Development of a broad-range 16S rDNA real-time PCR for the diagnosis of septic arthritis in children

Rosey, Anne-Laure; Abachin, Éric; Quesnes, Gilles; Cadilhac, C.; Péjin, Zagorka; Glorion, Christophe; Berche, Patrick; Ferroni, Agnès

doi:10.1016/j.mimet.2006.06.010

Cited by 133 publications

(107 citation statements)

References 22 publications

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“…Invasive K. kingae infections particularly affect children between 6 and 48 months of age, and over 60% of episodes occur below the age of 2 years [16,[51][52][53][54][55]. The annual incidence of invasive infections due to K. kingae ranged from 9.4 to 27.4 per 100,000 children aged under 4 years [36,56], and peaked in the 6-11-month-old group (40.3 cases/100,000) [57].…”

Section: Epidemiologymentioning

confidence: 99%

“…Since the 1980s, the reported number of cases of K. kingae OAIs has markedly increased, mainly owing to improvements in culture techniques [16,[71][72][73][74][75][76] and to the utilization of molecular methods [32,[51][52][53][54][55][77][78][79][80][81]. Many studies have thus demonstrated that K. kingae has become the major bacterial cause of OAIs in children aged between 6 and 48 months; this microorganism is currently recognized to account for 30-93.8% of all culture-positive OAIs [18,32,[51][52][53][54]77].…”

Section: Osteoarticular Infectionsmentioning

confidence: 99%

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30 Years of Study of Kingella Kingae : Post Tenebras , Lux

et al. 2013

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Kingella kingae is a Gram-negative bacterium that is today recognized as the major cause of joint and bone infections in young children. This microorganism is a member of the normal flora of the oropharynx, and the carriage rate among children under 4 years of age is approximately 10%. K. kingae is transmitted from child to child through close personal contact. Key virulence factors of K. kingae include expression of type IV pili, Knh-mediated adhesive activity and production of a potent RTX toxin. The clinical presentation of K. kingae invasive infection is often subtle and may be associated to mild-to-moderate biologic inflammatory responses, highlighting the importance a high index of suspicion. Molecular diagnosis of K. kingae infections by nucleic acid amplification techniques enables identification of this fastidious microorganism. Invasive infections typically respond favorably to medical treatment, with the exception of cases of endocarditis, which may require urgent valve replacement

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Section: Epidemiologymentioning

confidence: 99%

Section: Osteoarticular Infectionsmentioning

confidence: 99%

30 Years of Study of Kingella Kingae : Post Tenebras , Lux

et al. 2013

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“…Subacute haematogenous osteomyelitis is most likely due to an atypical host-pathogen relationship that may comprise any combination of: increased host resistance; decreased virulence of the causative organism; and/or prior antibiotic exposure [13,14,20,27,28]. Since the 1980s, the number of K. kingae osteoarticular infections (OAI) has markedly increased [22,23,[29][30][31][32][33] and several current studies indicate that K. kingae is becoming a leading cause of bacterial osteoarticular infections in children aged from 6-48 months [23,30,31]. K. kingae has a naturally low virulence and OAIs caused by this pathogen are characterized by a mild-to-moderate clinical and biological inflammatory response [22,23,29,30,33,34].…”

Section: Discussionmentioning

confidence: 99%

Patellar Subacute Hematogenous Osteomyelitis in Children Due To K. Kingae: A Report of Two Cases

Samara¹,

Steiger²,

Valaikaitė³

et al. 2017

J Infect Dis Preve

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Isolated osteomyelitis of the patella is a rare condition mainly occurring in the pediatric population. Diagnosis is often delayed as clinical presentation manifests with vague anterior knee pain, sometimes with mild local signs of inflammation but frequently without any local signs at all. While falls on the knee can explain mild knee pain, erythema, swelling and persistent peripatellar pain should raise a high index of suspicion for local infection. We present two cases of subacute osteomyelitis of the patella in young children. In both cases bone lesions presented as an osteolytic lesion of the patella. After open biopsy of the lesion, bacteriological analysis confirmed infection with Kingella kingae.Keywords: Osteomyelitis; Kingella kingae; Trauma; Bone edema; Intravenous antibiotics; Radiographic; PCR Level of EvidenceCase reports, level IV. Case Report 1A 14-month-old Caucasian girl was admitted to the emergency department (ED) of our hospital due to persistent limping for more than 2 weeks. There was no history of trauma. A febrile episode (38.7°C) had occurred approximately 2 weeks before presentation at the ED, but as symptoms had decreased progressively no investigations into the cause of infection and no treatment had been undertaken. On admittance to our hospital, the child was afebrile and walked with a stiff knee. Clinical examination revealed right-sided knee pain, slight prepatellar edema, and a mild knee joint effusion. Laboratory results showed a white blood cell count of 17,000 cells/mm 3 , normal Creactive protein (2 mg/dL) and erythrocyte sedimentation rate (11 mm/h), but a high platelet count (520.000cells/mm 3 ). Conventional radiograph showed no significant abnormality. MRI demonstrated prepatellar soft tissue swelling, joint effusion, synovial enhancement and bone edema, all signs compatible with septic arthritis (Figure 1). Moreover, MRI revealed an osteolytic lesion located in the upper part of the right patella with anterior erosion of the cortical bone. The child underwent joint aspiration where a small quantity of mildly opaque liquid was extracted; the joint cavity was then thoroughly irrigated and the patient was immediately started on intravenous antibiotics (cefuroxime). A switch to oral antibiotics was undertaken after 3 days and treatment was continued for another 20 days. No pathogen was cultivated from the joint fluid, but K. kingae specific rtPCR gave a positive result. At the final clinical control, 12 months after surgery, the child did not complain about any pain and gait was normal. The clinical exam did not reveal any tenderness, swelling or erythema around the knee and the range of motion of the right knee joint was normal. Radiographs showed a normal patella without pathological findings.

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“…Actualmente, ante la sospecha de una infección por K.kingae se recomienda sembrar la muestra simultáneamente en medio sólido y en un vial de hemocultivo. Por otro lado, el uso de la RPC de amplio espectro ha demostrado que el diagnóstico etiológico de K. kingae, había sido subestimado en pediatría, ya que permite detectar microorganismos fastidiosos y de crecimiento lento cuando los cultivos son negativos o tras el inicio de terapia antimicrobiana empírica [23][24] . La técnica habitualmente consta de RPC universal dirigida contra ARN ribosomal 16S e incluye una etapa, posterior a la RPC, de visualización en gel de agarosa, que es una fuente potencial de contaminación cruzada 23 .…”

Section: Kingella Kingae: Un Patógeno Emergente En Infecciones Osteo-unclassified

Espondilodiscitis causada por Kingella kingae en pediatría: reporte de un caso

Budnik

Porte²,

Arce

et al. 2011

Rev. chil. infectol.

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During the last years, spondilodiskitis due to Kingella kingae has been a new target of interest, since it is the second agent that causes non tuberculous espondilodiskitis in children, after Staphylococcus aureus. Its clinical presentation is very inespecifi c, sometimes with fever, abdominal or lumbar disconfort, nocturnal pain, altered walking and sedestation. Images, culture methods and PCR (polymerase chain reaction) can be helpful for diagnosis, although in an important percent of the cases, etiology cannot be determined. Although there are no established guidelines for treatment, before the suspicion, empiric antibiotic treatment should be started for good prognosis. We describe a case of a 3 year old boy, who had this disease and then a review about spondilodiskitis in childhood and microbiological aspects of Kingella kingae.Key words: Diskitis, Kingella kingae, infectious spondylitis, bone and joint infection, vertebral osteomyelitis. Palabras clave: Discitis, Kingella kingae, espondilitis infecciosa, infecciones osteoarticulares, osteomielitis vertebral.Universidad de Los Andes, Santiago, Chile. Facultad de Medicina (IBO).Clínica Santa María, Santiago, Chile. Servicio de Radiología (JDAV).Servicio de Traumatología (SVS). Servicio de Pediatría (JZR).Establecimiento(s) donde se realizó el trabajo: Clínica Santa María.Este trabajo no tiene conflictos de interés. IntroducciónL a espondilodiscitis es una patología muy infrecuente en pediatría, que requiere de un alto índice de sospecha diagnóstica, ya que un adecuado manejo determinará en parte el buen pronóstico. Aunque su etiología es controvertida, en la mayoría de los casos corresponde a infección de la columna vertebral que compromete el disco y los cuerpos vertebrales adyacentes. Avances en biología molecular han permitido identifi car nuevos agentes, particularmente Kingella kingae, cambiando el conocimiento de la etiología y así el enfoque terapéutico. En la actualidad, los agentes causantes descritos con mayor frecuencia son Staphylococcus aureus, Kingella kingae y Mycobacterium tuberculosis. La aproximación clínica de estos pacientes requiere del uso de imágenes y la obtención de muestra de tejidos para cultivo, estudio histológico y molecular. El tratamiento es con antimicrobianos, inicialmente endovenosos y luego orales, aunque no hay estudios que establezcan con certeza la terapia específi ca, su vía de administración y duración.Se describe a continuación el caso de un prescolar, que presentó una espondilodiscitis por K. kingae y posteriormente se realiza una revisión sobre esta localización de infección ostearticular en niños, fi nalizando con una actualización en K. kingae, patógeno que ha adquirido importancia en los últimos años en el desarrollo de infecciones osteo-articulares en niños.

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Development of a broad-range 16S rDNA real-time PCR for the diagnosis of septic arthritis in children

Cited by 133 publications

References 22 publications

30 Years of Study of Kingella Kingae : Post Tenebras , Lux

30 Years of Study of Kingella Kingae : Post Tenebras , Lux

Patellar Subacute Hematogenous Osteomyelitis in Children Due To K. Kingae: A Report of Two Cases

Espondilodiscitis causada por Kingella kingae en pediatría: reporte de un caso

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