A case of acute otitis media due to mixed infection with Mycoplasma pneumoniae and Streptococcus pneumoniae

Abstract

There have been a few reports on acute otitis media caused by Mycoplasma pneumoniae, but none on mixed infections with common bacteria. Here we report a case of acute otitis media caused by a mixed infection. The patient was a 19-month-old boy who presented with fever and an intermittent productive cough. He exhibited symptoms of acute nasopharyngitis with postnasal drip, while there was no abnormality of the tympanic membrane. Hence, clavulanic acid/amoxicillin (1:14) was prescribed for 4 days. However, the fever persisted and frequent dry cough was reported. Symptoms of right acute otitis media were noted, and rapid diagnostic evaluation of the pharynx was positive for M. pneumoniae. Penicillin-resistant Streptococcus pneumoniae (PRSP) was isolated from the nasopharynx at the initial examination, and hence, this was considered a case of mixed infection with M. pneumoniae and PRSP. After performing tympanostomy, the patient was prescribed tosufloxacin for 7 days. Subsequently, quick resolution of the fever was noted, while the presence of M. pneumoniae and PRSP was confirmed following evaluation of the middle ear fluid. It was concluded that clinical examination to confirm the presence of a mixed infection (involving M. pneumoniae and a common bacterium) should be considered if dry cough worsens, and the patient exhibits acute otitis media symptoms, while being treated for acute nasopharyngitis.