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The Past, Present, and Future of Kingella kingae Detection in Pediatric Osteoarthritis
1Clinical Microbiology Laboratory, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva 8410500, Israel.
Insights
Kingella kingae is a common cause of bone and joint infections in young children. Improved laboratory methods, including blood cultures and PCR, enhance its detection, with future diagnostics likely using next-generation sequencing.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Clinical Diagnostics
Background:
- Kingella kingae is a Gram-negative bacterium.
- It is a component of the pediatric oropharyngeal microbiota.
- It is increasingly recognized as a primary cause of septic arthritis, osteomyelitis, and spondylodiscitis in children aged 6 to 48 months.
Purpose of the Study:
- To review laboratory methods for detecting Kingella kingae.
- To summarize advancements in diagnostic techniques for Kingella kingae infections.
Main Methods:
- Literature review of laboratory detection methods.
- Analysis of traditional culture techniques and their limitations.
- Evaluation of enhanced culture methods (blood culture vials).
- Assessment of molecular diagnostic techniques (PCR targeting specific genes).
- Consideration of emerging technologies (metagenomic next-generation sequencing).
Main Results:
- Kingella kingae is difficult to isolate using standard solid culture media due to its fastidious nature.
- Inoculating samples into blood culture vials improves recovery by diluting inhibitory substances.
- Nucleic acid amplification tests (NAATs), particularly real-time PCR targeting rtxA, groEL, and mdh genes, significantly enhance detection sensitivity and specificity.
- Metagenomic next-generation sequencing (NGS) shows promise for future diagnostics, with ongoing improvements in sensitivity and specificity.
Conclusions:
- Effective detection of Kingella kingae relies on optimized laboratory methods beyond standard cultures.
- Blood culture vials and molecular assays like PCR are crucial for accurate diagnosis.
- Metagenomic NGS represents a promising future direction for diagnosing Kingella kingae infections, potentially becoming the primary diagnostic approach.
Abstract:
As a result of the increasing use of improved detection methods, Kingella kingae, a Gram-negative component of the pediatric oropharyngeal microbiota, is increasingly appreciated as the prime etiology of septic arthritis, osteomyelitis, and spondylodiscitis in children aged 6 to 48 months. The medical literature was reviewed to summarize the laboratory methods required for detecting the organism. Kingella kingae is notoriously fastidious, and seeding skeletal system samples onto solid culture media usually fails to isolate it. Inoculation of synovial fluid aspirates and bone exudates into blood culture vials enhances Kingella kingae recovery by diluting detrimental factors in the specimen. The detection of the species has been further improved by nucleic acid amplification tests, especially by using species-specific primers targeting Kingella kingae's rtxA, groEL, and mdh genes in a real-time PCR platform. Although novel metagenomic next-generation technology performed in the patient's plasma sample (liquid biopsy) has not yet reached its full potential, improvements in the sensitivity and specificity of the method will probably make this approach the primary means of diagnosing Kingella kingae infections in the future.
