<p>Systematic Review of <em>Kingella kingae</em> Musculoskeletal Infection in Children: Epidemiology, Impact and Management Strategies</p>

Abstract

Kingella kingae, a pathogen often responsible for musculoskeletal infections in children is the most common cause of septic arthritis and osteomyelitis in children 6 to 36 months of age. The aim of this study was to perform a systematic review of previous studies to determine the proportion of K. kingae in bacteriologically proven musculoskeletal infections among the pediatric population. A secondary objective was to describe the diagnostic strategies and outcome of patients with musculoskeletal infections caused by K. kingae. A systematic review was conducted to identify publications that report on musculoskeletal infections caused by K. kingae in the pediatric population (patients 0 to <18 years old with microbiologic culture and/or polymerase chain reaction (PCR) confirmation of K. kingae and a description of the musculoskeletal infection involved). Of 144 studies included in this review, we sought to determine the proportion of K. kingae pediatric musculoskeletal infections. A total of 711 (30.8%) out of 2308 pediatric cases with culture and/or PCR proven musculoskeletal infections had K. kingae successfully identified from twenty-nine studies. Of the 1070 patients who were aged less than 48 months, K. kingae was the organism identified in 47.6% of infections. We found the average age from the collated studies to be 17.73 months. Of 520 pediatric musculoskeletal patients in which K. kingae infections were identified and where the studies reported the sites of infection, a large proportion of cases (65%) were joint infections. This was followed by 18.4% osteoarticular infection (concomitant bone and joint involvement), with isolated bone and spine at 11.9% and 3.5%, respectively. Twenty-one papers reported clinical and laboratory findings in children with confirmed K. kingae infection. The median temperature reported at admission was 37.9°C and mean was 38.2°C. Fourteen studies reported on impact and treatment, with the majority of children experiencing good clinical outcome and function following antibiotic treatment with no serious orthopaedic sequelae.

Acute monoarthritis in young children: comparing the characteristics of patients with juvenile idiopathic arthritis versus septic and undifferentiated arthritis

“…Among SA, 82% was KK-SA. The estimated incidence of bone and joint infections in children in France is 10 per 100,000 children, with KK accounting for 30% of bone and joint infections in children and up to 80% in children younger than 4 years of age 5,7,9,10,28 . Compared to the literature, our cohort had a higher rate of SA, with KK being implicated in the vast majority of cases.…”

Kingella kingae Intrauterine Infection: An Unusual Cause of Chorioamnionitis and Miscarriage in a Patient with Undifferentiated Connective Tissue Disease

“…These OMV's are hemolytic and leukotoxic in an in vitro model and internalized by synoviocytes inducing the synthesis of granulocytemacrophage colony stimulating factor (GM-CSF) and interleukin 6 (IL-6), likely representing the in vivo immunitary response in joint infections [15]. K. kingae has been recognized as a leading cause of septic arthritis and osteomyelitis in children less than 4 years old, usually with no underlying medical conditions [3,4]. Other rare primary manifestations in pediatric population are: Pneumonia, endocarditis, soft tissue infection, endophtalmitis, orbital cellulitis, and meningitis [1,2,[16][17][18][19][20].…”

“…K. kingae is currently recognized as the most common etiology of septic arthritis and osteomyelitis in children between the ages of 6 and 48 months. More rarely, it can cause complicated endocarditis, meningitis, ocular infections, pericarditis, peritonitis, and pneumonia [3,4].…”

First report of Kingella kingae diagnosed in pediatric bone and joint infections in Morocco

“…K. kingae infections seem to be closely correlated to children’s ages. In a meta-analysis, Wong et al reported 47.6% of patients under 48 months of age were diagnosed with K. kingae BJI infections [ 4 ]. In this study, 55.6% of children were aged 6 to 48 months, and 14.8% (4/27) were under 6 months, 2 of them were aged < 1 month, with no history of trauma or unusual infections, and no warning signs of immunosuppression were found.…”

“…Using culture-based diagnostic methods in our hospital, we frequently observe negative cultures in pediatric BJI, and actually, we have no local data on the involvement of K. K in this infection type. It was reported that K. kingae represented 30.8% (711/2308) of pediatric cases with culture and/or PCR proven musculoskeletal infections [ 4 ]. Recently, improvement of nucleic acid amplification assay targeting either the rtx operon or the groEL gene (also known as cpn60 ) allowed a further increase in the diagnostic capability for pediatric K. kingae BJI [ 5 ].…”