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Epidemiology and Clinical Manifestations of Kingella kingae Disease

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Advances in Understanding Kingella kingae

Part of the book series: SpringerBriefs in Immunology ((BRIEFSIMMUN))

Abstract

Kingella kingae has become increasingly recognized as an important pathogen in the pediatric population. Children between the ages of 6 and 48 months commonly carry the organism asymptomatically in their oropharynx, with colonization rates of roughly 10 % at any given time. Carriage is a prerequisite for invasive disease, and children between 6 and 48 months of age are also most likely to develop invasive disease, including osteoarticular infections (OAIs), bacteremia, and endocarditis. K. kingae OAIs tend to follow a relatively indolent course, reflecting an inflammatory response that is less robust than with other pathogens causing bone and joint infections such as Staphylococcus aureus. As a result, the symptoms of infection may be non-specific and the time to presentation may be delayed. Bacteremia is a key step in all forms of K. kingae invasive disease and may be the sole manifestation of disease (occult bacteremia). K. kingae endocarditis is often particularly severe in young children, associated with complications such as stroke and meningitis. This chapter describes the epidemiology and clinical manifestations of K. kingae invasive disease.

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Abbreviations

OAI:

Osteoarticular infection

References

  1. Yagupsky P (2015) Kingella kingae: carriage, transmission, and disease. Clin Microbiol Rev 28(1):54–79. doi:10.1128/cmr.00028-14

    Article  PubMed  PubMed Central  Google Scholar 

  2. Yagupsky P, Greenberg D (2012) Kingella species. In: Long S (ed) Principles and practice of pediatric infectious diseases, 4th ed. Elsevier Inc., Edinburgh

    Google Scholar 

  3. Yagupsky P, Peled N, Katz O (2002) Epidemiological features of invasive Kingella kingae infections and respiratory carriage of the organism. J Clin Microbiol 40(11):4180–4184

    Article  PubMed  PubMed Central  Google Scholar 

  4. Amit U, Flaishmakher S, Dagan R, Porat N, Yagupsky P (2014) Age-dependent carriage of Kingella kingae in young children and turnover of colonizing strains. J Pediatr Infect Dis Soc 3(2):160–162. doi:10.1093/jpids/pit003

    Article  Google Scholar 

  5. Amit U, Dagan R, Yagupsky P (2013) Prevalence of pharyngeal carriage of Kingella kingae in young children and risk factors for colonization. Pediatr Infect Dis J 32(2):191–193. doi:10.1097/INF.0b013e3182755779

    Article  PubMed  Google Scholar 

  6. Yagupsky P, Dagan R, Prajgrod F, Merires M (1995) Respiratory carriage of Kingella kingae among healthy children. Pediatr Infect Dis J 14(8):673–678

    Article  CAS  PubMed  Google Scholar 

  7. Anderson de la Llana R, Dubois-Ferriere V, Maggio A, Cherkaoui A, Manzano S, Renzi G, Hibbs J, Schrenzel J, Ceroni D (2015) Oropharyngeal Kingella kingae carriage in children: characteristics and correlation with osteoarticular infections. Pediatr Res 78(5):574–579. doi:10.1038/pr.2015.133

    CAS  PubMed  Google Scholar 

  8. Ceroni D, Dubois-Ferriere V, Cherkaoui A, Gesuele R, Combescure C, Lamah L, Manzano S, Hibbs J, Schrenzel J (2013) Detection of Kingella kingae osteoarticular infections in children by oropharyngeal swab PCR. Pediatrics 131(1):e230–e235. doi:10.1542/peds.2012-0810

    Article  PubMed  Google Scholar 

  9. Dubnov-Raz G, Ephros M, Garty BZ, Schlesinger Y, Maayan-Metzger A, Hasson J, Kassis I, Schwartz-Harari O, Yagupsky P (2010) Invasive pediatric Kingella kingae infections: a nationwide collaborative study. Pediatr Infect Dis J 29(7):639–643. doi:10.1097/INF.0b013e3181d57a6c

    Article  PubMed  Google Scholar 

  10. Slonim A, Steiner M, Yagupsky P (2003) Immune response to invasive Kingella kingae infections, age-related incidence of disease, and levels of antibody to outer-membrane proteins. Clin Infect Dis 37(4):521–527. doi:10.1086/376913

    Article  CAS  PubMed  Google Scholar 

  11. Al-Qwbani M, Jiang N, Yu B (2016) Kingella kingae-associated pediatric osteoarticular infections: an overview of 566 reported cases. Clin Pediatr (Phila). doi:10.1177/0009922816629620

    Google Scholar 

  12. Chometon S, Benito Y, Chaker M, Boisset S, Ploton C, Berard J, Vandenesch F, Freydiere AM (2007) Specific real-time polymerase chain reaction places Kingella kingae as the most common cause of osteoarticular infections in young children. Pediatr Infect Dis J 26(5):377–381. doi:10.1097/01.inf.0000259954.88139.f4

    Article  PubMed  Google Scholar 

  13. Ceroni D, Dubois-Ferriere V, Anderson R, Combescure C, Lamah L, Cherkaoui A, Schrenzel J (2012) Small risk of osteoarticular infections in children with asymptomatic oropharyngeal carriage of Kingella kingae. Pediatr Infect Dis J 31(9):983–985. doi:10.1097/INF.0b013e31825d3419

    Article  PubMed  Google Scholar 

  14. Yagupsky P, Dagan R (2000) Population-based study of invasive Kingella kingae infections. Emerg Infect Dis 6(1):85–87. doi:10.3201/eid0601.000118

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Amit U, Dagan R, Porat N, Trefler R, Yagupsky P (2012) Epidemiology of invasive Kingella kingae infections in 2 distinct pediatric populations cohabiting in one geographic area. Pediatr Infect Dis J 31(4):415–417. doi:10.1097/INF.0b013e318240cf8a

    Article  PubMed  Google Scholar 

  16. Aupiais C, Ilharreborde B, Doit C, Blachier A, Desmarest M, Job-Deslandre C, Mazda K, Faye A, Bonacorsi S, Alberti C, Lorrot M (2015) Aetiology of arthritis in hospitalised children: an observational study. Arch Dis Child 100(8):742–747. doi:10.1136/archdischild-2014-307490

    Google Scholar 

  17. Basmaci R, Bonacorsi S, Ilharreborde B, Doit C, Lorrot M, Kahil M, Visseaux B, Houhou N, Bidet P (2015) High respiratory virus oropharyngeal carriage rate during Kingella kingae osteoarticular infections in children. Future Microbiol 10(1):9–14. doi:10.2217/fmb.14.117

    Article  CAS  PubMed  Google Scholar 

  18. Basmaci R, Ilharreborde B, Doit C, Presedo A, Lorrot M, Alison M, Mazda K, Bidet P, Bonacorsi S (2013) Two atypical cases of Kingella kingae invasive infection with concomitant human rhinovirus infection. J Clin Microbiol 51(9):3137–3139. doi:10.1128/jcm.01134-13

    Article  PubMed  PubMed Central  Google Scholar 

  19. El Houmami N, Minodier P, Dubourg G, Martin-Laval A, Lafont E, Jouve JL, Charrel R, Raoult D, Fournier PE (2015) An outbreak of Kingella kingae infections associated with hand, foot and mouth disease/herpangina virus outbreak in Marseille, France 2013. Pediatr Infect Dis J 34(3):246–250. doi:10.1097/INF.0000000000000572

    Article  PubMed  Google Scholar 

  20. Basmaci R, Bonacorsi S, Bidet P, Balashova NV, Lau J, Munoz-Almagro C, Gene A, Yagupsky P (2014) Genotyping, local prevalence and international dissemination of beta-lactamase-producing Kingella kingae strains. Clin Microbiol Infect 20(11):O811–O817. doi:10.1111/1469-0691.12648

    Article  CAS  PubMed  Google Scholar 

  21. Banerjee A, Kaplan JB, Soherwardy A, Nudell Y, Mackenzie GA, Johnson S, Balashova NV (2013) Characterization of TEM-1 beta-lactamase producing Kingella kingae clinical isolates. Antimicrob Agents Chemother 57(9):4300–4306. doi:10.1128/AAC.00318-13

    Google Scholar 

  22. Basmaci R, Bidet P, Yagupsky P, Munoz-Almagro C, Balashova NV, Doit C, Bonacorsi S (2014) Major intercontinentally distributed sequence types of Kingella kingae and development of a rapid molecular typing tool. J Clin Microbiol 52(11):3890–3897. doi:10.1128/JCM.01609-14

    Article  PubMed  PubMed Central  Google Scholar 

  23. Amit U, Porat N, Basmaci R, Bidet P, Bonacorsi S, Dagan R, Yagupsky P (2012) Genotyping of invasive Kingella kingae isolates reveals predominant clones and association with specific clinical syndromes. Clin Infect Dis 55(8):1074–1079. doi:10.1093/cid/cis622

    Article  CAS  PubMed  Google Scholar 

  24. Slonim A, Walker ES, Mishori E, Porat N, Dagan R, Yagupsky P (1998) Person-to-person transmission of Kingella kingae among day care center attendees. J Infect Dis 178(6):1843–1846

    Article  CAS  PubMed  Google Scholar 

  25. Yagupsky P, Porat N, Pinco E (2009) Pharyngeal colonization by Kingella kingae in children with invasive disease. Pediatr Infect Dis J 28(2):155–157. doi:10.1097/INF.0b013e318184dbb8

    Article  PubMed  Google Scholar 

  26. Kiang KM, Ogunmodede F, Juni BA, Boxrud DJ, Glennen A, Bartkus JM, Cebelinski EA, Harriman K, Koop S, Faville R, Danila R, Lynfield R (2005) Outbreak of osteomyelitis/septic arthritis caused by Kingella kingae among child care center attendees. Pediatrics 116(2):e206–e213. doi:10.1542/peds.2004-2051

    Article  PubMed  Google Scholar 

  27. Bidet P, Collin E, Basmaci R, Courroux C, Prisse V, Dufour V, Bingen E, Grimprel E, Bonacorsi S (2013) Investigation of an outbreak of osteoarticular infections caused by Kingella kingae in a childcare center using molecular techniques. Pediatr Infect Dis J 32(5):558–560. doi:10.1097/INF.0b013e3182867f5e

    Article  PubMed  Google Scholar 

  28. Yagupsky P, Erlich Y, Ariela S, Trefler R, Porat N (2006) Outbreak of Kingella kingae skeletal system infections in children in daycare. Pediatr Infect Dis J 25(6):526–532. doi:10.1097/01.inf.0000215243.42501.4f

    Article  PubMed  Google Scholar 

  29. Sena AC, Seed P, Nicholson B, Joyce M, Cunningham CK (2010) Kingella kingae endocarditis and a cluster investigation among daycare attendees. Pediatr Infect Dis J 29(1):86–88. doi:10.1097/INF.0b013e3181b48cc3

    Article  PubMed  Google Scholar 

  30. Gene A, Garcia-Garcia JJ, Sala P, Sierra M, Huguet R (2004) Enhanced culture detection of Kingella kingae, a pathogen of increasing clinical importance in pediatrics. Pediatr Infect Dis J 23(9):886–888

    Article  PubMed  Google Scholar 

  31. Dubnov-Raz G, Scheuerman O, Chodick G, Finkelstein Y, Samra Z, Garty BZ (2008) Invasive Kingella kingae infections in children: clinical and laboratory characteristics. Pediatrics 122(6):1305–1309. doi:10.1542/peds.2007-3070

    Article  PubMed  Google Scholar 

  32. Kampouroglou G, Dubois-Ferriere V, Anderson De La Llana R, Salvo D, Ceroni D (2015) Cartilage matrix infection in young children by Kingella kingae. Pediatr Int 57(4):805–806. doi:10.1111/ped.12685

    Article  PubMed  Google Scholar 

  33. Ceroni D, Merlini L, Salvo D, Lascombes P, Dubois-Ferriere V (2013) Pyogenic flexor tenosynovitis of the finger due to Kingella kingae. Pediatr Infect Dis J 32(6):702–703 (United States). doi:10.1097/INF.0b013e3182868f17

    Google Scholar 

  34. Ferroni A, Al Khoury H, Dana C, Quesne G, Berche P, Glorion C, Pejin Z (2013) Prospective survey of acute osteoarticular infections in a French paediatric orthopedic surgery unit. Clin Microbiol Infect 19(9):822–828. doi:10.1111/clm.12031

    Article  CAS  PubMed  Google Scholar 

  35. Ceroni D, Cherkaoui A, Ferey S, Kaelin A, Schrenzel J (2010) Kingella kingae osteoarticular infections in young children: clinical features and contribution of a new specific real-time PCR assay to the diagnosis. J Pediatr Orthop 30(3):301–304. doi:10.1097/BPO.0b013e3181d4732f

    Article  PubMed  Google Scholar 

  36. Carter K, Doern C, Jo CH, Copley LA (2016) The clinical usefulness of polymerase chain reaction as a supplemental diagnostic tool in the evaluation and the treatment of children with septic arthritis. J Pediatr Orthop 36:167–172. doi:10.1097/BPO.0000000000000411

    Google Scholar 

  37. Ceroni D, Cherkaoui A, Combescure C, Francois P, Kaelin A, Schrenzel J (2011) Differentiating osteoarticular infections caused by Kingella kingae from those due to typical pathogens in young children. Pediatr Infect Dis J 30(10):906–909. doi:10.1097/INF.0b013e31821c3aee

    Article  PubMed  Google Scholar 

  38. Basmaci R, Lorrot M, Bidet P, Doit C, Vitoux C, Pennecot G, Mazda K, Bingen E, Ilharreborde B, Bonacorsi S (2011) Comparison of clinical and biologic features of Kingella kingae and Staphylococcus aureus arthritis at initial evaluation. Pediatr Infect Dis J 30(10):902–904. doi:10.1097/INF.0b013e31821fe0f7

    Article  PubMed  Google Scholar 

  39. Mallet C, Ceroni D, Litzelmann E, Dubois-Ferriere V, Lorrot M, Bonacorsi S, Mazda K, Ilharreborde B (2014) Unusually severe cases of Kingella kingae osteoarticular infections in children. Pediatr Infect Dis J 33(1):1–4. doi:10.1097/INF.0b013e3182a22cc6

    Article  PubMed  Google Scholar 

  40. Williams N, Cooper C, Cundy P (2014) Kingella kingae septic arthritis in children: recognising an elusive pathogen. J Child Orthop 8(1):91–95. doi:10.1007/s11832-014-0549-4

    Article  PubMed  PubMed Central  Google Scholar 

  41. Jaakkola J, Kehl D (1999) Hematogenous calcaneal osteomyelitis in children. J Pediatr Orthop 19(6):699–704

    CAS  PubMed  Google Scholar 

  42. Luegmair M, Chaker M, Ploton C, Berard J (2008) Kingella kingae: osteoarticular infections of the sternum in children: a report of six cases. J Child Orthop 2(6):443–447. doi:10.1007/s11832-008-0144-7

    Article  PubMed  PubMed Central  Google Scholar 

  43. Rotbart HA, Gelfand WM, Glode MP (1984) Kingella kingae osteomyelitis of the clavicle. J Pediatr Orthop 4(4):500–502

    Article  CAS  PubMed  Google Scholar 

  44. Ruttan TK, Higginbotham E, Higginbotham N, Allen CH, Hauger S (2015) Invasive Kingella kingae resulting in a brodie abscess. J Pediatric Infect Dis Soc 4(2):e14–e16. doi:10.1093/jpids/piu046

    Article  PubMed  Google Scholar 

  45. Ceroni D, Belaieff W, Cherkaoui A, Lascombes P, Schrenzel J, de Coulon G, Dubois-Ferriere V, Dayer R (2014) Primary epiphyseal or apophyseal subacute osteomyelitis in the pediatric population: a report of fourteen cases and a systematic review of the literature. J Bone Joint Surg Am 96(18):1570–1575. doi:10.2106/jbjs.m.00791

    Article  PubMed  Google Scholar 

  46. Garron E, Viehweger E, Launay F, Guillaume JM, Jouve JL, Bollini G (2002) Nontuberculous spondylodiscitis in children. J Pediatr Orthop 22(3):321–328

    PubMed  Google Scholar 

  47. Ceroni D, Cherkaoui A, Kaelin A, Schrenzel J (2010) Kingella kingae spondylodiscitis in young children: toward a new approach for bacteriological investigations? A preliminary report. J Child Orthop 4(2):173–175. doi:10.1007/s11832-009-0233-2

    Article  PubMed  PubMed Central  Google Scholar 

  48. Ceroni D, Belaieff W, Kanavaki A, Della Llana RA, Lascombes P, Dubois-Ferriere V, Dayer R (2013) Possible association of Kingella kingae with infantile spondylodiscitis. Pediatr Infect Dis J 32(11):1296–1298. doi:10.1097/INF.0b013e3182a6df50

    Article  PubMed  Google Scholar 

  49. Bofinger JJ, Fekete T, Samuel R (2007) Bacterial peritonitis caused by Kingella kingae. J Clin Microbiol 45(9):3118–3120. doi:10.1128/JCM.00878-07

    Article  PubMed  PubMed Central  Google Scholar 

  50. Pavlovsky M, Press J, Peled N, Yagupsky P (2006) Blood culture contamination in pediatric patients: young children and young doctors. Pediatr Infect Dis J 25(7):611–614. doi:10.1097/01.inf.0000220228.01382.88

    Article  PubMed  Google Scholar 

  51. Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr, Tleyjeh IM, Rybak MJ, Barsic B, Lockhart PB, Gewitz MH, Levison ME, Bolger AF, Steckelberg JM, Baltimore RS, Fink AM, O’Gara P, Taubert KA (2015) Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation 132(15):1435–1486. doi:10.1161/cir.0000000000000296

    Article  CAS  PubMed  Google Scholar 

  52. Baltimore RS, Gewitz M, Baddour LM, Beerman LB, Jackson MA, Lockhart PB, Pahl E, Schutze GE, Shulman ST, Willoughby R Jr (2015) Infective endocarditis in childhood: 2015 update: a scientific statement from the American Heart Association. Circulation 132(15):1487–1515. doi:10.1161/cir.0000000000000298

    Article  PubMed  Google Scholar 

  53. Webb R, Voss L, Roberts S, Hornung T, Rumball E, Lennon D (2014) Infective endocarditis in New Zealand children 1994–2012. Pediatr Infect Dis J 33(5):437–442. doi:10.1097/inf.0000000000000133

    Article  PubMed  Google Scholar 

  54. Marom D, Levy I, Gutwein O, Birk E, Ashkenazi S (2011) Healthcare-associated versus community-associated infective endocarditis in children. Pediatr Infect Dis J 30(7):585–588. doi:10.1097/INF.0b013e31820f66c7

    Article  PubMed  Google Scholar 

  55. Bagherirad M, Entesari-Tatafi D, Mirzaee S, Appelbe A, Yap C, Athan E (2013) A case of Kingella kingae endocarditis complicated by native mitral valve rupture. Australas Med J 6(4):172–174. doi:10.4066/amj.2013.1577

    Article  PubMed  PubMed Central  Google Scholar 

  56. Korach A, Olshtain-Pops K, Schwartz D, Moses A (2009) Kingella kingae prosthetic valve endocarditis complicated by a paravalvular abscess. Isr Med Assoc J 11(4):251–253

    PubMed  Google Scholar 

  57. Foster MA, Walls T (2014) High rates of complications following Kingella kingae infective endocarditis in children: a case series and review of the literature. Pediatr Infect Dis J 33(7):785–786. doi:10.1097/INF.0000000000000303

    Article  PubMed  Google Scholar 

  58. Berkun Y, Brand A, Klar A, Halperin E, Hurvitz H (2004) Kingella kingae endocarditis and sepsis in an infant. Eur J Pediatr 163(11):687–688. doi:10.1007/s00431-004-1520-z

    PubMed  Google Scholar 

  59. Rotstein A, Konstantinov IE, Penny DJ (2010) Kingella-infective endocarditis resulting in a perforated aortic root abscess and fistulous connection between the sinus of valsalva and the left atrium in a child. Cardiol Young 20(3):332–333

    Article  PubMed  Google Scholar 

  60. Le Bourgeois F, Germanaud D, Bendavid M, Bonnefoy R, Desnous B, Beyler C, Blauwblomme T, Elmaleh M, Pierron C, Lorrot M, Bonacorsi S, Basmaci R (2016) Kingella kingae sequence type 25 causing endocarditis with multiple and severe cerebral complications. J Pediatr 169(326–326):e321. doi:10.1016/j.jpeds.2015.10.091

    Google Scholar 

  61. Brachlow A, Chatterjee A, Stamato T (2004) Endocarditis due to Kingella kingae: a patient report. Clin Pediatr (Phila) 43(3):283–286

    Article  Google Scholar 

  62. Lewis MB, Bamford JM (2000) Global aphasia without hemiparesis secondary to Kingella kingae endocarditis. Arch Neurol 57(12):1774–1775

    Article  CAS  PubMed  Google Scholar 

  63. Wells L, Rutter N, Donald F (2001) Kingella kingae endocarditis in a sixteen-month-old-child. Pediatr Infect Dis J 20(4):454–455

    Article  CAS  PubMed  Google Scholar 

  64. Van Erps J, Schmedding E, Naessens A, Keymeulen B (1992) Kingella kingae, a rare cause of bacterial meningitis. Clin Neurol Neurosurg 94(2):173–175

    Article  PubMed  Google Scholar 

  65. Ramana K, Mohanty S (2009) An adult case of urinary tract infection with Kingella kingae: a case report. J Med Case Rep 3:7236. doi:10.1186/1752-1947-3-7236

    Article  PubMed  PubMed Central  Google Scholar 

  66. Matta M, Wermert D, Podglajen I, Sanchez O, Buu-Hoi A, Gutmann L, Meyer G, Mainardi JL (2007) Molecular diagnosis of Kingella kingae pericarditis by amplification and sequencing of the 16S rRNA gene. J Clin Microbiol 45(9):3133–3134. doi:10.1128/JCM.00809-07

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  67. Carden SM, Colville DJ, Gonis G, Gilbert GL (1991) Kingella kingae endophthalmitis in an infant. Aust NZ J Ophthalmol 19(3):217–220

    Article  CAS  Google Scholar 

  68. Munoz-Egea MC, Garcia-Pedrazuela M, Gonzalez-Pallares I, Martinez-Perez M, Fernandez-Roblas R, Esteban J (2013) Kingella kingae keratitis. J Clin Microbiol 51(5):1627–1628. doi:10.1128/jcm.03426-12

    Article  PubMed  PubMed Central  Google Scholar 

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  1. Division of Infectious Diseases, The Children’s Hospital of Philadelphia, 3535 Market Street, Suite 1409, Philadelphia, PA, 19104, USA

    Kevin J. Downes

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  1. Physician-in-Chief, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA

    Joseph W. St. Geme, III

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Downes, K.J. (2016). Epidemiology and Clinical Manifestations of Kingella kingae Disease. In: St. Geme, III, J. (eds) Advances in Understanding Kingella kingae. SpringerBriefs in Immunology. Springer, Cham. https://doi.org/10.1007/978-3-319-43729-3_2

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