Kingella kingae infections in children

Abstract

Kingella kingae is a beta-hemolytic gram-negative bacillus. It was first described in the 1960's by EO King and has been reported as a cause of osteo-articular pediatric infections since the early 1980's. We performed a retrospective review of all pediatric cases of invasive K. kingae infection between 1997 and 2002, in order to define the incidence, clinical presentation and outcome of invasive K. kingae infections in a pediatric population. During the study period, a total of 24 pediatric patients with K. kingae infection were identified. There were 15 blood culture isolates of K. kingae, out of a total of 1151 (1.3%) positive blood cultures, and 9 synovial fluid culture isolates out of a total of 76 (11.8%) positive synovial fluids. Fifteen patients had osteo-articular infections and 9 had primary bacteremia without osteo-articular infection. Outcome was favorable in all cases and only in 2 patients with knee joint infection was surgical intervention performed, by means of formal knee arthrotomy. All patients recovered uneventfully, in 7 cases without any intervention and in the others with intravenous or oral antibiotic. In conclusion, invasive K. kingae infection is not uncommon in Israel. It usually has a mild course and thus is not always detected and treated. As K. kingae grows best in blood culture broth, blood and joint fluid should always be inoculated into blood culture bottles in suspected cases. This bacterium is highly sensitive to betalactame antibiotics and infection resolves quickly with antibiotic treatment. Surgical intervention for osteo-articular infection is seldom indicated.

Etiología y evolución de las infecciones osteo-articulares 2009-2015: Hospital Pediátrico del Centro Hospitalario Pereira Rossell, Uruguay

“…Existen dificultades para lograr el aislamiento de K. kingae debido a su crecimiento lento, su baja concentración en el foco de infección y su escasa capacidad de resistencia a condiciones adversas. Por lo tanto, con el fin de mejorar el rendimiento diagnóstico se puede realizar la inoculación de líquido sinovial o aspirado óseo en frascos de hemocultivo 27,28 . La sospecha clínica de IOA por éste debe incluir en el plan terapéutico empírico inicial un antimicrobiano como una cefalosporina segunda generación 17,29 .…”

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

“…Second, the clinical presentation of K. kingae disease is subtle and may be associated with normal levels of acute-phase reactants, and therefore, these parameters can often not be used to guide switching to oral antibiotics and defining the duration of treatment. Third, some reports even suggest that invasive K. kingae infections may resolve without treatment, and question the necessity of antimicrobial therapy [15,82,94]. However, this statement has to be considered to be controversial, since K. kingae organisms may be seeded elsewhere more easily, causing more precarious complications.…”

“…As described previously, the clinical course is usually better for children with OAIs due to K. kingae than with other classical pathogens, as evidenced by shorter hospitalization and fewer adverse events. Some reports even suggest that transient involvement of the skeletal system during an episode of K. kingae bacteremia may occur, and that fever and skeletal complaints may resolve without antimicrobial therapy, thus supporting an abortive clinical course [15,82,94]. Evolution towards chronic osteomyelitis and orthopedic sequelae seems to be uncommon [18,75,95], but not impossible, as any case may develop serious epiphyseal lesions [Ilharreborde B, Unpublished data].…”

Molecular Diagnosis of Kingella kingae Pericarditis by Amplification and Sequencing of the 16S rRNA Gene

“…In pediatric settings (18), K. kingae colonizes the respiratory and oropharyngeal tracts of almost 4% of toddlers, causing primarily septic arthritis and bacteremia in children younger than 4 years old (21). In this population, it is considered the second most common cause of septic arthritis, with almost 12% of documented cases of arthritis caused by this pathogen (6). A few other reports in pediatric settings include discitis, osteomyelitis, and infections of the central nervous system (1,5,13).…”