Block S L, Hammerschlag M R, Hedrick J, Tyler R, Smith A, Roblin P, Gaydos C, Pham D, Quinn T C, Palmer R, McCarty J
Kentucky Pediatric Research Inc., Bardstown, USA.
Pediatr Infect Dis J. 1997 Sep;16(9):858-62. doi: 10.1097/00006454-199709000-00008.
Aerobic bacterial pathogens are recovered from 65 to 85% of patients with acute otitis media (AOM). Although Chlamydia pneumoniae is a common pathogen of pediatric pneumonia, it has rarely been cultured from children with chronic otitis media and its role in AOM is unknown.
We cultured for C. pneumoniae in tympanocentesis aspirates and nasopharyngeal swabs from 101 consecutive, otherwise healthy children with AOM or refractory AOM. A control group of 50 similarly aged, healthy children was evaluated for nasopharyngeal carriage of C. pneumoniae. Specimens were also evaluated by PCR for C. pneumoniae.
C. pneumoniae was recovered by tympanocentesis in 8 (8%) of 101 children with AOM. Among the 8 children with C. pneumoniae-positive-AOM, 5 had C. pneumoniae detected by PCR in middle ear fluid, none had C. pneumoniae recovered by nasopharyngeal culture or PCR and 5 were younger than 16 months. C. pneumoniae was the sole pathogen isolated in 2 patients. Copathogens included beta-lactamase-positive positive Haemophilus influenzae (2), beta-lactamase positive Moraxella catarrhalis (1), penicillin-resistant Streptococcus pneumoniae (2) and penicillin-susceptible S. pneumoniae (1). C. pneumoniae was recovered from nasopharyngeal culture in 2 additional patients with C. pneumoniae-negative AOM and in none of 50 healthy control children, although 2 controls were positive by PCR from the nasopharynx.
This is the first study to report the isolation of C. pneumoniae in middle ear fluid of children with AOM.
在65%至85%的急性中耳炎（AOM）患者中可检测到需氧菌病原体。虽然肺炎衣原体是小儿肺炎的常见病原体，但很少从慢性中耳炎患儿中培养出该病原体，其在AOM中的作用尚不清楚。
我们对101例连续的、无其他疾病的AOM或难治性AOM患儿的鼓膜穿刺抽吸物和鼻咽拭子进行肺炎衣原体培养。对50名年龄相仿的健康儿童组成的对照组进行肺炎衣原体鼻咽携带情况评估。标本也通过肺炎衣原体PCR检测。
101例AOM患儿中，8例（8%）通过鼓膜穿刺培养出肺炎衣原体。在这8例肺炎衣原体阳性的AOM患儿中，5例中耳液通过PCR检测出肺炎衣原体，鼻咽培养或PCR均未检测出肺炎衣原体，且5例年龄小于16个月。2例患者中肺炎衣原体是唯一分离出的病原体。合并病原体包括β-内酰胺酶阳性的流感嗜血杆菌（2例）、β-内酰胺酶阳性的卡他莫拉菌（1例）、青霉素耐药的肺炎链球菌（2例）和青霉素敏感的肺炎链球菌（1例）。另外2例肺炎衣原体阴性的AOM患儿鼻咽培养出肺炎衣原体，50名健康对照儿童均未培养出，不过2名对照儿童鼻咽PCR检测呈阳性。
这是第一项报道在AOM患儿中耳液中分离出肺炎衣原体的研究。
