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Changing aetiology of paediatric septic arthritis

Pablo Yagupsky1

  • 1Clinical Microbiology Laboratory, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Journal of Paediatrics and Child Health
|July 14, 2021
PubMed

Insights

Kingella kingae is now the leading cause of septic arthritis in young children, often missed by traditional diagnostics. Improved molecular methods are crucial for accurate identification and management of this infection.

Area of Science:

  • Pediatric Infectious Diseases
  • Microbiology
  • Rheumatology

Background:

  • Septic arthritis in children traditionally involved Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae, and Haemophilus influenzae type b.
  • Conventional bacteriologic cultures often failed to identify the causative pathogen in a significant number of pediatric joint infections.
  • Vaccination programs and improved detection methods have significantly altered the understanding of pediatric infectious arthritis etiology.

Purpose of the Study:

  • To highlight the changing landscape of causative agents in pediatric septic arthritis.
  • To emphasize the emerging role of Kingella kingae as a primary cause of infectious arthritis in young children.
  • To discuss the diagnostic challenges and advancements in identifying Kingella kingae infections.

Main Methods:

  • Review of historical and recent data on pediatric septic arthritis etiology.
  • Implementation of blood culture vial inoculation for synovial fluid aspirates.
  • Advancement and utilization of sensitive molecular diagnostic techniques, particularly nucleic acid amplification tests (NAATs).

Main Results:

  • Kingella kingae has emerged as the predominant cause of septic arthritis in children aged 6-48 months, identified in 30-93% of cases.
  • The clinical presentation of Kingella kingae arthritis is often subtle, with normal or near-normal inflammatory markers and white blood cell counts.
  • Molecular methods, especially NAATs targeting K. kingae-specific genes, have significantly improved pathogen detection rates and reduced culture-negative infections.

Conclusions:

  • Kingella kingae is the leading etiology of septic arthritis in children under four years old.
  • The subtle clinical presentation and frequent normality of standard laboratory tests necessitate high clinical suspicion for Kingella kingae.
  • Advanced molecular detection methods are essential for accurate diagnosis and effective management of pediatric septic arthritis caused by Kingella kingae.

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