ETIOLOGY OF ACUTE OTITIS-MEDIA IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED CHILDREN

Background. Acute otitis media (AOM) is one of the most common infecti ons that are implicated as significant contributors to morbidity in HI V-infected children, To establish the optimal antibiotic therapy tympa nocentesis is indicated as the first line diagnostic procedure, becaus e unusual pathogens may play a role in advanced stages of deficient hu moral or cellular immunity, Methods. The microbiology of 60 episodes o f AOM diagnosed in 21 symptomatic HIV-infected children (ages 9 months to 12 years) was compared with that of 121 episodes of AOM occurring in 113 immunocompetent HIV-negative children (ages 6 months to 12 year s) in the last 5 years. Results. The prevalence of the three most comm on pathogens (Streptococcus pneumoniae, Haemophilus influenzae and gro up A beta-hemolytic Streptococcus) was similar in HIV-infected and in normal children (56.5% vs, 54.9% of the ears), Staphylococcus aureus w as significantly more frequent in AOM diagnosed in severely immunosupp ressed stages. A significantly lower proportion of middle ear effusion s obtained in HIV-infected children yielded no bacteria compared with normal children. Beta-lactamase production among isolates of H. influe nzae was a rare phenomenon, both in HIV-infected and in normal childre n, No penicillin-resistant S. pneumoniae was found. Conclusions. In HI V-infected children with absent or moderate immunosuppression empiric antibiotic therapy should be based on the recommendations given for im munocompetent children of the same geographic area. In severe immunosu ppressed stages, given the possible role of Staph, aureus, extended sp ectrum antibiotics should be considered.