Otitis media in children: bacteriological and immunologic views

ABSTRACT

Middle ear effusions [MEEs] from 452 children of whom 120 children aged 3 months to 2 years presented with acute suppurative otitis media [ASOM] and 332 children aged 2-8 years diagnosed as chronic suppurative otitis media [CSOM] with perforated drum were examined -bacteriologically for the causative bacteria. Our results showed that the prevailing bacteria in cases of AS OM were S. pneumoniae [30.8%], S. aureus [22.5%], H. influnzae [10.8%], S. viridans [10%] and E. coli [1.6%] and that H. infleunzae biotype [IV] was the commonest biotype isolated from cases of ASOM caused by H. infleunzae with a percentage [61. 5] followed by biotype [II] with a percentage [30.7] then biotype [III] with a percentage [7.8] The Prevailing bacteria in cases of CSOM were S. aureus [30.4%] P. aeruginosa [25.3%], S. viridans [12.6%], P. mirabilis [8.1%], E. coli [5%] and H. infleunzae [2.4%] and that H. infleunzae biotype [IV] was the commonest biotype isolated with a percentage [75] from cases of chronic otitis media caused by H. infleunzae followed by biotype [II] and biotype [III] with a percentage [12. 5] for each. The resistance of 21 strains of H. infleunzae to benzyl penicillin, ampicillin, flumox, cepharidine, cefoxitine, tetracycline, chloramphenicol, gentamycin, erythromycin, amikacin and sulfamethoxazol was 42.9%, 38.1%, 19.1%, 9.6%, 4.8%, 81%, 28.6%, 333.4%, 14.3%, 57.1% and 23.8% respectively. All strains were sensitive to ofloxacin, cefotaxime and aztreonam. Using the Enzyme Linked Immuno-sorbent Assay [ELlSA] system,, significant levels of interlukin- [1] [IL-1], interlukin-[6] [IL-6] and tumour necrosis factor [TNF] were detected in 50%, 36.67%, and 13.33% of cases of ASOM respectively and in 20%, 16.67% and 60% of cases of CSOM respectively. The number of positive cases for interhikin-[1] [IL-l], in cases of ASOM was of highly statistical significant value [P<0.001] compared with that of CSOM and the number of positive cases for TNF in cases of CSOM was of highly statistical significant value [P<0. 001] compared with that of ASOM. The number of cases positive for [IL-[6]]; showed no statistical significant difference between ASOM and CSOM. The level of IL-[l] in cases of ASOM was of highly statistical significant value [P<0.00] compared with that in cases of CSOM but the level of IL-[6] in cases of ASOM was of statistical significant value compared with that in cases of CSOM. TNF levels in cases of CSOM was of highly statistical significant value compared with that in cases of ASOM