Kingella kingae infectious arthritis: case report and review of literature of Kingella and Moraxella infections.
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Ampicillin↗
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[Kingella kingae osteoarticular infections in children. A report of a series of eight new cases].
UNLABELLED: Kingella kingae is a Gram-negative bacillus which belongs to the Neisseriaceae family. Its involvement in osteoarticular infections is relatively recent. METHODS AND RESULTS: We report eight cases of Kingella kingae osteoarticular infections that have been diagnosed at the paediatric surgical centre of Rouen University Hospital since October 1995. Six boys and two girls (mean age: 30.6 months) presented with osteomyelitis in six cases and arthritis in two. Only 75% of patients had a fever at time of diagnosis. The biological findings were slightly modified. All samples were obtained from blood, bone or joint fluid. These samples were systematically inoculated into a blood culture tube. Positive Kingella kingae culture was achieved in seven local samples and in one blood culture. All children received two antibiotics via intravenous injection while waiting for the bacteriologic results. Later, the antibiotic treatment (amoxycillin) was given per os. The mean duration of treatment was 33 days. Patients were given intravenous treatment for a period of only ten days. Six patients were followed up for a period of more than 18 months and outcome was always uneventful. DISCUSSION: Kingella kingae is usually present in the nasopharyngeal mucosa and spreads in the blood due to various infections. Different types of Kingella kingae infection have been reported with a large frequency of osteoarticular infection. CONCLUSION: This type of infection does not present any unusual characteristics as compared to other osteoarticular infections. Because of its antibiotic sensitivity treatment duration could be reduced. Kingella kingae is a fragile microbe and its culture is often difficult; therefore, it is important to use blood culture tubes to inoculate joint fluid and bone samples.
Anti-Bacterial Agents↗
Endocarditis caused by Kingella indologenes.
The first known case of endocarditis caused by Kingella indologenes is reported. A review of the literature reveals only seven cases of endocarditis caused by the other two species of the genus Kingella (Kingella kingae, six cases; Kingella denitrificens, one case). Kingella organisms appear to be sensitive to a wide variety of antimicrobial agents. The available data suggest that endocarditis caused by Kingella species occurs rarely and is associated with a benign clinical course.
Ampicillin↗
Isolation of Kingella kingae from synovial fluids using four commercial blood culture bottles.
According to the literature, Kingella kingae may be an underdiagnosed cause of joint and bone infections in children. The use of the Bactec blood culture system for culture of joint fluids has dramatically improved the isolation of this fastidious bacterium. The aim of this study was to test the recovery rate and detection time of four commercial blood culture systems: three different BacT/Alert (Organon Teknika, USA) bottles and one Bactec (Becton Dickinson Microbiology Systems, USA) bottle, all inoculated with Kingella kingae strains mixed with pooled synovial fluids. For each strain the same inoculum and volume of synovial fluid was distributed into each of the four bottles. All 24 strains tested grew in the BacT/Alert Aerobic (100%) and the BacT/Alert Pedi-BacT (100%) bottles. Twenty-one strains grew in the BacT/Alert FAN aerobic (88%) bottle, and 15 strains grew in the Bactec Plus Aerobic F (63%) bottle, in both systems within 12 days (P<0.01). The Kingella kingae strains were first detected in the BacT/Alert Pedi-BacT bottles (P<0.001). The results were reproducible. The BacT/Alert blood culture bottles were superior to previously described blood culture systems in isolating Kingella kingae from synovial fluid, even with small inoculums and small volumes of synovial fluid.
Blood↗
Endocarditis due to Kingella kingae.
Four cases of endocarditis due to Kingella kingae are described in compromised patients. All had primary heart disease, and two had systemic lupus erythematosis and congenital heart defect respectively, in addition. Confirmation of Kingella kingae was made in one case at autopsy. The literature on 11 cases of endocarditis, 2 bacteremia, 4 osteomyelitis, 5 septic arthritis and 1 intervertebral disc infection, all caused by Kingella kingae, is reviewed. Our findings confirm that the organism is of low pathogenicity. Children may be predisposed to infection with Kingella kingae.
Adolescent↗
Phylogeny of species in the family Neisseriaceae isolated from human dental plaque and description of Kingella oralis sp. nov [corrected].
Fourteen human periodontal isolates recovered from a purported Eikenella corrodens-selective medium containing 1 microgram of clindamycin per ml displayed biochemical traits which differed from those described for E. corrodens. These organisms were gram-negative rods which corroded agar. The isolates were oxidase positive and urease, indole, and esculin negative. They differed from E. corrodens in catalase, nitrate reduction, lysine decarboxylase, and ornithine decarboxylase activities. One isolate, strain UB-294, was presumptively identified as Kingella denitrificans. A second isolate, strain UB-204, differed from E. corrodens by being catalase positive and nitrate reduction negative. Twelve isolates, including strain UB-38T (T = type strain), were phenotypically similar to Kingella kingae except that they did not produce acid from maltose and were not beta-hemolytic. Essentially complete (1,480-base) 16S rRNA sequences were determined for strains UB-38T, UB-204, and UB-294 and the type strains of Neisseria animalis, Neisseria canis, Neisseria denitrificans, Neisseria elongata, Neisseria flavescens, Neisseria macaca, and Neisseria polysaccharea. These sequences were compared with the previously published sequences of six other species belonging to the family Neisseriaceae. On the basis of the results of the comparative sequence analysis, UB-294 was confirmed as a K. denitrificans strain, UB-204 was identified as a member of a new species which may belong in the genus Eikenella, and UB-38T was identified as a member of a new species of the genus Kingella, for which we propose the name Kingella oralis [corrected]. Since strain UB-204 was the only representative of a new species, it was not named.(ABSTRACT TRUNCATED AT 250 WORDS)
Bacterial Proteins↗
Cellular fatty acid composition of Kingella species, Cardiobacterium hominis, and Eikenella corrodens.
We determined the cellular fatty acid composition of reference strains and clinical isolates of each of the three Kingella species, Cardiobacterium hominis, and Eikenella corrodens by using capillary gas chromatography. Kingella denitrificans and Kingella kingae contained myristic (14:0) and palmitic (16:0) acids as major acids, whereas cis-vaccenic (18:1 omega 7c) and palmitic acids were the major acids in Kingella indologenes, C. hominis, and E. corrodens. C. hominis differed from the other four species by the absence of 3-hydroxylauric (3-OH-12:0) acid, from K. indologenes by the presence of 3-hydroxypalmitic (3-OH-16:0) acid, and from E. corrodens by the presence of 3-hydroxymyristic (3-OH-14:0) acid. E. corrodens contained a small amount (2%) of myristic acid, while the other four species contained moderate to large amounts (11 to 31%) of this acid.
Bacteroides↗
[Kingella kingae: a rare cause of meningitis].
UNLABELLED: Kingella kingae is the second most frequent germ involved in arthritis affecting young children. This germ isolation on ordinary environment is difficult, which may explain why it is seldom known. It is now widely accepted that a direct inoculate of articular and osseous samples on liquid substrate improves the culture sensitivity. Other septic localizations have been described such as endocarditis or, less commonly, meningitis. CASE REPORT: We report the observation of a five-year-old child, treated for meningitis, with CSF culture showing evidence of scarce colonies of Kingella kingae. CONCLUSION: By analogy with arthritis, Kingella kingae may regularly be undetected, not being isolated, in some cases of non-documented meningitis with a cerebrospinal fluid (CSF) cytology recalling a bacterial origin. It would be of interest to verify if the seeding of CSF in liquid substrate would increase the sensitiveness of the cultures.
Ceftriaxone↗
Contribution of a broad range polymerase chain reaction to the diagnosis of osteoarticular infections caused by Kingella kingae: description of twenty-four recent pediatric diagnoses.
BACKGROUND: Microbiologic diagnosis of septic arthritis and osteomyelitis in children is hindered by the less than optimal yield of blood and osteoarticular fluid cultures. PATIENTS AND METHODS: All patients admitted to a pediatric unit for osteoarticular infections (OAI) between January 2001 and February 2004 were enrolled in this prospective study. Osteoarticular fluid and biopsy samples that were negative by conventional culture were tested by polymerase chain reaction (PCR) with universal 16S ribosomal DNA primers. RESULTS: We enrolled 171 children. Culture was positive in 64 cases (37.4%), yielding Kingella kingae in 9 cases. The 107 culture-negative specimens were tested by 16S ribosomal DNA PCR. Fifteen samples (14%) were positive, all for Kingella DNA sequences. K. kingae was the second cause of OAI in this population (30.4%), after Staphylococcus aureus (38%). Patients with Kingella infection diagnosed by culture (9 cases) did not differ from those diagnosed by PCR (15 cases) in terms of their clinical characteristics (including prior antibiotic therapy). The characteristics of the 24 children with arthritis (n = 17) or osteomyelitis (n = 7) were similar to those reported elsewhere. Fever (>38 degrees C) and symptom onset shortly before hospitalization (median, 4.5 days) were significantly associated with arthritis. CONCLUSION: Use of molecular diagnostic methods increases the identification of K. kingae in osteoarticular infections.
Arthritis, Infectious↗
Five cases of Kingella kingae skeletal infection in a French hospital.
Five cases of Kingella kingae skeletal infections were diagnosed in children admitted to La Timone Hospital between 1992 and 1997. Patients were between 6 and 31 months old and presented with septic spondylodiskitis, calcaneus osteomyelitis, and hip-joint arthritis. All displayed either an upper respiratory tract infection or eczema during the month prior to their admission. Laboratory findings included an elevated leukocyte count and an elevated erythrocyte sedimentation rate. Standard radiography was unrevealing, but 99mTc bone scans and magnetic resonance imaging showed significant abnormalities. Isolation of Kingella kingae was achieved in all cases by culture of fluid aspirates using the Bactec blood culture system. This bacterium was sensitive to the most common antibiotics tested, and the outcome was favourable in all cases.
Arthritis↗
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↗
[Multifocal invasive Kingella kingae infection].
CASE REPORT: A 2-year-old child, non immunodeficient, presented with septicemia due to Kingella kingae successively complicated by meningitis, arthritis of one knee and endocarditis. Outcome was favourable after a long and adjusted antibiotherapy, involving in particular for the endocarditis ceftriaxone (100 mg/kg/d) and amikacin (20 mg/kg/d) during 3 weeks, then amoxicillin per os (200 mg/kg/d) during 3 weeks. CONCLUSIONS: Bacteriologic characteristics of the bacteria, the culture of which requires medium base with additional nutrient are reviewed. The tropism of Kingella kingae is essentially osteoarticular and cardiac as shown by the cases reported in the literature. Its susceptibility to antibiotics explains the frequent favourable outcome.
Amikacin↗
Kingella kingae infections in children.
OBJECTIVE: To increase awareness of Kingella kingae infections in children by presenting four cases seen at the Gold Coast Hospital, Southport, Queensland, and reviewing the literature. METHODOLOGY: Records of the four cases were reviewed and relevant information described. A MEDLINE search of the English literature from 1983 to 1998 was conducted. RESULTS: Osteoarticular infections are the commonest type of invasive paediatric infection but bacteraemia and endocarditis also occur. Isolation of the organism is difficult but inoculation of the specimen into enriched blood culture systems improves the recovery rate. The majority of isolates are sensitive to beta-lactam antibiotics but resistance has been described. CONCLUSIONS: Kingella kingae infections in children are more common than previously recognized. The organism should be actively sought in any child with suspected osteoarticular infections. Recommended empiric therapy is a third generation cephalosporin until susceptibility to penicillin is confirmed.
Arthritis, Infectious↗
Identification and characterization of an RTX toxin in the emerging pathogen Kingella kingae.
Kingella kingae is an emerging bacterial pathogen that is increasingly recognized as the causative agent of a variety of pediatric diseases, including septic arthritis and osteomyelitis. The pathogenesis of K. kingae disease is believed to begin with colonization of the upper respiratory tract. In the present study, we examined interactions between K. kingae and cultured respiratory epithelial cells and observed potent cytotoxicity, detected by both microscopy and lactic acid dehydrogenase (LDH) release assays. Experiments with synovial and macrophage cell lines revealed cytotoxicity for these cell types as well. Using mariner mutagenesis and a screen for loss of cytotoxicity, a genetic locus encoding an RTX toxin system was identified. Disruption of the K. kingae RTX locus resulted in a loss of cytotoxicity for respiratory epithelial, synovial, and macrophage cell lines. DNA sequence analysis demonstrated that the RTX locus is flanked by insertion elements and has a reduced G+C content compared to that of the whole genome. Two relatively less invasive Kingella species, K. oralis and K. denitrificans, were found to be noncytotoxic and to lack the RTX region, as determined by LDH release assays and Southern blotting. We concluded that K. kingae expresses an RTX toxin that has wide cellular specificity and was likely acquired horizontally. The possible roles for this toxin in the pathogenesis of K. kingae disease include breaching of the epithelial barrier and destruction of target tissues, such as synovium (joint lining).
Animals↗
Kingella kingae spondylodiscitis in a child.
Most osteoarticular infections in children are due to Staphylococcus aureus. In this case, the isolation of Kingella kingae by image guided disc aspiration resulted in modification and optimization of treatment. We take a look at a case of spondylodiscitis in a young child and review some of the current literature with regards to Kingella kingae infections.
Child↗
Outbreak of osteomyelitis/septic arthritis caused by Kingella kingae among child care center attendees.
OBJECTIVE: Kingella kingae often colonizes the oropharyngeal and respiratory tracts of children but infrequently causes invasive disease. In mid-October 2003, 2 confirmed and 1 probable case of K kingae osteomyelitis/septic arthritis occurred among children in the same 16- to 24-month-old toddler classroom of a child care center. The objective of this study was to investigate the epidemiology of K kingae colonization and invasive disease among child care attendees. METHODS: Staff at the center were interviewed, and a site visit was performed. Oropharyngeal cultures were obtained from the staff and children aged 0 to 5 years to assess the prevalence of Kingella colonization. Bacterial isolates were subtyped by pulsed-field gel electrophoresis (PFGE), and DNA sequencing of the 16S rRNA gene was performed. A telephone survey inquiring about potential risk factors and the general health of each child was also conducted. All children and staff in the affected toddler classroom were given rifampin prophylaxis and recultured 10 to 14 days later. For epidemiologic and microbiologic comparison, oropharyngeal cultures were obtained from a cohort of children at a control child care center with similar demographics and were analyzed using the same laboratory methods. The main outcome measures were prevalence and risk factors for colonization and invasive disease and comparison of bacterial isolates by molecular subtyping and DNA sequencing. RESULTS: The 2 confirmed case patients required hospitalization, surgical debridement, and intravenous antibiotic therapy. The probable case patient was initially misdiagnosed; MRI 16 days later revealed evidence of ankle osteomyelitis. The site visit revealed no obvious outbreak source. Of 122 children in the center, 115 (94%) were cultured. Fifteen (13%) were colonized with K kingae, with the highest prevalence in the affected toddler classroom (9 [45%] of 20 children; all case patients tested negative but had received antibiotics). Six colonized children were distributed among the older classrooms; 2 were siblings of colonized toddlers. No staff (n = 28) or children aged <16 months were colonized. Isolates from the 2 confirmed case patients and from the colonized children had an indistinguishable PFGE pattern. No risk factors for invasive disease or colonization were identified from the telephone survey. Of the 9 colonized toddlers who took rifampin, 3 (33%) remained positive on reculture; an additional toddler, initially negative, was positive on reculture. The children of the control child care center demonstrated a similar degree and distribution of K kingae colonization; of 118 potential subjects, 45 (38%) underwent oropharyngeal culture, and 7 (16%) were colonized with K kingae. The highest prevalence again occurred in the toddler classrooms. All 7 isolates from the control facility had an indistinguishable PFGE pattern; this pattern differed from the PFGE pattern observed from the outbreak center isolates. 16S rRNA gene sequencing demonstrated that the outbreak K kingae strain exhibited >98% homology to the ATCC-type strain, although several sequence deviations were present. Sequencing of the control center strain demonstrated more homology to the outbreak center strain than to the ATCC-type strain. CONCLUSIONS: This is the first reported outbreak of invasive K kingae disease. The high prevalence in the affected toddler class and the matching PFGE pattern are consistent with child-to-child transmission within the child care center. Rifampin was modestly effective in eliminating carriage. DNA sequence analysis suggests that there may be considerable variability within the species K kingae and that different K kingae strains may demonstrate varying degrees of pathogenicity.
Anti-Bacterial Agents↗
[Kingella kingae osteomyelitis].
A case of Kingella kingae osteomyelitis in a 1-year-old child is described. Kingella kingae osteoarticular infections in children and the difficulties of isolating this slow growing, fastidious bacterium are discussed.
Diagnosis, Differential↗
[Discitis caused by Kingella kingae--case report].
The patient with acute infection and the presence of bacterium Kingella kingae cultured from cerebrospinal fluid is presented. The analysis of clinical picture and the results of all performed tests did not allow to diagnose cerebrospinal meningitis. Despite of being not sure if Kingella kingae was an etiopathogenetic factor in the described subject, we decided to discuss this interesting case.
Acute Disease↗