polymerase chain reaction (PCR) has shown detectable virus in the middle ear space
respiratory viral infection predisposes to bacterial infection
coinfection with bacteria is present in more than 40 percent viral-induced acute otitis media
associated viruses include:
RSV
parainfluenzae
influenza virus
rhinovirus
enterovirus
Mycoplasma pneumoniae, Chlamydia pneumoniae, Chlamydia trachomatis are rare causes
Reference:
Mittal R, Lisi CV, Gerring R, et al; Current concepts in the pathogenesis and treatment of chronic suppurative otitis media. J Med Microbiol. 2015 Oct;64(10):1103-16.
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