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Pediatr Infect Dis J. 2018 Dec 3. doi: 10.1097/INF.0000000000002254. [Epub ahead of print]

Etiology of Childhood Otorrhea in Luanda, Angola, and a Review of Otitis Media in African Children.

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Children's Hospital, Helsinki University Hospital, Helsinki, Finland and University of Helsinki, Helsinki, Finland.
Pediatric Research Center, Helsinki, Finland.
David Bernardino Children's Hospital, Luanda, Angola.
Laboratory of Microbiology, David Bernardino Children's Hospital, Luanda, Angola.
Department of Clinical Microbiology, University of Helsinki and Helsinki University Hospital, HUSLAB, Helsinki, Finland.
Department of Otorhinolaryngology, Helsinki University Hospital, Helsinki, Finland.



In resource-poor settings, otorrhea causes a significant burden of disease in children. Etiologic studies and structured data on otorrhea and chronic otitis media among African children remain scarce.


Here, we reviewed 678 bacteriologically analyzed otorrhea samples from Luanda Children's Hospital from children ≤15 years of age between 2008 and 2015. We then compared these to data from other studies among African children through a literature review of 20 papers published over two decades.


Overall, 32 different bacteria were identified among 542 isolates from 654 children in Luanda. Gram-negative bacteria constituted the majority of all isolates (85%), whereby Pseudomonas sp was the most common (n = 158, 29%), followed by Proteus sp (n = 134, 25%). Among Staphylococcus aureus (n = 106, 10%), 69% of tested isolates were MRSA, and among Enterobacteriaceae 14% were ESBL isolates. Resistance to quinolones was rare. Furthermore, in a review of the literature, we found a high occurrence of otorrhea and chronic suppurative otitis media (CSOM) in children as well as possible gaps in existing knowledge.


In Angola, Gram-negative rods emerged as common causative agents of otorrhea in children followed by S. aureus. The magnitude of chronic otorrhea in Africa represents a cause for public health concern.

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