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1.
Pediatr Infect Dis J ; 41(1): 48-50, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34596625

RESUMO

Kingella kingae infections generally respond well to most beta-lactam antibiotics. We investigated an antibiotic treatment failure in a 3-year-old with K. kingae L3-4 spondylodiscitis. Her disease progressed even after 19 days of high-dose intravenous flucloxacillin. The clinical isolate did not produce a beta-lactamase and despite phenotypic testing and whole-genome sequencing, the mechanism of flucloxacillin resistance remains unknown.


Assuntos
Antibacterianos/uso terapêutico , Discite/diagnóstico , Discite/microbiologia , Farmacorresistência Bacteriana , Floxacilina/uso terapêutico , Kingella kingae/efeitos dos fármacos , Infecções por Neisseriaceae/tratamento farmacológico , Pré-Escolar , Feminino , Humanos , Kingella kingae/genética , Infecções por Neisseriaceae/diagnóstico por imagem , Infecções por Neisseriaceae/microbiologia , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/microbiologia , Tomografia Computadorizada por Raios X , Falha de Tratamento , Resultado do Tratamento
2.
J Pediatr Orthop ; 42(2): e206-e211, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-34923507

RESUMO

BACKGROUND: Identifying the causative pathogen for acute hematogenous musculoskeletal infections (MSKIs) allows for directed antimicrobial therapy and diagnostic confidence. However, 20% to 50% of children with acute MSKIs remain culture negative. The objective of this study was to compare characteristics of culture negative MSKI patients to those where a pathogen is identified. METHODS: Electronic medical records of children admitted between July 2014 to September 2018 to a single quaternary care pediatric hospital with acute MSKIs were retrospectively reviewed. Clinical and demographic characteristics were compared between culture positive and culture negative MSKIs. RESULTS: A total of 170 patients were included of whom 43 (25%) were culture negative. All culture negative patients had at least 1 culture type obtained, and the majority (84%) had both blood and source cultures performed. When compared with patients with a causative pathogen identified, culture negative patients were younger (2.3 vs. 9.8 y), smaller (13.5 vs. 31.6 kg), less likely to be febrile on arrival (56% vs. 77%), less likely to have an abscess on imaging (23% vs. 48%), and were more likely to have uncomplicated septic arthritis (35% vs. 8%). No critically ill patient was culture negative. Seven culture negative patients had additional Kingella kingae testing performed, none of which were positive. CONCLUSIONS: Despite targeted and standardized efforts to identify causative bacteria, 25% of children with acute MSKIs never have a pathogen identified. Culture negative patients are younger, less febrile, are less likely to have an abscess, and more likely to have isolated septic arthritis. LEVEL OF EVIDENCE: This is a retrospective cohort study interested in identifying patient characteristics that predict rate of culture positivity for acute MSKIs. This study meets criteria for Level II evidence.


Assuntos
Artrite Infecciosa , Kingella kingae , Sistema Musculoesquelético , Osteomielite , Antibacterianos/uso terapêutico , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/epidemiologia , Criança , Humanos , Lactente , Osteomielite/tratamento farmacológico , Estudos Retrospectivos
5.
J Paediatr Child Health ; 57(10): 1560-1563, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34259365

RESUMO

The management of septic arthritis in children requires the prompt administration of antibiotic therapy and the identification of the causative pathogen. In the past, Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae and Haemophilus influenzae type b were considered the main causative agents of the disease, but a substantial fraction of presumptive joint infections remained unconfirmed by conventional bacteriologic cultures. In the last two decades, our knowledge of the aetiology of paediatric infectious arthritis has substantially changed as the result of the implementation of vaccination programmes against H. influenzae type b and pneumococci, and by the use of improved detection methods. In 1988, the inoculation of synovial fluid aspirates into blood culture vials revealed that Kingella kingae, a commensal member of the oropharyngeal microbiota, was the prime aetiology of skeletal system infections in children aged 6-48 months. The clinical presentation of K. kingae arthritis is subtle, and the disease is frequently missed by classic clinical and laboratory diagnostic criteria. Many children are afebrile, the acute phase reactants levels and the white blood cell counts in the blood and synovial fluid specimens are frequently normal, requiring a high clinical acumen. Increasing use of sensitive molecular methods in recent years, and particularly nucleic acid amplification tests that target K. kingae-specific genes, has further improved the detection of this elusive pathogen, demonstrated that it is responsible for 30-93% of all cases of septic arthritis below 4 years of age and reduced the fraction of culture-negative infections.


Assuntos
Artrite Infecciosa , Kingella kingae , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/etiologia , Hemocultura , Criança , Humanos , Staphylococcus aureus , Líquido Sinovial
6.
J Infect ; 83(3): 321-331, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34265316

RESUMO

OBJECTIVES: The Pre-school Osteoarticular Infection (POI) study aimed to describe the burden of disease, epidemiology, microbiology and treatment of acute osteoarticular infections (OAI) and the role of Kingella kingae in these infections. METHODS: Information about children 3-60 months of age who were hospitalized with an OAI to 11 different hospitals across Australia and New Zealand between January 2012 and December 2016 was collected retrospectively. RESULTS: A total of 907 cases (73%) were included. Blood cultures grew a likely pathogen in only 18% (140/781). The peak age of presentation was 12 to 24 months (466/907, 51%) and Kingella kingae was the most frequently detected microorganism in this age group (60/466, 13%). In the majority of cases, no microorganism was detected (517/907, 57%). Addition of PCR to culture increased detection rates of K. kingae. However, PCR was performed infrequently (63/907, 7%). CONCLUSIONS: This large multi-national study highlights the need for more widespread use of molecular diagnostic techniques for accurate microbiological diagnosis of OAI in pre-school aged children. The data from this study supports the hypothesis that a substantial proportion of pre-school aged children with OAI and no organism identified may in fact have undiagnosed K. kingae infection. Improved detection of Kingella cases is likely to reduce the average length of antimicrobial treatment.


Assuntos
Artrite Infecciosa , Kingella kingae , Infecções por Neisseriaceae , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/epidemiologia , Criança , Pré-Escolar , Humanos , Lactente , Kingella kingae/genética , Infecções por Neisseriaceae/diagnóstico , Infecções por Neisseriaceae/epidemiologia , Reação em Cadeia da Polimerase , Estudos Retrospectivos
7.
BMC Infect Dis ; 21(1): 697, 2021 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-34284735

RESUMO

BACKGROUND: The progress of diagnostic strategies and molecular methods improved the detection of Kingella kingae in bone and joint infections, and now, Kingella kingae is being increasingly recognized as the most frequent cause of bone and joint infection BJI in early childhood. The main objective of this prospective study is to report the frequency of Kingella Kingae in negative culture bone and joint pediatric infections, and to describe the clinical and biologic features of these children. METHODS: From December 2016 to June 2019, we selected all hospitalized patients with suspected BJI. When culture was negative on the fifth day, children under 10 years were subsequently included in the study, and PCR assay was performed systematically for researching K. kingae specific gene cpn60. Microbial culture and identification were made using standard bacteriological methods. The demographics, clinical, laboratory, radiographic and clinical features were reviewed from medical records. RESULTS: We enrolled 65 children with culture negative BJI, 46 of them having under 10 years old have been screened for the cpn60 gene. Thus, the gene encoding Kingella kingae was positive for 27 BJI cases (58.7%). The mean age of children was 3.02 years, 55.6% were aged 6 months-4 years and 29.6% of them were aged 5-10 years. The male to female ratio was 1.7 and 16 cases (59.26%) occurred during the fall-winter period. The most frequent BJI type was septic arthritis (77.8%) and the most affected sites were knee (51.9%) and hip (37.0%). We recorded a mild clinical picture with normal to mildly raised inflammatory markers. All patients had good clinical and functional outcomes, with no serious orthopedic sequelae.. CONCLUSION: K kingae is an important pathogen of culture-negative BJI in Moroccan children. PCR testing should be performed in culture-negative cases of children not only in the typical age range of 6 months to 4 years. When implemented in the routine clinical microbiology laboratory, a specific K. kingae PCR assay can provide a better diagnostic performance of BJI.


Assuntos
Doenças Ósseas Infecciosas/microbiologia , Artropatias/microbiologia , Kingella kingae/isolamento & purificação , Infecções por Neisseriaceae/diagnóstico , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Marrocos , Estudos Prospectivos
9.
J Bone Joint Surg Am ; 103(13): 1229-1237, 2021 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-33844667

RESUMO

BACKGROUND: It is widely believed that septic arthritis poses a risk of joint destruction and long-term adverse outcomes for children if not treated emergently. In the present study, children who had primary confirmed septic arthritis were compared with those who had septic arthritis and adjacent osteomyelitis to evaluate differences that affect the relative risk of adverse outcomes. METHODS: Children who underwent multidisciplinary treatment for septic arthritis with or without contiguous osteomyelitis between 2009 and 2019 were retrospectively studied. Clinical, laboratory, treatment, and outcome data were compared between cohorts of children with primary confirmed septic arthritis and children with septic arthritis and contiguous osteomyelitis. RESULTS: One hundred and thirty-four children had primary confirmed septic arthritis, and 105 children had septic arthritis with contiguous osteomyelitis. Children with osteomyelitis were older (median, 7.4 versus 2.4 years), had higher initial C-reactive protein (median, 15.7 versus 6.4 mg/dL), and had a higher rate of thrombocytopenia (21.0% versus 1.5%). They also had a higher rate of bacteremia (69.5% versus 20.2%) for a longer duration (median, 2.0 versus 1.0 days). Detected pathogens in children with osteomyelitis as compared with those with primary septic arthritis were more likely to be Staphylococcus aureus (77.1% versus 32.1%) and less likely to be Kingella kingae (2.9% versus 32.1%). Children with contiguous osteomyelitis had longer hospitalizations (median, 8.0 versus 4.0 days), a higher rate of intensive care (21.0% versus 1.5%), a higher readmission rate (17.1% versus 5.2%), and a higher complication rate (38.1% versus 0.7%). CONCLUSIONS: Primary septic arthritis in children is dissimilar to septic arthritis associated with osteomyelitis. The present study demonstrates that long-term adverse outcomes in children with septic arthritis are likely due to the contiguous osteomyelitis. Children with primary septic arthritis are sufficiently distinguishable from those who have contiguous osteomyelitis to guide decisions for magnetic resonance imaging acquisition, duration of antibiotic therapy, and length of outpatient follow-up in order to recognize and address adverse outcomes. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Artrite Infecciosa/complicações , Osteomielite/complicações , Antibacterianos/uso terapêutico , Artrite Infecciosa/sangue , Artrite Infecciosa/microbiologia , Artrite Infecciosa/terapia , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Proteína C-Reativa/análise , Criança , Pré-Escolar , Feminino , Humanos , Kingella kingae/isolamento & purificação , Tempo de Internação , Imageamento por Ressonância Magnética , Masculino , Osteomielite/sangue , Osteomielite/microbiologia , Osteomielite/terapia , Readmissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Risco , Staphylococcus aureus/isolamento & purificação , Trombocitopenia/epidemiologia , Resultado do Tratamento
10.
J Paediatr Child Health ; 57(8): 1196-1200, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33655677

RESUMO

AIM: This study aimed to alert clinicians to the spectrum of presentations of Kingella kingae musculoskeletal infections. METHODS: Between August 2010 and March 2018, 55 children presented with positive K. kingae polymerase chain reaction on joint fluid, bone or deep soft tissue collections involving the limbs and subsequently underwent retrospective medical record, radiological and laboratory review. Demographics and clinical information are presented. RESULTS: Median age at presentation was 15.9 months (range 4.3 months-10.7 years) and 64% were male. Septic arthritis was the most common diagnosis (95%), median duration of symptoms was 4 days, 65% had a preceding infection (e.g. upper respiratory or gastrointestinal) and 22% re-presented to emergency departments after prior discharge. The lower limb was involved in 84%, with the knee being most affected (55%). If the lower limb was involved, 82% of previously weight-bearing children had a limp or were unable to weight bear. On presentation, median temperature was 36.7°C and inflammatory markers were mildly elevated. No blood cultures grew K. kingae. Five synovial fluid cultures were positive for K. kingae. Plain radiography showed effusion, soft tissue swelling or a lesion in 53% of patients. All 41 ultrasounds showed effusion, soft tissue swelling or synovial thickening. One patient with delayed diagnosis later presented with avascular necrosis of the femoral head. CONCLUSION: Kingella kingae is difficult to diagnose due to non-specific symptoms, absence of fevers and often unremarkable blood tests. Despite generally having good long-term outcomes, our case of avascular necrosis suggests accurate diagnosis and treatment are important.


Assuntos
Artrite Infecciosa , Kingella kingae , Infecções por Neisseriaceae , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/epidemiologia , Austrália , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Infecções por Neisseriaceae/diagnóstico , Infecções por Neisseriaceae/epidemiologia , Estudos Retrospectivos , Austrália do Sul/epidemiologia
12.
Bone Joint J ; 103-B(3): 584-588, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33641413

RESUMO

AIMS: The aim of this study was to determine the extent to which patient demographics, clinical presentation, and blood parameters vary in Kingella kingae septic arthritis when compared with those of other organisms, and whether this difference needs to be considered when assessing children in whom a diagnosis of septic arthritis is suspected. METHODS: A prospective case series was undertaken at a single UK paediatric institution between October 2012 and November 2018 of all patients referred with suspected septic arthritis. We recorded the clinical, biochemical, and microbiological findings in all patients. RESULTS: A total of 160 patients underwent arthrotomy for a presumed septic arthritis. Of these, no organism was identified in 61 and only 25 of these were both culture- and polymerase chain reaction (PCR)-negative. A total of 36 patients did not undergo PCR analysis. Of the remaining 99 culture- and PCR-positive patients, K. kingae was the most commonly isolated organism (42%, n = 42). The knee (n = 21), shoulder (n = 9), and hip (n = 5) were the three most commonly affected joints. A total of 28 cases (66%) of K. kingae infection were detected only on PCR. The mean age of K. kingae-positive cases (16.1 months) was significantly lower than that of those whose septic arthitis was due to other organisms (49.4 months; p < 0.001). The mean CRP was significantly lower in the K. kingae group than in the other organism group (p < 0.001). The mean ESR/CRP ratio was significantly higher in K. kingae (2.84) than in other infections (1.55; p < 0.008). The mean ESR and ESR/CRP were not significantly different from those in the 'no organism identified' group. CONCLUSION: K. kingae was the most commonly isolated organism from paediatric culture- and/or PCR-positive confirmed septic arthritis, with only one third of cases detected on routine cultures. It is important to develop and maintain a clinical suspicion for K. kingae infection in young patients presenting atypically. Routine PCR testing is recommended in these patients. Cite this article: Bone Joint J 2021;103-B(3):584-588.


Assuntos
Artrite Infecciosa/microbiologia , Kingella kingae/isolamento & purificação , Infecções por Neisseriaceae/microbiologia , Adolescente , Artrite Infecciosa/cirurgia , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Masculino , Infecções por Neisseriaceae/cirurgia , Reação em Cadeia da Polimerase , Estudos Retrospectivos
13.
Bone Joint J ; 103-B(3): 578-583, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33641416

RESUMO

AIMS: We aimed to describe the epidemiological, biological, and bacteriological characteristics of osteoarticular infections (OAIs) caused by Kingella kingae. METHODS: The medical charts of all children presenting with OAIs to our institution over a 13-year period (January 2007 to December 2019) were reviewed. Among these patients, we extracted those which presented an OAI caused by K. kingae and their epidemiological data, biological results, and bacteriological aetiologies were assessed. RESULTS: K. kingae was the main reported microorganism in our paediatric population, being responsible for 48.7% of OAIs confirmed bacteriologically. K. kingae affects primarily children aged between six months and 48 months. The highest prevalence of OAI caused by K. kingae was between seven months and 24 months old. After the patients were 27 months old, its incidence decreased significantly. The incidence though of infection throughout the year showed no significant differences. Three-quarters of patients with an OAI caused by K. kingae were afebrile at hospital admission, 11% had elevated WBCs, and 61.2% had abnormal CRPs, whereas the ESR was increased in 75%, constituting the most significant predictor of an OAI. On MRI, we noted 53% of arthritis affecting mostly the knee and 31% of osteomyelitis located primarily in the foot. CONCLUSION: K. kingae should be recognized currently as the primary pathogen causing OAI in children younger than 48 months old. Diagnosis of an OAI caused by K. kingae is not always obvious, since this infection may occur with a mild-to-moderate clinical and biological inflammatory response. Extensive use of nucleic acid amplification assays improved the detection of fastidious pathogens and has increased the observed incidence of OAI, especially in children aged between six months and 48 months. We propose the incorporation of polymerase chain reaction assays into modern diagnostic algorithms for OAIs to better identify the bacteriological aetiology of OAIs. Cite this article: Bone Joint J 2021;103-B(3):578-583.


Assuntos
Doenças Ósseas Infecciosas/microbiologia , Kingella kingae/isolamento & purificação , Infecções por Neisseriaceae/microbiologia , Doenças Ósseas Infecciosas/diagnóstico , Doenças Ósseas Infecciosas/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Masculino , Infecções por Neisseriaceae/diagnóstico , Infecções por Neisseriaceae/epidemiologia , Prevalência , Estudos Retrospectivos , Suíça/epidemiologia
14.
Sci Rep ; 11(1): 3422, 2021 02 09.
Artigo em Inglês | MEDLINE | ID: mdl-33564018

RESUMO

Acute arthritis is a common cause of consultation in pediatric emergency wards. Arthritis can be caused by juvenile idiopathic arthritis (JIA), septic (SA) or remain undetermined (UA). In young children, SA is mainly caused by Kingella kingae (KK), a hard to grow bacteria leading generally to a mild clinical and biological form of SA. An early accurate diagnosis between KK-SA and early-onset JIA is essential to provide appropriate treatment and follow-up. The aim of this work was to compare clinical and biological characteristics, length of hospital stays, duration of intravenous (IV) antibiotics exposure and use of invasive surgical management of patients under 6 years of age hospitalized for acute monoarthritis with a final diagnosis of JIA, SA or UA. We retrospectively analyzed data from < 6-year-old children, hospitalized at a French tertiary center for acute mono-arthritis, who underwent a joint aspiration. Non-parametric tests were performed to compare children with JIA, SA or UA. Bonferroni correction for multiple comparisons was applied with threshold for significance at 0.025. Among the 196 included patients, 110 (56.1%) had SA, 20 (10.2%) had JIA and 66 (33.7%) had UA. Patients with JIA were older when compared to SA (2.7 years [1.8-3.6] versus 1.4 [1.1-2.1], p < 0.001). Presence of fever was not different between JIA and SA or UA. White blood cells in serum were lower in JIA (11.2 × 109/L [10-13.6]) when compared to SA (13.2 × 109/L [11-16.6]), p = 0.01. In synovial fluid leucocytes were higher in SA 105.5 × 103 cells/mm3 [46-211] compared to JIA and UA (42 × 103 cells/mm3 [6.4-59.2] and 7.29 × 103 cells/mm3 [2.1-72] respectively), p < 0.001. Intravenous antibiotics were administered to 95% of children with JIA, 100% of patients with SA, and 95.4% of UA. Arthrotomy-lavage was performed in 66.7% of patients with JIA, 79.6% of patients with SA, and 71.1% of patients with UA. In children less than 6 years of age with acute mono-arthritis, the clinical and biological parameters currently used do not reliably differentiate between JIA, AS and UA. JIA subgroups that present a diagnostic problem at the onset of monoarthritis before the age of 6 years, are oligoarticular JIA and systemic JIA with hip arthritis. The development of new biomarkers will be required to distinguish JIA and AS caused by Kingella kingae in these patients.


Assuntos
Artrite Infecciosa , Artrite Juvenil , Kingella kingae , Infecções por Neisseriaceae , Administração Intravenosa , Antibacterianos/administração & dosagem , Artrite Infecciosa/sangue , Artrite Infecciosa/microbiologia , Artrite Infecciosa/terapia , Artrite Juvenil/sangue , Artrite Juvenil/microbiologia , Artrite Juvenil/terapia , Criança , Pré-Escolar , Feminino , França , Humanos , Lactente , Masculino , Infecções por Neisseriaceae/sangue , Infecções por Neisseriaceae/microbiologia , Infecções por Neisseriaceae/terapia
16.
Pediatr Infect Dis J ; 40(3): 182-185, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33427802

RESUMO

BACKGROUND: Transient synovitis of the hip affects mostly preschool children, and its etiology is unknown. Kingella kingae has been identified recently as a common etiologic agent of osteoarticular infections (OAI) in young children and could potentially be associated to transient synovitis of the hip. The main objective of this study was to evaluate the association between transient synovitis of the hip and oropharyngeal carriage of K. kingae among preschool children. METHODS: This was a prospective case-control study conducted at a tertiary care pediatric emergency department. Cases were children between 6 and 71 months of ages with a diagnosis of transient synovitis of the hip. For each transient synovitis case, an age-matched control was recruited among children presenting for a trauma. A second control group included children with any OAI. The independent variable was the presence of oropharyngeal K. kingae identified by a specific polymerase chain reaction assay. The primary analysis was the association between oropharyngeal K. kingae carriage and final diagnosis. RESULTS: A total of 73 children were included in the study. Among them, 25 had a transient synovitis, 16 an OAI, and 22 controls. Baseline demographics were similar between the groups. There was no difference in oropharyngeal carriage of K. kingae for children with transient synovitis (5/25; 0.20) in comparison to controls (3/22; 0.14), while it was higher for children with OAI (10/16; 0.63). CONCLUSIONS: There is no association between oropharyngeal K. kingae and transient synovitis of the hip among preschool children.


Assuntos
Portador Sadio , Articulação do Quadril/microbiologia , Kingella kingae , Infecções por Neisseriaceae/microbiologia , Orofaringe/microbiologia , Sinovite/microbiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Articulação do Quadril/patologia , Humanos , Masculino
17.
Acta Paediatr ; 110(6): 1750-1758, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33486790

RESUMO

AIM: The aim of this study was to provide an update on paediatric Kingella kingae infections. METHODS: We used the PubMed database to identify studies published in English, French and Spanish up to 15 November 2020. RESULTS: Kingella kingae colonised the oropharynx after the age of 6 months, and the mucosal surface was the portal of entry of the organism to the bloodstream and the source of child-to-child spread. Attending day care centres was associated with increased carriage rate and transmission and disease outbreaks were detected in day care facilities. Skeletal system infections were usually characterised by mild symptoms and moderately elevated inflammation markers, requiring a high clinical suspicion index. The organism was difficult to recover in cultures and molecular tests significantly improve its detection. Kingella kingae was generally susceptible to beta-lactam antibiotics, and skeletal diseases and bacteraemia responded to antimicrobial, leaving no long-term sequelae. However, patients with endocarditis frequently experienced life-threatening complications and the case fatality rate exceeded 10%. CONCLUSION: Kingella kingae was the prime aetiology of skeletal system infections in children aged 6-48 months. Paediatricians should be aware of the peculiar features of this infection and the need to use molecular tests for diagnosis.


Assuntos
Bacteriemia , Kingella kingae , Infecções por Neisseriaceae , Criança , Creches , Humanos , Lactente , Infecções por Neisseriaceae/diagnóstico , Infecções por Neisseriaceae/epidemiologia , Orofaringe
19.
J Pediatr Orthop ; 41(3): 190-196, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33417393

RESUMO

INTRODUCTION: Primary septic arthritis requires unique evaluation and treatment considerations for children in the 6- to 48-month age range because of the spectrum of identified pathogens and high rate of negative cultures. The purpose of this study is to evaluate primary septic arthritis in this age group in order to differentiate children with infection caused by Kingella kingae from those with other confirmed pathogens and those with no identified pathogen. METHODS: Preschool children who underwent multidisciplinary evaluation and treatment for septic arthritis between 2009 and 2019 were retrospectively studied. Three cohorts were established for comparison of clinical and laboratory features of primary septic arthritis: (1) confirmed K. kingae, (2) confirmed other pathogen, and (3) presumed (without identified pathogen). RESULTS: Among 139 children with septic arthritis, 40 (29%) were confirmed K. kingae, 29 (21%) other pathogen, and 70 (50%) presumed. Children with Kingella and those with presumed septic arthritis had significantly lower initial C-reactive protein (4.8 and 4.5 vs. 9.3 mg/dL) and fewer febrile hospital days (0.2 and 0.4 vs. 1.3 d) than children with other confirmed pathogens. Children with other pathogens had higher rates of bacteremia (38% vs. 0%) and positive joint fluid cultures (86% vs. 15%) than that of children with Kingella. The rate of polymerase chain reaction (PCR) acquisition was 38 of 40 (95.0%) Kingella cases, 18 of 29 (62.1%) other pathogen cases, and 33 of 70 (47.1%) presumed cases. CONCLUSIONS: K. kingae was the most commonly identified pathogen among 6-month to 4-year-old children. The Kingella and other identified pathogens in this study serve to guide empiric antimicrobial recommendations for this age range. Because of similarities between children with septic arthritis because of K. kingae and those with no identified pathogen, it is likely that an unrecognized burden of Kingella resides in culture negative cases, particularly if no PCR is sent. Systematic evaluation, including PCR acquisition, and a high index of suspicion for K. kingae are recommended to thoroughly evaluate septic arthritis in preschool children. LEVEL OF EVIDENCE: Level III-Retrospective cohort comparison.


Assuntos
Antibacterianos/uso terapêutico , Artrite Infecciosa/microbiologia , Bacteriemia/microbiologia , Kingella kingae/isolamento & purificação , Infecções por Neisseriaceae/complicações , Artrite Infecciosa/tratamento farmacológico , Bacteriemia/tratamento farmacológico , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Kingella kingae/genética , Masculino , Infecções por Neisseriaceae/tratamento farmacológico , Reação em Cadeia da Polimerase , Estudos Retrospectivos , Líquido Sinovial/microbiologia
20.
Arch Pediatr ; 28(1): 12-15, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33309121

RESUMO

BACKGROUND: Kingella kingae (Kk) is frequently responsible for invasive skeletal infections in children aged 3-36months. However, few outbreaks of invasive Kk infections in day care centers have been reported. The objective of the present study was to describe (a) the clinical and laboratory data recorded during an outbreak of invasive Kk skeletal infections, and (b) the management of the outbreak. METHOD: Four children from the same day care center were included in the study May and June 2019. We retrospectively analyzed the children's clinical presentation and their radiological and laboratory data. We also identified all the disease control measures taken in the day care center. RESULTS: We observed cases of septic arthritis of the wrist (case #1), shoulder arthritis (case #2), knee arthritis (case #3) ans cervical spondylodiscitis (case #4). All cases presented with an oropharyngeal infection and concomitant fever prior to diagnosis of the skeletal infection. All cases were misdiagnosed at the initial presentation. The mean (range) age at diagnosis was 10.75months (9-12). The three patients with arthritis received surgical treatment. All patients received intravenous and then oral antibiotics. In cases 1 and 2, Kk was detected using real-time PCR and a ST25-rtxA1 clone was identified. The outcome was good in all four cases. Four other children in the day care center presented with scabies during this period and were treated with systemic ivermectin. The Regional Health Agency was informed, and all the parents of children attending the day care center received an information letter. The day care center was cleaned extensively. CONCLUSION: Our results highlight the variety of features of invasive skeletal Kk infections in children and (given the high risk of transmission in day care centers) the importance of diagnosing cases as soon as possible.


Assuntos
Artrite Infecciosa/epidemiologia , Creches , Discite/epidemiologia , Surtos de Doenças/prevenção & controle , Kingella kingae/isolamento & purificação , Infecções por Neisseriaceae/epidemiologia , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/terapia , Artrite Infecciosa/transmissão , Vértebras Cervicais/microbiologia , Pré-Escolar , Terapia Combinada , Diagnóstico Diferencial , Discite/diagnóstico , Discite/microbiologia , Discite/terapia , Feminino , França/epidemiologia , Humanos , Articulação do Joelho/microbiologia , Masculino , Infecções por Neisseriaceae/diagnóstico , Infecções por Neisseriaceae/terapia , Infecções por Neisseriaceae/transmissão , Estudos Retrospectivos , Articulação do Ombro/microbiologia , Articulação do Punho/microbiologia
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