Immunopathogenesis of polymicrobial otitis media

• Published in: Journal of leukocyte biology Vol. 87; no. 2; pp. 213 - 222
• Main Author: Bakaletz, Lauren O.
• Format: Journal Article
• Language: English
• Published: England Society for Leukocyte Biology 01.02.2010; John Wiley and Sons Inc
• Subjects: Animals; Bacterial Infections - immunology; Bacterial Infections - pathology; Bacterial Infections - physiopathology; Child; Child, Preschool; ear infection; Eustachian tube; Humans; innate immunity; Moraxella catarrhalis; nontypeable Haemophilus influenzae; Otitis Media - immunology; Otitis Media - pathology; Otitis Media - physiopathology; Respiratory Mucosa - immunology; Respiratory Mucosa - microbiology; Respiratory Mucosa - physiopathology; Respiratory Mucosa - virology; Respiratory Tract Infections - immunology; Respiratory Tract Infections - pathology; Respiratory Tract Infections - physiopathology; Reviews; Streptococcus pneumoniae; Virus Diseases - immunology; Virus Diseases - pathology; Virus Diseases - physiopathology
• ISSN: 0741-5400; 1938-3673; 1938-3673
• DOI: 10.1189/jlb.0709518

The synergistic relationship between URT viruses and bacteria in OM pathogenesis is not fully understood, but overall is predicated on viral impairment of airway defenses. OM, or inflammation of the middle ear, is a highly prevalent infection in children worldwide. OM is a multifactorial disease with multiple risk factors, including preceding or concurrent viral URT infection. Hence, OM is also a polymicrobial disease. The mechanisms by which viruses predispose to bacterial OM are replete; however, all are predicated on the general principle of compromise of primary host airway defenses. Thus, despite an as‐yet incomplete understanding of the molecular mechanisms involved in bacterial superinfection of a virus‐compromised respiratory tract, the URT viruses are known to induce histopathology of airway mucosal epithelium, up‐regulate expression of eukaryotic receptors used for bacterial adherence, alter the biochemical and rheological properties of airway mucus, and affect innate and acquired host immune functions, among others. Although discussed here in the context of OM, during preceding or concurrent viral infection of the human respiratory tract, viral impairment of airway defenses and the resulting predisposition to subsequent bacterial coinfection are also known to be operational in the mid and lower airway as well.