Recent advances in otitis media
ABSTRACT Otitis media (OM) is a pervasive illness in infants and children, and many children suffer multiple episodes during the first years of life. High rates of acute otitis media (AOM) are reported in developed and emerging countries. Early onset is common in both settings. Recurrent OM is associated with several factors, including early onset of disease, having a sibling with a history of AOM and absence of breast-feeding. Early onset disease has been hypothesized to result from Eustachian tube dysfunction, immunologic naivete and immaturity, and viral upper respiratory tract infection. Nasopharyngeal colonization with bacterial otopathogens increases the likelihood of AOM and the disease is most frequent in children with viral respiratory tract infection colonized with multiple otopathogens (Streptococcus pneumoniae, nontypeable Haemophilus influenzae [NTHi], Moraxella catarrhalis), potentially as a result of inflammation resulting from competition among the bacterial species within the nasopharynx. Epidemiologic observations and studies of pathogenesis suggest that successful strategies for reducing the burden of disease will be best accomplished by targeting multiple viral and/or bacterial pathogens and preventing early onset disease. Guidelines (2004) for the treatment of AOM in children establish a clear hierarchy among the various antibacterials for the treatment of this disease. Failure to achieve early bacterial eradication during antibiotic therapy for AOM increases the clinical failure rates in AOM in young children. Most recurrent AOM episodes occurring within 1 month after successful completion of antibiotic therapy are due to new otopathogens. Failure to eradicate middle ear and/or nasopharyngeal pathogens is associated with higher rates of clinical recurrent AOM, even when the patients show clinical improvement or cure at the end of therapy for the initial episode. Optimal strategy for the prevention of AOM recurrences requires sterilization of the middle ear and eradication of nasopharyngeal carriage of otopathogens during antimicrobial therapy.
- SourceAvailable from: Sara Filippini
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- "Streptococcus pneumoniae (S. pneumoniae) is a Gram-positive commensal of the nasopharyngeal tract of both children and healthy adults. However, S. pneumoniae is also a leading cause of morbidity and mortality worldwide, being responsible for non-invasive and invasive diseases such as acute otitis media, pneumonia, sepsis and meningitis    . "
ABSTRACT: RrgB321, a fusion protein of the three Streptococcus pneumoniae pilus-1 backbone RrgB variants, is protective in vivo against pilus islet 1 (PI-1) positive pneumococci. In addition, antibodies to RrgB321 mediate a complement-dependent opsonophagocytosis of PI-1 positive strains at levels comparable to those obtained with antisera against glycoconjugate vaccines. In the pneumococcus, pilus-1 displays a biphasic expression pattern, with different proportions of two bacterial phenotypes, one expressing and one not expressing the pilus-1. These two populations can be stably separated in vitro giving rise to the enriched high (H) and low (L) pilus expressing populations. In this work we demonstrate that: (i) the opsonophagocytic killing mediated in vitro by RrgB321 antisera is strictly dependent on the pilus expression ratio of the strain used; (ii) during the opsonophagocytosis assay pilus-expressing pneumococci are selectively killed, and (iii) no switch towards the pilus non-expressing phenotype can be observed. Furthermore, in sepsis and pneumonia models, mice immunized with RrgB321 are significantly protected against challenge with either the H or the L pilus-expressing population of strains representative of the three RrgB variants. This suggests that the pilus-1 expression is not down-regulated, and also that the expression of the pilus-1 could be up-regulated in vivo. In conclusion, these data provide evidence that RrgB321 is protective against PI-1 positive strains regardless of their pilus expression level, and support the rationale for the inclusion of this fusion protein into a multi-component protein-based pneumococcal vaccine.Vaccine 12/2011; 30(7):1349-56. DOI:10.1016/j.vaccine.2011.12.080 · 3.49 Impact Factor
- The Annals of otology, rhinology & laryngology. Supplement 02/2005; 194:104-13.
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ABSTRACT: In this article, we provide a critical review of the literature on speech perception and phonological processing in infancy, and in populations with different experiential histories as a window to understanding how the notion of critical periods might apply to the acquisition of one part of language: the sound system. We begin by suggesting the use of the term "optimal period" because (a) both the onset (opening) and offset (closing) of openness to experience is variable rather than absolute and (b) phonological acquisition involves the emergence of a series of nested capabilities, each with its own sensitive period and each best explained at one of several different levels of specificity. In support, we cite evidence suggesting that to fully understand plasticity and commitment in phonological acquisition, it is necessary to consider not only the biological and experiential factors which may contribute to the onset and the offset of openness to experience but also how the sequentially developing parts of phonology constrain and direct development. In summary, we propose a nested, cascading model wherein biology, experience, and functional use each contribute.Developmental Psychobiology 04/2005; 46(3):233-51. DOI:10.1002/dev.20060 · 3.16 Impact Factor