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Updated: Nov 16, 2025
Knee Arthrocentesis in Adults
Published on: February 25, 2022
Osteoarticular infection in children
Benoit Coulin1, Giacomo Demarco1, Vanessa Spyropoulou1
1Pediatric Orthopedics Service, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland.
Insights
Kingella kingae is a primary cause of osteoarticular infections (OAIs) in young children, often presenting with subtle symptoms. Nucleic acid amplification tests are crucial for accurate diagnosis and improved detection rates.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Orthopedics
Background:
- Osteoarticular infections (OAIs) are significant pediatric conditions.
- Kingella kingae is an increasingly recognized pathogen in pediatric OAIs.
Purpose of the Study:
- To characterize the epidemiological, biological, and bacteriological features of K. kingae-associated OAIs in children.
- To highlight diagnostic challenges and propose improved detection methods.
Main Methods:
- Retrospective review of pediatric OAI cases over 13 years (2007-2019).
- Extraction and analysis of epidemiological, clinical, biological, and microbiological data for K. kingae OAIs.
- Review of imaging findings (MRI) for affected joints and bones.
Main Results:
- K. kingae was the leading cause of bacteriologically confirmed OAIs (48.7%) in the pediatric cohort.
- Peak incidence occurred in children aged 6–48 months, particularly 7–24 months.
- Patients often presented afebrile with mild inflammatory markers; elevated ESR was a key indicator. Arthritis (knee) and osteomyelitis (foot) were common MRI findings.
Conclusions:
- K. kingae is a primary pathogen for OAIs in children under 48 months.
- Diagnosis can be challenging due to mild clinical and biological inflammatory responses.
- Nucleic acid amplification assays, like PCR, are vital for improved detection and should be integrated into OAI diagnostic algorithms.
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.
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