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30 years of study of Kingella kingae: post tenebras, lux
Dimitri Ceroni1, Victor Dubois-Ferrière, Abdessalam Cherkaoui
1Paediatric Orthopaedic Service, University of Geneva Hospitals, 6 Rue Willy-Donzé, 1211 Geneva 14, Switzerland. dimitri.ceroni@hcuge.ch
Insights
Kingella kingae causes most bone and joint infections in young children. Early suspicion and molecular diagnosis are key for treating this common oropharyngeal bacterium.
Area of Science:
- Microbiology
- Pediatric Infectious Diseases
- Bacterial Pathogenesis
Background:
- Kingella kingae is a Gram-negative bacterium and a common cause of pediatric osteoarticular infections.
- It is part of the oropharyngeal normal flora in about 10% of children under four.
- Transmission occurs through close personal contact.
Purpose of the Study:
- To highlight Kingella kingae as a significant pathogen in pediatric bone and joint infections.
- To discuss its virulence factors, clinical presentation, and diagnostic methods.
- To emphasize the importance of early diagnosis and treatment.
Main Methods:
- Review of current literature on Kingella kingae.
- Analysis of virulence factors including type IV pili, Knh adhesion, and RTX toxin.
- Discussion of diagnostic approaches, particularly nucleic acid amplification techniques.
- Evaluation of treatment outcomes for invasive infections.
Main Results:
- Kingella kingae is the leading cause of septic arthritis and osteomyelitis in young children.
- Subtle clinical signs and mild inflammatory responses necessitate a high index of suspicion.
- Molecular diagnostic methods are crucial for identifying this fastidious bacterium.
- Most invasive infections respond well to treatment, but endocarditis may require surgery.
Conclusions:
- Kingella kingae is a critical pathogen in pediatric bone and joint infections.
- Prompt diagnosis using molecular techniques is essential for effective management.
- While generally treatable, specific complications like endocarditis require specialized intervention.
Abstract:
Kingella kingae is a Gram-negative bacterium that is today recognized as the major cause of joint and bone infections in young children. This microorganism is a member of the normal flora of the oropharynx, and the carriage rate among children under 4 years of age is approximately 10%. K. kingae is transmitted from child to child through close personal contact. Key virulence factors of K. kingae include expression of type IV pili, Knh-mediated adhesive activity and production of a potent RTX toxin. The clinical presentation of K. kingae invasive infection is often subtle and may be associated to mild-to-moderate biologic inflammatory responses, highlighting the importance a high index of suspicion. Molecular diagnosis of K. kingae infections by nucleic acid amplification techniques enables identification of this fastidious microorganism. Invasive infections typically respond favorably to medical treatment, with the exception of cases of endocarditis, which may require urgent valve replacement.
