1
|
Simões EAF, Carosone-Link P, Sanvictores DM, Uhler KM, Lucero M, Tallo V, Chan KH. Otitis media sequelae and hearing in adolescence after administration of an 11-valent conjugate pneumococcal vaccine in infancy: a prospective cohort study with long-term follow-up of the ARIVAC trial. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:647-655. [PMID: 39096922 PMCID: PMC11319240 DOI: 10.1016/s2352-4642(24)00128-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND Pneumococcal conjugate vaccines (PCVs) have been shown in randomised controlled trials and epidemiological studies to prevent acute otitis media caused by vaccine serotype pneumococci, although their role in preventing complications of acute otitis media is less clear. We hypothesised that the 11-valent PCV would reduce the long-term sequelae of acute otitis media, including moderate-to-severe ear disease and hearing loss. METHODS This prospective cohort study, referred to as 11PCV study, included follow-up after 16-20 years of children previously enrolled in 2000-04, at age 6 weeks to 6 months, in the randomised, placebo-controlled, ARIVAC trial of 11-valent PCV for the prevention of radiographical pneumonia. The ARIVAC trial and this 11PCV study were conducted at six study centres in Bohol, Philippines. Ear disease was classified using video-otoscopy review and observations derived from the ear exam. The final classification of the worst ear disease was mild (ie, acute otitis media, otitis media with effusion, healed perforation, or tympanosclerosis), moderate (ie, dry perforation or adhesive otitis media), or severe (chronic suppurative otitis media). Hearing loss was assessed following a standard schema and classified according to the worst ear as mild (>15 to 30 dB puretone average) or moderate-to-profound (>30 dB pure tone average). We calculated the relative and absolute risk reduction in the primary outcome of moderate-to-severe ear disease and the secondary outcomes of mild or moderate-to-profound hearing loss in adolescents who previously received the 11-valent PCV compared with those who received placebo during infancy in ARIVAC. FINDINGS Of the 15 593 children assessed for eligibility in ARIVAC, 12 194 were randomly assigned and 8926 were alive and could be located for enrolment in this 11PCV study between Sept 19, 2016, and Dec 13, 2019. 8321 (4188 in the vaccine group and 4133 in the placebo group) completed follow-up of the 11PCV study by March 30, 2020, and had sufficient data to classify ear disease and be included in the primary outcome analysis. The primary outcome of the absolute risk reduction in moderate-to-severe ear disease in the vaccine group (310 [7·4%] of 4188) versus those in the placebo group (356 [8·6%] of 4133) was 1·2% (95% CI 0·0-2·4; p=0·046) and the relative risk reduction was 14·1% (0·0 to 26·0). There were no differences in secondary outcomes of mild hearing loss or moderate-to-profound hearing loss between the vaccine and placebo groups. INTERPRETATION The absolute risk reduction for moderate-to-severe ear disease in adolescence of 1·2% (12 per 1000 children) was almost three times higher than the 0·45% reduction (4·5 per 1000 children) in radiographical pneumonia in the first 2 years of life shown in ARIVAC. Administration of 11-valent PCV in infancy was associated with absolute and relative risk reductions in the sequelae of acute otitis media 16-20 years after the original ARIVAC trial. FUNDING Bill & Melinda Gates Foundation.
Collapse
Affiliation(s)
- Eric A F Simões
- Department of Epidemiology, Center for Global Health, Colorado School of Public Health, Aurora, CO, USA; Department of Pediatrics, Children's Hospital Colorado, Aurora, CO, USA; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Phyllis Carosone-Link
- Department of Pediatrics, Children's Hospital Colorado, Aurora, CO, USA; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Diozele M Sanvictores
- Department of Clinical Trials, Epidemiology, and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Kristin M Uhler
- Department of Pediatric Otorhinolaryngology, Children's Hospital Colorado, Aurora, CO, USA; Department of Audiology, Speech-Pathology, and Learning, Children's Hospital Colorado, Aurora, CO, USA; Department of Otorhinolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, USA
| | - Marilla Lucero
- Department of Clinical Trials, Epidemiology, and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Veronica Tallo
- Department of Clinical Trials, Epidemiology, and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Kenny H Chan
- Department of Pediatric Otorhinolaryngology, Children's Hospital Colorado, Aurora, CO, USA; Department of Otorhinolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| |
Collapse
|
2
|
Wu P, Cao X, Zhang R, Liu Y, Li H, Wang W, Li W. The long-term efficacy and safety of balloon dilation eustachian tuboplasty combined with tympanostomy tube insertion for patients with otitis media with effusion: study protocol for a prospective randomized controlled trial. Trials 2024; 25:572. [PMID: 39210408 PMCID: PMC11363521 DOI: 10.1186/s13063-024-08405-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 08/16/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Otitis media with effusion (OME) is a common disease in ear, nose, and throat clinics characterized by aural fullness and hearing loss and mainly caused by eustachian tube dysfunction (ETD). Tympanostomy tube insertion (TTI) is a conventional surgical treatment option that can alleviate symptoms but does not provide a definitive cure, and it is prone to recurrence. Balloon dilation eustachian tuboplasty (BDET) has become a novel procedure for the treatment of ETD, demonstrating significant potential in addressing the aforementioned limitations. However, it is not widely available in the clinic and few high-quality randomized clinical trials was conducted to investigate its long-term efficacy and security in OME. Therefore, the purpose of this study is to verify the efficacy of BDET combined with TTI for patients with OME and its prospects for providing a definitive cure. METHODS AND ANALYSIS This is a prospective, parallel-group, single-blind, randomized controlled prospective trial. Totally 124 patients with OME will be randomized into either group A or B. Group A will receive conventional therapy (TTI) while group B will use BDET therapy in addition to TTI. Outcome assessments will take place at baseline and at the 3rd, 6th, 12th, and 24th months after surgery. The primary outcome is eustachian tube function, which will be measured by the eustachian tube dysfunction questionnaire (ETDQ-7) and eustachian tube score (ETS). The secondary outcomes include middle ear function, hearing situation, and quality of life, which will be measured by acoustic impedance measurement, pure-tone audiometry, and Chinese-version Chronic Ear Survey (CCES). The main analysis of change in the outcomes will use mixed-model with repeated measures (MMRM) analyses of variance (ANOVAs). DISCUSSION This is the first prospective trial in Chinese populations that aims to validate the long-term efficacy and safety of BDET-combined TTI therapy in patients with OME. This parallel-group, single-blind, randomized controlled trial may provide an opportunity to decrease the recurrence rate of OME and explore a definitive cure for patients with OME. This trial's rigorous design enhances the reliability of the findings, ensuring a robust answer to the research question. In the future, the research team will further expand upon the clinical evidence and applications of the BDET combined therapy. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2400079632. Registered on 8 January 2024, https://www.chictr.org.cn/bin/project/edit?pid=214452 .
Collapse
Affiliation(s)
- Peixia Wu
- Vertigo and Balance Disorder Center, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
- Department of Nursing, Eye and ENT Hospital of Fudan University, Shanghai, China.
| | - Xuejiao Cao
- School of Nursing, Fudan University, Shanghai, China
| | - Ruiqi Zhang
- School of Nursing, Fudan University, Shanghai, China
| | - Yaoqian Liu
- Department of Otorhinolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Huawei Li
- Department of Otorhinolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, China
- The Institutes of Brain Science and the Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Wuqing Wang
- Department of Otorhinolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Wenyan Li
- Department of Otorhinolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, China
- The Institutes of Brain Science and the Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
| |
Collapse
|
3
|
Robinson M, Burgner D, Lin A, Jacoby P, Eikelboom R, Vijayasekaran S, Brennan-Jones CG. Risk of otitis media in offspring following maternal prenatal stress exposure. Int J Pediatr Otorhinolaryngol 2024; 182:112022. [PMID: 38941719 DOI: 10.1016/j.ijporl.2024.112022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/12/2024] [Accepted: 06/23/2024] [Indexed: 06/30/2024]
Abstract
OBJECTIVES There is limited but consistent evidence that suggests prenatal factors, including maternal stress, may contribute to susceptibility for otitis media. We aimed to determine the effect of multiple life stress events during pregnancy on risk of acute and recurrent otitis media in offspring at three and five years of age. METHODS Exposure data on stressful life events were collected from pregnant women in a longitudinal prospective pregnancy cohort study, at 18 and 34 weeks' gestation. We used longitudinal regression models stratified by offspring sex to examine associations between the number, type and timing of maternal prenatal stress events and the likelihood of any OM in addition to recurrent OM infection at age three and five years, adjusting for pre-specified prenatal sociodemographic and environmental confounders. RESULTS Each additional stressful life event in pregnancy was associated with increased risk of any OM at both ages (3 years: OR = 1.07, 95%CI = 1.02, 1.12; 5 years: OR = 1.07, 95%CI = 1.02, 1.12), with larger effect sizes for recurrent otitis media (3 years: OR = 1.11, 95%CI = 1.05, 1.17; 5 years: OR = 1.09, 95%CI = 1.04, 1.14). Risk of offspring otitis media did not differ with timing of stress nor by offspring sex. Specific types of stress (pregnancy and relationship problems, issues with other children) were each associated with increased risk of recurrent OM at age three and five years. CONCLUSIONS We observed a dose-response relationship between maternal stressful life events in pregnancy and the risk for offspring otitis media in the preschool years, most marked for recurrent otitis media.
Collapse
Affiliation(s)
- Monique Robinson
- Telethon Kids Institute, The University of Western Australia, Australia.
| | - David Burgner
- Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia; Department of Paediatrics, Monash University, Clayton, Australia
| | - Ashleigh Lin
- School of Population and Global Health, The University of Western Australia, Australia
| | - Peter Jacoby
- Telethon Kids Institute, The University of Western Australia, Australia
| | - Robert Eikelboom
- Ear Sciences Centre, Medical School, The University of Western Australia, Australia; Ear Science Institute Australia, Perth, Australia; Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa; Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Shyan Vijayasekaran
- Perth ENT Centre, Perth, Australia; Otolaryngology Head and Neck Surgery, Perth Children's Hospital, Perth, Australia; Medical School, The University of Western Australia, Australia
| | | |
Collapse
|
4
|
Alnifaee NS, Althubaiti RF, Almatrafi MK, Alotaibi TA, Almjnouni GG, Sadakah GK, Khojah AM. Parental Knowledge, Attitudes, and Practices Towards Pediatric Ear Infections in the Makkah Region of Saudi Arabia: A Cross-Sectional Study. Cureus 2024; 16:e61990. [PMID: 38989347 PMCID: PMC11233199 DOI: 10.7759/cureus.61990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Pediatric ear infections constitute a significant public health concern worldwide, adversely impacting children's health and well-being. Parents play a crucial role in prevention, ensuring timely healthcare access, and therefore minimizing potential complications. This study aims to assess parental knowledge, attitudes, and practices towards pediatric ear infections in Makkah region. METHODOLOGY A descriptive cross-sectional study was conducted among Saudi parents who were ≥18 years old and lived in Makkah region. Convenience sampling was used to recruit 319 participants through social media platforms; data were collected from June to September 2023 via an online self-administered questionnaire. The questionnaire assessed sociodemographic characteristics, along with knowledge, attitudes, and practices related to pediatric ear infections. RESULTS A total of 319 parents were included in the study. The majority of the participants were female 228 (71.5%), and 208 (65.2%) had a university education level. The most common age groups were 18-30 years and 31-40 years. More than half of the participants (167, 52.4%) demonstrated adequate knowledge regarding pediatric ear infections. Positive attitudes and practices were reported by 183 (57.4%) and 285 (89.3%) of participants, respectively. Adequate knowledge was significantly higher among participants with younger ages (p<0.05). It was found that having a younger age (18-30 years) was an independent predictor of good knowledge (OR: 1.26 (1.96-3.65), p=0.009) and positive practice (OR: 1.53 (1.01-2.33), p=0.045). CONCLUSION We found that the majority of parents in Makkah region had a good level of knowledge regarding childhood ear infections, with an overall positive attitude and practice. The study revealed that younger parents had superior knowledge and younger age was an independent predictor for good knowledge and positive attitude.
Collapse
Affiliation(s)
| | | | - Maha K Almatrafi
- College of Medicine and Surgery, Umm Al-Qura University, Makkah, SAU
| | - Turki A Alotaibi
- College of Medicine and Surgery, Umm Al-Qura University, Makkah, SAU
| | | | - Ghadir K Sadakah
- College of Medicine and Surgery, Umm Al-Qura University, Makkah, SAU
| | - Amer M Khojah
- Department of Pediatrics, College of Medicine and Surgery, Umm Al-Qura University, Makkah, SAU
| |
Collapse
|
5
|
Landwehr KR, Granland CM, Martinovich KM, Scott NM, Seppanen EJ, Berry L, Strickland D, Fulurija A, Richmond PC, Kirkham LAS. An infant mouse model of influenza-driven nontypeable Haemophilus influenzae colonization and acute otitis media suitable for preclinical testing of novel therapies. Infect Immun 2024; 92:e0045323. [PMID: 38602405 DOI: 10.1128/iai.00453-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 03/13/2024] [Indexed: 04/12/2024] Open
Abstract
Nontypeable Haemophilus influenzae (NTHi) is a major otitis media (OM) pathogen, with colonization a prerequisite for disease development. Most acute OM is in children <5 years old, with recurrent and chronic OM impacting hearing and learning. Therapies to prevent NTHi colonization and/or disease are needed, especially for young children. Respiratory viruses are implicated in driving the development of bacterial OM in children. We have developed an infant mouse model of influenza-driven NTHi OM, as a preclinical tool for the evaluation of safety and efficacy of clinical therapies to prevent NTHi colonization and the development of OM. In this model, 100% of infant BALB/cARC mice were colonized with NTHi, and all developed NTHi OM. Influenza A virus (IAV) facilitated the establishment of dense (1 × 105 CFU/mL) and long-lasting (6 days) NTHi colonization. IAV was essential for the development of NTHi OM, with 100% of mice in the IAV/NTHi group developing NTHi OM compared with 8% of mice in the NTHi only group. Histological analysis and cytokine measurements revealed that the inflammation observed in the middle ear of the infant mice with OM reflected inflammation observed in children with OM. We have developed the first infant mouse model of NTHi colonization and OM. This ascension model uses influenza-driven establishment of OM and reflects the clinical pathology of bacterial OM developing after a respiratory virus infection. This model provides a valuable tool for testing therapies to prevent or treat NTHi colonization and disease in young children.
Collapse
Affiliation(s)
- Katherine R Landwehr
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
- School of Population Health, Curtin University, Perth, Australia
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, Australia
| | - Caitlyn M Granland
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
| | - Kelly M Martinovich
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
- Centre for Child Health Research, University of Western Australia, Perth, Australia
| | - Naomi M Scott
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
| | - Elke J Seppanen
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
| | - Luke Berry
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, Australia
| | - Deborah Strickland
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, Australia
- Centre for Child Health Research, University of Western Australia, Perth, Australia
| | - Alma Fulurija
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
- Centre for Child Health Research, University of Western Australia, Perth, Australia
| | - Peter C Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
- Department of Paediatrics, School of Medicine, University of Western Australia, Perth, Australia
- Department of Immunology, Perth Children's Hospital, Child and Adolescent Health Service, Perth, Australia
| | - Lea-Ann S Kirkham
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
- Centre for Child Health Research, University of Western Australia, Perth, Australia
| |
Collapse
|
6
|
Jin Y, Yang X, Sun H, Zhang J, Yang S, Jiang S, Song Q, Zhang G, Ma B, Yang K, Pan L, Huang L, Li Y. Global, Regional, and National Burdens of Otitis Media From 1990 to 2019: A Population Based Study. Ear Hear 2024; 45:658-665. [PMID: 38178304 PMCID: PMC11008441 DOI: 10.1097/aud.0000000000001453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 11/05/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVES Otitis media is one of the most important causes of hearing loss at an early age. Effective vaccination with the routine 7-valent pneumococcal conjugate vaccine (PCV-7) was introduced in 2000. It has been gradually replaced by the pneumococcal nontypeable Haemophilus influenzae protein D conjugate vaccine or the higher-valent 13-valent PCV (PCV-13) since 2010. Data on the change in otitis media burden in recent years are sparse at the global, regional, and national levels. DESIGN The Global Burden of Disease 2019 study was used to evaluate the prevalence, incidence, mortality, disability-adjusted life year (DALY) rates, and the average annual percentage changes (AAPCs) in otitis media in geographic populations worldwide from 1990 to 2019. These global trends were further analyzed by subgroup (age, sex, and sociodemographic index [SDI]). RESULTS Globally, the all-age rate of prevalence (AAPC = -0.7, 95% confidence interval [CI] = -0.7 to -0.8), DALYs (AAPC = -1.0, 95% CI = -1.1 to -1.0), and mortality (AAPC = -6.8, 95% CI = -7.3 to -6.4) from otitis media decreased constantly between 1990 and 2019. The all-age rate of incidence decreased sharply between 2000 and 2009 with an AAPC of -1.2 (95% CI = -1.4 to -0.9) and continued the downward trend between 2010 and 2019 (AAPC = -0.2, 95% CI = -0.3 to -0.1). In 2019, children aged 1 to 4 years old had the highest incidence at 29,127.3 per 100,000 population, while young adults under 30 years old accounted for 91.3% of the incident cases. Individuals living in middle-SDI countries had the largest increase in the incidence of otitis media, with an AAPC of 0.3 (95% CI = 0.3 to 0.3) between 1990 and 2019. The incidence and DALYs from otitis media decreased with increasing SDI. Regionally, the largest increase in incidence was observed in high-income Asia Pacific, Eastern Europe, and Western Sub-Saharan Africa between 1990 and 2019. Nationally, the largest increase in the incidence of otitis media was observed in the Republic of Korea, with an AAPC of 0.8 (95% CI = 0.6 to 1.1) in the same time period. CONCLUSIONS There have been successful previous endeavors to reduce DALYs and mortality attributed to otitis media on a global scale. The worldwide incidence of otitis media experienced a sharp decline following the introduction of PCV-7 in 2000, and this downward trend persisted in subsequent years with the adoption of PCV-13/pneumococcal nontypeable Haemophilus influenzae protein D conjugate vaccine. Continual epidemiological surveillance of otitis media's global trends, pathogen distribution, and resistance patterns remains imperative.
Collapse
Affiliation(s)
- Yan Jin
- Department of Emergency, The First Hospital of China Medical University, Shenyang, China
- These authors contributed equally to this work
| | - Xue Yang
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Disease, The First Hospital of China Medical University, Shenyang, China
- These authors contributed equally to this work
| | - Hao Sun
- Department of Clinical Epidemiology and Evidence-based Medicine, The First Hospital of China Medical University, Shenyang, China
- These authors contributed equally to this work
| | - Jing Zhang
- Department of Biostatistics and Epidemiology, School of Public Health, Health Science Center, Shenzhen University, Shenzhen, China
- These authors contributed equally to this work
| | - Shize Yang
- Department of Thoracic Surgery, The First Hospital of China Medical University, Shenyang, China
- These authors contributed equally to this work
| | - Shuyi Jiang
- Department of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China
- These authors contributed equally to this work
| | - Qingbin Song
- Department of Vascular and Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
- These authors contributed equally to this work
| | - Guofeng Zhang
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Disease, The First Hospital of China Medical University, Shenyang, China
- These authors contributed equally to this work
| | - Bing Ma
- Department of Clinical Epidemiology and Evidence-based Medicine, The First Hospital of China Medical University, Shenyang, China
- These authors contributed equally to this work
| | - Kaijie Yang
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Disease, The First Hospital of China Medical University, Shenyang, China
| | - Leilei Pan
- Department of Noncommunicable Chronic Disease Prevention, Liaoning Provincial Center for Disease Prevention and Control, Shenyang, China
| | - Longping Huang
- Department of General Surgery, Hepatobiliary Surgery, The Fourth People’s Hospital of Shenyang, Shenyang, China
| | - Yongze Li
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Disease, The First Hospital of China Medical University, Shenyang, China
| |
Collapse
|
7
|
Akhlaghi A, Hashemi SB, Hamidi A, Khosravi A, Jahangiri R. Exploring the OTITIS Research Landscape Through a Scientometric Approach. Indian J Otolaryngol Head Neck Surg 2024; 76:1697-1710. [PMID: 38566640 PMCID: PMC10982269 DOI: 10.1007/s12070-023-04387-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 11/18/2023] [Indexed: 04/04/2024] Open
Abstract
Otitis media is a common health problem affecting people of all ages and significantly impacting public health and healthcare costs. Otitis media, a type of middle ear disease, is one of the most common types. This scientometric study aimed to provide an overview of the knowledge domain in otitis media research. Documents were retrieved from the Web of Science database. A scientometric study was then performed on a sample of 27,213 documents. This study found that research on otitis media has increased significantly in recent years, with an annual growth rate of 4.58%. The average age of the documents analyzed was 18 years, with an average of 21.88 citations and an average of 4.58 authors. The United States, the United Kingdom, and Japan ranked first to third in terms of number of publications. Still, the United States, China, and Sweden were in a better position in terms of impact on the research network. Co-occurrence word analysis showed that significant attention was given to topics such as chronic inflammation in autism, acute inflammation in otitis media, and increased fluid in the middle ear. This study highlights the need to prioritize and focus attention on otitis, particularly otitis media, due to its prevalence and impact on public health. The use of scientometric software, such as Biblioshiny and CiteSpace, provides a valuable means of assessing research trends and identifying important areas for future study in the field of knowledge.
Collapse
Affiliation(s)
- Allahkaram Akhlaghi
- Department of Otolaryngology, Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Basir Hashemi
- Department of Otolaryngology, Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Hamidi
- Department of Medical Library and Information Sciences, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Abdolrasool Khosravi
- Department of Medical Library and Information Sciences, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Reza Jahangiri
- Department of Otolaryngology, Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
8
|
Njuma Libwea J, Ngomba VA, Taku NA, Ndongo CB, Ngono Noah BD, Fointama N, Kobela M, Huhtala H, Epee E, Koulla-Shiro S, Ndombo PK. Prevalence of prolonged otitis media with effusion among 2 to 3 years old Cameroonian children in the era of 13-valent pneumococcal conjugate vaccines. IJID REGIONS 2024; 10:240-247. [PMID: 38532743 PMCID: PMC10964058 DOI: 10.1016/j.ijregi.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 11/08/2023] [Accepted: 11/12/2023] [Indexed: 03/28/2024]
Abstract
Objectives There is data scarcity on the overall effects of pneumococcal conjugate vaccines (PCVs) on otitis media (OM) in low- and middle-income countries. The impact of the 13-valent PCV (PCV13) program on OM was evaluated in Cameroon where infant vaccination was implemented in July 2011 using a 3-dose primary series at 6, 10 and 14 weeks of age. Methods Through community-based surveillance, we used a retrospective cohort study design to assess OM prevalence among PCV13-vaccinated children aged 24 to 36 months in 2015. This was compared with a 2013 age-matched cohort of PCV13-unvaccinated children. OM was diagnosed by clinical inspection for chronic suppurative OM (CSOM) and tympanometry for OM with effusion (OME). CSOM was defined as draining of the middle ear with duration of more than 2 weeks and prolonged OME was defined as a flat 'type B' tympanogram. PCV13-vaccinated and PCV13-unvaccinated cohorts were compared by calculating prevalence odds ratios for OM and baseline characteristics. Results Altogether, 111 OM cases were identified; 42/433 (9.7%) in the PCV13-unvaccinated in 2013 and 69/413 (16.7%) in the PCV13-vaccinated cohort in 2015. In the 2013 baseline survey, 3/433 (0.7%) children were identified with unilateral CSOM compared to 9/413 (2.2%) in the PCV13-vaccinated cohort in 2015. Bilateral prolonged OME was diagnosed in 7/433 (1.6%) PCV13-unvaccinated children and in 12/413 (2.9%) in PCV13-vaccinated children. Proportions of children with unilateral prolonged OME were 31/433 (7.2%) in the PCV13-unvaccinated group compared with 48/413 (11.6%) in the PCV13-vaccinated group. Multivariate logistic regression analysis showed evidence that PCV13-vaccinated children in 2015 had 40% less risk of contracting OM compared to PCV13-unvaccinated children in 2013 (adjusted prevalence odds ratios = 0.60 [95% confidence interval: 0.38 to 0.94], P = 0.025). Additionally, attributable proportion estimates show that, 58% of OM infections among the PCV13-vaccinated group would still have occurred despite PCV13 vaccination. Conclusion Our findings provide significant evidence on the effect of PCV13 in decreasing OM or OME among children in this age group. It also supports justification for government's continuation of PCV13 immunization program in the absence of GAVI's funding. Further research is needed to assess the long-term impact of the PCV13 program on in OM Cameroon.
Collapse
Affiliation(s)
- John Njuma Libwea
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland
- Expanded Programme on Immunization, Yaoundé, Cameroon
- Directorate for disease control, epidemics and pandemics, Ministry of Public Health, Yaoundé, Cameroon
| | - Viviane Armelle Ngomba
- Directorate for disease control, epidemics and pandemics, Ministry of Public Health, Yaoundé, Cameroon
| | - Nadesh Ashukem Taku
- Mother & Child Centre (MCH), Chantal Biya Foundation, Yaoundé, Cameroon
- Faculty of Sciences, Department of Microbiology, University of Buea, Buea, Cameroon
| | | | | | - Ninying Fointama
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Marie Kobela
- Expanded Programme on Immunization, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Heini Huhtala
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Emilienne Epee
- Directorate for disease control, epidemics and pandemics, Ministry of Public Health, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Sinata Koulla-Shiro
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Paul Koki Ndombo
- Mother & Child Centre (MCH), Chantal Biya Foundation, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| |
Collapse
|
9
|
Ben-Shoshan M. Extended- or Single-Day Drug Challenge, That Is the Question. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:449-450. [PMID: 38336397 DOI: 10.1016/j.jaip.2023.11.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Moshe Ben-Shoshan
- Division of Allergy, Immunology and Dermatology, Montreal Children's Hospital, Montreal, QC, Canada.
| |
Collapse
|
10
|
Voß N, Sadok N, Goretzki S, Dohna-Schwake C, Meyer MF, Mattheis S, Lang S, Stähr K. [Increased rate of complications of pediatric acute otitis media and sinusitis in 2022/2023]. HNO 2024; 72:83-89. [PMID: 38108853 PMCID: PMC10827887 DOI: 10.1007/s00106-023-01393-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Acute mastoiditis and orbital complications of acute rhinosinusitis are among the most common complications of pediatric infections in otolaryngology. OBJECTIVE The aim of this study was to investigate the frequency of pediatric acute mastoiditis in the setting of acute otitis media as well as pediatric orbital complications in the setting of acute rhinosinusitis. Data from before the pandemic were compared to data after the end of the COVID-19 restrictions. MATERIALS AND METHODS Included were hospitalized children who presented with acute mastoiditis from acute otitis media or with orbital complications from acute rhinosinusitis during the period from April 2017 to March 2023. Compared were three periods using descriptive statistics: April 2017 to March 2020 (before the pandemic in Germany), April 2020 to March 2022 (during the contact restrictions of the pandemic), and April 2022 to March 2023 (after the contact restrictions were lifted). RESULTS A total of 102 children (43 with acute mastoiditis, 42%, and 59 with orbital complications of acute sinusitis, 58%) were included. During the 2022/2023 period, more than twice as many children with acute mastoiditis and approximately three times as many children with orbital complications of acute rhinosinusitis were hospitalized compared to the average of the periods 2017/2018, 2018/2019, and 2019/2020. In the 2021/2022 period, the number of these patients was below the average of previous years. CONCLUSION This year's seasonal cluster of upper respiratory tract infections is associated with a higher-than-average incidence of orbital complications and mastoiditis.
Collapse
Affiliation(s)
- Noemi Voß
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Essen (AöR), Hufelandstraße 55, 45147, Essen, Deutschland.
| | - Nadia Sadok
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Essen (AöR), Hufelandstraße 55, 45147, Essen, Deutschland
| | - Sarah Goretzki
- Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Essen (AöR), Hufelandstraße 55, 45147, Essen, Deutschland
| | - Christian Dohna-Schwake
- Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Essen (AöR), Hufelandstraße 55, 45147, Essen, Deutschland
| | - Moritz F Meyer
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Essen (AöR), Hufelandstraße 55, 45147, Essen, Deutschland
| | - Stefan Mattheis
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Essen (AöR), Hufelandstraße 55, 45147, Essen, Deutschland
| | - Stephan Lang
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Essen (AöR), Hufelandstraße 55, 45147, Essen, Deutschland
| | - Kerstin Stähr
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Essen (AöR), Hufelandstraße 55, 45147, Essen, Deutschland
| |
Collapse
|
11
|
Cottrell J, Namavarian A, Yip J, Campisi P, Chadha NK, Damji A, Hong P, Lachance S, Leitao D, Nguyen LHP, Saunders N, Strychowsky J, Yunker W, Vaccani JP, Chan Y, de Almeida JR, Eskander A, Witterick IJ, Monteiro E. Proposed Quality Indicators for Aspects of Pediatric Acute Otitis Media Management. J Otolaryngol Head Neck Surg 2024; 53:19160216241248538. [PMID: 38888942 PMCID: PMC11098001 DOI: 10.1177/19160216241248538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 02/12/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND The high incidence of pediatric acute otitis media (AOM) makes the implications of overdiagnosis and overtreatment far-reaching. Quality indicators (QIs) for AOM are limited, drawing from generalized upper respiratory infection QIs, or locally developed benchmarks. Recognizing this, we sought to develop pediatric AOM QIs to build a foundation for future quality improvement efforts. METHODS Candidate indicators (CIs) were extracted from existing guidelines and position statements. The modified RAND Corporation/University of California, Los Angeles (RAND/UCLA) appropriateness methodology was used to select the final QIs by an 11-member expert panel consisting of otolaryngology-head and neck surgeons, a pediatrician and family physician. RESULTS Twenty-seven CIs were identified after literature review, with an additional CI developed by the expert panel. After the first round of evaluations, the panel agreed on 4 CIs as appropriate QIs. After an expert panel meeting and subsequent second round of evaluations, the panel agreed on 8 final QIs as appropriate measures of high-quality care. The 8 final QIs focus on topics of antimicrobial management, specialty referral, and tympanostomy tube counseling. CONCLUSIONS Evidence of variable and substandard care persists in the diagnosis and management of pediatric AOM despite the existence of high-quality guidelines. This study proposes 8 QIs which compliment guideline recommendations and are meant to facilitate future quality improvement initiatives that can improve patient outcomes.
Collapse
Affiliation(s)
- Justin Cottrell
- Department of Otolaryngology—Head and Neck Surgery, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Amirpouyan Namavarian
- Department of Otolaryngology—Head & Neck Surgery, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada
| | - Jonathan Yip
- Department of Otolaryngology—Head & Neck Surgery, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada
| | - Paolo Campisi
- Department of Otolaryngology—Head & Neck Surgery, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada
| | - Neil K. Chadha
- Division of Otolaryngology—Head and Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Ali Damji
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Paul Hong
- Division of Otolaryngology—Head and Neck Surgery, Department of Surgery, Dalhousie University, QEII Health Sciences Centre, Halifax, NS, Canada
| | - Sophie Lachance
- Département d’Oto-rhino-laryngologie et chirurgie cervico-faciale, CHUL, Pavillon Ferdinand-Vandry, Université Laval, Québec, QC, Canada
| | - Darren Leitao
- Department of Otolaryngology—Head and Neck Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Lily H. P. Nguyen
- Department of Otolaryngology—Head and Neck Surgery, McGill University, Montréal, QC, Canada
| | - Natasha Saunders
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Julie Strychowsky
- Department of Otolaryngology—Head and Neck Surgery, Western University, London Health Sciences Centre—Victoria Hospital, London, ON, Canada
| | - Warren Yunker
- Section of Pediatric Surgery and Otolaryngology—Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Jean-Philippe Vaccani
- Department of Otolaryngology—Head and Neck Surgery, The University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Yvonne Chan
- Department of Otolaryngology—Head & Neck Surgery, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada
| | - John R. de Almeida
- Department of Otolaryngology—Head & Neck Surgery, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada
| | - Antoine Eskander
- Department of Otolaryngology—Head & Neck Surgery, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada
| | - Ian J. Witterick
- Department of Otolaryngology—Head & Neck Surgery, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada
| | - Eric Monteiro
- Department of Otolaryngology—Head & Neck Surgery, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada
| |
Collapse
|
12
|
Lalbiaktluangi C, Yadav MK, Singh PK, Singh A, Iyer M, Vellingiri B, Zomuansangi R, Zothanpuia, Ram H. A cooperativity between virus and bacteria during respiratory infections. Front Microbiol 2023; 14:1279159. [PMID: 38098657 PMCID: PMC10720647 DOI: 10.3389/fmicb.2023.1279159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/27/2023] [Indexed: 12/17/2023] Open
Abstract
Respiratory tract infections remain the leading cause of morbidity and mortality worldwide. The burden is further increased by polymicrobial infection or viral and bacterial co-infection, often exacerbating the existing condition. Way back in 1918, high morbidity due to secondary pneumonia caused by bacterial infection was known, and a similar phenomenon was observed during the recent COVID-19 pandemic in which secondary bacterial infection worsens the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) condition. It has been observed that viruses paved the way for subsequent bacterial infection; similarly, bacteria have also been found to aid in viral infection. Viruses elevate bacterial infection by impairing the host's immune response, disrupting epithelial barrier integrity, expression of surface receptors and adhesion proteins, direct binding of virus to bacteria, altering nutritional immunity, and effecting the bacterial biofilm. Similarly, the bacteria enhance viral infection by altering the host's immune response, up-regulation of adhesion proteins, and activation of viral proteins. During co-infection, respiratory bacterial and viral pathogens were found to adapt and co-exist in the airways of their survival and to benefit from each other, i.e., there is a cooperative existence between the two. This review comprehensively reviews the mechanisms involved in the synergistic/cooperativity relationship between viruses and bacteria and their interaction in clinically relevant respiratory infections.
Collapse
Affiliation(s)
- C. Lalbiaktluangi
- Department of Microbiology, Central University of Punjab, Bathinda, Punjab, India
| | - Mukesh Kumar Yadav
- Department of Microbiology, Central University of Punjab, Bathinda, Punjab, India
| | - Prashant Kumar Singh
- Department of Biotechnology, Mizoram University (A Central University), Pachhunga University College, Aizawl, Mizoram, India
| | - Amit Singh
- Department of Microbiology, Central University of Punjab, Bathinda, Punjab, India
| | - Mahalaxmi Iyer
- Department of Zoology, Central University of Punjab, Bathinda, Punjab, India
| | | | - Ruth Zomuansangi
- Department of Microbiology, Central University of Punjab, Bathinda, Punjab, India
| | - Zothanpuia
- Department of Biotechnology, Mizoram University (A Central University), Pachhunga University College, Aizawl, Mizoram, India
| | - Heera Ram
- Department of Zoology, Jai Narain Vyas University, Jodhpur, India
| |
Collapse
|
13
|
Khairkar M, Deshmukh P, Maity H, Deotale V. Chronic Suppurative Otitis Media: A Comprehensive Review of Epidemiology, Pathogenesis, Microbiology, and Complications. Cureus 2023; 15:e43729. [PMID: 37727177 PMCID: PMC10505739 DOI: 10.7759/cureus.43729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/18/2023] [Indexed: 09/21/2023] Open
Abstract
Otitis media is a significant contributor to healthcare visits and the prescription of drugs. Its associated complications and consequences pose the primary factors for preventable hearing impairment, especially in developing nations. Chronic suppurative otitis media (CSOM) is prevalent among children globally as one of the commonest chronic infectious diseases during childhood. The subsequent complications and sequelae play a central role in causing avoidable hearing loss, particularly within developing countries. In addition to impaired hearing, this condition can lead to severe health complications, such as issues involving the intracranial region. Despite the involvement of microbial, immunological, and genetic factors as well as Eustachian tube characteristics, in the development of CSOM, there remains a need for further elucidation regarding its pathogenesis. Based on its microorganisms, the treatment of choice will be affected to prevent further complications in the child. The primary approach to treating acute otitis media (AOM) involves effectively addressing ear pain and fever symptoms, while antibiotics are only administered in cases where children experience severe, long-lasting, or frequent infections. Despite the extensive investigation on AOM pathogenesis, research is scarce regarding CSOM. Given that antibiotic resistance and drug-induced ear damage are growing problems and surgery-related complications, it is imperative to devise effective therapeutic interventions against CSOM arises. Therefore, comprehending the host's immune function concerning CSOM and identifying how bacteria sidestep these potent responses becomes crucial. Acquiring insight into molecular mechanisms associated with CSOM will enable scientists to formulate innovative treatment approaches to combat this disease, thereby averting hearing loss consequences. The management consists of watchful waiting, primarily for children with chronic effusions and hearing loss.
Collapse
Affiliation(s)
- Mihika Khairkar
- Department of Otolaryngology, Head and Neck Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Prasad Deshmukh
- Department of Otolaryngology, Head and Neck Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Hindol Maity
- Department of Microbiology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, IND
- Department of Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vijayshri Deotale
- Department of Microbiology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, IND
| |
Collapse
|
14
|
Zhang C, Liu Y, An H, Wang X, Xu L, Deng H, Wu S, Zhang JR, Liu X. Amino Acid Starvation-Induced Glutamine Accumulation Enhances Pneumococcal Survival. mSphere 2023; 8:e0062522. [PMID: 37017541 PMCID: PMC10286718 DOI: 10.1128/msphere.00625-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/19/2023] [Indexed: 04/06/2023] Open
Abstract
Bacteria are known to cope with amino acid starvation by the stringent response signaling system, which is mediated by the accumulation of the (p)ppGpp alarmones when uncharged tRNAs stall at the ribosomal A site. While a number of metabolic processes have been shown to be regulatory targets of the stringent response in many bacteria, the global impact of amino acid starvation on bacterial metabolism remains obscure. This work reports the metabolomic profiling of the human pathogen Streptococcus pneumoniae under methionine starvation. Methionine limitation led to the massive overhaul of the pneumococcal metabolome. In particular, methionine-starved pneumococci showed a massive accumulation of many metabolites such as glutamine, glutamic acid, lactate, and cyclic AMP (cAMP). In the meantime, methionine-starved pneumococci showed a lower intracellular pH and prolonged survival. Isotope tracing revealed that pneumococci depend predominantly on amino acid uptake to replenish intracellular glutamine but cannot convert glutamine to methionine. Further genetic and biochemical analyses strongly suggested that glutamine is involved in the formation of a "prosurvival" metabolic state by maintaining an appropriate intracellular pH, which is accomplished by the enzymatic release of ammonia from glutamine. Methionine starvation-induced intracellular pH reduction and glutamine accumulation also occurred to various extents under the limitation of other amino acids. These findings have uncovered a new metabolic mechanism of bacterial adaptation to amino acid limitation and perhaps other stresses, which may be used as a potential therapeutic target for infection control. IMPORTANCE Bacteria are known to cope with amino acid starvation by halting growth and prolonging survival via the stringent response signaling system. Previous investigations have allowed us to understand how the stringent response regulates many aspects of macromolecule synthesis and catabolism, but how amino acid starvation promotes bacterial survival at the metabolic level remains largely unclear. This paper reports our systematic profiling of the methionine starvation-induced metabolome in S. pneumoniae. To the best of our knowledge, this represents the first reported bacterial metabolome under amino acid starvation. These data have revealed that the significant accumulation of glutamine and lactate enables S. pneumoniae to form a "prosurvival" metabolic state with a lower intracellular pH, which inhibits bacterial growth for prolonged survival. Our findings have provided insightful information on the metabolic mechanisms of pneumococcal adaptation to nutrient limitation during the colonization of the human upper airway.
Collapse
Affiliation(s)
- Chengwang Zhang
- Department of Basic Medical Science, School of Medicine, Lishui University, Lishui, Zhejiang, China
| | - Yanhong Liu
- Center for Infectious Disease Research, Department of Basic Medical Science, School of Medicine, Tsinghua University, Beijing, China
| | - Haoran An
- Center for Infectious Disease Research, Department of Basic Medical Science, School of Medicine, Tsinghua University, Beijing, China
- Tsinghua-Peking Center for Life Sciences, Tsinghua University, Beijing, China
| | - Xueying Wang
- National Protein Science Facility, Tsinghua University, Beijing, China
| | - Lina Xu
- National Protein Science Facility, Tsinghua University, Beijing, China
| | - Haiteng Deng
- School of Life Sciences, Tsinghua University, Beijing, China
| | - Songquan Wu
- Department of Basic Medical Science, School of Medicine, Lishui University, Lishui, Zhejiang, China
| | - Jing-Ren Zhang
- Center for Infectious Disease Research, Department of Basic Medical Science, School of Medicine, Tsinghua University, Beijing, China
- Tsinghua-Peking Center for Life Sciences, Tsinghua University, Beijing, China
| | - Xiaohui Liu
- National Protein Science Facility, Tsinghua University, Beijing, China
- School of Life Sciences, Tsinghua University, Beijing, China
| |
Collapse
|
15
|
Hu T, Song Y, Done N, Mohanty S, Liu Q, Sarpong EM, Lemus-Wirtz E, Signorovitch J, Weiss T. Economic burden of acute otitis media, pneumonia, and invasive pneumococcal disease in children in the United States after the introduction of 13-valent pneumococcal conjugate vaccines during 2014-2018. BMC Health Serv Res 2023; 23:398. [PMID: 37098521 PMCID: PMC10127426 DOI: 10.1186/s12913-023-09244-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 03/06/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Streptococcus pneumoniae remains a leading cause of morbidity, mortality, and healthcare resource utilization (HRU) among children. This study quantified HRU and cost of acute otitis media (AOM), pneumonia, and invasive pneumococcal disease (IPD). METHODS The IBM MarketScan® Commercial Claims and Encounters and Multi-State Medicaid databases from 2014 to 2018 were analyzed. Children with AOM, all-cause pneumonia, or IPD episodes were identified using diagnosis codes in inpatient and outpatient claims. HRU and costs were described for each condition in the commercial and Medicaid-insured populations. National estimates of the number of episodes and total cost ($US 2019 for each condition were extrapolated using data from the US Census Bureau. RESULTS Approximately 6.2 and 5.6 million AOM episodes were identified in commercial and Medicaid-insured children, respectively, during the study period. Mean cost per AOM episode was $329 (SD $1505) for commercial and $184 (SD $1524) for Medicaid-insured children. A total of 619,876 and 531,095 all-cause pneumonia cases were identified among commercial and Medicaid-insured children, respectively. Mean cost per all-cause pneumonia episode was $2304 (SD $32,309) in the commercial and $1682 (SD $19,282) in the Medicaid-insured population. A total of 858 and 1130 IPD episodes were identified among commercial and Medicaid-insured children, respectively. Mean cost per IPD episode was $53,213 (SD $159,904) for commercial and $23,482 (SD $86,209) for the Medicaid-insured population. Nationally, there were over 15.8 million cases of AOM annually, with total estimated cost of $4.3 billion, over 1.5 million cases of pneumonia annually, with total cost of $3.6 billion, and about 2200 IPD episodes annually, for a cost of $98 million. CONCLUSIONS The economic burden of AOM, pneumonia, and IPD among US children remains substantial. IPD and its manifestations were associated with higher HRU and costs per episode, compared to AOM and all-cause pneumonia. However, owing to their higher frequencies, AOM and all-cause pneumonia were the main contributors to the economic burden of pneumococcal disease nationally. Additional interventions, such as the development of pneumococcal conjugate vaccinees with sustained protection of existing vaccine type serotypes as well as broader inclusion of additional serotypes, are necessary to further reduce the burden of disease caused by these manifestations.
Collapse
Affiliation(s)
- Tianyan Hu
- Merck & Co., Inc, 126 East Lincoln Ave, P.O. Box 2000, Rahway, NJ, 07065, USA
| | - Yan Song
- Analysis Group, Inc, Boston, MA, USA
| | | | - Salini Mohanty
- Merck & Co., Inc, 126 East Lincoln Ave, P.O. Box 2000, Rahway, NJ, 07065, USA.
| | - Qing Liu
- Analysis Group, Inc, Boston, MA, USA
| | - Eric M Sarpong
- Merck & Co., Inc, 126 East Lincoln Ave, P.O. Box 2000, Rahway, NJ, 07065, USA
| | | | | | - Thomas Weiss
- Merck & Co., Inc, 126 East Lincoln Ave, P.O. Box 2000, Rahway, NJ, 07065, USA
| |
Collapse
|
16
|
Srivastava T, Harinath S. Benefit of Educational Video on Parental Knowledge, Attitude and Practice About Middle Ear Infection in Children. Indian J Otolaryngol Head Neck Surg 2023; 75:23-31. [PMID: 37206757 PMCID: PMC10188746 DOI: 10.1007/s12070-022-03102-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 10/19/2021] [Indexed: 10/15/2022] Open
Abstract
The aim of the study was to determine the benefit of educational video on parental knowledge, attitude and practice about risk factors of middle ear infection in children. An educational video was developed in English with information on anatomy of the ear, signs and symptoms, risk factors, consequences, prevention, and management related to ear infections. A KAP (Knowledge, attitude and practice) questionnaire was also developed comprising of 33 questions. Parents were requested to fill the questionnaire online and after watching the educational video they were asked to fill the same questionnaire after 1 month. 61 parents responded to both pre questionnaire and post questionnaire. In knowledge domain, thirty five parents gave correct answers to more than sixty percent of questions in the pre questionnaire and fifty six parents gave correct answers to more than sixty percent of the question in the post questionnaire. In attitude domain, all sixty one parents gave correct answers to more than sixty percent of questions in the pre questionnaire. In practice domain, twenty six parents gave correct answers to more than sixty percent of questions in the pre questionnaire and forty nine parents gave correct answers to more than sixty percent of the question in the post questionnaire after watching the educational video. Using the test of proportion, there was statistically significant difference in scores in pre questionnaire and post questionnaire in knowledge and practice domain. In the present study, there was statistically significant improvement in parents overall knowledge and practice about middle ear infection after watching the educational video.
Collapse
Affiliation(s)
- Tejaswini Srivastava
- Faculty of audiology and speech language pathology, Sri Ramachandra Institute of Higher Education and Research (DU), Porur, Chennai, India
| | - Sathya Harinath
- Faculty of audiology and speech language pathology, Sri Ramachandra Institute of Higher Education and Research (DU), Porur, Chennai, India
| |
Collapse
|
17
|
Helfrich ET, Saraiva CM, Chimiak JM, Nochetto M. A review of 149 Divers Alert Network emergency call records involving diving minors. Diving Hyperb Med 2023; 53:7-15. [PMID: 36966517 PMCID: PMC10318175 DOI: 10.28920/dhm53.1.7-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 12/08/2022] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Minors have been scuba diving for decades, and while the initial concerns about potential long-term complications related to bone development appear to be unfounded, the incidence of scuba diving injuries among them has been poorly studied. METHODS We reviewed 10,159 cases recorded in the DAN Medical Services call centre database from 2014 through 2016 and identified 149 cases of injured divers younger than 18 years. Records were analysed for case categorisation on the most common dive injuries. Information about demographics, level of training, risk factors, and relevant behavioural aspects were collected when available. RESULTS While the most common reason for the call was to rule out decompression sickness, the majority of cases pertained to ear and sinus issues. However, 15% of the dive-related injuries involving minors had a final diagnosis of pulmonary barotrauma (PBt). While no reliable data is available on the incidence of PBt in adult divers, the authors' impression based on personal experience suggests that the number of cases of PBt in minors trends higher than in the general diving population. The narratives on some relevant records describe unmanageable levels of anxiety leading to panic. CONCLUSIONS Based on the results and narratives on these cases, it is reasonable to infer that psychological immaturity, suboptimal management of adverse situations, and inadequate supervision might have led to severe injuries among these minor divers.
Collapse
Affiliation(s)
| | | | | | - Matias Nochetto
- Divers Alert Network, Durham (NC), USA
- Corresponding author: Dr Matias Nochetto, Vice President, Medical Services, Divers Alert Network, Durham NC, USA
| |
Collapse
|
18
|
Yu H, Gu D, Yu F, Li Q. Social distancing cut down the prevalence of acute otitis media in children. Front Public Health 2023; 11:1079263. [PMID: 36778556 PMCID: PMC9911446 DOI: 10.3389/fpubh.2023.1079263] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/04/2023] [Indexed: 01/28/2023] Open
Abstract
Objectives To evaluate the additional, unintended benefits of social distancing in cutting down the prevalence of acute otitis media (AOM) in children, especially during coronavirus disease 2019 (COVID-19) periods. Methods The daily outpatient attendance of AOM for childhood (from 6 months to 12 years) was compared in the tertiary hospital in Shanghai during pre-COVID-19 and COVID-19 year. Results A total of 24,543 AOM cases were included from 2015 to 2020. When age was taken into account, children in kindergarten (aged 4-6) constitute 66.2% (16,236/24,543) of all case, followed by primary school students (6,441/24,543, 26.2%) and preschoolers <3 years old (1,866/24,543, 7.6%). There was an estimated 63.6% (54.32-70.36%) reduction in the daily outpatient attendance of AOM associated with the introduction of social distancing in 2020 (COVID-19 year). The epidemic trend of AOM in 2015-2019 was characterized by seasonal fluctuations, with highest incidence in December (18.8 ± 0.5%) and lower in February (4.5 ± 0.2%), June (3.7 ± 0.7%) and August (3.5 ± 0.5%). And distribution characteristics of different ages in COVID-19 period broadly in line with that in non-pandemic period. Conclusion Seasonal fluctuation in the prevalence of AOM was observed in pre-COVID-19 period (2015-2019), with a peak in winter and a nadir in summer. The >50% drop of outpatient attendance of AOM in 2020 (COVID-19 year) suggest that social distancing, mask effects and good hand hygiene can significantly reduce the incidence of AOM, which provides a preventive and therapeutic point of view for AOM.
Collapse
|
19
|
Early S, Saad MA, Mallidi S, Mansour A, Seist R, Hasan T, Stankovic KM. A fluorescent photoimmunoconjugate for imaging of cholesteatoma. Sci Rep 2022; 12:19905. [PMID: 36402793 PMCID: PMC9675863 DOI: 10.1038/s41598-022-22072-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 10/10/2022] [Indexed: 11/21/2022] Open
Abstract
Cholesteatoma is a potentially serious complication of chronic ear infections and requires surgical intervention for definitive management. Long-term complications include a frequent need for repeat surgical intervention for disease recurrence, and techniques to improve efficacy of single-stage surgery are an important area of continued research. This study investigates a novel application of the photosensitizer immune conjugate (PIC) cetuximab-benzoporphyrin derivative (Cet-BPD) for in vitro localization of human cholesteatoma tissue, coupled with an in vivo safety study for middle ear application of Cet-BPD in a murine model. In fresh human cholesteatoma tissues, Cet-BPD demonstrates selective localization to the hyperplastic squamous cell tissue associated with cholesteatoma, without localizing to other tissues such as middle ear mucosa. Applied to the murine middle ear, Cet-BPD does not demonstrate any deleterious effect on murine hearing when assessed by any of auditory brainstem response (ABR) thresholds, distortion product otoacoustic emission thresholds, or ABR wave I amplitudes. These findings demonstrate the technical promise and encouraging safety profile for the use of PICs for intraoperative localization and treatment of cholesteatoma.
Collapse
Affiliation(s)
- Samuel Early
- grid.39479.300000 0000 8800 3003Department of Otolaryngology – Head and Neck Surgery and Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Otolaryngology – Head and Neck Surgery, Harvard Medical School, Boston, MA USA ,grid.413086.80000 0004 0435 1668Department of Otolaryngology – Head and Neck Surgery, University of California San Diego Medical Center, San Diego, CA USA
| | - M. Ahsan Saad
- grid.32224.350000 0004 0386 9924Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA USA
| | - Srivalleesha Mallidi
- grid.32224.350000 0004 0386 9924Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA USA ,grid.429997.80000 0004 1936 7531Department of Biomedical Engineering, Tufts University, Medford, MA USA
| | - Amer Mansour
- grid.39479.300000 0000 8800 3003Department of Otolaryngology – Head and Neck Surgery and Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA USA
| | - Richard Seist
- grid.39479.300000 0000 8800 3003Department of Otolaryngology – Head and Neck Surgery and Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Otolaryngology – Head and Neck Surgery, Harvard Medical School, Boston, MA USA ,grid.168010.e0000000419368956Department of Otolaryngology – Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA USA
| | - Tayyaba Hasan
- grid.32224.350000 0004 0386 9924Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA USA
| | - Konstantina M. Stankovic
- grid.39479.300000 0000 8800 3003Department of Otolaryngology – Head and Neck Surgery and Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Otolaryngology – Head and Neck Surgery, Harvard Medical School, Boston, MA USA ,grid.168010.e0000000419368956Department of Otolaryngology – Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA USA
| |
Collapse
|
20
|
Choi SY, Yon DK, Choi YS, Lee J, Park KH, Lee YJ, Kim SS, Kim SH, Yeo SG. The Impact of the COVID-19 Pandemic on Otitis Media. Viruses 2022; 14:2457. [PMID: 36366555 PMCID: PMC9696639 DOI: 10.3390/v14112457] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/31/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
Otitis media is one of the most common diseases in children, with 80% of children experiencing it by the age of three years. Therefore, the resulting social burden is enormous. In addition, many countries still suffer from complications due to otitis media. Meanwhile, COVID-19 has affected many diseases, with otitis media being one of the most strongly affected. This review aims to find out how COVID-19 has affected otitis media and its significance. A series of measures brought about by COVID-19, including emphasis on personal hygiene and social distancing, had many unexpected positive effects on otitis media. These can be broadly classified into four categories: first, the incidence of otitis media was drastically reduced. Second, antibiotic prescriptions for otitis media decreased. Third, the incidence of complications of otitis media was reduced. Fourth, the number of patients visiting the emergency room due to otitis media decreased. The quarantine measures put in place due to COVID-19 suppressed the onset and exacerbation of otitis media. This has great implications for the treatment and prevention of otitis media.
Collapse
Affiliation(s)
- Soo-Young Choi
- Department of Otorhinolaryngology Head & Neck Surgery, Kyung Hee University School of Medicine, Kyung Hee University Medical Center, Seoul 02447, Korea
| | - Dong-Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University School of Medicine, Kyung Hee University Medical Center, Seoul 02447, Korea
| | - Yong-Sung Choi
- Department of Pediatrics, Kyung Hee University School of Medicine, Kyung Hee University Medical Center, Seoul 02447, Korea
| | - Jinseok Lee
- Department of Biomedical Engineering, Kyung Hee University, Yongin 17104, Korea
| | - Ki-Ho Park
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University School of Medicine, Kyung Hee University Medical Center, Seoul 02447, Korea
| | - Young-Ju Lee
- Department of Obstetrics and Gynecology, Kyung Hee University School of Medicine, Kyung Hee University Medical Center, Seoul 02447, Korea
| | - Sung-Soo Kim
- Department of Biochemistry and Molecular Biology, College of Medicine, Kyung Hee University, Seoul 02447, Korea
| | - Sang-Hoon Kim
- Department of Otorhinolaryngology Head & Neck Surgery, Kyung Hee University School of Medicine, Kyung Hee University Medical Center, Seoul 02447, Korea
| | - Seung-Geun Yeo
- Department of Otorhinolaryngology Head & Neck Surgery, Kyung Hee University School of Medicine, Kyung Hee University Medical Center, Seoul 02447, Korea
| |
Collapse
|
21
|
Recurrent Acute Otitis Media Environmental Risk Factors: A Literature Review from the Microbiota Point of View. Appl Microbiol 2022. [DOI: 10.3390/applmicrobiol2030046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Acute otitis media (AOM) constitutes a multifactorial disease, as several host and environmental factors contribute to its occurrence. Prevention of AOM represents one of the most important goals in pediatrics, both in developing countries, in which complications, mortality, and deafness remain possible consequences of the disease, compared to in developed countries, in which this condition has an important burden in terms of medical, social, and economical implications. The strategies for AOM prevention are based on reducing the burden of risk factors, through the application of behavioral, environmental, and therapeutic interventions. The introduction of culture-independent techniques has allowed high-throughput investigation of entire bacterial communities, providing novel insights into the pathogenesis of middle ear diseases through the identification of potential protective bacteria. The upper respiratory tract (URT) is a pivotal region in AOM pathogenesis, as it could act as a source of pathogens than of protective microorganisms for the middle ear (ME). Due to its direct connection with the external ambient, the URT is particularly exposed to the influence of environmental agents. The aim of this review was to evaluate AOM environmental risk factors and their impact on URT microbial communities, and to investigate AOM pathogenesis from the microbiota perspective.
Collapse
|
22
|
Takata M, Ubukata K, Miyazaki H, Iwata S, Nakamura S. Diversity of amino acid substitutions of penicillin-binding proteins in penicillin-non-susceptible and non-vaccine type Streptococcus pneumoniae. J Infect Chemother 2022; 28:1523-1530. [PMID: 35963598 DOI: 10.1016/j.jiac.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE In Japan, the introduction of pneumococcal conjugate vaccine (PCV) in children has decreased vaccine-type (VT) pneumococcal infections caused by penicillin (PEN)-non-susceptible Streptococcus pneumoniae. PEN-non-susceptible strains have gradually emerged among non-vaccine types (NVT). In this study, we aim to investigate the pbp gene mutations and the characteristics of PEN-binding proteins (PBPs) that mediate PEN resistance in NVT strains. MATERIALS AND METHODS Pneumococcal 41 strains of NVT isolated from patients with invasive pneumococcal infection were randomly selected. Nucleotide sequences for pbp genes encoding PBP1A, PBP2X, and PBP2B were analyzed, and amino acid (AA) substitutions that contribute to β-lactam resistance were identified. In addition, the three-dimensional (3D) structure of abnormal PBPs in the resistant strain was compared with that of a reference R6 strain via homology modeling. RESULTS In PEN-non-susceptible NVT strains, Thr to Ala or Ser substitutions in the conserved AA motif (STMK) were important in PBP1A and PBP2X. In PBP2B, substitutions from Thr to Ala, adjacent to the SSN motif, and from Glu to Gly were essential. The 3D structure modeling indicated that AA substitutions are characterized by accumulation around the enzymatic active pocket in PBPs. Many AA substitutions detected throughout the PBP domains were not associated with resistance, except for AA substitutions in or adjacent to AA motifs. Clonal complexes and sequence types showed that almost all NVT cases originated in other countries and spread to Japan via repeat mutations. CONCLUSIONS NVT with diverse AA substitutions increased gradually with pressure from both antimicrobial agents and vaccines.
Collapse
Affiliation(s)
- Misako Takata
- Department of Microbiology, Tokyo Medical University, Tokyo, Japan
| | - Kimiko Ubukata
- Department of Microbiology, Tokyo Medical University, Tokyo, Japan; Department of General Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Haruko Miyazaki
- Department of Microbiology, Tokyo Medical University, Tokyo, Japan
| | - Satoshi Iwata
- Department of Infectious Diseases, National Cancer Hospital, Tokyo, Japan; Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Shigeki Nakamura
- Department of Microbiology, Tokyo Medical University, Tokyo, Japan
| |
Collapse
|
23
|
Tikhomirova A, Zilm PS, Trappetti C, Paton JC, Kidd SP. The central role of arginine in Haemophilus influenzae survival in a polymicrobial environment with Streptococcus pneumoniae and Moraxella catarrhalis. PLoS One 2022; 17:e0271912. [PMID: 35877653 PMCID: PMC9312370 DOI: 10.1371/journal.pone.0271912] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/08/2022] [Indexed: 11/18/2022] Open
Abstract
Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis are bacterial species which frequently co-colonise the nasopharynx, but can also transit to the middle ear to cause otitis media. Chronic otitis media is often associated with a polymicrobial infection by these bacteria. However, despite being present in polymicrobial infections, the molecular interactions between these bacterial species remain poorly understood. We have previously reported competitive interactions driven by pH and growth phase between H. influenzae and S. pneumoniae. In this study, we have revealed competitive interactions between the three otopathogens, which resulted in reduction of H. influenzae viability in co-culture with S. pneumoniae and in triple-species culture. Transcriptomic analysis by mRNA sequencing identified a central role of arginine in mediating these interactions. Arginine supplementation was able to increase H. influenzae survival in a dual-species environment with S. pneumoniae, and in a triple-species environment. Arginine was used by H. influenzae for ATP production, and levels of ATP generated in dual- and triple-species co-culture at early stages of growth were significantly higher than the combined ATP levels of single-species cultures. These results indicate a central role for arginine-mediated ATP production by H. influenzae in the polymicrobial community.
Collapse
Affiliation(s)
- Alexandra Tikhomirova
- Department of Molecular and Biomedical Science, Research Centre for Infectious Diseases, University of Adelaide, Adelaide, Australia
| | - Peter S. Zilm
- Department of Oral Microbiology, School of Dentistry, University of Adelaide, North Terrace Campus, Adelaide, South Australia, Australia
| | - Claudia Trappetti
- Department of Molecular and Biomedical Science, Research Centre for Infectious Diseases, University of Adelaide, Adelaide, Australia
| | - James C. Paton
- Department of Molecular and Biomedical Science, Research Centre for Infectious Diseases, University of Adelaide, Adelaide, Australia
| | - Stephen P. Kidd
- Department of Molecular and Biomedical Science, Research Centre for Infectious Diseases, University of Adelaide, Adelaide, Australia
- Australian Centre for Antimicrobial Resistance Ecology, The University of Adelaide, Adelaide, Australia
- * E-mail:
| |
Collapse
|
24
|
Luo Y, He P, Wen X, Gong R, Hu X, Zheng X. Otitis Media and Its Association With Hearing Loss in Chinese Adults: A Population Based Study of 4 Provinces in China. Front Public Health 2022; 10:852556. [PMID: 35651868 PMCID: PMC9149286 DOI: 10.3389/fpubh.2022.852556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/07/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Otitis media is a recognized cause of significant hearing loss, particularly in developing countries. This study aimed to investigate the relationship between otitis media and hearing loss in Chinese adults aged 18 years and older. Methods The survey was based on WHO Ear and Hearing Disorders Survey Protocol and 36,783 adults at the ages between 18 years and above were selected in this study. Trained local examiners performed pure tone audiometry to screen people with hearing loss, and those who were screened positively for hearing loss were referred to audiologists to make final diagnosis. All participants underwent clinical ENT check-up and otoscopic examination by doctors trained in ENT. Each participant was assigned a single middle ear diagnosis. Diagnoses were assigned as per the WHO classification of ear and hearing disorders. Results Logistic regressions showed that higher prevalence of hearing loss was found in participants with otitis media, with an unadjusted odds ratio of 5.67 (95%CI: 4.66, 6.90). The next two models (Model 2–3) had slight impact on ORs. The interaction of residency and otitis media was statistically significant (OR = 1.70, 95%CI = 1.15, 2.53); otitis media patients in rural areas had higher risk of hearing loss. However, this interaction became not significant in 65 years old and above participants. Conclusions Otitis media was associated with the risk of hearing loss. Compared with urban patients with otitis media, rural patients have the higher risk of hearing loss. Action to reduce the risk of hearing loss in otitis media will require attention to rural-urban disparities.
Collapse
Affiliation(s)
- Yanan Luo
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Ping He
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Xu Wen
- College of Biochemical Engineering, Beijing Union University, Beijing, China
| | - Rui Gong
- China Rehabilitation Research Center for Deaf Children, Beijing, China
| | - Xiangyang Hu
- China Rehabilitation Research Center for Deaf Children, Beijing, China
| | - Xiaoying Zheng
- Chinese Academy of Medical Sciences/Peking Union Medical College, School of Population Medicine and Public Health, Beijing, China
| |
Collapse
|
25
|
Lempinen L, Laulajainen‐Hongisto A, Aarnisalo AA, Bernardino L, Peltola H, Pitkäranta A, Pelkonen T, Jero J. Hearing impairment in Angolan children with acute bacterial meningitis with and without otitis media. Acta Paediatr 2022; 111:1585-1593. [PMID: 35500132 DOI: 10.1111/apa.16383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 04/20/2022] [Accepted: 04/29/2022] [Indexed: 11/28/2022]
Abstract
AIM Bacterial meningitis (BM) is a common cause of hearing loss in childhood. Our aim was to investigate bacterial aetiology, hearing impairment and outcome in childhood BM with vs. without otitis media (OM) in Angola. METHODS Hearing was tested by auditory brainstem response in 391 (76%) children with confirmed BM. The bacteria identified from the ear discharge were compared to those from cerebrospinal fluid (CSF). The hearing findings were compared among children with vs. without OM on days 1 and 7 of hospitalization, and at follow-ups of 1, 3 and 6 month(s). RESULTS No correlation was found in bacteriology between the ear discharge and CSF. On day 7 in hospital, hearing impairment (>40 dB) was common, regardless of whether concomitant OM or not (in 27% vs. 30%, respectively). Any hearing deficit on day 7 was associated with a higher risk of complicated or fatal clinical course (OR 2.76, CI95% 1.43-5.29, p = 0.002). CONCLUSION No significant difference prevailed in hearing thresholds between children with or without OM in hospital on day 7 or at later follow-ups. Any hearing impairment during hospital stay associated with a higher risk for complicated clinical course or death.
Collapse
Affiliation(s)
- Laura Lempinen
- Department of Otorhinolaryngology, Head and Neck Surgery University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Anu Laulajainen‐Hongisto
- Department of Otorhinolaryngology, Head and Neck Surgery University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Antti A. Aarnisalo
- Department of Otorhinolaryngology, Head and Neck Surgery University of Helsinki and Helsinki University Hospital Helsinki Finland
| | | | - Heikki Peltola
- Children’s Hospital University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Anne Pitkäranta
- Department of Otorhinolaryngology, Head and Neck Surgery University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Tuula Pelkonen
- Pediatric Hospital David Bernardino Luanda Angola
- Children’s Hospital University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Jussi Jero
- University of Helsinki and Helsinki University Hospital Helsinki Finland
| |
Collapse
|
26
|
Lin H, Jia Y, Kong X, Wang S, Liu X, Liu Y, Deng Y. In Vivo Evaluation of Cefuroxime Axetil-Loaded Bioadhesive Nanoparticles to Treat Haemophilus influenzae-Induced Otitis Media. Front Bioeng Biotechnol 2022; 10:884797. [PMID: 35573224 PMCID: PMC9099258 DOI: 10.3389/fbioe.2022.884797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/04/2022] [Indexed: 11/25/2022] Open
Abstract
Otitis media (OM) is a common disease in children. One of the most common pathogens causing OM is non-typeable Haemophilus influenzae (NTHi). NTHi in the middle ear can be successfully eradicated by a regimen of oral antibiotics sustained for 7–10 days (e.g., cefuroxime axetil 250 mg/day for patients aged 3 months to 2 years and 500 mg/day for patients ages ≥2 years). However, lack of compliance is relevant to treatment failure or early relapse. In order to overcome these challenges, we have developed antibiotics-loaded bioadhesive nanoparticles (BNPs) that can adhere to the epidermis of the middle ear after local administration and significantly prolong the release time of antibiotics in the middle ear. Compared with oral administration of CA, local delivery of free antibiotic cefuroxime axetil (CA), and CA loaded non-bioadhesive nanoparticles (CA/NNPs), BNPs loaded with cefuroxime axetil (CA/BNPs) showed significantly longer retention time in the middle ear, resulting in continuous release of the drug and higher therapeutic efficacy against OM with only a single dosage. CA concentrations were maintained above the minimum inhibitory concentration (MIC) for NTHi throughout 7 days’ treatment. NTHi OM in a mouse model was successfully eradicated without causing tissue toxicity. CA/BNPs minimize systemic drug exposure through local administration, as demonstrated by undetectable levels in the blood.
Collapse
Affiliation(s)
| | | | | | | | | | - Yang Liu
- *Correspondence: Yang Liu, ; Yang Deng,
| | - Yang Deng
- *Correspondence: Yang Liu, ; Yang Deng,
| |
Collapse
|
27
|
A Retrospective Database Analysis to Estimate the Burden of Acute Otitis Media in Children Aged <15 Years in the Veneto Region (Italy). CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9030436. [PMID: 35327808 PMCID: PMC8947099 DOI: 10.3390/children9030436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 12/04/2022]
Abstract
This study aimed to assess trends in the incidence of acute otitis media (AOM), a common childhood condition, following the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) in the Veneto region of Italy in 2010. AOM episodes (overall, simple, and recurrent (≥3 or ≥4 episodes in 6 or 12 months, respectively, with ≥1 episode in the preceding 6 months)) in children <15 years of age were identified in Pedianet from 2010−2017. Interrupted time series analyses were conducted to assess changes in the annual incidence rates (IRs) in early (2010−2013) and late (2014−2017) PCV13 periods. In total, 72,570 children (402,868 person-years) were identified; 21,048 had 41,683 AOM episodes. Mean annual AOM IR was 103/1000 person-years (95% confidence interval: 102−104), decreasing from 126 to 79/1000 person-years. AOM IRs were highest in children 2−4 years of age, followed by <2 and 5−14 years of age. Overall and simple AOM IRs decreased among children 0−14 years of age, including 2−4 and 5−14 years of age, while recurrent AOM IRs decreased in children <2 years of age. Following PCV13 introduction, AOM IRs decreased substantially in children <15 years of age, with the greatest benefit observed in older children, driven by a reduction in simple AOM IRs. AOM disease burden remains substantial.
Collapse
|
28
|
Mun SK, Chang M. Development of prediction models for the incidence of pediatric acute otitis media using Poisson regression analysis and XGBoost. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:18629-18640. [PMID: 34694557 DOI: 10.1007/s11356-021-17135-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/17/2021] [Indexed: 06/13/2023]
Abstract
Otitis media has profound health and economic impact, and its occurrence is known to be influenced by air pollution and climate. The purpose of this study was to develop prediction models using climate and air pollution indicators for the occurrence of acute otitis media (AOM). The study was conducted from January 1, 2014, to December 31, 2019, and included pediatric patients (age < 12 years) diagnosed on their emergency room visit in our tertiary medical institution. We obtained data on the weekly number of AOM patients and the weekly average values of air pollution and climate indicators. Poisson regression analysis and eXtreme Gradient Boosting (XGBoost) were used to develop prediction models for the overall pediatric patients and for the patients classified according to sex (male and female) and age (< 2 years and ≥ 2 years). For the overall population, the correlation coefficients between the original and estimated data in the testing set were 0.441 (p < 0.001) and 0.844 (p < 0.001) for the models developed using Poisson regression analysis and XGBoost, respectively. The root-mean-square errors in the testing set were 3.094 and 1.856, respectively. For patients classified according to sex and age, the prediction models developed using XGBoost showed better performance than the models developed using Poisson regression analysis. In conclusion, this study successfully developed prediction models with air pollution and climate indicators for the incidence of pediatric AOM, using XGBoost. This model can be further developed to prevent pediatric AOM.
Collapse
Affiliation(s)
- Seog-Kyun Mun
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, 84 Heukseok-ro, Dongjak-gu, 06974, Seoul, South Korea
| | - Munyoung Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, 84 Heukseok-ro, Dongjak-gu, 06974, Seoul, South Korea.
| |
Collapse
|
29
|
Hu N, Fardell J, Wakefield CE, Marshall GM, Bell JC, Nassar N, Lingam R. School academic performance of children hospitalised with a chronic condition. Arch Dis Child 2022; 107:289-296. [PMID: 34475105 PMCID: PMC8862027 DOI: 10.1136/archdischild-2020-321285] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/05/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine academic outcomes among children hospitalised with a chronic health condition. DESIGN Population-level birth cohort. SETTING New South Wales, Australia. PARTICIPANTS 397 169 children born 2000-2006 followed up to 2014. INTERVENTION/EXPOSURE Hospitalisations with a chronic condition. MAIN OUTCOME MEASURES Academic underperformance was identified as 'below the national minimum standard' (BNMS) in five literacy/numeracy domains using the national assessment (National Assessment Program-Literacy and Numeracy) data. Multivariable logistic regression assessed the adjusted ORs (aORs) of children performing BNMS in each domain at each grade (grades 3, 5 and 7, respectively). RESULTS Of children hospitalised with a chronic condition prior to National Assessment Program-Literacy and Numeracy (NAPLAN) (16%-18%), 9%-12% missed ≥1 test, with a maximum of 37% of those hospitalised ≥7 times, compared with 4%-5% of children not hospitalised. Excluding children who missed a NAPLAN test, more children hospitalised with a chronic condition performed BNMS across all domains and grades, compared with children not hospitalised (eg, for BNMS in reading at grade 3: n=2588, aOR 1.35 (95% CI 1.28 to 1.42); for BNMS in numeracy at grade 3: n=2619, aOR 1.51 (95% CI 1.43 to 1.59)). Increasing frequency and bed-days of hospitalisation were associated with 2-3 fold increased odds of performing BNMS across all domains and grades. Children hospitalised with mental health/behavioural conditions had the highest odds of performing BNMS across all domains at each grade. CONCLUSIONS Children hospitalised with a chronic condition underperform academically across literacy/numeracy domains at each school grade. Health and educational supports are needed to improve these children's academic outcomes.
Collapse
Affiliation(s)
- Nan Hu
- Population Child Health Research Team, School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia
| | - Joanna Fardell
- Behavioural Sciences Unit, School of Women's and Children's Health University of New South Wales, Randwick, New South Wales, Australia,Kids Cancer Centre, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - Claire E Wakefield
- Behavioural Sciences Unit, School of Women's and Children's Health University of New South Wales, Randwick, New South Wales, Australia,Kids Cancer Centre, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - Glenn M Marshall
- Kids Cancer Centre, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - Jane C Bell
- Child Population and Translational Health Research, Children's Hospital at Westmead, The University of Sydney, Westmead, New South Wales, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, Children's Hospital at Westmead, The University of Sydney, Westmead, New South Wales, Australia
| | - Raghu Lingam
- Population Child Health Research Team, School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia
| |
Collapse
|
30
|
Xie D, Zhao T, Zhang X, Kui L, Wang Q, Wu Y, Zheng T, Ma P, Zhang Y, Molteni H, Geng R, Yang Y, Li B, Zheng QY. Autophagy Contributes to the Rapamycin-Induced Improvement of Otitis Media. Front Cell Neurosci 2022; 15:753369. [PMID: 35153674 PMCID: PMC8832103 DOI: 10.3389/fncel.2021.753369] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/31/2021] [Indexed: 12/02/2022] Open
Abstract
Otitis media (OM) is a pervasive disease that involves hearing loss and severe complications. In our previous study, we successfully established a mouse model of human OM using Tlr2tm1Kir (TLR2-/-) mice with middle ear (ME) inoculation of streptococcal peptidoglycan-polysaccharide (PGPS). In this study, we found that hearing loss and OM infections in OM mice were significantly alleviated after treatment with rapamycin (RPM), a widely used mechanistic target of RPM complex 1 (mTORC1) inhibitor and autophagy inducer. First of all, we tested the activity of mTORC1 by evaluating p-S6, Raptor, and mTOR protein expression. The data suggested that the protein expression level of p-S6, Raptor and mTOR are decreased in TLR2-/- mice after the injection of PGPS. Furthermore, our data showed that both the autophagosome protein LC3-II, Beclin-1, ATG7, and autophagy substrate protein p62 accumulated at higher levels in mice with OM than in OM-negative mice. The expression of lysosomal-associated proteins LAMP1, Cathepsin B, and Cathepsin D increased in the OM mice compared with OM-negative mice. Rab7 and Syntaxin 17, which is necessary for the fusion of autophagosomes with lysosomes, are reduced in the OM mice. In addition, data also described that the protein expression level of p-S6, mTOR and Raptor are lower than PGPS group after RPM treatment. The accumulation of LC3-II, Beclin-1, and ATG7 are decreased, and the expression of Rab7 and Syntaxin 17 are increased significantly after RPM treatment. Our results suggest that autophagy impairment is involved in PGPS-induced OM and that RPM improves OM at least partly by relieving autophagy impairment. Modulating autophagic activity by RPM may be a possible effective treatment strategy for OM.
Collapse
Affiliation(s)
- Daoli Xie
- Hearing and Speech Rehabilitation Institute, College of Special Education, Binzhou Medical University, Yantai, China
| | - Tong Zhao
- Hearing and Speech Rehabilitation Institute, College of Special Education, Binzhou Medical University, Yantai, China
| | - Xiaolin Zhang
- Department of Otolaryngology-Head and Neck Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Lihong Kui
- Hearing and Speech Rehabilitation Institute, College of Special Education, Binzhou Medical University, Yantai, China
| | - Qin Wang
- Hearing and Speech Rehabilitation Institute, College of Special Education, Binzhou Medical University, Yantai, China
| | - Yuancheng Wu
- Hearing and Speech Rehabilitation Institute, College of Special Education, Binzhou Medical University, Yantai, China
| | - Tihua Zheng
- Hearing and Speech Rehabilitation Institute, College of Special Education, Binzhou Medical University, Yantai, China
| | - Peng Ma
- Department of Genetics, School of Pharmacy, Binzhou Medical University, Yantai, China
| | - Yan Zhang
- Department of Otolaryngology, Head and Neck Surgery, Second Affiliated Hospital, Xi’an Jiaotong University School of Medicine, Xi’an, China
| | - Helen Molteni
- Department of Otolaryngology, Head and Neck Surgery, Case Western Reserve University, Cleveland, OH, United States
| | - Ruishuang Geng
- Hearing and Speech Rehabilitation Institute, College of Special Education, Binzhou Medical University, Yantai, China
| | - Ying Yang
- Hearing and Speech Rehabilitation Institute, College of Special Education, Binzhou Medical University, Yantai, China
| | - Bo Li
- Hearing and Speech Rehabilitation Institute, College of Special Education, Binzhou Medical University, Yantai, China
| | - Qing Yin Zheng
- Department of Otolaryngology, Head and Neck Surgery, Case Western Reserve University, Cleveland, OH, United States
| |
Collapse
|
31
|
Cao X, Yi HJ. Audiological characteristics and exploratory treatment of a rare condition of acute-otitis-media-associated sudden sensorineural hearing loss. World J Clin Cases 2021; 9:11311-11319. [PMID: 35071561 PMCID: PMC8717494 DOI: 10.12998/wjcc.v9.i36.11311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/15/2021] [Accepted: 11/04/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute otitis media (AOM) is a common disease that is more prevalent in children. Most studies concerning AOM-associated sudden sensorineural hearing loss are case reports and retrospective in nature, hence the etiology of AOM-associated sudden hearing loss has not been fully established.
AIM To analyze audiological characteristics of AOM-associated sudden hearing loss and evaluate efficacy of combined tympanostomy tube placement (TTP) and intratympanic methylprednisolone.
METHODS Eight adult patients who were diagnosed with AOM-associated sudden hearing loss and ineffectively treated by conventional medical therapy were enrolled in this study. Basic data were collected, and pure tone audiometry was performed to assess the audiological characteristics. Combination therapy with TTP and intratympanic methylprednisolone injection was given to the patients.
RESULTS Mixed or sensorineural hearing loss was observed at high frequencies (2–4 kHz). All the cases in this study were cured after TTP and intratympanic methylprednisolone. After treatment, the average hearing threshold at affected frequencies was significantly lower than those in the pretreatment group (P < 0.05) and was similar to that in the healthy ears (P > 0.05).
CONCLUSION AOM rarely induces sudden sensorineural hearing loss. Combination therapy with TTP and intratympanic methylprednisolone injection may be effective after failure of conventional medical treatment.
Collapse
Affiliation(s)
- Xin Cao
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Hai-Jin Yi
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| |
Collapse
|
32
|
Jespersen SI, Demant MN, Pedersen ML, Homøe P. Acute otitis media and pneumococcal vaccination - an observational cross-sectional study of otitis media among vaccinated and unvaccinated children in Greenland. Int J Circumpolar Health 2021; 80:1858615. [PMID: 33407056 PMCID: PMC7801097 DOI: 10.1080/22423982.2020.1858615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 10/29/2020] [Accepted: 11/29/2020] [Indexed: 12/25/2022] Open
Abstract
Streptococcus pneumoniae is one of the main pathogens leading to otitis media. In 2010, the 13-valent pneumococcal conjugate vaccine (PCV13) was implemented in the Greenlandic childhood vaccination programme, but the effect of this change is not yet well documented. The objective of this study is to evaluate the effect of the implementation based on the number of episodes of acute otitis media (AOM). Data are obtained from medical records. We included all children born from 1 January 2015 to 30 September 2016, and thus eligible for the three doses of PCV13 including one year of follow-up time. Exclusion criteria were uncertain vaccination status and predefined comorbidities. The children were divided into two groups based on vaccination status: "Vaccinated" or "Incomplete/delayed". We included 1077 children in total, 742 children were allocated to the "Vaccinated" group and 335 children were allocated to the "Incomplete/delayed" group. There were significantly fewer episodes of AOM in the "Incomplete/delayed" group (p = 0.01). In conclusion Greenlandic children completely and timely vaccinated with PCV13 and born between January 2015 and September 2016 did not have fewer episodes of AOM compared to children who had incomplete or delayed vaccination status. Abbreviations: PCV13: 13-valent pneumococcal conjugate vaccine; OM: otitis media; AOM: acute otitis media; CSOM: chronic suppurative otitis media; WHO: World Health Organisation; NTHi: nontypeable Haemophilus influenzae.
Collapse
Affiliation(s)
- Simon Imer Jespersen
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Malene Nøhr Demant
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Greenland Center for Health Research, Institute of Nursing and Health Science, University of Greenland, Ilisimatusarfik, Nuuk, Greenland
| | - Michael Lynge Pedersen
- Greenland Center for Health Research, Institute of Nursing and Health Science, University of Greenland, Ilisimatusarfik, Nuuk, Greenland
- Steno Diabetes Center Greenland, Nuuk, Greenland
| | - Preben Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Greenland Center for Health Research, Institute of Nursing and Health Science, University of Greenland, Ilisimatusarfik, Nuuk, Greenland
| |
Collapse
|
33
|
Pichichero ME, Chapman TJ, Bajorski P. Pneumonia, Sinusitis, Influenza and Other Respiratory Illnesses in Acute Otitis Media-Prone Children. Pediatr Infect Dis J 2021; 40:975-980. [PMID: 34382614 PMCID: PMC8511197 DOI: 10.1097/inf.0000000000003228] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recurrent acute otitis media in the first years of life can be explained by immune dysfunction. Consequently, it would be expected that otitis-prone (OP) children would be more susceptible to other infectious diseases, especially respiratory infections, since a component of the immune problem involves nasopharyngeal innate immunity. DESIGN Cohort study with prospective identification of all physician-diagnosed, medically attended respiratory illness visits in children 6 months to 5 years of age to determine the incidence of pneumonia, acute sinusitis, influenza and other bacterial and viral infections among OP compared with non-OP (NOP) children. Tympanocentesis to microbiologically confirm acute otitis media disease. RESULTS Two hundred eighty-five children were studied. Thirty-nine met a standard definition of stringently defined OP (sOP) determined by tympanocentesis and 246 were NOP. sOP children had increased frequency of presumptive respiratory infections, pneumonia (6-fold higher, P < 0.001), sinusitis (2.1-fold higher, P = 0.026) and influenza (2.9-fold higher, P = 0.002), compared with NOP children. Demographic and risk factor covariate-adjusted fold difference between sOP and NOP children for all respiratory infection illness visits was 2.4-fold (P < 0.00001) at 6-18 months of age, 2.2-fold (P < 0.00001) at 18-30 months of age and at age and 2.4-fold (P = 0.035) higher at 30 to 42 months. For both sOP and NOP children, more frequent medically attended respiratory infection illness visits from 6-18 months of age predicted more frequent visits experienced from 18-60 months of age. CONCLUSIONS Clinicians should be aware of a significant increased likelihood of bacterial and viral respiratory infection proneness among OP children.
Collapse
Affiliation(s)
- Michael E. Pichichero
- Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, 1425 Portland Avenue, Rochester, NY 14621
| | - Timothy J. Chapman
- Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, 1425 Portland Avenue, Rochester, NY 14621
| | - Peter Bajorski
- Department of Mathematical Science, College of Science, Rochester Institute of Technology, Rochester, NY
| |
Collapse
|
34
|
Kaffenberger TM, Eichar BW, McCoy JL, Yang TS, Shaffer AD, Dohar JE. Cystic fibrosis mutation classes in pediatric otitis media - Fickle or faulty? Am J Otolaryngol 2021; 42:103067. [PMID: 33957545 DOI: 10.1016/j.amjoto.2021.103067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Recent data have challenged the historical paradigm that cystic fibrosis (CF) protects against otitis media (OM). These findings raised questions about the pathogenesis of this ostensible change. In this study our aim is to characterize acute OM (AOM) risk based on CF genotype. METHODS A retrospective chart review was completed at a tertiary care pediatric hospital. Charts of 159 CF patients seen at our facility from 2010 to 2019 were reviewed. Data collected included demographics, AOM infections, cystic fibrosis transmembrane conductance regulator (CFTR) allele mutations, pulmonary exacerbations (PE), and pancreatic insufficiency (PI) status. Mutation alleles were divided into five classes based on CF guidelines, which were further classified as severe (classes I-III) or mild (classes IV-V). RESULTS 54% of patients had at least one episode of AOM with a mean of 1.5 episodes of AOM (standard deviation = 2.3). 86% of patients had severe/severe (S/S) alleles and 14% had severe/mild (S/M). S/S patients had significantly more PE (p = .004) and increased rates of PI (p < .001). Of the 131 patients with S/S mutations, 57% had an episode of AOM while only 46% the 22 S/M patients had an AOM episode (p = .357). CONCLUSIONS To our knowledge this is the first report showing a clinical trend towards increased middle ear disease in patients with severe CFTR mutations. Future prospective studies will be powered to demonstrate whether this trend is statistically significant. Patients with S/S mutations not only have more severe clinical phenotypes but may have additional unexpected complications such as middle ear disease.
Collapse
Affiliation(s)
- Thomas M Kaffenberger
- Department of Otolaryngology, University of Pittsburgh School of Medicine, 203 Lothrop St. Suite 500, Pittsburgh, PA 15213, USA
| | - Bradley W Eichar
- Department of Otolaryngology, University of Pittsburgh School of Medicine, 203 Lothrop St. Suite 500, Pittsburgh, PA 15213, USA.
| | - Jennifer L McCoy
- Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA 15224, USA.
| | - Tiffany S Yang
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA 15224, USA.
| | - Amber D Shaffer
- Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA 15224, USA.
| | - Joseph E Dohar
- Department of Otolaryngology, University of Pittsburgh School of Medicine, 203 Lothrop St. Suite 500, Pittsburgh, PA 15213, USA; Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA 15224, USA; Department of Communication Science and Disorders, University of Pittsburgh School of Health & Rehabilitation, Forbes Tower, 3600 Forbes Ave., Pittsburgh, PA 15260, USA.
| |
Collapse
|
35
|
Hussain T, Moqadasi M, Malik S, Salman Zahid A, Nazary K, Khosa SM, Arshad MM, Joyce J, Khan R, Puvvada S, Walizada K, Khan AR. Uropathogens Antimicrobial Sensitivity and Resistance Pattern From Outpatients in Balochistan, Pakistan. Cureus 2021; 13:e17527. [PMID: 34646592 PMCID: PMC8485873 DOI: 10.7759/cureus.17527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 01/09/2023] Open
Abstract
Objective To determine the pattern of microbes responsible for urinary tract infections and their susceptibility to different antibiotics. Method This is a cross-sectional study conducted at Quetta, Pakistan. The urine samples of 400 patients were collected and sent for culture and sensitivity analysis. The results were recorded on an excel datasheet. Descriptive statistics were used to describe the data. Results Out of 400 urine samples, 266 samples were culture positive for microorganisms. The most common organism on analysis was Escherichia coli 123/266 (46.24%) followed by Staphylococcus saprophyticus 59/266 (22.18%) and Klebsiella pneumonia 49/266 (18.42%). Gram-negative microorganisms were most susceptible to fosfomycin, cefoperazone/sulbactam, and meropenem. Gram-positive microorganisms were most susceptible to fosfomycin, cefoperazone/sulbactam, meropenem, and amoxicillin/clavulanate. High rates of resistance in E. coli were observed to most commonly prescribed broad-spectrum antibiotics; ceftriaxone (64.35%), cefotaxime (76.54%), ceftazidime (49.43%), cefepime (53.44%), levofloxacin (71.26%), and amoxicillin/clavulanate (70.31%). E. coli was the major multidrug-resistant organism. Conclusion High rates of antibiotic resistance and multi-drug resistance were revealed in this study due to the widespread and injudicious use of broad-spectrum antibiotics. Thus, it is highly recommended to regulate the pharmacies. Physicians should judiciously prescribe antibiotics and practice the culture and sensitivity of urine samples rather than blind prescription. Continued surveillance on uropathogens prevalence and resistance, new and next-generation antibiotics, and rapid diagnostic tests to differentiate viral from bacterial infections is the need of time.
Collapse
Affiliation(s)
- Taimoor Hussain
- Neurology/General Practitioner, Bolan Medical College, Quetta, PAK
| | - Mehdi Moqadasi
- Medical Laboratory Technology, Shafa Khana Sahib Zaman Hosptial, Quetta, PAK
| | - Sheza Malik
- Medicine, Army Medical College Rawalpindi, Rawalpindi, PAK
| | | | | | | | | | - John Joyce
- Intern, M.S. Ramaiah Medical College, Bangalore, IND
| | - Rajeswari Khan
- Medicine and Surgery, College of Medicine & Sagore Dutta Hospital, Kolkata, IND
| | - Sneha Puvvada
- Medicine and Surgery, M.S. Ramaiah Medical College, Bangalore, IND
| | | | - Abdul Rahim Khan
- Internal Medicine, Jinnah Medical and Dental College, Karachi, PAK
| |
Collapse
|
36
|
Lee SH, Ha SM, Jeong MJ, Park DJ, Polo CN, Seo YJ, Kim SH. Effects of reactive oxygen species generation induced by Wonju City particulate matter on mitochondrial dysfunction in human middle ear cell. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:49244-49257. [PMID: 33932209 DOI: 10.1007/s11356-021-14216-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 04/27/2021] [Indexed: 06/12/2023]
Abstract
Atmospheric particulate matter (PM) contains different components that can elicit varying adverse health effects in humans and animals. Studies on PM toxicity and its underlying mechanisms in the middle ear are limited, and they generally use a PM standard. However, as PM composition varies temporally and geographically, it is crucial to identify the toxic PM constituents according to season and region and investigate their associated health effects. Thus, we sought to determine whether PM induces cytotoxicity and inflammatory factor and reactive oxygen species (ROS) generation in human middle ear epithelial cells obtained from patients with otitis media. The cells were treated with both standard urban PM and PM directly captured from the atmosphere in Wonju City. The association between mitochondrial dysfunction and PM was investigated. PM exposure significantly increased COX-2 and TNF-α mRNA expression, increased ROS generation, induced inflammatory responses, and caused abnormalities in mitochondrial motility and function. Furthermore, PM induced cell apoptosis, which consequently reduced cell survival, particularly at the concentration of 100 μg/mL. Overall, our study provides new insights into the toxic effects of standard and atmospheric PM on middle ear cell line.
Collapse
Affiliation(s)
- Su Hoon Lee
- Research Institute of Hearing Enhancement, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Ilsan-dong, Wonju-si, Gangwon-do, 26426, South Korea
- Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Ilsan-dong, Wonju-si, Gangwon-do, 26426, South Korea
| | - Sun Mok Ha
- Research Institute of Hearing Enhancement, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Ilsan-dong, Wonju-si, Gangwon-do, 26426, South Korea
- Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Ilsan-dong, Wonju-si, Gangwon-do, 26426, South Korea
| | - Min Jae Jeong
- Department of Environmental Engineering, College of Public Health, Yonsei University, 1 Yonseidae-gil, Wonju, Gangwon-do, 26493, South Korea
| | - Dong Jun Park
- Research Institute of Hearing Enhancement, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Ilsan-dong, Wonju-si, Gangwon-do, 26426, South Korea
- Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Ilsan-dong, Wonju-si, Gangwon-do, 26426, South Korea
| | - Carlos Noriega Polo
- College of Medicine, Universitat de València, Av. de Blasco Ibáñez, 13, 46010, València, Valencia, Spain
| | - Young Joon Seo
- Research Institute of Hearing Enhancement, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Ilsan-dong, Wonju-si, Gangwon-do, 26426, South Korea.
- Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Ilsan-dong, Wonju-si, Gangwon-do, 26426, South Korea.
| | - Seong Heon Kim
- Department of Environmental Engineering, College of Public Health, Yonsei University, 1 Yonseidae-gil, Wonju, Gangwon-do, 26493, South Korea.
| |
Collapse
|
37
|
McCoy JL, Kaffenberger TM, Yang TS, Dohar JE. Otitis media prone children with cystic fibrosis: A new normal. Am J Otolaryngol 2021; 42:103137. [PMID: 34174638 DOI: 10.1016/j.amjoto.2021.103137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/13/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To determine if children with cystic fibrosis (CF) who are otitis media prone and treated with tympanostomy tube placement (TTP) follow the natural course of non-CF children regarding the incidence of tympanostomy tube otorrhea (TTO) (21-34%). METHODS All CF patients seen at a large tertiary pediatric hospital were retrospectively reviewed from 2010 to 2019. A total of 483 patients were identified and seventeen met the inclusion criteria and were included in the analysis. Data collected included demographics, CF diagnosis history including date of diagnosis and genotype, TTP notes, and otorrhea found in otolaryngology clinic and pediatrician clinic notes for up to 18 months post-TTP. RESULTS CF was diagnosed at a median age of 13 days (0 days to 6 years). In terms of surgical frequency, 14/17 (82.4%) patients had one TTP, 2/17 (11.8%) had two TTPs, and 1/17 (5.9%) had five TTPs. The median (range) age at first TTP was 2 years (3 months to 13 years). After the first TTP, TTO occurred in 5 (29.4%) patients at 3 months, 6 (35.3%) at 6 and 9 months, and 7 (41.2%) at 12 and 18 months at median (range) = 1 (0-5) otolaryngology appointments and median (range) = 0 (0-8) pediatrician appointments. CONCLUSION To our knowledge this is the first study to report that CF children are more likely to be severely affected with recurrent acute otitis media (RAOM), to require TTP, and to exhibit a natural history of TTO commensurate with the non-CF population.
Collapse
|
38
|
Ear Infection Trajectories and Academic, Behavioral, and Quality-of-Life Outcomes: A Population-Based Longitudinal Study. J Dev Behav Pediatr 2021; 42:588-596. [PMID: 34518499 DOI: 10.1097/dbp.0000000000000931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 12/28/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate (1) typical trajectories of parent-reported ear infections throughout childhood and (2) their associations with child outcomes. METHOD Design and participants: Two parallel cohorts assessed biennially from 2004 to 2014 spanning ages 0-1 to 10-11 years (B cohort, n = 3721) and ages 4-5 to 14-15 years (K cohort, n = 3489) in the Longitudinal Study of Australian Children. Ear infection: Parent-reported ongoing ear infections (B: waves 1-6; K: waves 1, 2, 4, and 5). Outcomes (wave 6): National academic standardized test, teacher-reported learning, parent- and teacher-reported behavior, and self-reported quality of life. Analysis: Latent class models identified ear infection trajectories. Linear regression quantified associations between trajectories and outcomes. RESULTS Four probability trajectories of ear infections emerged in both cohorts: "consistently low" (B 86.2%, K 87.0%), "moderate to low" (5.5%, 9.7%), "low to moderate" (7.0%, 1.5%), and "consistently high" (1.4%, 1.8%). In K cohort, the "consistently high" group had the worst outcomes (effect sizes 0.2-0.8 SDs), with effect sizes largest for psychosocial and language outcomes. "Moderate to low" and "low to moderate" groups showed marginal to no academic associations, although behavior and quality-of-life scores were 0.2 to 0.3 SDs poorer than the "consistently low" group. Similar but attenuated associations were seen in B cohort. CONCLUSION Sizable adverse adolescent outcomes follow parent reports of persistent ongoing ear infections throughout childhood. Despite a possibility of reverse causation, this suggests that cumulative rather than age-specific ear infections are most important to outcomes. Clinicians may generally be reassuring about ongoing ear infections limited to either early or middle childhood but should proactively identify and manage the small subgroup whose early infections persist throughout the elementary school years.
Collapse
|
39
|
Edmondson-Jones M, Dibbern T, Hultberg M, Anell B, Medin E, Feng Y, Talarico C. Impact of pneumococcal conjugate vaccines on healthcare utilization and direct costs for otitis media in children ≤2 years of age in two Swedish regions. Hum Vaccin Immunother 2021; 18:1942712. [PMID: 34319865 PMCID: PMC8920213 DOI: 10.1080/21645515.2021.1942712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
In Sweden, the 7-valent pneumococcal conjugate vaccine (PCV7) was introduced in 2009 and replaced by the pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) or the 13-valent PCV (PCV13) from late 2009. We assessed the impact of PCVs on rates of antibiotic prescribing, tympanostomy tube placement (TTP), and healthcare resource utilization and direct costs of physician-diagnosed otitis media/acute otitis media (OM) in children ≤2 years of age living in Skåne (PCV7 then PHiD-CV) or Västra Götalandsregionen (VGR; PCV7 then PCV13). Retrospective cohort study using linked patient-level data from national and regional (Skåne and VGR) healthcare databases in Sweden from July 1, 2005, to December 31, 2013 (NCT02742753). Descriptive time-series analyses showed antibiotic prescriptions and TTP incidence declined after PHiD-CV/PCV13 introduction versus the pre-PCV period. The annualized mean frequencies of antibiotic use, primary care visits, outpatient visits, TTP and myringotomy procedures all decreased after PHiD-CV/PCV13 compared with pre-PCV cohorts. Annualized mean total OM-associated healthcare costs decreased in the PCV7 versus pre-PCV cohorts by 20.0% in Skåne and 10.2% in VGR, and further declined in the PHiD-CV and PCV13 cohorts (20.7% and 15.3%, respectively, relative to the PCV7 cohort), although the duration of PCV7 use differed between regions. Decreases in adjusted annualized cost ratios between cohorts per child susceptible to OM were statistically significant after PCV7 introduction and again with either PHiD-CV or PCV13 introduction in both regions. Following sequential PCV introduction, OM-related healthcare utilization and associated costs decreased in the study regions in Sweden.
Collapse
Affiliation(s)
| | | | | | | | - Emma Medin
- Parexel International, Stockholm, Sweden
| | | | | |
Collapse
|
40
|
Bogomilsky MR, Kulmakov SA, Soldatsky YL, Polunin MM, Minasyan VS, Edgem SR, Ivanenko AM, Zhilina SV. [Features of bacterial microbiota in acute purulent otitis media in children]. Vestn Otorinolaringol 2021; 86:4-8. [PMID: 34269016 DOI: 10.17116/otorino2021860314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE OF THE STUDY The purpose is to study the spectrum of bacterial pathogens that cause acute purulent otitis media (APOM) in children of the Moscow region in modern conditions and assess their sensitivity to the main groups of antibiotics. MATERIAL AND METHODS The study included 1.864 children who underwent examination and received treatment in the otorhinolaryngological department of Morozovskaya Pediatric Municipal Clinical Hospital in the period from 01 July 2018 to 31 June 2020 with a diagnosis of APOM. RESULTS The study showed that the leading bacterial pathogens of APOM are Streptococcus pneumoniae (28.0%), Staphylococcus aureus (27.2%), Streptococcus pyogenes (22.2%), Haemophilus influenzae (7.8%), and Pseudomonas aeruginosa (6.5%). Attention is drawn to the increase in the level of resistance of S. pneumoniae to oxacillin (11.64%). CONCLUSIONS The data obtained indicate the feasibility and prospects of vaccination against pneumococcal infection as one of the ways to curb the spread of resistance of S. pneumoniae to antibacterial drugs.
Collapse
Affiliation(s)
- M R Bogomilsky
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - S A Kulmakov
- Pirogov Russian National Research Medical University, Moscow, Russia.,Morozovskaya Pediatric Municipal Clinical Hospital, Moscow, Russia
| | - Yu L Soldatsky
- Morozovskaya Pediatric Municipal Clinical Hospital, Moscow, Russia
| | - M M Polunin
- Pirogov Russian National Research Medical University, Moscow, Russia.,Morozovskaya Pediatric Municipal Clinical Hospital, Moscow, Russia
| | - V S Minasyan
- Pirogov Russian National Research Medical University, Moscow, Russia.,Morozovskaya Pediatric Municipal Clinical Hospital, Moscow, Russia
| | - S R Edgem
- Morozovskaya Pediatric Municipal Clinical Hospital, Moscow, Russia
| | - A M Ivanenko
- Morozovskaya Pediatric Municipal Clinical Hospital, Moscow, Russia
| | - S V Zhilina
- Morozovskaya Pediatric Municipal Clinical Hospital, Moscow, Russia
| |
Collapse
|
41
|
D'Aeth JC, van der Linden MPG, McGee L, de Lencastre H, Turner P, Song JH, Lo SW, Gladstone RA, Sá-Leão R, Ko KS, Hanage WP, Breiman RF, Beall B, Bentley SD, Croucher NJ. The role of interspecies recombination in the evolution of antibiotic-resistant pneumococci. eLife 2021; 10:e67113. [PMID: 34259624 PMCID: PMC8321556 DOI: 10.7554/elife.67113] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/16/2021] [Indexed: 12/27/2022] Open
Abstract
Multidrug-resistant Streptococcus pneumoniae emerge through the modification of core genome loci by interspecies homologous recombinations, and acquisition of gene cassettes. Both occurred in the otherwise contrasting histories of the antibiotic-resistant S. pneumoniae lineages PMEN3 and PMEN9. A single PMEN3 clade spread globally, evading vaccine-induced immunity through frequent serotype switching, whereas locally circulating PMEN9 clades independently gained resistance. Both lineages repeatedly integrated Tn916-type and Tn1207.1-type elements, conferring tetracycline and macrolide resistance, respectively, through homologous recombination importing sequences originating in other species. A species-wide dataset found over 100 instances of such interspecific acquisitions of resistance cassettes and flanking homologous arms. Phylodynamic analysis of the most commonly sampled Tn1207.1-type insertion in PMEN9, originating from a commensal and disrupting a competence gene, suggested its expansion across Germany was driven by a high ratio of macrolide-to-β-lactam consumption. Hence, selection from antibiotic consumption was sufficient for these atypically large recombinations to overcome species boundaries across the pneumococcal chromosome.
Collapse
Affiliation(s)
- Joshua C D'Aeth
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College LondonLondonUnited Kingdom
| | - Mark PG van der Linden
- Institute for Medical Microbiology, National Reference Center for Streptococci, University Hospital RWTH AachenAachenGermany
| | - Lesley McGee
- Respiratory Diseases Branch, Centers for Disease Control and PreventionAtlantaUnited States
| | - Herminia de Lencastre
- Laboratory of Molecular Genetics, Instituto de Tecnologia Química e Biológica, Universidade Nova de LisboaOeirasPortugal
- Laboratory of Microbiology and Infectious Diseases, The Rockefeller UniversityNew YorkUnited States
| | - Paul Turner
- Cambodia Oxford Medical Research Unit, Angkor Hospital for ChildrenSiem ReapCambodia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Jae-Hoon Song
- Department of Molecular Cell Biology, Sungkyunkwan University School of MedicineSuwonRepublic of Korea
| | - Stephanie W Lo
- Parasites & Microbes, Wellcome Sanger Institute, Wellcome Genome CampusHinxtonUnited Kingdom
| | - Rebecca A Gladstone
- Parasites & Microbes, Wellcome Sanger Institute, Wellcome Genome CampusHinxtonUnited Kingdom
| | - Raquel Sá-Leão
- Laboratory of Molecular Microbiology of Human Pathogens, Instituto de Tecnologia Química e Biológica, Universidade Nova de LisboaOeirasPortugal
| | - Kwan Soo Ko
- Department of Molecular Cell Biology, Sungkyunkwan University School of MedicineSuwonRepublic of Korea
| | - William P Hanage
- Center for Communicable Disease Dynamics, Harvard T.H. Chan School of Public HealthBostonUnited States
| | - Robert F Breiman
- Department of Global Health, Rollins School of Public Health, Emory UniversityAtlantaUnited States
| | - Bernard Beall
- Respiratory Diseases Branch, Centers for Disease Control and PreventionAtlantaUnited States
| | - Stephen D Bentley
- Parasites & Microbes, Wellcome Sanger Institute, Wellcome Genome CampusHinxtonUnited Kingdom
| | - Nicholas J Croucher
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College LondonLondonUnited Kingdom
| |
Collapse
|
42
|
Hu YJ, Wang J, Harwell JI, Wake M. Association of in utero antibiotic exposure on childhood ear infection trajectories: Results from a national birth cohort study. J Paediatr Child Health 2021; 57:1023-1030. [PMID: 33586839 DOI: 10.1111/jpc.15371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/13/2020] [Accepted: 01/13/2021] [Indexed: 11/28/2022]
Abstract
AIM Most prescribed medicines during pregnancy are antibiotics, with unknown effects on a fetus and on the infant's acquired microbiome. This study investigates associations between in utero antibiotic exposure and ear infection trajectories over the first decade of life, hypothesising effects on early or persistent, rather than later-developing, ear infections. METHODS Design and participants: The Longitudinal Study of Australian Children birth cohort recruited a nationally-representative sample of 5107 infants in 2004. MEASURES Mothers reported antibiotic use in pregnancy when a child was 3-21 months old (wave 1), and ongoing problems with ear infection every 2 years spanning ages 0-1 to 10-11 years (waves 1-6). ANALYSIS Latent class models identified ear infection trajectories, and univariable and multivariable multinomial logistic regression determined odds of adverse trajectories by antibiotic exposure. RESULTS A total of 4500 (88.1% of original sample) children contributed (mean baseline age 0.7 years; 51.3% boys); 10.4% of mothers reported antibiotic use in pregnancy. Four probability trajectories for ear infection emerged: 'consistently low' (86.2%), 'moderate to low' (5.6%), 'low to moderate' (6.7%) and 'consistently high' (1.4%). Antibiotic use in pregnancy was associated with children following 'consistently high' (adjusted odds ratio 2.04, 95% confidence interval 1.08-3.88, P = 0.03) and 'moderate to low' (adjusted odds ratio 1.78, 95% confidence interval 1.25-2.53, P = 0.001) trajectories. CONCLUSIONS Antibiotic use in pregnancy is associated with an increased risk of persistent and early childhood ear infections. This highlights the wisdom of cautious antibiotic use during pregnancy, and the need for the study of potential mechanisms underlying these associations.
Collapse
Affiliation(s)
- Yanhong J Hu
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jing Wang
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Joseph I Harwell
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Melissa Wake
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
43
|
Michel O. Pain Relief by Analgesic Eardrops: Paradigm Shift in the Treatment of Acute Otitis Media? Drug Res (Stuttg) 2021; 71:363-371. [PMID: 34098586 DOI: 10.1055/a-1494-3087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Acute otitis media is a common middle ear infection in children with the predominant symptoms of hearing impairment and pain. If antibiotics are given, they need time to have an effect on the inflammation, so the focus is on pain control. For pain management local anesthetics have the advantage of lesser systemic side effects but are still subject to scrutiny. In this review the literature between 2000 and 2020 was systematically searched for investigating studies and recommendation in guidelines against the background of the mode of action. 11 clinical studies, 2 guidelines and 5 reports resp. reviews could be identified. Contraindications and side effects were not found in these studies. The analgesic ear drops showed in placebo-controlled studies a relatively short duration of action when applied once but rapid onset of action. There is evidence that analgesic ear drops could provide a first-line analgesia in otitis media without systemic adverse effects such as gastrointestinal disturbance and nausea and could support an antibiotic-saving wait-and-see attitude. The review shows a change in attitude towards the recommendation to include local anesthetics ear drops in otitis media but still there is a lack in treatment protocols which go beyond a single administration. The results do not yet show a significant paradigm shift. The reviews revealed indications that a more adapted galenic preparation could give more effectiveness. Pharmaceutical research in this field should be intensified to exploit the analgesic potential of local anesthetic ear drops in acute otitis media.
Collapse
Affiliation(s)
- Olaf Michel
- Universitair Ziekenhuis - Vrije Universiteit Brussel UZ-VUB
| |
Collapse
|
44
|
Comparing Watchful Waiting Approach vs. Antibiotic Therapy in Children with Nonsevere Acute Otitis Media: A Randomized Clinical Trial. Int J Pediatr 2021; 2021:5515467. [PMID: 34135974 PMCID: PMC8178009 DOI: 10.1155/2021/5515467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/28/2021] [Accepted: 05/11/2021] [Indexed: 01/04/2023] Open
Abstract
Objective To compare both approaches for the treatment of nonsevere acute otitis media (AOM) in Iran. Methods This randomized clinical trial was performed at a pediatric infectious diseases clinic in Buali tertiary hospital in Sari, north of Iran, from 2016 to 2018. All participants in this study were previously healthy children with AOM diagnosis, who were 6 months to 6 years old. The patients were randomly assigned into two groups: the intervention (80 mg/kg/day amoxicillin for 7-10 days) and the control group (watchful waiting approach). AOM recovery and adverse drug reactions were evaluated after 72 hours, and the patients were followed for the frequency of AOM and middle ear effusion 1 and 3 months' postintervention. Results A total of 396 children have participated in this study. AOM recovery was significantly different in the two groups (73% vs. 44% in the intervention and control groups, respectively). Recurrence of AOM and middle ear effusion (MEE) persistence, one month following the intervention, have not shown any significant differences between the two groups. However, the AOM recurrence between 1 and 3 months was more frequent in the control group. The frequency of diarrhea was also higher in the intervention group compared to the control but no significant difference was found between the two groups regarding vomiting and skin rash. Conclusion The faster recovery from AOM is achieved when an antibiotic treatment regimen is applied, although the risk of potential side effects should be considered.
Collapse
|
45
|
Won J, Monroy GL, Dsouza RI, Spillman DR, McJunkin J, Porter RG, Shi J, Aksamitiene E, Sherwood M, Stiger L, Boppart SA. Handheld Briefcase Optical Coherence Tomography with Real-Time Machine Learning Classifier for Middle Ear Infections. BIOSENSORS-BASEL 2021; 11:bios11050143. [PMID: 34063695 PMCID: PMC8147830 DOI: 10.3390/bios11050143] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 12/13/2022]
Abstract
A middle ear infection is a prevalent inflammatory disease most common in the pediatric population, and its financial burden remains substantial. Current diagnostic methods are highly subjective, relying on visual cues gathered by an otoscope. To address this shortcoming, optical coherence tomography (OCT) has been integrated into a handheld imaging probe. This system can non-invasively and quantitatively assess middle ear effusions and identify the presence of bacterial biofilms in the middle ear cavity during ear infections. Furthermore, the complete OCT system is housed in a standard briefcase to maximize its portability as a diagnostic device. Nonetheless, interpreting OCT images of the middle ear more often requires expertise in OCT as well as middle ear infections, making it difficult for an untrained user to operate the system as an accurate stand-alone diagnostic tool in clinical settings. Here, we present a briefcase OCT system implemented with a real-time machine learning platform for middle ear infections. A random forest-based classifier can categorize images based on the presence of middle ear effusions and biofilms. This study demonstrates that our briefcase OCT system coupled with machine learning can provide user-invariant classification results of middle ear conditions, which may greatly improve the utility of this technology for the diagnosis and management of middle ear infections.
Collapse
Affiliation(s)
- Jungeun Won
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA;
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (G.L.M.); (R.I.D.); (D.R.S.J.); (J.S.); (E.A.)
| | - Guillermo L. Monroy
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (G.L.M.); (R.I.D.); (D.R.S.J.); (J.S.); (E.A.)
| | - Roshan I. Dsouza
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (G.L.M.); (R.I.D.); (D.R.S.J.); (J.S.); (E.A.)
| | - Darold R. Spillman
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (G.L.M.); (R.I.D.); (D.R.S.J.); (J.S.); (E.A.)
| | - Jonathan McJunkin
- Department of Otolaryngology, Carle Foundation Hospital, Champaign, IL 61822, USA; (J.M.); (R.G.P.)
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA
| | - Ryan G. Porter
- Department of Otolaryngology, Carle Foundation Hospital, Champaign, IL 61822, USA; (J.M.); (R.G.P.)
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA
| | - Jindou Shi
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (G.L.M.); (R.I.D.); (D.R.S.J.); (J.S.); (E.A.)
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Edita Aksamitiene
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (G.L.M.); (R.I.D.); (D.R.S.J.); (J.S.); (E.A.)
| | - MaryEllen Sherwood
- Stephens Family Clinical Research Institute, Carle Foundation Hospital, Urbana, IL 61801, USA; (M.S.); (L.S.)
| | - Lindsay Stiger
- Stephens Family Clinical Research Institute, Carle Foundation Hospital, Urbana, IL 61801, USA; (M.S.); (L.S.)
| | - Stephen A. Boppart
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA;
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (G.L.M.); (R.I.D.); (D.R.S.J.); (J.S.); (E.A.)
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
- Correspondence:
| |
Collapse
|
46
|
Fan F, Ma Y, Ai R, Ding Z, Li D, Zhu Y, He Q, Zhang X, Dong Y, He Y. Glycolytic Metabolism Is Critical for the Innate Antibacterial Defense in Acute Streptococcus pneumoniae Otitis Media. Front Immunol 2021; 12:624775. [PMID: 33953708 PMCID: PMC8089373 DOI: 10.3389/fimmu.2021.624775] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 03/24/2021] [Indexed: 12/28/2022] Open
Abstract
Objective Streptococcus pneumoniae (S.pn) is a common respiratory pathogen and a frequent cause of acute otitis media (AOM) in children. However, little is known about the immunometabolism during AOM. This study was to assess the presence of glucose metabolic reprogramming during AOM and its underlying mechanism affecting inflammatory response and middle ear injury. Methods The levels of glycolytic metabolism were evaluated by measuring the expression of glycolysis-related genes and the production of metabolites. HE stain, immunofluorescence, immunohistochemistry, enzyme-linked immunosorbent assay (ELISA) and Western blot were performed to measure the effect of glucose metabolic reprogramming on inflammatory response, pneumococcal clearance, hypoxia-inducible factor 1 alpha (HIF-1α) expression and cytokine secretion during AOM, respectively. Results The analysis of microarray revealed an increase of the expression of glycolysis-related genes during S.pn-induced AOM, which was verified by real-time PCR. Increased glycolysis promoted the production of IL-1β and TNF-α and facilitated the clearance of S.pn by enhancing phagocytosis and killing capability of neutrophils, but also aggravated the middle ear injury. Furthermore, these pathogenic effects could be reversed after glycolytic inhibitor 2DG treatment. Additionally, HIF-1α was observed to involve in glycolytic metabolism during AOM. Conclusion S.pn infection induced increased glycolysis conversion during AOM, which promoted inflammatory responses and bacterial clearance, but also aggravated tissue damage.
Collapse
Affiliation(s)
- Fangmei Fan
- Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine (Ministry of Education), Chongqing Medical University, Chongqing, China
- Department of Laboratory Medicine, Guiyang Maternity & Child Health Hospital, Guiyang, China
| | - Yurong Ma
- Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine (Ministry of Education), Chongqing Medical University, Chongqing, China
- Department of Laboratory Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Rongshuang Ai
- Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine (Ministry of Education), Chongqing Medical University, Chongqing, China
| | - Zhiqiang Ding
- School of Computer Science, Chongqing Institute of Engineering, Chongqing, China
| | - Dingyi Li
- Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine (Ministry of Education), Chongqing Medical University, Chongqing, China
| | - Yiting Zhu
- Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine (Ministry of Education), Chongqing Medical University, Chongqing, China
| | - Qian He
- Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine (Ministry of Education), Chongqing Medical University, Chongqing, China
| | - Xinxin Zhang
- Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine (Ministry of Education), Chongqing Medical University, Chongqing, China
| | - Yilin Dong
- Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine (Ministry of Education), Chongqing Medical University, Chongqing, China
| | - Yujuan He
- Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine (Ministry of Education), Chongqing Medical University, Chongqing, China
| |
Collapse
|
47
|
Meherali S, Hartling L, Campbell A, Robin F, Scott S. Parent information needs and experience regarding acute otitis media in children: A systematic review. PATIENT EDUCATION AND COUNSELING 2021; 104:554-562. [PMID: 32998839 DOI: 10.1016/j.pec.2020.09.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/07/2020] [Accepted: 09/12/2020] [Indexed: 05/23/2023]
Abstract
BACKGROUND Acute otitis media (AOM)-inflammation of the middle ear-is the most common pediatric condition, affecting up to 75 % of children at some time before age 5 years. Despite the high incidence of AOM in children, it presents diverse challenges to parents who do not have accurate information on AOM and its management. OBJECTIVE To respond to this paucity of information we sought to synthesize the literature to provide a comprehensive understanding of parental information needs and experiences relating to AOMmanagement. This systematic review is an important first step in developing parent-informed knowledge translation tools for AOM to bridge the knowledge-practice gap. PATIENT INVOLVEMENT None. METHOD Four electronic databases were searched and articles were screened according to pre- established inclusion criteria. Articles were included in the review if they (1) examined parental information needs and experiences with respect to AOM; (2) were written in English; and (3) were published from January 2000 onward. RESULTS Out of 1121 articles retrieved, 21 articles met the inclusion criteria. The findings from this review revealed that parents' knowledge about AOM is generally limited. Further, parents were often poorly informed about what AOM was, which resulted in uncertainty about how to help their child with AOM. DISCUSSION Our review findings illustrate that parents of children with AOM have pervasive unmet information needs and information deficits negatively impact AOM management, child and family well-being. PRACTICAL VALUE Parental experiences and information needs identified through this review were used to develop innovative, evidence-based knowledge translation tools for parents of children with AOM.
Collapse
|
48
|
Early S, Yang R, Li X, Zhang Z, van der Valk JC, Ma X, Kohane DS, Stankovic KM. Initial Method for Characterization of Tympanic Membrane Drug Permeability in Human Temporal Bones In Situ. Front Neurol 2021; 12:580392. [PMID: 33708167 PMCID: PMC7940379 DOI: 10.3389/fneur.2021.580392] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 01/28/2021] [Indexed: 12/28/2022] Open
Abstract
Background and Introduction: Acute otitis media is the most common reason for a visit to the pediatrician, often requiring systemic administration of oral antibiotics. Local drug therapy applied to the middle ear could avoid side effects associated with systemic antibiotic administration, however in the majority of patients this would require drugs to diffuse across an intact tympanic membrane. Experimental methods for testing trans-tympanic drug flux in human tissues in situ would be highly valuable to guide drug therapy development for local drug delivery to the middle ear. Materials and Methods: A total of 30 cadaveric human temporal bones were characterized by trans-tympanic impedance testing to determine how steps in tissue processing and storage might impact intactness of the tympanic membrane and thus suitability for use in studies of trans-tympanic drug flux. Ciprofloxacin drug solutions of varying concentrations were then applied to the lateral surface of the tympanic membrane in eight samples, and middle ear aspirate was collected over the following 48 h to evaluate trans-tympanic flux to the middle ear. Results: Tissue processing steps that involved extensive tissue manipulation were consistently associated with evidence of microperforations in the tympanic membrane tissue. Maintaining the tympanic membrane in situ within the temporal bone, while using an otologic drill to obtain transmastoid access to the middle ear, was demonstrated as a reliable, non-damaging technique for accessing both lateral and medial surfaces for trans-tympanic flux testing. Results in these bones demonstrated trans-tympanic flux of ciprofloxacin when administered at sufficiently high concentration. Discussion and Conclusion: The study describes key techniques and best practices, as well as pitfalls to avoid, in the development of a model for studying trans-tympanic drug flux in human temporal bones in situ. This model can be a valuable research tool in advancing progress toward eventual clinical studies for trans-tympanic drug delivery to the middle ear.
Collapse
Affiliation(s)
- Samuel Early
- Eaton-Peabody Laboratories, Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States.,Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, United States.,School of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Rong Yang
- Laboratory for Biomaterials and Drug Delivery, Department of Anesthesiology, Division of Critical Care Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA, United States.,Robert Frederick Smith School of Chemical and Biomolecular Engineering, Cornell University, Ithaca, NY, United States
| | - Xiyu Li
- Laboratory for Biomaterials and Drug Delivery, Department of Anesthesiology, Division of Critical Care Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA, United States
| | - Zipei Zhang
- Laboratory for Biomaterials and Drug Delivery, Department of Anesthesiology, Division of Critical Care Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA, United States
| | - Jens C van der Valk
- Eaton-Peabody Laboratories, Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States.,Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, United States.,Leiden University Medical Center, Leiden, Netherlands
| | - Xiaojie Ma
- Eaton-Peabody Laboratories, Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States.,Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, United States.,Department of Otolaryngology, Qilu Hospital of Shandong University, Jinan, China
| | - Daniel S Kohane
- Laboratory for Biomaterials and Drug Delivery, Department of Anesthesiology, Division of Critical Care Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA, United States
| | - Konstantina M Stankovic
- Eaton-Peabody Laboratories, Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States.,Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, United States.,Program in Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, MA, United States.,Harvard Program in Therapeutic Science, Harvard Medical School, Boston, MA, United States
| |
Collapse
|
49
|
Pagano AS, Márquez S, Smith CM, Laitman JT. Identification of critical windows in early development of human upper respiratory tract and middle ear disease. Anat Rec (Hoboken) 2021; 304:1953-1973. [PMID: 33586870 DOI: 10.1002/ar.24600] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/16/2021] [Accepted: 01/20/2021] [Indexed: 12/23/2022]
Abstract
Otitis media (OM) or middle ear disease is a prevalent pediatric condition generally related to early growth of the cartilaginous Eustachian tube (CET). This study used a developmental series of dry crania to reconstruct CET and dilator tubae (DT, the muscle opening the CET) morphology. Timing and directionality of CET and upper respiratory tract (URT) growth were investigated. Traditional and 3D geometric morphometrics (GM) were used to assess bony landmarks on the crania. The series was divided using dental eruption into seven growth stages ranging from before eruption of deciduous dentition (approximately the first 6 postnatal months) to eruption of the first permanent maxillary molar (after approximately 6 years). Bony endpoints of the CET and DT were used to calculate their morphology. GM analysis showed substantial shape differences between newborns, early infants, and all later developmental stages. Univariate measures showed the largest growth change between birth and 6 months. Subsequently, CET morphology changed little in the latter half of year 1, instead maturing gradually until approximately 3 years whereas DT relative length and orientation finish growth by the end of year 1. Incongruence in slower CET growth and faster DT growth could impact CET function between 6 and 12 months and be a contributing factor of OM. Tubal aeration may improve after this time when both CET and DT morphology mature, coinciding with clinically reported drop-off in ear infections.
Collapse
Affiliation(s)
- Anthony S Pagano
- Department of Medical Sciences, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Samuel Márquez
- Department of Cell Biology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA.,Department of Otolaryngology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Christopher M Smith
- Department of Anthropology, CUNY Graduate Center, New York, New York, USA.,New York Consortium in Evolutionary Primatology (NYCEP), New York, New York, USA.,Center for Anatomy and Functional Morphology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jeffrey T Laitman
- Department of Anthropology, CUNY Graduate Center, New York, New York, USA.,New York Consortium in Evolutionary Primatology (NYCEP), New York, New York, USA.,Center for Anatomy and Functional Morphology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
50
|
Tikhomirova A, Trappetti C, Paton JC, Watson-Haigh N, Wabnitz D, Jervis-Bardy J, Jardeleza C, Kidd SP. A single nucleotide polymorphism in an IgA1 protease gene determines Streptococcus pneumoniae adaptation to the middle ear during otitis media. Pathog Dis 2021; 79:ftaa077. [PMID: 33301554 DOI: 10.1093/femspd/ftaa077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/08/2020] [Indexed: 01/13/2023] Open
Abstract
Factors facilitating the chronicity of otitis media (OM) in children are, to date, not fully understood. An understanding of molecular factors aiding bacterial persistence within the middle ear during OM could reveal pathways required for disease. This study performed a detailed analysis of Streptococcus pneumoniae populations isolated from the nasopharynx and middle ear of one OM case. Isolates were assessed for growth in vitro and infection in a mouse intranasal challenge model. Whole genome sequencing was performed to compare the nasopharyngeal and middle ear isolates. The middle ear isolate displayed a reduced rate of growth and enhanced potential to transit to the middle ear in a murine model. The middle ear population possessed a single nucleotide polymorphism (SNP) in the IgA1 protease gene igA, predicted to render its product non-functional. Allelic exchange mutagenesis of the igA alleles from the genetic variant middle ear and nasopharyngeal isolates was able to reverse the niche-adaptation phenotype in the murine model. These results indicate the potential role of a SNP in the gene encoding the IgA1 protease, in determining S. pneumoniae adaptation to the middle ear during chronic OM. In contrast, a functional IgA1 protease was associated with increased colonisation of the nasopharynx.
Collapse
Affiliation(s)
- Alexandra Tikhomirova
- Research Centre for Infectious Diseases, Australian Centre for Antimicrobial Resistance Ecology, and Department of Molecular and Biomedical Science, The University of Adelaide, 5005, Adelaide, Australia
| | - Claudia Trappetti
- Research Centre for Infectious Diseases, Australian Centre for Antimicrobial Resistance Ecology, and Department of Molecular and Biomedical Science, The University of Adelaide, 5005, Adelaide, Australia
| | - James C Paton
- Research Centre for Infectious Diseases, Australian Centre for Antimicrobial Resistance Ecology, and Department of Molecular and Biomedical Science, The University of Adelaide, 5005, Adelaide, Australia
| | - Nathan Watson-Haigh
- South Australian Genomics Centre, South Australian Health & Medical Research Institute, North Terrace, Adelaide, SA 5000, Australia
| | - David Wabnitz
- Department of Otolaryngology, The Women's and Children's Hospital, King William Road, 5006, Adelaide, Australia
| | - Jake Jervis-Bardy
- Department of Otolaryngology, The Women's and Children's Hospital, King William Road, 5006, Adelaide, Australia
| | - Camille Jardeleza
- Department of Otolaryngology, The Women's and Children's Hospital, King William Road, 5006, Adelaide, Australia
| | - Stephen P Kidd
- Research Centre for Infectious Diseases, Australian Centre for Antimicrobial Resistance Ecology, and Department of Molecular and Biomedical Science, The University of Adelaide, 5005, Adelaide, Australia
- Australian Centre for Antimicrobial Resistance Ecology, The University of Adelaide, Adelaide, Australia
| |
Collapse
|