and Beta Hemolytic Clostridium ramosum Streptococci Isolated From a Child

Presenting

with Acute

Otitis Media

Itzhak Brook, M.S., M.D., Richard H. Schwartz, M.D., Guido

THE children

aerobic bacteriology of acute otitis media is well defined with Streptococcus pneumon2ae and Haemophilus influenzae the most frequently isolated pathogens..* Brook et al. have previously reported a high. incidence of anaerobic organisms isolated from middle ear aspirates in children with both acute’ and chroniC2 otitis media. To our knowledge, C~~mm ramosum has never been isolated from a child presenting with acute otitis media, although clostridium species previously have been. recovered from cases of chronic otitis media.3 We report the isolation of this organism concomitantly with beta hemolytic streptococci from a culture of a middle ear exudate obtained by tympanocentesis from a child with acute suppurative otitis media.

external auditory canal were immediately cultured for aerobic and anaerobic bacteria. aspirates was plated within nve minutes on Mood and chocolate agar for aerobes and for anaerobes on a blood agar plate and thioglycolate broth

in

using the Marione bag system containing an indicator and a catalyst. Conventional aerobic pathogens a.~ well as anaerobic bacteria were sought for. using previously described The aerobic and anaerobic ~a~lt~a~~ ~i~icie~l ~ heavy. growth of Group A beta he’mo![ytic streptococci. The culture of the ear canal revealed only a sparse growth of ~. epidermidis. The anaerobic plate yielded a heavy growth of C. ramosum. Oral therapy with ampiciUin 60 ~~1~~ daily was instituted. Follow-up examination on the tenth day revealed the tympanic ra~ea‘~ha~n~e to have normal. biphasic mobility.

Case

.

.

~.

Report A two-year-old presented with a two-day history of fussiness, fever and otalgia. His right tympanic membrane was bulging, acutely inflamed and exhibited diminished mobility. After obtaining a cultures of the external auditory canal, antisepsis ~~~ ~.c~~m~xl~s~~e~ ~i~.~ l~t~dx~~~ ~c~l~ticrn ~‘~~~c~~~~3

.bycopiu~itrigation with. saline. The ear canal was dried and culjure4 with an NP calcium algenate swab. Tympanocentesis was then performed through a speculum swabbed with,betadine and nns€d.:witit::Bst€~e. saline. The .exudate’; and the

Controni, M.S.