Increase in middle ear infections of Streptococcus pyogenes etiology among patients of the Department of Pediatric Otolaryngology of the Medical University of Warsaw in correlation with world reports

Abstract

Introduction. Beta-hemolytic streptococcus is one of the most common causes of out-of-hospital infections. It can cause local or general infections of varying severity, most commonly in the throat, paranasal sinuses, ear and skin. Some infections are invasive in nature. In the last months of 2022, an alarming increase in infections caused by Streptococcus pyogenes, including invasive infections, has been observed in many countries in Europe and around the world compared to previous years. Aim. The purpose of this study was to compare the number of hospitalized patients with acute otitis media and acute mastoiditis of S. pyogenes etiology in the first six months of 2023 with hospitalizations for the same reason in the previous 5 years, and to assess the correlation with the observed worldwide trend of an increase in the number of observed beta-hemolytic streptococcus type A infections. Material and methods. A retrospective analysis of the data of patients diagnosed with acute otitis media and acute mastoiditis of S. pyogenes etiology hospitalized in the Department of Pediatric Otolaryngology in the first six months of 2023 was carried out, and their number was compared with patients hospitalized for the same reason in the previous 5 years. Results. Between January 2023 and the end of June 2023, 15 patients with acute otitis media were hospitalized in the Department of Pediatric Otolaryngology, in which S. pyogenes was isolated by bacteriological examination. Purulent leakage from the ear was observed in 10 patients. Isolated otitis media was diagnosed in 4 patients. In 10 children, AOM was complicated by acute mastoiditis, which was confirmed by CT scan. The most severe complication was sepsis of GAS etiology. Intravenous antibiotic therapy and surgical treatment were implemented in all patients, achieving a cure. From 2018 to 2022, the number of patients hospitalized for the same reason was significantly lower each year. Conclusions. The number of patients hospitalized in the Department of Otolaryngology in the last two months of 2022 and in the first six months of 2023 due to AOM, as well as AOM complicated by mastoiditis, in which the etiologic agent turned out to be S. pyogenes confirmed the observed worldwide trend towards an increase in the incidence of GAS. GAS-induced AOM is characterized by greater local aggressiveness, manifested by a higher incidence of tympanic membrane perforation, as well as mastoiditis with bone destruction. The primary antibiotic used to treat GAS infections is penicillin, with sensitivity to penicillin also implying sensitivity to all beta-lactam antibiotics. The treatment of GAS with intratemporal complications in the form of acute mastoiditis caused by S. pyogenes, especially progressing with bone destruction, requires combined antimicrobal therapy with surgical treatment.