Kingella kingae: an emerging pediatric pathogen.
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Child↗
Biomedical subjects
Pablo Yagupsky
Publications and source records attributed to Pablo Yagupsky.
Murine typhus is a common cause of febrile illness in Bedouin children in Israel.
Murine typhus is known to be endemic among populations living in poverty and exposed to rats and their fleas. A prospective 2-y study was conducted to determine the contribution of murine typhus to undifferentiated febrile illnesses among Bedouin children attending an outpatient clinic in southern Israel. Children with fever > or = 38.5 degrees C lasting for > or = 3 d were enrolled in the study. Murine typhus was serologically confirmed by the microimmunofluorescence test. A total of 549 children met the inclusion criteria of whom 76 (13.8%) had serologically-confirmed murine typhus. The disease was diagnosed in 27 of 434 (6.2%) patients aged < 5 y and in 49 of 115 (42.6%) older children (p<0.001). Murine typhus was diagnosed in 54 of 288 (18.8%) patients between June and November and in 22 of 261 (8.4%) between December and May (p<0.001). Patients with murine typhus had significantly higher prevalence of anaemia, leukopenia, hyponatraemia, and elevated liver enzymes compared to children without the disease. A single child was hospitalized and all 76 patients recovered without complications. Murine typhus is an important cause of febrile illnesses among Bedouin children > or = 5 y of age living in southern Israel and usually runs a benign clinical course.
Animals↗
Outbreak of Kingella kingae skeletal system infections in children in daycare.
OBJECTIVE: The objective of this study is to describe the investigation of an outbreak of one culture-proven and two presumptive cases of Kingella kingae osteomyelitis detected within a 15-day period in a daycare center in Israel. METHODS: Surveillance pharyngeal cultures were obtained from all attendees at the index daycare center and from two neighboring facilities. Combined amoxicillin-rifampin prophylaxis was administered to all children aged 6 to 30 months living in the community. K. kingae isolates were typed by pulsed field gel electrophoresis, random amplified polymorphic DNA analysis and sequencing of the rRNA genes. RESULTS: Surveillance cultures showed that four of 11 attendees at the index facility as well as five of 12 and one of 15 attendees at neighboring daycare centers carried K. kingae. Typing of isolates showed that the isolate from a child with osteomyelitis was identical to all other isolates from the same daycare center and different from organisms derived from the other facilities. Administration of prophylactic antibiotics resulted in partial eradication of the organism. CONCLUSIONS: Dissemination of K. kingae in a susceptible pediatric population may result in an outbreak of invasive disease. Our experience suggests the need for increased alertness for clusters of K. kingae infections among children in daycare.
Age Distribution↗
Blood culture contamination in pediatric patients: young children and young doctors.
OBJECTIVE: The objective of this study was to assess the role played by the patient's age and physician's experience in determining the contamination rate of pediatric blood cultures. METHODS: The proportion of true-positive (isolation of a pathogen) and false-positive (isolation of a contaminant) results among blood cultures obtained by in-training physicians and experienced pediatricians from young children (aged 1-35 months) and older children (>or=36 months of age) and the value of a positive blood culture to predict a true-positive result were retrospectively determined. RESULTS: The odds of a positive blood culture to predict isolation of a true-pathogen was 0.366 only when the sample was obtained by an inexperienced physician and 0.523 when it was drawn by an experienced physician (P < 0.001), 0.419 when it was obtained from a young child and 0.429 when it was drawn from an older child (P = 0.781). The predictive value of a positive result for isolating a pathogen was significant higher when an experienced physician drew the blood culture regardless of the patient's age. CONCLUSIONS: Patient's young age and lack of experience of the physician who draws the specimen increase the risk of blood culture contamination. These results strengthen the need to improve the technical skills of young physicians.
Blood↗
Selection of antibiotic-resistant pathogens in the community.
In recent years, the importance of the community as a breeding ground for antibiotic-resistant pathogens is being recognized. Prescription of antimicrobial drugs for viral infections, inadequate dosage, use of long-acting macrolides and broad-spectrum antibiotics, and accessibility of over-the-counter antibiotics in many countries are the main drivers of increasing resistance. Education of physicians and the public on the correct use of antibiotics, introduction of rapid and reliable laboratory methods to distinguish between viral and bacterial infections, and offering economic incentives to the pharmaceutical industry to develop new drugs appear to be key issues in the confrontation with this serious public health problem.
Anti-Bacterial Agents↗
Acute otitis media caused by Streptococcus pyogenes in children.
BACKGROUND: Streptococcus pyogenes, or group A beta -hemolytic Streptococcus (GAS), is an important causative agent of bacterial pharyngotonsillititis and skin, soft-tissue, and invasive infections. Although it is also an important pathogen in acute otitis media (AOM), its exact role has not been determined. METHODS: Patients aged 0-18 years with AOM, from whom a specimen of middle-ear fluid was obtained and cultured during 1999-2003, were enrolled. Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and GAS were considered pathogens. Information collected included demographic characteristics, clinical history, and signs and symptoms. RESULTS: GAS otitis was observed in 350 (3.1%) of 11,311 episodes (of which 117 were also culture-positive for other pathogens). The other 10,961 episodes involved H. influenzae only (n = 2507), S. pneumoniae only (n = 2131), dual infection with H. influenzae and S. pneumoniae (n = 1290), M. catarrhalis only (n = 129), and other combinations of pathogens (n = 271). Increased age and Jewish ethnicity were independent, significant, positive risk factors for GAS AOM, and fall season was a negative risk factor. Episodes of GAS infection were less frequently bilateral, febrile, and accompanied by other systemic findings than were other episodes of other types of infection. Most patients with GAS AOM presented with acute drainage from the ears. A lower proportion of cases of AOM were due to GAS in children with recurrent AOM and in patients recently treated with antibiotics, compared with patients with AOM who did not have these factors. The risk for mastoiditis was highest among patients with GAS AOM, compared with patients infected with other pathogens: 11.6 episodes per 1000 episodes of GAS AOM, compared with 2.2, 0.3, and 0 episodes of mastoiditis per 1000 episodes of AOM due to S. pneumoniae, H. influenzae, and M. catarrhalis, respectively. CONCLUSION: Compared with AOM caused by pathogens other than GAS, GAS AOM is characterized by older age and higher local aggressiveness manifested by lower rates of fever and respiratory symptoms and higher rates of tympanic perforation and mastoiditis.
Acute Disease↗
Characterization and immunogenicity of Kingella kingae outer-membrane proteins.
In recent years, Kingella kingae has emerged as an important pediatric pathogen but the antigenicity of the organism and the host immune response have not been studied. Outer membrane proteins (OMPs) of 57 K. kingae isolates were characterized and the immune response of 19 children with invasive infections was studied by immunoblotting. Kingella kingae OMPs were remarkably similar disregarding place and time of isolation and associated clinical condition (asymptomatic carriage, bacteremia, endocarditis, septic arthritis or osteomyelitis). Most OMPs were immunogenic but the specific bands that reacted in each strain and the intensity of the reactions varied substantially. When convalescent sera were reacted with heterologous strains, bands that either were not recognized by the homologous serum or were not present in the homologous strain were visualized. These results demonstrate that OMPs of K. kingae are highly conserved but suggest that some epitopes are polymorphic, resulting in a variable pattern of immune response.
Adult↗
Population structure of group B streptococcus from a low-incidence region for invasive neonatal disease.
The population structure of group B streptococcus (GBS) from a low-incidence region for invasive neonatal disease (Israel) was investigated using multilocus genotype data. The strain collection consisted of isolates from maternal carriage (n=104) and invasive neonatal disease (n=50), resolving into 46 sequence types. The most prevalent sequence types were ST-1 (17.5 %), ST-19 (10.4 %), ST-17 (9.7 %), ST-22 (8.4 %) and ST-23 (6.5 %). Serotype III was the most common, accounting for 29.2 % of the isolates. None of the serotypes was significantly associated with invasive neonatal disease. burst analysis resolved the 46 sequence types into seven lineages (clonal complexes), from which only lineage ST-17, expressing serotype III only, was significantly associated with invasive neonatal disease. Lineage ST-22 expressed mainly serotype II, and was significantly associated with carriage. The distribution of the various sequence types and lineages, and the association of lineage ST-17 with invasive disease, are consistent with the results of analyses from a global GBS isolate collection. These findings could imply that the global variation in disease incidence is independent of the circulating GBS populations, and may be more affected by other risk factors for invasive GBS disease, or by different prevention strategies.
Carrier State↗
Laboratory exposures to brucellae and implications for bioterrorism.
Brucellae are class 3 organisms and potential agents of bioterrorism. Because of effective public health measures, brucellosis has become a rare disease in industrialized countries, and clinical microbiology laboratories are frequently unfamiliar with the genus. A low index of suspicion by physicians or failure to notify the laboratory, equivocal Gram-stain results, misidentification of the organism by commercial systems, unsafe laboratory practices, and laboratory accidents have been responsible for numerous cases of exposure to the organism and laboratory-acquired disease in recent years. Discovery of a laboratory exposure to brucellae should prompt an exhaustive investigation of the event and its circumstances, definition of the population at risk, enforcement of safe laboratory practices, and antimicrobial drug prophylaxis for exposed persons. Inadvertent exposures to brucellae in the clinical laboratory indicate a widespread lack of preparedness to cope with eventual biologic threats involving use of the organism.
Brucella↗
Differentiation between septic arthritis and transient synovitis of the hip in children.
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Algorithms↗
Unsuspected Kingella kingae infections in afebrile children with mild skeletal symptoms: the importance of blood cultures.
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Bacteremia↗
Murine typhus among Arabs and Jews in Israel 1991--2001.
The aim of this study was to explore the incidence and differences in the epidemiology of murine typhus between Jews and Arabs in Israel. Between 1991 and 2001, 406 cases of murine typhus were diagnosed; 57% of cases occurred between August and November. Differences between Arabs vs. Jews regarding mean yearly incidence (1.84 vs. 0.35/100,000 people; p = 0.003), median age (35 vs. 44 years; p < 0.001), and male:female ratio (1:1 vs. 1.3:1; p = 0.009), were found. Control measures to decrease morbidity of murine typhus should take into consideration the socio-economic and environmental factors influencing the differences observed.
Animals↗
Kingella kingae: from medical rarity to an emerging paediatric pathogen.
In recent years, Kingella kingae has emerged as an important cause of invasive infections in young children, especially septic arthritis, osteomyelitis, spondylodiscitis, bacteraemia, and endocarditis, and less frequently lower respiratory tract infections and meningitis. The organism is part of the pharyngeal flora of young children and is transmitted from child-to-child. The clinical presentation of invasive K kingae disease is often subtle and laboratory tests are frequently normal. A substantial fraction of children with invasive K kingae infections have a recent history of stomatitis or symptoms of upper-respiratory-tract infection. The organism is susceptible to a wide array of antibiotics that are usually given empirically to young children including beta lactams, and with the exception of cases of endocarditis, the disease runs a benign clinical course. Although isolation and recognition of the organism is not difficult, clinicians and microbiologists should be aware of its fastidious nature. To optimise the recovery of K kingae, inoculation of synovial fluid specimens into blood culture vials is strongly recommended.
Adolescent↗
Bartholin's gland abscess caused by Brucella melitensis.
We report herein a case of Bartholin's gland abscess caused by Brucella melitensis. Clinical microbiology laboratory workers in areas where this disease is endemic should be familiar with the bacteriological features of this organism and consider the possibility of a brucellar etiology in a broad range of clinical settings.
Adult↗
Use of the BACTEC MYCO/F LYTIC medium for detection of Brucella melitensis bacteremia.
In a prospective volume-controlled study, the sensitivity of the BACTEC MYCO/F LYTIC medium was similar to that of the Peds Plus/F and Plus Aerobic/F vials for detecting Brucella melitensis bacteremia, but the time to detection with the MYCO/F LYTIC medium (101.4 +/- 46.7 h) was significantly longer than that with the combined comparator media (65.5 +/- 18.9 h, P = 0.004).
Bacteremia↗
Kingella kingae infections of the skeletal system in children: diagnosis and therapy.
As the result of improved bacteriological techniques, Kingella kingae is emerging as an important cause of infections of the skeletal system in children younger than 2 years of age. This review details the bacteriological features and detection methods of this pathogen, as well as the epidemiology, clinical presentation, treatment and prognosis of septic arthritis, osteomyelitis and diskitis caused by the organism.
Anti-Bacterial Agents↗
Lack of evidence of transmission of Pseudomonas aeruginosa among cystic fibrosis patients attending health camps at the Dead Sea, Israel.
BACKGROUND: Transmission of Pseudomonas aeruginosa among cystic fibrosis patients attending health camps has been reported previously. OBJECTIVES: To determine the transmission of P. aeruginosa among CF patients during three winter camps in the Dead Sea region in southern Israel. METHODS: Three consecutive CF patient groups were studied, each of which spent 3 weeks at the camp. The patients were segragated prior to camp attendance: patients who were not colonized with P. aeruginosa constituted the first group, and colonized patients made up the two additional groups. Sputum cultures were obtained upon arrival, at mid-camp and on the last day. Environmental cultures were also obtained. Patients were separated during social activities and were requested to avoid social mingling. Isolates were analyzed by antibiotic susceptibility profile and by pulsed field gel electrophoresis. RESULTS: Ninety isolates from 19 patients produced 28 different fingerprint patterns by PFGE. Isolates from two siblings and two patients from the same clinic displayed the same fingerprint pattern. These patients were already colonized with these organisms upon arrival. Two couples were formed during the camp, but PFGE showed no transmission of organisms. All other patients' isolates displayed unique fingerprint patterns and were distinguishable from those of other attendees, and none of the P. aeruginosa-negative patients acquired P. aeruginosa during camp attendance. Environmental cultures were negative for P. aeruginosa. CONCLUSIONS: We were unable to demonstrate cross-infection of P. aeruginosa among CF patients participating in health camps at the Dead Sea who were meticulously segregated.
Adolescent↗
Immune response to invasive Kingella kingae infections, age-related incidence of disease, and levels of antibody to outer-membrane proteins.
The immune response to Kingella kingae was determined by enzyme-linked immunosorbent assay, using outer-membrane proteins as coating antigen, in 19 children with invasive infection. The age-related incidence of K. kingae disease in southern Israel during 1988-2002 was calculated and correlated with serum antibody levels in healthy children. Significant increases in immunoglobulin G (IgG) levels were found in children convalescing after invasive infections. The incidence was 1.3, 40.3, 23.9, 5.7, and 1.9 cases/100,000 children among those aged 0-5, 6-11, 12-23, 24-35, and 36-47 months, respectively. A low attack rate and undetectable serum IgA and high IgG levels were found during the first 6 months of life, which indicates that protection was conferred by maternally derived immunity. The high attack rate found among 6-24-month-old children coincides with the age at which antibody levels were lowest. Low incidence of disease and increasing antibody levels were found among older children, which probably represents cumulative experience with K. kingae antigens via colonization or infection.
Age Factors↗