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Recovery of a unique bacterial organism in human middle ear fluid and its possible role in chronic otitis media

The middle ear fluids of 10 children with persistent otitis media with effusion (OME) were found to contain an unclassified, slow-growing, gram-positive organism. Large gram-positive cocci, often present as diplococci or tetrads, were readily seen in each effusion. Culture of the fluid on a blood agar plate required 2 to 5 days of incubation at 37 degrees C and yielded a slow-growing coccus in pure culture in 70% of cases and in mixed culture in 30% of cases. The organism in question was unique and could be distinguished from aerococci, gemellas, enterococci, and micrococci. It grew in 6.5% saline and on bile esculin agar. It did not grow at 45 degrees C or anaerobically. It was uniformly catalase and hippurate positive. It gave negative reactions with tellurite, tetrazolium, and pyruvate and did not utilize any of the carbohydrates tested. Reactions to bile esculin were variable. The episodes of OME associated with the bacterium in question were asymptomatic, had been present from 1 to 8 months, and occurred in children who had previously experienced OME. The middle ear fluids were typically serous or seromucinous and contained inflammatory cells. The data suggest that the gram-positive coccus is a newly described middle ear pathogen and may be responsible, in part, for persistent middle ear effusion. The characteristically slow growth of the organism in vitro could hinder recovery of the organism from clinical specimens and may therefore have prevented its earlier recognition.