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The Clinical Course of Bronchiolitis Associated with Acute Otitis Media

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The Clinical Course of Bronchiolitis Associated with Acute Otitis Media Arch Dis Child 2000;83:317–319 317 The clinical course of bronchiolitis associated with Arch Dis Child: first published as 10.1136/adc.83.4.317 on 1 October 2000. Downloaded from acute otitis media Gila Shazberg, Shoshana Revel-Vilk, David Shoseyov, Anat Ben-Ami, Aharon Klar, Haggit Hurvitz Abstract has not, to the best of our knowledge, been Background—Acute otitis media (AOM) systematically studied. The aim of the present is the most common bacterial co-infection study was to investigate whether AOM, bacte- of viral bronchiolitis. rial or viral, influences the clinical course of Aims—To evaluate the influence of AOM bronchiolitis. on the clinical course of bronchiolitis. Subjects—150 children younger than 24 months old, diagnosed with bronchiolitis, hospitalised between December 1997 and Methods May 1999. We enrolled children younger than 24 months Methods—Body temperature, respiratory old, hospitalised with bronchiolitis, in the rate, oxygen saturation, and the need for period between December 1997 and May oxygen supplementation were recorded on 1999. Bronchiolitis was defined as an admission and daily throughout hospitali- acute viral respiratory syndrome, charac- sation. Complete blood count, erythrocyte terised by cough, tachypnoea (respiratory rate > 40/min), dyspnoea, and prolonged sedimentation rate, and assay for respira- 5 tory syncytial virus were performed on expirium with wheezing and/or crackles. admission. All children were examined Children with underlying bronchopulomonary daily for the appearance of AOM. The dysplasia and congenital heart disease were clinical course of children with bronchio- excluded. litis and AOM was compared to those Demographic information obtained on ad- without AOM. mission included gender, age, birth weight, and Results—AOM was diagnosed in 79/150 gestational age. Clinical data obtained prospec- (53%) children with bronchiolitis. Most tively included body temperature, respiratory rate at rest, oxygen saturation (SaO ) in room were diagnosed within the first two days of 2 hospitalisation. No significant diVerence air, and the need for oxygen supplementation. was found in the clinical and laboratory All these parameters were recorded on admis- findings on admission and on daily follow sion and daily throughout hospitalisation. http://adc.bmj.com/ up between children with and without Laboratory tests included complete blood AOM. count and erythrocyte sedimentation rate on admission. RSV infection was diagnosed by a Conclusions—This 2.5 year prospective nasal washing for RSV enzyme linked immuno- study showed no diVerence in the course sorbent assay using Abbott TESTPACK RSV of bronchiolitis, whether an ear infection (no. 2027-16, Abbott Laboratories, North was present or not. Chicago, USA). Chest x ray was performed (Arch Dis Child 2000;83:317–319) on September 23, 2021 by guest. Protected copyright. according to clinical indication and reviewed Keywords: acute otitis media; bronchiolitis; respiratory by a radiologist. course All children were examined daily for the appearance of AOM. Criteria for the diagnosis of AOM included the presence of Viral pathogens, especially respiratory syncy- cloudy or yellow discoloration and opacifica- tial virus (RSV), are a common cause of upper tion of the tympanic membrane, combined Department of and lower respiratory tract infection in young Pediatrics, Bikur with at least one of the following indicators of Cholim Hospital, children. AOM is the most common bacterial acute inflammation: ear pain, notable redness, Hadassah Medical co-infection of viral respiratory infection and and distinct fullness or bulging.6 In patients School, Hebrew occurs in 57–67% of children with RSV with AOM tympanocentesis was performed. University, 5 Strauss infection.1–4 In those children with bronchioli- The aspirated fluid was yellow, thick, and St, Jerusalem 91004, tis and AOM, viral antigens, mostly RSV, have purulent; this finding confirmed the diagnosis Israel S Shazberg been found in middle ear aspirates, either of AOM. Tympanocentesis was not performed S Revel-Vilk alone or in association with pathogenic in children older than 1 year of age or D Shoseyov bacteria. when parental consent was not given. Bacterial A Ben-Ami Contradictory evidence exists regarding culture was performed on middle ear A Klar the role of AOM in bronchiolitis. It is not aspirate. H Hurvitz clear whether it is mainly a viral disease,4 an The clinical course of children with bronchi- Correspondence to: integral part of bronchiolitis, or mainly a olitis and AOM was compared to that of Dr Shazberg bacterial disease complicating the viral children without AOM. The data were ex- email: shazberg@ infection and thus requiring antimicrobial pressed as mean (SD) for each group and the md2.huji.ac.il treatment.2 Whatever the cause of AOM, its diVerences between groups were evaluated Accepted 22 May 2000 eVect on the clinical course of bronchiolitis with the two tailed Student’s t test. www.archdischild.com 318 Shazberg, Revel-Vilk, Shoseyov, Ben-Ami, Klar, Hurvitz Table 1 Characteristics of children hospitalised with bronchiolitis with and without AOM Table 3 Five days follow up of body temperature, arterial Arch Dis Child: first published as 10.1136/adc.83.4.317 on 1 October 2000. Downloaded from haemoglobin O2 saturation (SaO2 ), and respiratory rate Total With AOM Without AOM AOM Temperature Respiratory Female/male 66/84 40/39 26/45 ° Day (+/−) ( C) rate SaO2 Age < 3 months 77 38 39 Age 3–12 months 63 37 26 1 + 38.02 (1.0) 56.4 (11.7) 90.2 (5) Age > 12 months 10 4 6 − 38.05 (0.9) 59.08 (14.7) 90.7 (4.11) Gestational age (weeks) 39 (2.2) 39 (2.1) 39 (2.4) 2 + 37.56 (0.8) 50.2 (9.6) 91.95 (2.7) Birth weight (kg) 2.9 (1) 3 (0.9) 2.9 (1) − 37.38 (0.75) 53.08 (13) 91.1 (4.28) Oxygen supplementation (days) 2.7 (3) 2.8 (2.9) 2.6 (3) 3 + 37.32 (0.69) 49.8 (10.8) 92.3 (3.8) WBC × 109/l 12.8 (4.7) 12.9 (3.8) 12.7 (5.5) − 37.28 (0.8) 51.8 (14.5) 91.1 (6.24) Neutrophils % 46 (16) 46 (16) 46 (17) 4 + 37.1 (0.56) 50.3 (9.6) 92.4 (2.7) ESR (mm/h) 46 (27) 51 (26) 39 (27) − 37. 2 (0.7) 48.6 (10.7) 91.7 (3.4) 5 + 37.07 (0.5) 48.4 (8.58) 92.8 (2.9) Data expressed as mean (SD). No significant statistical diVerence between the two groups was − 37.1 (0.63) 46.8 (11.8) 92.5 (2.7) detected. AOM, acute otitis media; WBC, white blood cell; ESR, erythrocyte sedimentation rate. Data expressed as mean (SD). No significant statistical diVerence between the two groups was detected. Table 2 Culture results of middle ear aspirates in children AOM, acute otitis media; SaO2, oxygen saturation. with bronchiolitis and AOM Bacteriological findings No. of patients Discussion AOM is found frequently as co-infection in Haemophilus influenzae 13 infants and young children with bronchiolitis. Streptococcus pneumoniae 12 Haemophilus + S pneumoniae 1 In the present study, 53% of children with Staphylococcus aureus 5 bronchiolitis had AOM, most of them aged 3 Others 3 7–9 Sterile 22 months to 1 year. Tympanocentesis which Culture not done 8 was performed in the majority of infants Total 64 confirmed the diagnosis of AOM. Thirty six per cent of middle ear aspirates revealed bacte- Results rial pathogens. Culture negative aspirates could In the period between December 1997 and have resulted from previous antibiotic treat- ment, microbiological failure or a viral ear May 1999, covering three RSV seasons, we 10 11 enrolled 150 children with bronchiolitis. Their infection. mean age was 20 weeks (median 14 weeks) and To the best of our knowledge, the eVect of male:female ratio 1.7 (84/66). RSV infection AOM on the clinical course of RSV bronchioli- was identified in 69% of the children with tis has not been evaluated objectively. We bronchiolitis. anticipated that the ear infection would exag- AOM was diagnosed in 79 (53%) of the gerate the clinical course of the bronchiolitis. children with bronchiolitis. The male:female Nevertheless, our present 2.5 year prospective ratio was 1 (39/40). Mean age, gender, study, including daily follow up of body gestational age, and birth weight were similar in temperature and respiratory parameters, both groups. Children aged 3 month to 1 year showednodiVerence in the course of the http://adc.bmj.com/ were more prone to develop AOM (table 1). disease whether an ear infection was present or In 69% of patients with AOM the ear infec- not. tion was diagnosed within the first two days of It is worth noting that no clinical or labora- hospitalisation; 77% were RSV positive. Only tory parameters could predict AOM on six children developed AOM after the fifth day admission or later in the course of the of hospitalisation. Two of them were RSV posi- bronchiolitis. The ear infection usually ap- peared during the first two days of tive. 7 Tympanocentesis was performed in 73% hospitalisation. It might be that the early on September 23, 2021 by guest. Protected copyright. (64/79) of children with AOM. Bacterial diagnosis and treatment with both antibiotics pathogen was isolated in 36% of middle ear and tympanocentesis modified the potential aspirates. Table 2 summarises bacteriological deleterious eVect of this infection on the clini- findings. cal course of bronchiolitis. The influence of AOM on the course of Further studies are needed in order to evalu- bronchiolitis was analysed. No significant ate the influence of AOM on the clinical course diVerence in the clinical and laboratory find- of bronchiolitis and to determine the therapeu- ings on admission was found between children tic recommendations for this group of young with or without AOM.
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