Investigation of an Outbreak of Osteoarticular Infections Caused by Kingella Kingae in a Childcare Center Using Molecular Techniques

Bidet, Philippe; Collin, Elodie; Basmaci, Romain; Courroux, Céline; Prisse, Véronique; Dufour, Véronique; Bingen, Édouard; Grimprel, E.; Bonacorsi, Stéphane

doi:10.1097/inf.0b013e3182867f5e

Cited by 52 publications

(57 citation statements)

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“…Exploring the associations between STs and clinical syndromes may be useful to better understand the pathophysiology of K. kingae infections and to interpret the presence of K. kingae strains in the oropharynx of infected patients without osteoarticular sampling. Genotyping studies using PFGE and MLST have allowed researchers to describe the genetic diversity of the K. kingae species (13,14) and investigate the genetic relatedness between the strains, notably during outbreaks (8)(9)(10)(11). However, these genotyping tools are time-consuming and labor-intensive.…”

Section: Discussionmentioning

confidence: 99%

“…The optimization of conventional culture techniques and the development of current molecular techniques, such as real-time PCR, led to the recognition of K. kingae as the major pathogen causing osteoarticular infections (OAIs) in children younger than 4 years in many countries (3)(4)(5)(6) and as a common etiology of occult bacteremia (7) and, more rarely, of endocarditis in children and adults (3,7,8). Moreover, six outbreaks of invasive K. kingae infections in daycare centers in the United States, Israel, and France were recently described (8)(9)(10)(11)(12), with an average infection rate of around 20% (9)(10)(11) and up to an 85% carriage rate among healthy attendees (11), suggesting the increased colonization fitness, transmissibility, and invasiveness of some K. kingae clones.…”

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Major Intercontinentally Distributed Sequence Types of Kingella kingae and Development of a Rapid Molecular Typing Tool

et al. 2014

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f Although Kingella kingae is the most common etiology of osteoarticular infections in young children, is a frequent cause of bacteremia in those younger than 4 years, and has been involved in clusters of invasive infections among daycare center attendees, the population structure of the species has not been systematically studied. Using multilocus sequence typing, we investigated the genetic diversity of the largest intercontinental collection of K. kingae strains to date. To facilitate typing of bacterial isolates, we developed a novel genotyping tool that targets the DNA uptake sequence (DUS). Among 324 strains isolated from asymptomatic carriers and patients from Israel, Europe, North America, and Australia with various invasive forms of the disease from 1960 to 2013, we identified 64 sequence types (STs) and 12 ST complexes (STcs). Five predominant STcs, comprising 72.2% of all strains, were distributed intercontinentally. ST-6 was the most frequent, showing a worldwide distribution, and appeared genotypically isolated by exhibiting few neighboring STs, suggesting an optimal fitness. ST-14 and ST-23 appeared to be the oldest groups of bacteria, while ST-25 probably emerged more recently from the highly evolutive ST-23. Using the DUS typing method, randomly chosen isolates were correctly classified to one of the major STcs. The comprehensive description of K. kingae evolution would help to detect new emerging clones and decipher virulence and fitness mechanisms. The rapid and reproducible DUS typing method may serve in the initial investigation of K. kingae outbreaks.

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Major Intercontinentally Distributed Sequence Types of Kingella kingae and Development of a Rapid Molecular Typing Tool

et al. 2014

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“…On the other hand, ST25 is a France-specific clone that, to date, has been involved only in OAI. Furthermore, ST25 was recently involved in an outbreak of osteomyelitis (18). Our case may underline the higher propensity of ST25 to infect bone tissue than joint tissue.…”

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confidence: 77%

Two Atypical Cases of Kingella kingae Invasive Infection with Concomitant Human Rhinovirus Infection

et al. 2013

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eWe describe two atypical cases of Kingella kingae infection in children diagnosed by PCR, one case involving a soft tissue abscess and one case a femoral Brodie abscess. Both patients had concomitant human rhinovirus infection. K. kingae strains, isolated from an oropharyngeal swab, were characterized by multilocus sequence typing and rtxA sequencing. CASE REPORTSP atient 1 was a healthy 14-month-old girl who was admitted to our tertiary care center because mobilization of her elbow had been painful for 2 days, and an induration of the superior anterior side of her arm was noted, without skin redness. She presented with a 5-day history of febrile viral upper respiratory tract (URT) infection with a maximal temperature of 39.7°C. A biologic inflammatory syndrome was noted, with 14,400 leukocytes/mm 3 , 574,000 platelets/mm 3 , 5.36 g/liter of fibrinogen (normal value, 2 to 4 g/liter), and a C-reactive protein (CRP) level of 47 mg/liter (normal value, 0 to 10 mg/liter). X-ray analysis and ultrasonography of the left upper arm were performed, but neither bone lesion, subperiostal abscess (Fig. 1a), nor joint effusion was reported. However, a soft tissue collection with a hypoechogenic center measuring 22 mm by 5 mm was identified in the anterior muscular compartment of the left arm (Fig. 1b). Surgery was performed for debridement before treatment with antibiotics. Blood cultures, as well as the aerobic and anaerobic cultures of the purulent collection, were sterile, despite inoculation into blood culture vials, but Kingella kingae-specific real-time PCR (1) gave positive results in the abscess. In addition, K. kingae was isolated from an oropharyngeal swab, as previously described (2). The isolated strain was susceptible to amoxicillin and cefamandole but resistant to nalidixic acid and lincomycin, as determined by the disc diffusion method (3). Intravenous antibiotic therapy was therefore initiated immediately after bacteriological sampling, with cefamandole (140 mg/kg of body weight/day) for 5 days. The postoperative evolution was favorable, with no more fever and no more pain during mobilization of the upper limb. On day 3, the biologic inflammatory syndrome decreased; the leukocyte count was 8,200 cells/mm 3 , the fibrinogen level was 4.32 g/liter, and the CRP level was 10 mg/liter. She was discharged on day 5 and given oral antibiotic therapy with amoxicillin (100 mg/kg/day) for 5 more days. Her clinical and biologic features were still normal 3 months later at the control examination.With the use of multilocus sequence typing (MLST) analysis (4), the K. kingae isolate was shown to belong to sequence type 14 (ST14) and to harbor rtxA14 of hemolytic RTX toxin. Unfortunately, because of the low DNA load in the abscess sample and the length of the MLST genes, we failed to amplify all six MLST genes directly on the DNA extract of the abscess. However, three genes (aroE, cpn60, and recA) were successfully studied and displayed the same alleles as those of the oropharyngeal strain. These partial results emphasized ...

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“…(Table 1). Finally, the invasive Tel-Nof strain, which belonged to DUST-6 (lane 14), was also present in 11 asymptomatic contacts. Concerning the Nevatim outbreak, due to the high number of available strains (n ϭ 15) and the high number of potential different patterns (Fig.…”

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“…Although the majority of invasive K. kingae infections are sporadic, 11 outbreaks of invasive disease have been reported in U.S., French, and Israeli day care centers (12)(13)(14)(15)(16)(17)(18)(19)(20)(21), as well as one still unpublished event in Spain (C. Varela Martínez, personal communication). Clinical isolates from ill children and K. kingae organisms detected in the pharynxes of attendees at the affected facility were characterized by the traditional pulsed-field gel electrophoresis (PFGE) or multilocus sequence typing (MLST) method, and widespread dissemination of the invasive strain in the day care population was usually demonstrated, although in some cases other, less virulent strains were also found to be circulating in the facilities (17).…”

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Investigation of Kingella kingae Invasive Infection Outbreaks in Day Care Facilities: Assessment of a Rapid Genotyping Tool Targeting the DNA Uptake Sequence

et al. 2017

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Outbreaks of Kingella kingae invasive infections have recently been reported in day care centers. Pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) revealed that although the invasive strains had widespread dissemination in the day care population, less virulent strains were also circulating in the facilities. However, these typing tools are costly, time-consuming, and laborintensive and provide delayed results. A study was conducted to assess the performance of a rapid and cost-effective genotyping tool targeting the DNA uptake sequence (DUS) in the investigation of outbreaks of K. kingae disease. DUS typing (DUST) patterns of each strain from 7 different clusters were compared to distinguish genotypically linked strains from others. PFGE and, when available, MLST results were used as gold standards. DUST was assessed on 80 K. kingae isolates from Nir-Itzhak (n ϭ 14), Tel-Nof (n ϭ 14), Palmahim (n ϭ 5), Umm-al-Fahm (n ϭ 7), Eilat (n ϭ 8), Nevatim (n ϭ 15) in Israel and Paris, France (n ϭ 17). A unique DUST pattern was involved in the Nir-Itzhak, Palmahim, Umm-al-Fahm, and Paris episodes. Two DUST patterns were found in Eilat, whereas at least 3 were identified in the TelNof and Nevatim episodes. In total, 11 (13.8%) children carried a K. kingae isolate that differed from the outbreak strain. These results were concordant with those obtained with the traditional PFGE and MLST methods. DUST appears to be sensitive and specific in distinguishing the invasive outbreak strain from others in asymptomatic carriers and could be useful to limit unnecessary exposure of the entire day care population to selective antibiotic pressure.KEYWORDS Kingella kingae, DNA uptake sequence, outbreaks, bone and joint infection, genotyping A s a result of increasing use of improved detection methods, Kingella kingae is being increasingly recognized as an important pediatric pathogen and the most common etiology of skeletal system infections in children aged 6 to 48 months in countries where sensitive molecular diagnostic methods are routinely used for processing joint aspirates and bone exudates (1-3). The organism is carried in the oropharynx without clinical symptoms and is transmitted from child to child by close contact among siblings and playmates (4-7). The colonized mucosal surface is also the portal of entry of K. kingae to the bloodstream, from where it may invade the skeletal system and the endocardium, for which the species exhibits a particular tropism (8-10). The K. kingae strains carried differ in virulence. Some strains belonging to a few distinct genotypic

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Investigation of an Outbreak of Osteoarticular Infections Caused by Kingella Kingae in a Childcare Center Using Molecular Techniques

Cited by 52 publications

References 10 publications

Major Intercontinentally Distributed Sequence Types of Kingella kingae and Development of a Rapid Molecular Typing Tool

Major Intercontinentally Distributed Sequence Types of Kingella kingae and Development of a Rapid Molecular Typing Tool

Two Atypical Cases of Kingella kingae Invasive Infection with Concomitant Human Rhinovirus Infection

Investigation of Kingella kingae Invasive Infection Outbreaks in Day Care Facilities: Assessment of a Rapid Genotyping Tool Targeting the DNA Uptake Sequence

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