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Donald B. Roberts, MD
From the Department of Pediatrics, Trip/er Army Medical Center, Hawaii 96859
DEFINITION
Total 16 1
* Abbreviations used are: PPLO, pleuropneumonia-like organisms; FA, fluorescent antibody.
Total 13 1
Abbreviations used are: MK, rhesus monkey kidney; Hep-2, human epidermoid carcinoma oflarynx; DF, WI-26 strain
of human diploid fibroblasts.
Totals 21 9 10 3 43 23 66
Percentages 32 14 15 5 65 35 100
were grown in percentages similar to the percent- Table 4 summarizes the cultures for Mycoplasma
ages obtained from a voluminous literature on cul- from ears with abnormalities of a nonbullous na-
tures from AOM. A search of the English language ture. These were considered by the various authors
literature failed to find any other reports of cultures to be either acute otitis media or serous otitis media.
of any kind from ears with MB. Out of a total of 858 such cultures there was one
positive for M pneumoniae. That was a culture of with meningitis after his fourth attack. Karelitz did
an external canal swab following a myringotomy not do cultures of the ears.
and was not bacteriologically sterile.26 A study by Yoshie is frequently cited as evi-
There is, then, only one published case of the dence that MB can be caused by influenza virus.
aspirate of an ear with MB growing Mpneumoniae Since the study has been quoted so often, it will be
and one growing a virus, in contrast to the 40 of 66 examined in some detail here. Yoshie’s report con-
which grew one or more of the three most common cerned “influenzal otitis media,” which he defined
pathogens in acute purulent otitis media. It is not as .an acute
“. . hemorrhagic otitis media accompa-
known whether the one case positive for M pneu- nied by severe otodynia.” During “a small epidemic
moniae was sterile for the usual bacterial patho- of influenza-like febrile infection. . . .“ there were
gens. 876 outpatients seen in a clinic, 97 of whom had
In spite of the available evidence summarized “otitis media,” and 27 of these had what was
above, many authors continue to state that MB is thought to be “influenzal” otitis media. Yoshie
caused by Mpneumoniae, and that Mpneumoniae chose ten cases to culture out these 27 and isolated
is one of the agents causing AOM. The reasons for viruses in four; he does not state the collection
these statements will be the subject of the following method. Although he states that bacteriologic ex-
discussion. aminations were done, there is no mention of the
results in any of the ear discharges examined; thus
it is impossible to determine whether these were
DISCUSSION OF THE LITERATURE also positive for pathogenic bacteria.
Because of the unspecified appearance of the ears
Role of Viruses
studied, the criteria for selecting the cases for study,
Long before the first description of the Eaton the uncertainty of method of sample collection
agent (pleuropneumonia-like organisms (PPLO), used, and the lack of standard bacteriology reports,
Mycoplasma pneumoniae), MB was thought to be the case for a viral etiology for the otitis itself,
caused by “influenza.”32 There were a number of separate from the accompanying respiratory infec-
published observations that MB accompanied cases tion, is a weak one. The study says nothing about
of clinical influenza. Indeed, MB was sometimes the viral etiology of bullous myringitis.
called “influenzal otitis.” That MB was not neces- Tilles et al24 cultured needle aspirates from nine
sarily specific for influenzal disease was noted over patients with MB and grew an adenovirus 3 from
40 years ago by Karelitz.’ He described the clinical the bacteriologically sterile otitic fluid of one of
appearance, symptoms, and course of 147 cases of them from an 8-year-old child. (In the same study
“myringitis bullosa hemorrhagica” in 87 patients. they grew known bacterial pathogens in five of the
He found that “myringitis bullosa hemorrhagica” nine.)
occurred with a variety of upper respiratory tract
infections including measles. In addition, 17 of Ka-
Role of M pneumoniae
relitz’s patients had purulent drainage, either spon-
taneously or after myringotomy. There were three A study reported by Rifkind et al25 first raised
cases of mastoiditis in children, and one child died the possibility of Mpneumoniae as a cause of MB.
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