Kingella kingae infection in healthy children

Kingella kingae is a gram-negative occasional, but normal, inhabitant of the nasopharynx. We present two new cases of this infection that occurred in previously healthy children, and compare and contrast them to other cases reported in the literature. K. kingae osteomyelitis generally has an insidious, subacute onset, whereas septic arthritis has an acute presentation. To date, all strains of K. kingae have been sensitive to penicillin, and no residual damage has been reported following osteomyelitis or septic arthritis, except that residual disk space narrowing did occur after K. kingae discitis.     

Kingella kingae infections in children

Kingella kingae is a beta-hemolytic gram-negative bacillus. It was first described in the 1960's by EO King and has been reported as a cause of osteo-articular pediatric infections since the early 1980's. We performed a retrospective review of all pediatric cases of invasive K. kingae infection between 1997 and 2002, in order to define the incidence, clinical presentation and outcome of invasive K. kingae infections in a pediatric population. During the study period, a total of 24 pediatric patients with K. kingae infection were identified. There were 15 blood culture isolates of K. kingae, out of a total of 1151 (1.3%) positive blood cultures, and 9 synovial fluid culture isolates out of a total of 76 (11.8%) positive synovial fluids. Fifteen patients had osteo-articular infections and 9 had primary bacteremia without osteo-articular infection. Outcome was favorable in all cases and only in 2 patients with knee joint infection was surgical intervention performed, by means of formal knee arthrotomy. All patients recovered uneventfully, in 7 cases without any intervention and in the others with intravenous or oral antibiotic. In conclusion, invasive K. kingae infection is not uncommon in Israel. It usually has a mild course and thus is not always detected and treated. As K. kingae grows best in blood culture broth, blood and joint fluid should always be inoculated into blood culture bottles in suspected cases. This bacterium is highly sensitive to betalactame antibiotics and infection resolves quickly with antibiotic treatment. Surgical intervention for osteo-articular infection is seldom indicated.     

Soft tissue infection caused by Kingella kingae in a child

During the last years an increasing number of reports concerning Kingella kingae infections in children has been published. Most cases were osteoarticular infections. The authors report the clinical and laboratory findings from a 3-year-old child with a presternal soft tissue infection due to K kingae. After surgical excochleation and antibiotic treatment there was an uneventful recovery. J Pediatr Surg 36:946-947.     

Kingella kingae osteomyelitis of the clavicle

Kingella kingae is the most recent addition to the list of etiologic agents causing osteomyelitis and septic arthritis in previously well children. A case is presented of a child with K. kingae osteomyelitis of the clavicle--an uncommon site of infection due to any organism. In the hope of facilitating the detection and treatment of this increasingly recognized pathogen, a brief discussion of its microbiologic characteristics and a summary of the patients reported to date with bone and joint infections due to this organism are included. To our knowledge, this is the first discussion of K. kingae in the orthopedic literature.     

Kingella kingae osteoarthritis and osteomyelitis in children

Kingella kingae is still a poorly understood germ which is responsible for osteoarticular infections. We observed nine cases of osteoarthritis involving K. kingae in children. They included 4 cases of arthritis, 2 of osteomyelitis, and 3 of spondylodiscitis. The germ was cultured in all cases by direct surgical approach or by needle aspiration of the septic locus. Evolution was always good after immobilization and nonspecific antibiotherapy. Our nine clinical cases, along with the few cases already published, allow us to state that K. kingae shows a strong affinity for bones and joints in the young child. Clinical presentation is nonspecific. The bacterial sampling must be cultured in enriched atmospheres (CO2). The strains are sensitive to most common antibiotics.     

Kingella kingae septic arthritis with endocarditis in an adult

Kingella kingae is part of the nonpathogenic flora normally found in the oral cavity and pharynx. Recent reports have established that K. kingae can cause invasive infections in pediatric patients. Few cases have been described in adults, however. We report a case of K. kingae arthritis of the knee followed by endocarditis in a 59-year-old woman. Physicians and microbiologists should be alert to the possibility of K. kingae infection. K. kingae is easy to detect provided its specific culture requirements are taken into account. Synovial fluid inoculation into blood culture vials considerably increases the likelihood of K. kingae recovery in patients with septic arthritis.     

Kingella kingae septic arthritis in children: recognising an elusive pathogen

Purpose

Kingella kingae is an increasingly identified cause of musculoskeletal infections in young children. We report our experience with a recently developed polymerase chain reaction (PCR) method and review the clinical course of children diagnosed with K. kingae septic arthritis in a tertiary referral paediatric hospital.

Methods

All positive cases of K. kingae identified by PCR analysis of synovial fluid from August 2010 until July 2013 were included. A chart review was undertaken to determine history, presentation and management.

Results

27 Children (14 male, 13 female) had PCR positive synovial fluid samples for K. kingae with median age of 19 months (range 4 months to 5 years 3 months). The sites of infection were knee (17 cases), hip (2 cases), ankle (5 cases), shoulder (2 cases) and elbow. The median temperature on presentation was 37.1 °C, median peripheral white blood cell count 12.4 (9.9–13.8) × 10⁹/L, erythrocyte sedimentation rate 55 (48–60) mm/h and C-reactive protein 24 (8–47) mg/L. The median synovial fluid white cell count was 21.8 (16.7–45.0) × 10⁹/L. Routine cultures identified K. kingae in only two synovial fluid samples. Two samples were additionally positive for Staphylococcus aureus.

Conclusions

Kingella kingae is a significant cause of septic arthritis in young children. The authors recommend maintaining a high index of suspicion in young children presenting with joint inflammation, especially if indices of infection are mild. It appears likely that children historically treated with antibiotics for “culture negative” septic arthritis were infected with K. kingae. PCR techniques for detection of K. kingae should be encouraged.     

Osteomyelitis Calcaneum due to a Scorpion Sting

Children are susceptible to various injuries, including insect bites, and scorpion bites are common in the lower extremity of children in Middle East countries. In most cases, the sting will produce just a local reaction; however, serious complications that can result in death have occurred. In this case report, we describe a case of osteomyelitis of the calcaneum after a scorpion sting.     

Osteomyelitis of the calcaneus due to atypical Mycobacterium

World wide tuberculous infection of bone remains common but there are few case reports of atypical mycobacteria causing bone infection. A case is reported of recurrent osteomyelitis of the calcaneus due to such an atypical Mycobacterium and associated with interferon-γ receptor deficiency (IFN-γ) receptor deficiency.     

Kingella kingae: osteoarticular infections of the sternum in children: a report of six cases

Purpose   Kingella kingae is increasingly recognized as a pathogen of osteoarticular infections (OAI) below the age of 2 years. It was reported that bones and joints which are rarely infected by other pathogens were frequently invaded by K. kingae. Based on a series of six cases, we present the typical clinical and paraclinical manifestation of K. kingae infections of the sternum and sterno-manubrial joint. Methods  A review of the clinical, laboratory, radiological, microbiological, and molecular data of six consecutive children admitted to a paediatric unit for OAI of the sternum was done. Results  Culture alone allowed for the detection of K. kingae as the responsible pathogen in three cases, molecular methods in the three other cases. Clinical and laboratory findings, as well as imaging methods, proved to be useful in the diagnostic process. Conclusion  Our findings suggest that infections of the lower sternum and the junction between the manubrium and the xyphoid process are typical, if not pathognomonic, for the organism. A respective diagnostic and therapeutic protocol was established. Study conducted at Debrousse Paediatric Hospital, Lyon, France.     

Osteomyelitis of the public symphysis due to Streptococcus anginosus

Summary An unusual case of osteomyelitis of the public symphysis in an insulin-dependent diabetic is reported. The infection occurred after the insertion of a penile prosthesis and the organism was streptococcus anginosus. Healing took place after wide excision and drainage, with penicillin given systemically.

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Résumé Présentation d'un cas d'ostéomyélite de la symphyse pubienne causée par un Streptococcus anginosus

     

Osteomyelitis of the pelvis due to Fusobacterium nucleatum.

Anaerobic pelvic osteomyelitis occurs rarely in children. A case of Fusobacterium nucleatum osteomyelitis of the right ilium [correction of ileum] in a child without apparent risk factors is described. This case emphasizes the value of diagnostic aspirates. Therapy with a combination of intravenous and oral clindamycin led to successful resolution of the infection.     

Osteomyelitis of the spine due to Salmonella infection — conservative treatment with quinolone: a case report

Although osteomyelitis due to Salmonella infection is known to be associated with sickle cell anemia, various hemoglobinopathies and immune suppressive states, it may also occur in normal hosts. A 16-year-old Chinese boy without sickle cell disease or any other condition that would compromise the immune system had osteomyelitis of the lumbar spine caused by Salmonella enteritidis. The condition was treated conservatively with ciprofloxacin (quinolone group). This may be the first reported case in which a patient with spinal osteomyelitis due to Salmonella infection, who was otherwise healthy, was successfully treated nonoperatively with quinolone.     

Septic Arthritis and Osteomyelitis due to the Chromoblastomycosis Agent Fonsecaea pedrosoi

Fonsecaea pedrosoi is the most common agent of chromoblastomycosis, a chronic localized fungal infection of the skin and subcutaneous tissues mainly involving the lower extremities. We report a rare case of septic arthritis and osteomyelitis due to the chromoblastomycosis agent F pedrosoi, which was successfully treated with arthrotomy and debridement, followed by a long course of oral antifungal therapy. To our knowledge, this is the second case of F pedrosoi osteomyelitis treated successfully to be ever reported.