PEDIATRICS Vol. 92 No. 6 December 1993, pp. 800-804
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Clinical Features and Epidemiology of Invasive Kingella kingae Infections in Southern Israel

Pablo Yagupsky MD1, Ron Dagan MD2, Charles B. Howard FRCS3, Menachem Einhorn MD2, Imad Kassis MD2, and Alexander Simu MD1

1 From the Clinical Microbiology Laboratory, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
2 From the Pediatric Infectious Disease Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
3 From the Pediatric Orthopedic Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel

Objective. To characterize the clinical spectrum and epidemiology of invasive Kingella kingae infections in children living in southern Israel.

Design. Five-year observational, descriptive study.

Population. Children in whom K. kingae was isolated from blood or other normally sterile body fluid.

Results. Twenty-five patients with invasive K. kingae infection (13 male and 12 female) were identified. Twenty-four of these children were younger than 2 years. The annual incidence was 14.3, 27.4, and 31.9 cases per 100 000 children le4 years, le24 months, and le12 months, respectively. Seventeen (68%) of 25 patients sought treatment between July and December. Concomitant upper respiratory tract infection or stomatitis was observed in 14 (56%) of the patients, suggesting a respiratory or buccal source for the infection. Four children were bacteremic: 2 of them suffered from a lower respiratory tract infection, and the remaining 2 had bacteremia with no evident focal infection. Twenty-one children had skeletal infections and none of them was bacteremic; 16 had septic arthritis, 3 had osteomyelitis, 1 had both osteomyelitis and septic arthritis of the adjacent joint, and 1 had dactylitis of the hand. Involvement of the ankle was unusually frequent among children with septic arthritis, whereas the calcaneus was involved in 3 of the 4 children with osteomyelitis. Antibiotic treatment resulted in full recovery in all cases, and only 2 patients with septic arthritis required surgical drainage.

Conclusion. Kingella kingae is a much more common cause of invasive infection in young children than has been previously recognized. The disease has a clear seasonal pattern, usually affects the skeletal system, frequently involves unusual bones and joints, and follows a benign course.

Key Words: Kingella kingae • invasive infections • epidemiology • osteomyelitis • septic arthritis

Submitted on April 15, 1993
Accepted on May 21, 1993




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