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Recurrent acute otitis media - aetiology, diagnostics and prevention

Gisselsson-Solén, Marie LU (2011) In Lund University, Faculty of Medicine Doctoral Dissertation Series 2011:111.
Abstract (Swedish)
Popular Abstract in Swedish

Akut mediaotit - öroninflammation - är den vanligaste bakteriella infektionen hos barn. Den vanligaste öroninflammationsbakterien är pneumokocken. Öroninflammation är en infektion som varierar stort i svårighetsgrad; medan många öroninflammationer läker utan behandling kan andra ge upphov till livshotande komplikationer.

Eftersom självläkningsfrekvensen är ganska hög och eftersom vi på grund av ökande resistensproblematik tvingats bli alltmer återhållsamma med antibiotika, behandlar man idag inte regelmässigt alla öroninflammationer. För att vi i detta sammanhang ska undvika att komplikationerna till öroninflammation ökar krävs fördjupade kunskaper om diagnostik, orsaker och möjligheter... (More)
Popular Abstract in Swedish

Akut mediaotit - öroninflammation - är den vanligaste bakteriella infektionen hos barn. Den vanligaste öroninflammationsbakterien är pneumokocken. Öroninflammation är en infektion som varierar stort i svårighetsgrad; medan många öroninflammationer läker utan behandling kan andra ge upphov till livshotande komplikationer.

Eftersom självläkningsfrekvensen är ganska hög och eftersom vi på grund av ökande resistensproblematik tvingats bli alltmer återhållsamma med antibiotika, behandlar man idag inte regelmässigt alla öroninflammationer. För att vi i detta sammanhang ska undvika att komplikationerna till öroninflammation ökar krävs fördjupade kunskaper om diagnostik, orsaker och möjligheter till att förebygga sjukdomen. En särskilt problematisk grupp är barn med återkommande öroninflammationer - öronbarn. Den enda förebyggande åtgärd som använts i Sverige mot återkommande öroninflammationer är att operera in rör i öronen, vilket ungefär halverar antalet öroninflammationer.



Vi har undersökt möjligheterna att förebygga öroninflammationer hos öronbarn med hjälp av ett särskilt "småbarnsvaccin" mot pneumokocker, och det visar sig att vaccinerade barn har 26% färre öroninflammationer och hälften så ofta får rör i öronen jämfört med icke-vaccinerade.



Genom att utföra bakterieodlingar från nässvalget på öronbarn har vi kunnat konstatera att de ovanligt ofta bär på bakterien Haemophilus influenzae, både då de är sjuka och då de är friska.



Vi har också funnit att öronbarn uppvisar avvikelser i immunförsvaret oftare än andra. De flesta av dessa avvikelser rättar till sig efter några år och kräver ingen behandling, men de kan vara en del av förklaringen till varför en del barn blir öronbarn.



Slutligen har vi undersökt möjligheten att använda ett urin-snabbtest för pneumokocker på prover tagna från nässvalget och örat. Testet går bra att använda även på dessa prover, och hittar de flesta infektioner orsakade av pneumokocker, även i de fall som patienten redan äter antibiotika, vilket vanliga odlingar ofta har svårt att göra. (Less)
Abstract
Acute otitis media (AOM) is the most common bacterial infection in children. The clinical course varies from spontaneous recovery to life-threatening complications, and this variability mainly depends on the causative pathogen. Bacteria usually invade the middle ear from the nasopharynx, where they are carried frequently, both during sickness and health. The most common bacterium to cause AOM, and also one of the most virulent, is S. pneumoniae.



Prediction of the causative pathogen can support the decision of whether or not to prescribe antibiotics for AOM. The rapid pneumococcal urine test Binax NOW was tried on nasopharyngeal and middle ear secretions and was found to have a high sensitivity and specificity for... (More)
Acute otitis media (AOM) is the most common bacterial infection in children. The clinical course varies from spontaneous recovery to life-threatening complications, and this variability mainly depends on the causative pathogen. Bacteria usually invade the middle ear from the nasopharynx, where they are carried frequently, both during sickness and health. The most common bacterium to cause AOM, and also one of the most virulent, is S. pneumoniae.



Prediction of the causative pathogen can support the decision of whether or not to prescribe antibiotics for AOM. The rapid pneumococcal urine test Binax NOW was tried on nasopharyngeal and middle ear secretions and was found to have a high sensitivity and specificity for detecting pneumococci in these fluids.



About 10% of children suffer from recurrent AOM (rAOM). During the last decade, childhood vaccines against S. pneumoniae have been introduced. Vaccination causes a modest reduction of AOM episodes. Whether children with rAOM benefit more than others from vaccination was investigated in a study on young children with an early AOM onset. Vaccination caused a 26% reduction in AOM episodes among children with rAOM.



Knowledge of nasopharyngeal carriage patterns in rAOM children might help in developing new preventive strategies. Children in the vaccine study were rapidly colonized with otitis pathogens. H. influenzae was difficult to eradicate for these children, and was frequently carried during both sickness and health.



Although hereditary factors are known to be important, it is still unclear why some children contract rAOM. We found that deficiencies of the immunological markers IgG2, MBL and C1q were frequent among rAOM children. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Professor Schilder, Anne, Department of Otorhinolaryngology - Head and Neck Surgery University Medical Center Utrecht / Wilhelmina Children's Hospital PO Box 85090 3508 AB UTRECHT The Netherlands
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Binax NOW, immunological aberrations, immune deficiency, Haemophilus influenzae, Streptococcus pneumoniae, nasopharyngeal colonization, conjugate pneumococcal vaccine, Acute otitis media, recurrent acute otitis media
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
volume
2011:111
pages
118 pages
publisher
Faculty of Medicine, Lund University
defense location
Hörsalen, Palaestra et Odeum
defense date
2011-12-10 09:15
ISSN
1652-8220
ISBN
978-91-86871-61-1
language
English
LU publication?
yes
id
d3d940c6-7f14-432b-8753-12918e029d68 (old id 2205610)
date added to LUP
2011-11-21 11:39:38
date last changed
2016-09-19 08:44:50
@phdthesis{d3d940c6-7f14-432b-8753-12918e029d68,
  abstract     = {Acute otitis media (AOM) is the most common bacterial infection in children. The clinical course varies from spontaneous recovery to life-threatening complications, and this variability mainly depends on the causative pathogen. Bacteria usually invade the middle ear from the nasopharynx, where they are carried frequently, both during sickness and health. The most common bacterium to cause AOM, and also one of the most virulent, is S. pneumoniae. <br/><br>
<br/><br>
Prediction of the causative pathogen can support the decision of whether or not to prescribe antibiotics for AOM. The rapid pneumococcal urine test Binax NOW was tried on nasopharyngeal and middle ear secretions and was found to have a high sensitivity and specificity for detecting pneumococci in these fluids. <br/><br>
<br/><br>
About 10% of children suffer from recurrent AOM (rAOM). During the last decade, childhood vaccines against S. pneumoniae have been introduced. Vaccination causes a modest reduction of AOM episodes. Whether children with rAOM benefit more than others from vaccination was investigated in a study on young children with an early AOM onset. Vaccination caused a 26% reduction in AOM episodes among children with rAOM. <br/><br>
<br/><br>
Knowledge of nasopharyngeal carriage patterns in rAOM children might help in developing new preventive strategies. Children in the vaccine study were rapidly colonized with otitis pathogens. H. influenzae was difficult to eradicate for these children, and was frequently carried during both sickness and health. <br/><br>
<br/><br>
Although hereditary factors are known to be important, it is still unclear why some children contract rAOM. We found that deficiencies of the immunological markers IgG2, MBL and C1q were frequent among rAOM children.},
  author       = {Gisselsson-Solén, Marie},
  isbn         = {978-91-86871-61-1},
  issn         = {1652-8220},
  keyword      = {Binax NOW,immunological aberrations,immune deficiency,Haemophilus influenzae,Streptococcus pneumoniae,nasopharyngeal colonization,conjugate pneumococcal vaccine,Acute otitis media,recurrent acute otitis media},
  language     = {eng},
  pages        = {118},
  publisher    = {Faculty of Medicine, Lund University},
  school       = {Lund University},
  series       = {Lund University, Faculty of Medicine Doctoral Dissertation Series},
  title        = {Recurrent acute otitis media - aetiology, diagnostics and prevention},
  volume       = {2011:111},
  year         = {2011},
}