European Journal of Pediatrics

, 168:1365 | Cite as

Clinical and microbiological impact of human bocavirus on children with acute otitis media

  • Levent Bekir Beder
  • Muneki Hotomi
  • Masashi Ogami
  • Kazuma Yamauchi
  • Jun Shimada
  • Dewan Sakhawat Billal
  • Nobuhisa Ishiguro
  • Noboru YamanakaEmail author
Original Paper


Human Bocavirus (HBoV) as a newly discovered parvovirus has been commonly detected in respiratory tract infections. However, its role in acute otitis media (AOM) has not been well studied. We examined HBoV in Japanese children with AOM and evaluated the virus prevalence together with clinical manifestations and bacterial findings. Overall, 222 nasopharyngeal swabs and 176 middle ear fluids (MEF) samples were collected from 222 children with AOM (median age, 19 months) between May 2006 and April 2007. HBoV detection was performed by PCR and bacterial isolation by standard culture methods. HBoV was found in the nasopharyngeal aspirates of 14 children (6.3%) and in the MEF of six children (2.7%). When HBoV detection results were evaluated with clinical characteristics of children, resolution time of AOM was significantly longer (p=0.04), and rate of fever symptom was also higher in HBoV-positive group (p=0.04). Furthermore, we found positive correlation between detection of HBoV and Streptococcus pneumoniae in the MEF (p=0.004). Nevertheless, nasopharyngeal proportion of S. pneumoniae was similar between virus positive and negative groups. Furthermore, S. pneumoniae was detected as a single pathogen in all MEF of HBoV-positive cases but one, while it presents mixed with other pathogenic bacteria in nasopharynx. In conclusion, HBoV may worsen the clinical symptoms and prolong the clinical outcome of AOM in pediatric population. Finally, HBoV may prime the secondary bacterial infection in the middle ear in favor of S. pneumoniae.


Human Bocavirus Otitis media Streptococcus pneumoniae Clinical outcome 



This work was partially supported by grants-in-aid for scientific researches from the Ministry of Education, Culture, Sports, Science and Technology [19791227 (to KY), 19591987 (to NY)].

We thank all ENT specialists of ATOMS study group for their contribution in maintenance of clinical database and collecting samples from children. We also appreciated Ms Yuki Tatsumi for assistance in the laboratory.

Conflict of interest

The authors declare that they have no financial relationship with the ATOMS study group.


  1. 1.
    Allander T, Tammi MT, Eriksson M et al (2005) Cloning of a human parvovirus by molecular screening of respiratory tract samples. Proc Natl Acad Sci USA 102:12891–12896. doi: 10.1073/pnas.0504666102 PubMedCrossRefGoogle Scholar
  2. 2.
    Alymova IV, Portner A, Takimoto T et al (2005) The novel parainfluenza virus hemagglutinin-neuraminidase inhibitor BCX 2798 prevents lethal synergism between a paramyxovirus and Streptococcus pneumoniae. Antimicrob Agents Chemother 49:398–405. doi: 10.1128/AAC.49.1.398-405.2005 PubMedCrossRefGoogle Scholar
  3. 3.
    Arola M, Ziegler T, Ruuskanen O (1990) Respiratory virus infection as a cause of prolonged symptoms in acute otitis media. J Pediatr 116:697–701. doi: 10.1016/S0022-3476(05) 82650-2 PubMedCrossRefGoogle Scholar
  4. 4.
    Bulut Y, Guven M, Otlu B et al (2007) Acute otitis media and respiratory viruses. Eur J Pediatr 166:223–228. doi: 10.1007/s00431-006-0233-x PubMedCrossRefGoogle Scholar
  5. 5.
    Canafax DM, Yuan Z, Chonmaitree T et al (1998) Amoxicillin middle ear fluid penetration and pharmacokinetics in children with acute otitis media. Pediatr Infect Dis J 17:149–156. doi: 10.1097/00006454-199802000-00014 PubMedCrossRefGoogle Scholar
  6. 6.
    Chieochansin T, Samransamruajkit R, Chutinimitkul S et al (2008) Human bocavirus (HBoV) in Thailand: clinical manifestations in a hospitalized pediatric patient and molecular virus characterization. J Infect 56:137–142. doi: 10.1016/j.jinf.2007.11.006 PubMedCrossRefGoogle Scholar
  7. 7.
    Choi EH, Lee HJ, Kim SJ et al (2006) The association of newly identified respiratory viruses with lower respiratory tract infections in Korean children, 2000–2005. Clin Infect Dis 43:585–592. doi: 10.1086/506350 PubMedCrossRefGoogle Scholar
  8. 8.
    Chonmaitree T, Heikkinen T (1997) Role of viruses in middle-ear disease. Ann N Y Acad Sci 830:143–157. doi: 10.1111/j.1749-6632.1997.tb51886.x PubMedCrossRefGoogle Scholar
  9. 9.
    Chonmaitree T, Owen MJ, Howie VM (1990) Respiratory viruses interfere with bacteriologic response to antibiotic in children with acute otitis media. J Infect Dis 162:546–549PubMedGoogle Scholar
  10. 10.
    Chonmaitree T, Owen MJ, Patel JA et al (1992) Effect of viral respiratory tract infection on outcome of acute otitis media. J Pediatr 120:856–862. doi: 10.1016/S0022-3476(05) 81950-X PubMedCrossRefGoogle Scholar
  11. 11.
    Chonmaitree T, Patel JA, Sim T et al (1996) Role of leukotriene B4 and interleukin-8 in acute bacterial and viral otitis media. Ann Otol Rhinol Laryngol 105:968–974PubMedGoogle Scholar
  12. 12.
    Endo R, Ishiguro N, Kikuta H et al (2007) Seroepidemiology of human bocavirus in Hokkaido prefecture, Japan. J Clin Microbiol 45:3218–3223. doi: 10.1128/JCM.02140-06 PubMedCrossRefGoogle Scholar
  13. 13.
    Esposito S, Bosis S, Niesters HG et al (2008) Impact of human bocavirus on children and their families. J Clin Microbiol 46:1337–1342. doi: 10.1128/JCM.02160-07 PubMedCrossRefGoogle Scholar
  14. 14.
    Garcia-Garcia ML, Calvo C, Pozo F et al (2008) Human bocavirus detection in nasopharyngeal aspirates of children without clinical symptoms of respiratory infection. Pediatr Infect Dis J 27:358–360PubMedCrossRefGoogle Scholar
  15. 15.
    Hayashi T, Otaka R, Abe Y, et al (2007) Treatment outcome of acute otitis media in children treated with a newly released guideline in Japan. In: Lim D (ed) 9th International Symposium on Recent Advances in Otitis Media, Florida, USA, p 89Google Scholar
  16. 16.
    Heikkinen T, Thint M, Chonmaitree T (1999) Prevalence of various respiratory viruses in the middle ear during acute otitis media. N Engl J Med 340:260–264. doi: 10.1056/NEJM199901283400402 PubMedCrossRefGoogle Scholar
  17. 17.
    Kesebir D, Vazquez M, Weibel C et al (2006) Human bocavirus infection in young children in the United States: molecular epidemiological profile and clinical characteristics of a newly emerging respiratory virus. J Infect Dis 194:1276–1282. doi: 10.1086/508213 PubMedCrossRefGoogle Scholar
  18. 18.
    Kleemola M, Nokso-Koivisto J, Herva E et al (2006) Is there any specific association between respiratory viruses and bacteria in acute otitis media of young children? J Infect 52:181–187. doi: 10.1016/j.jinf.2005.05.012 PubMedCrossRefGoogle Scholar
  19. 19.
    Longtin J, Bastien M, Gilca R et al (2008) Human bocavirus infections in hospitalized children and adults. Emerg Infect Dis 14:217–221. doi: 10.3201/eid1402.070851 PubMedCrossRefGoogle Scholar
  20. 20.
    Ma X, Endo R, Ishiguro N et al (2006) Detection of human bocavirus in Japanese children with lower respiratory tract infections. J Clin Microbiol 44:1132–1134. doi: 10.1128/JCM.44.3.1132-1134.2006 PubMedCrossRefGoogle Scholar
  21. 21.
    Manning A, Russell V, Eastick K et al (2006) Epidemiological profile and clinical associations of human bocavirus and other human parvoviruses. J Infect Dis 194:1283–1290. doi: 10.1086/508219 PubMedCrossRefGoogle Scholar
  22. 22.
    Monteny M, Niesters HG, Moll HA et al (2007) Human bocavirus in febrile children, The Netherlands. Emerg Infect Dis 13:180–182PubMedCrossRefGoogle Scholar
  23. 23.
    Noah TL, Becker S (2000) Chemokines in nasal secretions of normal adults experimentally infected with respiratory syncytial virus. Clin Immunol 97:43–49. doi: 10.1006/clim.2000.4914 PubMedCrossRefGoogle Scholar
  24. 24.
    Regamey N, Frey U, Deffernez C et al (2007) Isolation of human bocavirus from Swiss infants with respiratory infections. Pediatr Infect Dis J 26:177–179. doi: 10.1097/01.inf.0000250623.43107.bc PubMedCrossRefGoogle Scholar
  25. 25.
    Ruohola A, Meurman O, Nikkari S et al (2006) Microbiology of acute otitis media in children with tympanostomy tubes: prevalences of bacteria and viruses. Clin Infect Dis 43:1417–1422. doi: 10.1086/509332 PubMedCrossRefGoogle Scholar
  26. 26.
    Smuts H, Hardie D (2006) Human bocavirus in hospitalized children, South Africa. Emerg Infect Dis 12:1457–1458PubMedGoogle Scholar
  27. 27.
    Uhari M, Hietala J, Tuokko H (1995) Risk of acute otitis media in relation to the viral etiology of infections in children. Clin Infect Dis 20:521–524PubMedGoogle Scholar
  28. 28.
    von Linstow ML, Hogh M, Hogh B (2008) Clinical and epidemiologic characteristics of human bocavirus in Danish infants: results from a prospective birth cohort study. Pediatr Infect Dis J 27:897–902. doi: 10.1097/INF.0b013e3181757b16 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Levent Bekir Beder
    • 1
  • Muneki Hotomi
    • 1
  • Masashi Ogami
    • 1
  • Kazuma Yamauchi
    • 1
  • Jun Shimada
    • 1
  • Dewan Sakhawat Billal
    • 1
  • Nobuhisa Ishiguro
    • 2
  • Noboru Yamanaka
    • 1
    Email author
  1. 1.Department of Otolaryngology-Head and Neck SurgeryWakayama Medical UniversityWakayamaJapan
  2. 2.Department of PediatricsHokkaido University Graduate School of MedicineSapporoJapan

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