Host Immune Responses to Otopathogens during Otitis Media

Abstract

A hundred and twenty individuals were enrolled in this 1:1 case-control study. Whole blood samples were collected from sixty apparently healthy control subjects while ear swabs and whole blood samples were collected from sixty patients with otitis media, who were attended to the outpatient clinic of ENT department in Al-Hilla Teaching Hospital/ Babylon and Al-Imam Al-Sadiq Hospital/ Babylon and from some private clinics during a period extended from October-2020 to January-2021. Patients were diagnosed by otolaryngology consultant surgeon and were examined by otoscope. About patients with otitis media, in the current study the number and proportion of male patients were more than that of female patients, 34 (56.7 %) versus 26 (43.3 %), and the male to female ratio showed slight male predilection, 1.3:1. The difference in the frequency distribution of patients with otitis media according to gender was not significantly different from that of control subjects (p = 0.446).In the current study, that age of onset of otitis media among patients is highly variable and has a wide range; nevertheless, children under 10 years of age were the predominant group affected accounting for 31.7 % out of all patients in the study.Clinically, most of patients in the current study had acute otitis media (AOM) accounting for 76.7 % followed by chronic suppurative otitis media (CSOM) accounting for 15.0 % and lastly by otitis media with effusion (OME) accounting for 8.3 % only. Recurrent inflammation is shown in 19 (31.7 %) of cases.In the current study, the most common blood group was A (36.7 %) followed by B (26.7 %) then by O (23.3 %) and lastly AB (13.3 %). There was no significant difference in the frequency distribution of individuals according to blood group between patients with otitis media and control group (p<0.05). However, there was a highly significant difference in the frequency distribution of individuals according to blood group O between patients with otitis media and control group (p = 0.007). Therefore, according to the current study, none of the blood group was a risk factor, but on the contrary, blood group O was proved as a protective factor against otitis media by approximately 55 %, with an odds ratio of 0.35 (Confidence interval of 0.16 -0.76).The comparison of serum ferritin level between patients with otitis media and control group revealed that ferritin level was lower in patients with otitis media in comparison with control group in a highly significant manner (p< 0.001), in terms of median (inter-quartile range) the levels were 30.43 (49.61) versus 100.30 (67.65), in patients and control groups, respectively. The results of bacterial culture showed the growth of the following microorganisms with corresponding proportions: Staphylococcus aureus accounting for 17 (28.3 %); Staphylococcus epidermidis accounting for 6 (10.0 %); Klebsiella pneumoniae accounting for 9 (15.0 %); Klebsiella oxytoca accounting for 2 (3.3 %); Pseudomonas aeruginosa accounting for 9 (15.0 %); Pseudomonas stutzeri accounting for 2 (3.3 %); Escherichia coli accounting for 6 (10.0 %); Streptococcus pneumoniae accounting for 3 (5.0 %); Acinetobacter baumannii accounting for 3 (5.0 %) and Candida albicans accounting for 3 (5.0 %). This study revealed that both gram-positive and gram-negative organisms were responsible for infection of middle-ear. Gram-negative rods outnumber the gram-positive organisms. Otherwise, Streptococcus pneumoniae remains the most frequently detected bacteria from patients with AOM in this study.