 and April 2010 (NCT01031082). Middle ear fluid samples were cultured for bacteria; antibacterial susceptibility was done and serotyping undertaken for Streptococcus pneumoniae and Haemophilus influenzae. Nasopharyngeal aspirates were analyzed for respiratory viruses using immunofluorescence assay and polymerase chain reaction.


RESULTS
Of 260 AOM episodes (HIV+:15; HIV-:182; HEU:63), bacteria were found in 54.6%, including Haemophilus influenzae (30.8%), 98.8% of which were nontypeable, and Streptococcus pneumoniae (20.4%), Staphylococcus aureus (15.8%), Moraxella catarrhalis (5.0%) and Streptococcus pyogenes (1.5%). Nonsusceptibility of Streptococcus pneumoniae to penicillin was 64.2%. Respiratory viruses were detected in 74.2% of cases. Human rhinovirus was most frequently detected (37.7%), followed by adenovirus (14.2%) and human bocavirus (11.5%) overall and irrespective of HIV status. Respiratory viruses were identified concurrently with S. pneumoniae, H. influenzae, M. catarrhalis (76.9-78.8%) and Staphylococcus aureus (63.4%) cultured from middle ear fluid, as well as in 72.0% of episodes negative for any bacteria.


CONCLUSIONS
The study suggests that respiratory viruses and pathogenic bacteria play an important role in the development of AOM in children. A similar spectrum of pathogens was observed independently of HIV status. Vaccines targeting both nontypeable Haemophilus influenzae and S. pneumoniae may have a broad impact on AOM in South Africa.
From the *Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, †Department of Science and Technology National Research Foundation, Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; ‡National Institute for Communicable Diseases, A division of National Health Laboratory Services, Sandringham, Gauteng, South Africa; §Department of Ear, Nose and Throat Surgery, Chris Hani-Baragwanath Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; ¶GlaxoSmithKline Pharmaceuticals Ltd., Bangalore, India; and ‖GlaxoSmithKline Vaccines, Wavre, Belgium.
Shabir A
SA
Madhi
Niresha
N
Govender
Kishen
K
Dayal
Raghavendra
R
Devadiga
Melissa K
MK
Van Dyke
Nadia
N
van Niekerk
Clare Louise
CL
Cutland
Peter V
PV
Adrian
Marta C
MC
Nunes
D001419:Bacteria / Q000145:classification / Q000302:isolation & purification*; D001424:Bacterial Infections / Q000150:complications*; D002675:Child, Preschool; D005122:Exudates and Transudates / Q000382:microbiology; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007223:Infant; D008297:Male; D056265:Microbial Interactions; D009305:Nasopharynx / Q000821:virology; D010033:Otitis Media / Q000382:microbiology* / Q000821:virology*; D011446:Prospective Studies; D013019:South Africa; D014777:Virus Diseases / Q000150:complications*; D014780:Viruses / Q000145:classification / Q000302:isolation & purification*