Patterns of Kingella kingae Disease Outbreaks

Houmami, Nawal El; Minodier, Philippe; Dubourg, Grégory; Mirand, Audrey; Jouve, Jean-Luc; Basmaci, Romain; Charrel, Rémi N.; Bonacorsi, Stéphane; Yagupsky, Pablo; Raoult, Didier; Fournier, Pierre‐Edouard

doi:10.1097/inf.0000000000001010

Cited by 40 publications

(25 citation statements)

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“…Notably, dysbiosis of the oral microbiota was also recently reported in smokers (31). Gemella, Neisseria, and Kingella, which contain species with pathogenic potential, were also enriched with the combination of pneumococcal colonization and cigarette smoke exposure in our model (32)(33)(34). Our data suggest that, rather than decreasing colonization resistance by outcompeting commensal bacteria, the expansion of S. pneumoniae during cigarette smoke exposure provides an advantage for other potential pathogens present in the URT.…”

Section: Cigarette Smoke and The Nasal Microbiotamentioning

confidence: 51%

Streptococcus pneumoniae Colonization Is Required To Alter the Nasal Microbiota in Cigarette Smoke-Exposed Mice

et al. 2017

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Smokers have nasal microbiota dysbiosis, with an increased frequency of colonizing bacterial pathogens. It is possible that cigarette smoke increases pathogen acquisition by perturbing the microbiota and decreasing colonization resistance. However, it is difficult to disentangle microbiota dysbiosis due to cigarette smoke exposure from microbiota changes caused by increased pathogen acquisition in human smokers. Using an experimental mouse model, we investigated the impact of cigarette smoke on the nasal microbiota in the absence and presence of nasal pneumococcal colonization. We observed that cigarette smoke exposure alone did not alter the nasal microbiota composition. The microbiota composition was also unchanged at 12 h following low-dose nasal pneumococcal inoculation, suggesting that the ability of the microbiota to resist initial nasal pneumococcal acquisition was not impaired in smoke-exposed mice. However, nasal microbiota dysbiosis occurred as a consequence of established high-dose nasal pneumococcal colonization at day 3 in smoke-exposed mice. Similar to clinical reports on human smokers, an enrichment of potentially pathogenic bacterial genera such as Fusobacterium, Gemella, and Neisseria was observed. Our findings suggest that cigarette smoke exposure predisposes to pneumococcal colonization independent of changes to the nasal microbiota and that microbiota dysbiosis observed in smokers may occur as a consequence of established pathogen colonization.KEYWORDS bacterial colonization, cigarette smoke, microbiota, mouse model, Streptococcus pneumoniae, upper respiratory tract T he microbiota plays an important role in food metabolism, modulates the host immune system, and offers protection from pathogen invasion, termed "colonization resistance" (1-3). Bacteria colonize the skin, as well as mucosal surfaces, including the oral cavity, gut, vagina, upper respiratory tract (URT), and lungs (4-7). Emerging evidence suggests that cigarette smoke exposure is associated with URT microbiota dysbiosis and increases the frequency of asymptomatic nasal colonization by Streptococcus pneumoniae and several other pathogens (8-11). An increased incidence of nasal pneumococcal colonization, in turn, contributes to the increased risk of invasive pneumococcal disease (IPD) observed in smokers and cigarette smoke-exposed mice (12, 13).Cigarette smoke exposure is an environmental stress that may perturb the balanced

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Section: Cigarette Smoke and The Nasal Microbiotamentioning

confidence: 51%

Streptococcus pneumoniae Colonization Is Required To Alter the Nasal Microbiota in Cigarette Smoke-Exposed Mice

et al. 2017

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“…Previous investigations from Israel, France, and the USA have described that K. kingae disease is common in day care institutions. Outbreaks have been described in day care facilities causing clusters of serious infections such as osteomyelitis, septic arthritis, endocarditis, and meningitis (9,10,(18)(19)(20)(21).…”

Section: Discussionmentioning

confidence: 99%

The first report on epidemiology of oropharyngeal Kingella kingae carriage in Scandinavian children: K. kingae carriage is very common in children attending day care facilities in Western Norway

Lillebø

Breistein

Aamas

et al. 2019

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Kingella kingae colonizes the upper airways in children and has been recognized as the most common causative agent of osteoarticular infections (OAI) in children below 4 years of age. This is the first Scandinavian study to investigate oropharyngeal K. kingae carriage in healthy children. From June 2015 to August 2016, we recruited 198 healthy children aged 11–14 months from routine consultations at health promotion centers in Hordaland County, Norway for a cross‐sectional study. After their parents had provided informed consent; demographic data were registered, and an oropharyngeal swab was collected. The oropharyngeal swab was analyzed with a real‐time PCR assay specific to K. kingae targeting the RTX toxin locus. Results showed an asymptomatic carriage rate of 12.6%. A striking and highly significant difference was observed between the children that had started attending day care facilities as compared with children still being at home (33.33% vs 8.5%; p < 0.001). K. kingae is prevalent in young children in Norway. This study emphasize that K. kingae should be considered an important etiological agent in OAI. Transmission seems to be facilitated in day care facilities. The correlation between oropharyngeal carriage and OAI needs to be further explored.

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“…Finally, the sequence types of the Parisian and certain Israeli strains were available (10,14,20,25) and were also used as comparators.…”

Section: Methodsmentioning

confidence: 99%

“…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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confidence: 99%

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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Patterns of Kingella kingae Disease Outbreaks

Abstract: K. kingae outbreaks displayed severe K. kingae diseases that were poorly confirmed with culture methods. We argue for the use of genomic technologies to investigate further K. kingae outbreaks.

Cited by 40 publications

References 48 publications

Streptococcus pneumoniae Colonization Is Required To Alter the Nasal Microbiota in Cigarette Smoke-Exposed Mice

Streptococcus pneumoniae Colonization Is Required To Alter the Nasal Microbiota in Cigarette Smoke-Exposed Mice

The first report on epidemiology of oropharyngeal Kingella kingae carriage in Scandinavian children: K. kingae carriage is very common in children attending day care facilities in Western Norway

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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