AOM is a multipathogen disease, and can be caused by a number
of different viruses and bacteria. Viruses alone are found in
only 20% of cases, while co-infection with bacteria is seen in 65% of
cases [17]. Among the viruses, Coronavirus, Respiratory Syncytial
Virus, and Adenovirus are most commonly associated with AOM
[5]. S. pneumoniae and H. influenzae are by far the most common
bacterial pathogens in AOM, being recovered in up to 80% of cases.
M. catarrhalis is usually the thirdmost frequent bacterium isolated
(3–20%) and GAS makes up 1–5% of cases, although the incidence
of GAS infection differs between countries, depending on when
the study was performed, and whether severe cases of AOM were
includednx. This