viral otitis

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This post may be forwarded hither & yon.

I've often cited Chonmaitree et al 1992 (2) and am delighted to find

another study wherein researchers dared evaluate viral presence in

otitis media with effusion (1). Parents of a child with persisting

otitis not responsive to antibiotics ought ask the child's physician,

May we consider whether or not my child's otitis might be viral? Since

many but not all strains of HSV and CMV are responsive to Valtrex, might

we try a course of Valtrex so as to see if the otitis diminishes?

1:* Presence of herpesviruses in middle ear fluid of children with

otitis media with effusion.*

Bulut Y, Karlidag T, Seyrek A, Keles E, Toraman ZA.

Department of Microbiology, College of Medicine, Firat University,

Elazig, Turkey. ybulut@...

http://www.blackwell-synergy.com/doi/abs/10.1111/j.1442-200X.2007.02314.x

BACKGROUND: Otitis media with effusion (OME) is a disease that

frequently occurs in children. Etiopathogenesis of the diseases has

not been completely elucidated. There are limited numbers of studies

on the presence of herpesviruses in otitis media cases with OME. The

present study was undertaken to determine the rate of some

herpesviruses in OME cases of children. METHODS: A total of

92-middle ear fluids were collected from 51 children. The samples

were analyzed using polymerase chain reaction (PCR) for detection of

herpesviruses including Herpes simplex virus (HSV), cytomegalovirus

(CMV), Varicella zoster virus (VZV), and Epstein-Barr virus (EBV).

RESULTS: PCR analysis of the 92 samples showed that genomes of EBV

in 12 (13.04%), HSV in seven (7.60%), CMV in five (5.43%), and VZV

in three (3.26%) were present. Two of these samples were positive

for both HSV and EBV genomes. Therefore, 25 (27.17%) of the samples

were determined to be infected with any of the herpesviruses tested.

CONCLUSIONS: In the present study, herpesviruses were determined at

a high rate in middle ear fluids of children with OME. However, the

present study is a preliminary study and more extensive studies,

especially experimental studies, are required to elucidate the role

of herpesviruses in pathogenesis of OME and whether there is a

relation between rate of herpesviruses in OME cases, and the

reactivation of latent infections.

PMID: 17250503

2. *Presence of cytomegalovirus and herpes simplex virus in middle ear

fluids from children with acute otitis media.*

Chonmaitree T, Owen MJ, Patel JA, Hedgpeth D, Horlick D, Howie VM.

Department of Pediatrics, University of Texas Medical Branch,

Galveston 77550.

Clin Infect Dis. 1992 Oct;15(4):650-3.

Twenty-seven (10%) of 271 infants and children with acute otitis

media (AOM) were found to be infected with cytomegalovirus (CMV) or

herpes simplex virus type 1 (HSV). CMV or HSV, alone or in

combination with bacteria or other viruses, was isolated from the

middle ear fluid (MEF) of 10 patients. In three cases, CMV alone was

isolated from the MEF, and in one case, HSV alone was isolated. One

of the CMV cases involved an acute primary or reactivation of CMV

infection, with CMV-bacterial otitis and conjunctivitis as major

manifestations. One patient with AOM and stomatitis had purulent

otitis associated with the presence of HSV in MEF, with no other

bacterial or viral pathogens noted in MEF or nasal wash specimens.

While most patients with CMV infection were probably asymptomatic

excreters at the time of development of AOM, CMV did enter the

middle ear. The presence of CMV in MEF was prolonged, and the

patients continued to have clinical signs of otitis despite negative

bacterial cultures. Among patients with bacterial otitis, a higher

proportion of those who had CMV found only in nasal wash specimens

had persistent bacteria in MEF, compared with those who were

concurrently infected with other viruses (57% vs. 19%; P less than

.04). This report is the first to suggest an etiologic role for CMV

and HSV in AOM.

PMID: 1330014