Kingella-infective endocarditis resulting in a perforated aortic root abscess and fistulous connection between the sinus of Valsalva and the left atrium in a child

Rotstein, Amichay; Konstantinov, Igor E.; Penny, Daniel J.

doi:10.1017/s1047951110000314

Cited by 17 publications

(10 citation statements)

References 1 publication

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Antecedent poor dental hygiene (243) or dental extractions (244) have been reported in adolescents and adult patients. A native valve is af-fected in 95% of children (138,168,(245)(246)(247)(248)(249)(250)(251)(252), whereas native (133,245,(252)(253)(254)(255) and prosthetic (21,23,243,(256)(257)(258)(259) valve involvement have been reported with approximately similar frequency in adult patients. The mitral valve is affected in over 90% of cases (113,124,130,133,168,244,245,247,248,250,252,255,257,(260)(261)(262)(263)(264)(265)(266), followed by the aortic valve (6, 23, 243, 246, 249, 253-256, 259, 267, 268), while tricuspid (269) or pulmonary …”

Section: Endocarditismentioning

confidence: 99%

“…Despite K. kingae's remarkable susceptibility to antimicrobial drugs, serious complications, such as embolism or mycotic aneurism to the femoral (9,130,251), brachial (124), or ophthalmic (9) arteries, valvular insufficiency (113,242,245,247,249,250,264,269), congestive heart failure (133,249,272) or cardiogenic shock (21,130,258), pulmonary infarction (269), mitral valve rupture (244) or perforation (242,250,263), paravalvular abscess formation (249,259,265), cerebrovascular accidents (113, 168, 242, 255, 257, 261-263, 265, 266, 272, 273), meningitis (113,138,242,245), brain abscess (251), and embolic arthritis (138) and cellulitis (252), are common. Emergency cardiac surgery has been prescribed for life-threatening complications that do not respond to conservative medical treatment (9, 130, 244, 248-250, 259, 263, 267, 271, 272), many patients require late valvuloplasty (269) or valve replacement (242,247,259), and the overall mortality rate of the disease is Ͼ10% (9,18,…”

Section: Endocarditismentioning

confidence: 99%

See 1 more Smart Citation

Kingella kingae: Carriage, Transmission, and Disease

2015

View full text Add to dashboard Cite

SUMMARY Kingella kingae is a common etiology of pediatric bacteremia and the leading agent of osteomyelitis and septic arthritis in children aged 6 to 36 months. This Gram-negative bacterium is carried asymptomatically in the oropharynx and disseminates by close interpersonal contact. The colonized epithelium is the source of bloodstream invasion and dissemination to distant sites, and certain clones show significant association with bacteremia, osteoarthritis, or endocarditis. Kingella kingae produces an RTX (repeat-in-toxin) toxin with broad-spectrum cytotoxicity that probably facilitates mucosal colonization and persistence of the organism in the bloodstream and deep body tissues. With the exception of patients with endocardial involvement, children with K. kingae diseases often show only mild symptoms and signs, necessitating clinical acumen. The isolation of K. kingae on routine solid media is suboptimal, and detection of the bacterium is significantly improved by inoculating exudates into blood culture bottles and the use of PCR-based assays. The organism is generally susceptible to antibiotics that are administered to young patients with joint and bone infections. β-Lactamase production is clonal, and the local prevalence of β-lactamase-producing strains is variable. If adequately and promptly treated, invasive K. kingae infections with no endocardial involvement usually run a benign clinical course.

show abstract

Section: Endocarditismentioning

confidence: 99%

Section: Endocarditismentioning

confidence: 99%

Kingella kingae: Carriage, Transmission, and Disease

2015

View full text Add to dashboard Cite

show abstract

“…A predisposing cardiac malformation or rheumatic heart disease is commonly observed, but some patients have previously normal heart valves. 11,24,[43][44][45][46] Typically, the left side of the heart is involved, usually the mitral valve. In general, fever and acutephase reactants are more elevated in patients with endocarditis compared with those with uncomplicated bacteremia; however, no particular cutoff value accurately distinguishes between the 2 conditions.…”

Section: Bacteremiamentioning

confidence: 99%

Kingella kingae: An Emerging Pathogen in Young Children

2011

View full text Add to dashboard Cite

Kingella kingae is being recognized increasingly as a common etiology of pediatric osteoarticular infections, bacteremia, and endocarditis, which reflects improved culture methods and use of nucleic acid-amplification techniques in clinical microbiology laboratories. K kingae colonizes the posterior pharynx of young children and is transmitted from child to child through close personal contact. Day care attendance increases the risk for colonization and transmission, and clusters of K kingae infections among day care center attendees have been reported. Key virulence factors in K kingae include type IV pili and a potent RTX toxin. In previously healthy children, >95% of K kingae infections are diagnosed between the ages of 6 and 48 months. Among children with underlying medical conditions, K kingae disease may occur at older ages as well. The clinical presentation of K kingae disease is often subtle and may be associated with normal levels of acute-phase reactants, which underscores the importance of a high index of suspicion. K kingae is usually susceptible to ß-lactam antibiotics, and infections typically respond well to medical treatment, with the exception of cases of endocarditis.

show abstract

“…In many patients with endocarditis due to K. kingae, valve replacement is not always necessary, since the response to antimicrobial therapy is good if administered quickly [63]. However, serious lifethreatening complications may happen, such as destruction of heart valves, cardiac failure, septic shock, mycotic aneurisms and cerebrovascular accidents, and the overall mortality rate remains high, at approximately 15% [18,28,56,58,63,[65][66][67][68][69]. For these reasons, echocardiographic evaluation of patients from whom the organism is isolated from a normally sterile site, especially blood, has been recommended by a few authors [70].…”

Section: Bacterial Endocarditismentioning

confidence: 99%

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

et al. 2013

View full text Add to dashboard Cite

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

show abstract

Kingella-infective endocarditis resulting in a perforated aortic root abscess and fistulous connection between the sinus of Valsalva and the left atrium in a child

Cited by 17 publications

References 1 publication

Kingella kingae: Carriage, Transmission, and Disease

Kingella kingae: Carriage, Transmission, and Disease

Kingella kingae: An Emerging Pathogen in Young Children

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

Contact Info

Product

Resources

About