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Dominance of Haemophilus influenzae in ear discharge from Indigenous Australian children with acute otitis media with tympanic membrane perforation

Smith-Vaughan, Heidi C., Binks, Michael J., Marsh, Robyn L., Kaestli, Mirjam E., Ward, Linda M., Hare, Kim M., Pizzutto, Susan J., Thornton, Ruth, Morris, Peter S. and Leach, Amanda J. (2013). Dominance of Haemophilus influenzae in ear discharge from Indigenous Australian children with acute otitis media with tympanic membrane perforation. BMC Ear Nose and Throat Disorders,13(12):1-9.

Document type: Journal Article
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IRMA ID cmartelxPUB101
NHMRC Grant No. 1023781
1024175
Title Dominance of Haemophilus influenzae in ear discharge from Indigenous Australian children with acute otitis media with tympanic membrane perforation
Author Smith-Vaughan, Heidi C.
Binks, Michael J.
Marsh, Robyn L.
Kaestli, Mirjam E.
Ward, Linda M.
Hare, Kim M.
Pizzutto, Susan J.
Thornton, Ruth
Morris, Peter S.
Leach, Amanda J.
Journal Name BMC Ear Nose and Throat Disorders
Publication Date 2013
Volume Number 13
Issue Number 12
ISSN 1472-6815   (check CDU catalogue  open catalogue search in new window)
Scopus ID 2-s2.0-84886501014
Start Page 1
End Page 9
Total Pages 9
Place of Publication United Kingdom
Publisher BioMed Central Ltd.
HERDC Category C1 - Journal Article (DIISR)
Abstract Background
Indigenous Australian children living in remote communities experience high rates of acute otitis media with tympanic membrane perforation (AOMwiP). Otitis media in this population is associated with dense nasopharyngeal colonization of three primary otopathogens; Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis. Little is known about the relative abundance of these pathogens during infection. The objective of this study was to estimate the abundance and concordance of otopathogens in ear discharge and paired nasopharyngeal swabs from children with AOMwiP (discharge of not more than 6 weeks’ duration and perforation size <2%).

Methods
Culture and quantitative PCR (qPCR) estimation of H. influenzae, S. pneumoniae, M. catarrhalis and total bacterial load were performed on paired nasopharyngeal and ear discharge swabs from 55 Indigenous children with AOMwiP aged 3.5 – 45.6 months and resident in remote communities.

Results
By culture, H. influenzae, S. pneumoniae, and M. catarrhalis were detected in 80%, 84% and 91% of nasopharyngeal swabs, and 49%, 33% and 4% of ear discharge swabs, respectively. Using qPCR, H. influenzae, S. pneumoniae, and M. catarrhalis were detected in 82%, 82%, and 93% of nasopharyngeal swabs, and 89%, 41% and 18% of ear discharge swabs, respectively. Relative abundance of H. influenzae in ear discharge swabs was 0-68% of the total bacterial load (median 2.8%); whereas S. pneumoniae and M. catarrhalis relative abundances were consistently <2% of the total bacterial load. S. pneumoniae and M. catarrhalis abundances were significantly lower in ear discharge compared with nasopharyngeal swabs (p = 0.001, p < 0.001); no significant difference was observed in H. influenzae mean abundance at the two sites.

Conclusions
H. influenzae was the dominant otopathogen detected in ear discharge swabs collected from children with AOMwiP. High prevalence and abundance of S. pneumoniae and M. catarrhalis in the nasopharynx did not predict ear discharge prevalence and abundances of these pathogens. PCR was substantially more sensitive than culture for ear discharge, and a necessary adjunct to standard microbiology. Quantitative methods are required to understand species abundance in polymicrobial infections and may be needed to measure accurately the microbiological impact of interventions and to provide a better understanding of clinical failure in these children.
Keywords Otitis media
Haemophilus influenzae
Moraxella catarrhalis
Streptococcus pneumoniae
Bacterial load
Abundance
Relative abundance
qPCR
Additional Notes This is an Open Access article distributed under the terms of the Creative Commons Attribution License 3.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Description for Link Link to CC Attribution 3.0 License
Link to published version
URL https://creativecommons.org/licenses/by/3.0/au/legalcode
http://www.biomedcentral.com/1472-6815/13/12/abstract


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