Invasive pediatric kingella kingae infections: A nationwide collaborative study

Gal Dubnov-Raz, Moshe Ephros, Ben Zion Garty, Yechiel Schlesinger, Ayala Maayan-Metzger, Joseph Hasson, Imad Kassis, Orna Schwartz-Harari, Pablo Yagupsky

Research output: Contribution to journalArticlepeer-review

114 Scopus citations

Abstract

Background: Kingella kingae is a gram-negative coccobacillus, increasingly recognized as an invasive pediatric pathogen. To date, only few small series of invasive K. kingae infections have been published, mostly from single medical centers. A nationwide multicenter study was performed to investigate the epidemiologic, clinical, and laboratory features of children with culture-proven K. kingae infections. Methods: Clinical microbiology laboratories serving all 22 medical centers in Israel were contacted in a search for children aged 0 to 18 years from whom K. kingae was isolated from a normally sterile site, dating from as far back as possible until December 31, 2007. Medical records of identified patients were reviewed using uniform case definitions. Results: A total of 322 episodes of infection were identified in 321 children, of which 96% occurred before the age of 36 months. The annual incidence in children aged <4 years was 9.4 per 100,000. Infections showed a seasonal nadir between February and April. Skeletal system infections occurred in 169 (52.6%) children and included septic arthritis, osteomyelitis, and tenosynovitis. Occult bacteremia occurred in 140 children (43.6%), endocarditis in 8 (2.5%), and pneumonia in 4 (1.2%). With the exception of endocarditis cases, patients usually appeared only mildly ill. About one-quarter of children had a body temperature <38°C, 57.1% had a blood white blood cell count <15,000/mm, 22.0% had normal C-reactive protein values, and 31.8% had nonelevated erythrocyte sedimentation rate. Conclusions: K. kingae infections usually occur in otherwise healthy children aged 6 to 36 months, mainly causing skeletal system infections and bacteremia, and occasionally endocarditis and pneumonia. Clinical presentation is usually mild, except for endocarditis, necessitating a high index of suspicion.

Original languageEnglish
Pages (from-to)639-643
Number of pages5
JournalPediatric Infectious Disease Journal
Volume29
Issue number7
DOIs
StatePublished - 1 Jan 2010
Externally publishedYes

Keywords

  • Kingella kingae
  • arthritis
  • bacteremia
  • children
  • endocarditis

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