Microbiology of serous otitis media in children: correlation with age and length of effusion.

The purpose of this study was to correlate the microbiology of serous otitis media in children with the duration of the condition and the patient's age. Aspirates of serous ear fluids from 114 children were examined for aerobic and anaerobic bacteria. Bacterial growth was noted in 47 patients (41%). Aerobic organisms only were recovered in 27 aspirates (57% of the culture-positive aspirates); anaerobic bacteria only in 7 (15%); and mixed aerobic and anaerobic bacteria in 13 (28%). A total of 83 bacterial isolates were recovered, accounting for 1.8 isolates per specimen (1.2 aerobes and 0.6 anaerobe). There were a total of 57 aerobic isolates, including Haemophilus influenzae (15 isolates), Streptococcus pneumoniae (13), and Staphylococcus sp (12). Twenty-six anaerobes were recovered, including anaerobic gram-positive cocci (10), Prevotella spp (8), and Propionibacterium acnes (4). The rate of positive cultures (20 of 36; 56%) was higher in patients younger than 2 years of age than in those older than 2 years of age (27 of 78; 35%). Streptococcus pneumoniae and H influenzae were more often isolated in children younger than 2 years of age and those with effusion for 3 to 5 months, whereas anaerobes were recovered more often in those older than 2 years of age and those with effusion for 6 to 13 months. These data illustrate the effects of the length of effusion and age on the recovery of aerobic and anaerobic bacteria in serous otitis media.

Managing febrile seizures in children.

A febrile seizure is a benign convulsion that occurs in infants or small children and is brought on by fever without evidence of meningitis or encephalitis. Little is known about the etiology, but pharmacologic treatment should be easy to administer, have virtually no adverse effects, and be efficacious. Supporting the family is also crucial during this stressful event.

Aerobic and anaerobic bacteriology of concurrent chronic otitis media with effusion and chronic sinusitis in children.

OBJECTIVE: To correlate the aerobic and anaerobic microbiologic findings of concurrent chronic otitis media with effusion and chronic maxillary sinusitis. METHODS: Cultures were obtained from 32 children with concurrent chronic otitis media with effusion and maxillary sinusitis who underwent tympanostomy tube placement. RESULTS: A total of 42 isolates, 24 aerobic and 18 anaerobic, were recovered from 30 patients; 27 were isolated from both sites, 4 from the ear only, and 11 from the sinus only. The most common isolates were Haemophilus influenzae (9 isolates), Streptococcus pneumoniae (n = 7), Prevotella species (n = 8), and Peptostreptococcus species (n = 6). Microbiological concordance between the ear and sinus was found in 22 (69%) of culture-positive patients. CONCLUSION: The concordance in recovery of organisms in more than two thirds of the patients illustrates the common bacterial etiology between chronic otitis media with effusion and chronic sinusitis in children.

Managing febrile seizures in children.

A febrile seizure is a benign convulsion that occurs in infants or small children and is brought on by fever without evidence of meningitis or encephalitis. Little is known about the etiology; however, it is associated with disease processes outside the central nervous system. In most children, the primary causative factors appears to be the height and rapidity of temperature elevation, which usually exceeds 101.8 degrees F (38.8 degrees C). Seizures occur most often during the temperature rise itself rather than after a prolonged elevation. Variation persists in interpretation, evaluation, and treatment of children with febrile seizures, rendering the diagnosis one of exclusion. Pharmacologic treatment for febrile seizures should be easy to administer, have virtually no adverse effects, and be remarkably efficacious. Along with invasive intervention and pharmacologic management, the clinician must also provide counseling during this stressful event.

Immune response to Fusobacterium nucleatum and Prevotella intermedia in patients with chronic maxillary sinusitis.

Our objective was to study the immune response to 2 anaerobic bacteria in patients with chronic maxillary sinusitis. Immunoglobulin G class antibody titers to Fusobacterium nucleatum and Prevotella intermedia were measured by enzyme-linked immunosorbent assay. Serum levels in the patients were determined on the day sinus aspiration for culture was done, and 75 to 90 days later, after completion of antimicrobial therapy, Prevotella intermedia was isolated from 16 aspirates, and F. nucleatum from 12. Median antibody levels at day 1 for F. nucleatum and P. intermedia were significantly higher in patients whose serum aspirates harbored these organisms than at days 75 to 90 in those who were cured (p < .05). However, the levels stayed elevated in the 5 patients who did not improve. The elevated antibody levels to F. nucleatum and P. intermedia, known oral pathogens, suggest a potential pathogenic role for these organisms in chronic maxillary sinusitis.

Aerobic and anaerobic bacteriology of otorrhea associated with tympanostomy tubes in children.

The microbiology of in 55 ear aspirates obtained from 34 children with chronic otorrhea was studied. Aspiration of the middle ear exudate was done immediately following removal of tympanostomy tube (TT). The middle ear aspirates and swab specimens of the external auditory canals were cultured for aerobic and anaerobic bacteria. Sixty-five isolates were recovered only from the middle ears, 73 only from the external ear canals, and 73 were present at both sites. Analysis of the 138 middle ear isolates demonstrated the recovery of aerobic bacteria only in 28 patients (50%), anaerobes only in seven (13%), and both aerobes and anaerobes in 20 (36%). There were 77 aerobic and 61 anaerobic isolates. Commonly recovered aerobes were Pseudomonas aeruginosa (17 isolates), Staphylococcus aureus (11), Proteus sp. (7), Moraxella catarrhalis (6), Klebsiella pneumoniae (5) and non-typable Haemophilus influenzae (5). Commonly isolated anaerobes were Peptostreptococcus sp. (25 isolates), Prevotella sp. (10), Bacteroides sp. (8) and Fusobacterium sp. (6). Pseudomonas aeruginosa and S. aureus were more often isolated in children older then 6 years. These findings demonstrate the polymicrobial bacteriology of TT-related otorrhea in children. Specimens collected from the external auditory canals can be misleading. Reliable information can be obtained from the ear exudes when collected through the TT or through the open perforation after their removal.

Bacteriology and beta-lactamase activity in acute and chronic maxillary sinusitis.

OBJECTIVE: To assess the bacteriology and beta-lactamase enzyme activity in aspirates of 10 acutely and 13 chronically inflamed maxillary sinuses. RESULTS: The predominant organisms isolated in acute sinusitis were Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, and those found in chronic sinusitis were Prevotella species, Fusobacterium species, and Peptostreptococcus species. Four beta-lactamase-producing organisms (BLPOs) were isolated in four specimens (40%) obtained from acutely inflamed sinuses, and 14 BLPOs were recovered from 10 chronically inflamed sinuses (77%). The predominant BLPOs in acute sinusitis were H influenzae, and M catarrhalis; those in chronic sinusitis were Staphylococcus aureus, Prevotella species, Fusobacterium species, and Bacteroides fragilis. CONCLUSIONS: Beta-lactamase activity was detected in 12 (three in acute and nine in chronic sinusitis) of the 14 aspirates that contained BLPOs. The detection of beta-lactamase activity in sinus aspirates provides support for the role of BLPOs in the failure of penicillin therapy in sinusitis.

Antimicrobial management of chronic sinusitis in children.

This study retrospectively investigated the microbiology and management of 40 children who suffered from chronic sinusitis. The sinuses infected were the maxillary (15 cases), ethmoid (13), and frontal (seven). Pansinusitis was present in five patients. All aspirates were cultured for aerobic and anaerobic bacteria. A total of 121 isolates (97 anaerobic and 24 aerobic) were recovered. Anaerobes were recovered from all 37 culture-positive specimens, and in 14 cases (38 per cent) they were mixed with aerobes. Twenty-three beta-lactamase-producing bacteria were isolated from 16 (43 per cent) patients. The 15 patients who received clindamycin had the most rapid response to therapy and a change of therapy and surgical drainage was required in one case. Of the 16 patients who received amoxycillin or ampicillin, 16 responded to therapy, six needed a change of therapy, including four who also had surgical drainage. Of the six who were treated with erythromycin, three needed antibiotic change, two with surgical drainage. Of the three that received cefaclor, two were cured, and one had an antibiotic change. Resistant organisms were recovered in all the cases that required therapeutic change. These findings support the important role of anaerobic bacteria in the polymicrobial cause of chronic sinusitis in children, and the superiority of therapy effective against these organisms.

Changes in the core tonsillar bacteriology of recurrent tonsillitis: 1977-1993.

Microbiological studies of the core of tonsils removed from children with recurrent tonsillitis due to group A beta-hemolytic streptococci were conducted during three periods, with 50 patients in each period: 1977-1978 (period 1), 1984-1985 (period 2), and 1992-1993 (period 3). Mixed flora were present in all tonsils, with 8.1 organisms per tonsil (3.8 aerobes and 4.3 anaerobes). The predominant isolates in each period were Staphylococcus aureus, Moraxella catarrhalis, Peptostreptococcus species, pigmented Prevotella species, Porphyromonas species, and Fusobacterium species. The rate of recovery of Haemophilus influenzae type b increased from 24% in period 1 to 76% in period 2 (P < .001); a decline to 12% in period 3 correlated with a concomitant increase in the frequency of recovery of non-type b strains of H. influenzae from 4% and 10% in periods 1 and 2, respectively, to 64% in period 3 (P < .001). Both the rate of recovery of beta-lactamase-producing bacteria and the number of these organisms per tonsil increased over time. Specifically, beta-lactamase-producing strains were detected in 37 tonsils (74%) during period 1, in 46 tonsils (92%) during period 2, and in 47 tonsils (94%) during period 3, and the number of such strains per tonsil increased from 1.1 in period 1 to 2.9 and 3.3 in periods 2 and 3, respectively.

Quantitative bacterial cultures and beta-lactamase activity in chronic suppurative otitis media.

Aspiration of the exudate through open perforation was performed in 54 children with chronic suppurative otitis media. Eighty aerobic and 81 anaerobic isolates were recovered. Aerobic bacteria only were involved in 20 patients (37%), and anaerobic organisms only in seven (13%). Mixed aerobic and anaerobic isolates were recovered from 27 patients (50%). The most common bacteria isolated were anaerobic gram-positive cocci, Bacteroides melaninogenicus group, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Staphylococcus aureus. There were 45 beta-lactamase-producing bacteria (BLPB), 30 aerobes, and 15 anaerobes recovered from 38 patients (70%). beta-Lactamase activity was detected in 30 of the 38 ear aspirates (79%) that contained BLPB. All but one of these organisms were in excess of 10(4) colony-forming units/mL. The detection of beta-lactamase activity in the ear aspirates provides evidence of the role of BLPB in the failure of penicillin therapy to eradicate chronic ear infection.

Comparison of the microbiology of group A and non-group A streptococcal tonsillitis.

We studied the microbial flora of tonsils removed from 20 children who suffered from recurrent group A beta-hemolytic streptococcal (GABHS) tonsillitis and 20 who had tonsillar hypertrophy following recurrent non-GABHS tonsillitis. Similar polymicrobial aerobic and anaerobic flora were recovered from the cores of the tonsils in each group. beta-Lactamase-producing bacteria (BLPB) were recovered more often in the group with GABHS. This difference was due mostly to the lower incidence of beta-lactamase-producing strains of Branhamella catarrhalis and Bacteroides sp in hypertrophic tonsils following non-GABHS tonsillitis. beta-Lactamase-producing Staphylococcus aureus was found with equal frequency in both groups. These findings demonstrate that although BLPB are recovered more often in recurrently inflamed tonsils following GABHS infection, BLPB also can be found in hypertrophic tonsils following non-GABHS tonsillitis.

Bacteriology of chronic tonsillitis in young adults.

Tonsils were obtained from 22 young adults (mean age, 23 years) suffering from chronic tonsillitis. Mixed aerobic and anaerobic flora was obtained from core tonsillar cultures in all patients, yielding an average of 9.0 isolates (5.3 anaerobes and 3.7 aerobes) per specimen. The predominant anaerobic isolates were Bacteroides sp, Fusobacterium sp, and gram-positive cocci. The predominant aerobic isolates were alpha-hemolytic streptococci, Staphylococcus aureus, Branhamella catarrhalis, beta-hemolytic streptococci, and hemophilus sp. beta-Lactamase-production was noted in 32 isolates recovered from 18 tonsils (82%). These included all eight isolates of S aureus and five B fragilis, and 11 of 24 B melaninogenicus group (46%). Our findings indicate the polymicrobial nature of deep tonsillar flora in young adults with chronic tonsillitis, and demonstrate the presence of beta-lactamase-producing organisms in most of the patients.

Quantitative measurement of beta lactamase in tonsils of children with recurrent tonsillitis.

Tonsils were obtained from 50 children suffering from recurrent tonsillitis. The tonsils' core material was cultured for aerobic and anaerobic microorganisms. Beta lactamase production was assayed in all isolates and beta lactamase activity was measured in the contents of each tonsil. Mixed aerobic and anaerobic flora was obtained in all patients, yielding an average of 7.9 isolates (4.4 anaerobes and 3.5 aerobes) per specimen. Beta lactamase production was noted in 58 isolates recovered from 39 tonsils (78%). These were all 21 isolates of S. aureus and 10 B. fragilis, 18 of 45 B. melaninogenicus (40%), 7 of 14 B. oralis (50%), and 2 of 13 H. influenzae type B (15%). Beta lactamase activity was detected in 33 of the 39 (85%) tonsils which harbored beta lactamase-producing bacteria, and in none of the 11 tonsils which had no beta lactamase-producing bacteria. Our findings indicate the polymicrobial nature of deep tonsillar flora in children with recurrent tonsillitis, and demonstrate the presence of detectable beta lactamase activity in the tonsillar tissue in most of the tonsils which harbored beta lactamase-producing organism.

Aerobic and anaerobic bacteriologic features of serous otitis media in children.

Aspirates of serous ear fluids from 57 children were examined for aerobic and anaerobic bacteria. Bacterial growth was noted in 23 patients (40 per cent). Aerobic organisms only were recovered in 13 aspirates (57 per cent of the culture-positive aspirates); anaerobic bacteria in four (17 per cent); and mixed aerobic and anaerobic bacteria in six (26 per cent). A total of 45 bacterial isolates were recovered, accounting for 2.0 isolates per specimen (1.4 aerobes and 0.6 anaerobe). There were a total of 31 aerobic isolates, including Hemophilus influenzae (eight isolates), Staphylococcus aureus and Streptococcus pneumoniae (five of each), and Staphylococcus epidermidis and alpha-hemolytic streptococcus (four of each). Fourteen anaerobes were recovered, including anaerobic gram-positive cocci and Bacteroides melaninogenicus (five isolates each) and Propionibacterium acnes (three isolates).

Aerobic and anaerobic bacteria in tonsils of children with recurrent tonsillitis.

Tonsils were obtained from 50 children suffering from recurrent tonsillitis. Patients' ages ranged from 2.5 to 17 years (mean 6 years); 29 were males and 21 females. The tonsils were sectioned in half after heat searing of the surface and the core material was cultured for aerobic and anaerobic microorganisms. Mixed aerobic and anaerobic flora was obtained in all patients, yielding an average of 7.8 isolates (4.1 anaerobes and 3.7 aerobes) per specimen. There were 207 anaerobes isolated. The predominant isolates were 101 Bacteroides sp (including 10 B fragilis group, and 47 B melaninogenicus group), 29 Fusobacterium sp, 34 Gram-positive anaerobic cocci (25 Peptococcus sp and 9 Peptostreptococcus sp) and 16 Veillonella sp. There were 185 aerobic isolates. The predominant isolates were 41 alpha-hemolytic streptococci, 24 Staphylococcus aureus, 19 beta-hemolytic streptococci (11 group A, 4 group B, and 2 each group C and F), 14 Haemophilus sp (including 12 H influenzae type B) and 5 H parainfluenzae. Beta-lactamase production was noted in 56 isolates recovered from 37 tonsils. These were all isolates of S aureus (24) and B fragilis (10), 15 of 47 B melaninogenicus (32%), 5 of the 12 B oralis (42%), and 2 of 12 H influenzae type B (17%). Our findings indicate the polymicrobial aerobic and anaerobic nature of deep tonsillar flora in children with recurrent tonsillitis, and demonstrate the presence of many beta-lactamase-producing organisms in 74% of the patients.

Surface vs core-tonsillar aerobic and anaerobic flora in recurrent tonsillitis.

Specimens from both the surface and the core of tonsils from 23 children with recurrent tonsillitis were cultured for aerobic and anaerobic microorganisms. Mixed aerobic and anaerobic flora were obtained from all patients. The predominant anaerobic isolates were Bacteroides sp, Fusobacterium nucleatum, anaerobic Gram-positive cocci, and Eubacterium sp. The predominant aerobic isolates were alpha-hemolytic streptococci, Staphylococcus aureus, beta-hemolytic streptococci, and Haemophilus sp. beta-Lactamase production was noted in 49 isolates from 19 patients (83%). Seventy percent of the aerobic isolates were recovered in both core and surface specimens, compared with 57% of the anaerobic isolates. Ten percent of aerobes were recovered only in the core, compared with 33% of the anaerobes, and 20% of the aerobes in the surface only, compared wtih 10% of the anaerobes. These data demonstrate the discrepancies between surface and core cultures in the isolation of anaerobic bacteria, and raise the question whether surface cultures can accurately predict the presence of beta-lactamase-producing organisms or other pathogens in the recurrently infected tonsil.

Beta-lactamase-producing isolates of Bacteroides species from children.

Two hundred twenty-four isolates of Bacteroides sp. were recovered from recurrently inflamed tonsils, infected peritoneal fluid, abscesses, wounds, and burns of hospitalized children. Isolates were examined for beta-lactamase production by the chromogenic cephalosporin analog 87/312 methodology. Altogether, 119 isolates were beta-lactamase producers. Of these, 53 were in the B. fragilis group, 28 were in the B. melaninogenicus groups, 12 were B. oralis, 4 were B. ruminicola subsp. brevis, and 22 were Bacteroides sp. Of 28 beta-lactamase-producing strains of B. melaninogenicus, 25 were recovered from tonsils. These observations indicate that in pediatric patients there is a significant incidence of beta-lactamase producers among anaerobes other than B. fragilis.