{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T01:27:30Z","timestamp":1771637250239,"version":"3.50.1"},"reference-count":31,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2015,7,15]],"date-time":"2015-07-15T00:00:00Z","timestamp":1436918400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Otolaryngology"],"published-print":{"date-parts":[[2015,8]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Pneumococcal acute otitis media (AOM) has been previously considered as a more severe disease than that caused by other otopathogens, based on clinical and\/or otologic scores. We sought to test this hypothesis in the pneumococcal conjugated vaccine (PCV) era.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Children &lt;6\u00a0years who presented with \u2018severe\u2019 AOM episodes with middle ear fluid (MEF) cultures during 2008\u20132013 were retrospectively identified. \u2018Severe\u2019 AOM episodes were considered if tympanocentesis was required or if spontaneous otorrhea was present. Data were extracted for demographics, clinical and laboratory tests. Children were categorised according to their PCV status as \u2018unimmunised\u2019 or \u2018PCV7\/PCV13 immunised\u2019 and according to their MEF culture results into the \u2018pneumococcal\u2019 or the \u2018non\u2010pneumococcal\u2019 group. Leukocytosis was defined as white blood cells (WBC) count &gt;15\u00a0000\/\u03bcL, and elevated C\u2010reactive protein (CRP) level was considered as &gt;50\u00a0mg\/L.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 295 eligible AOM episodes, 106 (36%) were culture positive. Children in the pneumococcal group (65, 61%) had a significantly higher WBC counts and higher CRP levels, were more often &lt;2\u00a0years old and were more prone to complicate with acute mastoiditis (AM), compared to children in the non\u2010pneumococcal group, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.03, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.02, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.04 and <jats:italic>P<\/jats:italic>\u00a0=\u00a00.03, respectively. In the pneumococcal group, unimmunised children had higher WBC counts when compared with PCV13\u2010immunised children (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.04), but there were no appreciable differences in CRP levels between unimmunised and PCV7\/PCV13\u2010immunised children.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Pneumococcal AOM is associated with higher leukocytosis and CRP levels than non\u2010pneumococcal AOM. Circulating <jats:italic>Streptococcus pneumoniae<\/jats:italic> strains causing \u2018severe\u2019 AOM in PCV13\u2010immunised children yielded lower inflammatory responses when compared with unimmunised children.<\/jats:p><\/jats:sec>","DOI":"10.1111\/coa.12384","type":"journal-article","created":{"date-parts":[[2015,1,31]],"date-time":"2015-01-31T06:59:32Z","timestamp":1422687572000},"page":"370-377","source":"Crossref","is-referenced-by-count":8,"title":["Severity of pneumococcal <i>versus<\/i> non\u2010pneumococcal acute otitis media in children"],"prefix":"10.1111","volume":"40","author":[{"given":"S.","family":"Ovnat Tamir","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Edith Wolfson Medical Center Tel Aviv University Sackler Faculty of Medicine Holon Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Y.","family":"Roth","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Edith Wolfson Medical Center Tel Aviv University Sackler Faculty of Medicine Holon Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Goldfarb","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Edith Wolfson Medical Center Tel Aviv University Sackler Faculty of Medicine Holon Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I.","family":"Grotto","sequence":"additional","affiliation":[{"name":"Public Health Services Israel Ministry of Health Jerusalem Israel"},{"name":"Faculty of Health Sciences Ben\u2010Gurion University of the Negev Beer Sheva Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T.","family":"Marom","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Edith Wolfson Medical Center Tel Aviv University Sackler Faculty of Medicine Holon Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,7,15]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599811431228"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0b013e31820662d7"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2009-2689"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.inf.0000069759.79176.e1"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0b013e3181f253d5"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2011.02.021"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/0009922811398391"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2010.03.017"},{"key":"e_1_2_8_10_1","first-page":"7","article-title":"Clinico\u2010bacteriologic studies on acute otitis media aspiration of the tympanum as a diagnostic and therapeutic method","volume":"107","author":"Lahikainen E.A.","year":"1953","journal-title":"Acta Otolaryngol. 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