Published online January 4, 2006
PEDIATRICS
Vol. 117
No. 1
January 2006, pp.
249-250
(doi:10.1542/peds.2005-2403)
Kingella kingae: An Emerging Pathogen of Acute Osteoarticular Infections in Children: In Reply
Karen M. Kiang, MD
Acute Disease Investigation and Control Section
Minnesota Department of Health
Minneapolis, MN 55164-0975
Epidemic Intelligence Service
Epidemiology Program Office
Centers for Disease Control and Prevention,
Atlanta, GA 30333
Ruth Lynfield, MD
Acute Disease Investigation and Control Section
Minnesota Department of Health
Minneapolis, MN 55164-0975
In Reply.—
We greatly appreciate the comments from Drs Saphyakhajon and Greene, which reinforce the importance of recognizing Kingella kingae as a significant pathogenic cause of osteoarticular and other infections among young children. The growing body of knowledge surrounding K kingae over the past decade reflects, in part, our increasing awareness of the organism and ability to isolate it in the laboratory. As stated in our article, no causative organism is found in 40% to 70% of cases of pediatric osteoarticular infections,1–5 and up to 84% to 91% of cases of K kingae infection are missed if only the conventional culture technique is used without an accompanying blood-culture–bottle method.6–9 The retrospective study by Moumile et al10 reported that K kingae was the second most commonly recovered pathogen behind Staphylococcus aureus in a large cohort of children with culture-positive osteoarticular infections. This finding is further supported by a recent prospective study by Verdier et al,11 in which samples from 171 children with osteoarticular infection were cultured. Of the 64 (37.4%) culture-positive cases, 47% were S aureus, 16% were ß-hemolytic Streptococcus, and 14% were K kingae. The investigators acknowledged that the use of blood-culture bottles strongly increased their diagnostic yield (7 of the 9 K kingae isolates grew only in blood-culture bottles). The investigators then performed polymerase chain reaction (PCR) on all culture-negative samples using universal, broad-range bacterial 16S ribosomal DNA primers. An organism was identified in 15 of the culture-negative samples; all were K kingae. In summary, K kingae was again the second most commonly recovered pathogen behind S aureus; of the 79 culture- or PCR-positive cases, 38% were S aureus, 30% were K kingae, and 13% were ß-hemolytic Streptococcus.
This study highlights many of the take-home points emphasized in our article regarding K kingae as an important cause of septic arthritis and osteomyelitis in children: in general, a high percentage of osteoarticular infection cases remain culture-negative; the blood-culture–bottle system greatly increases the chance of isolating an organism (especially K kingae); and K kingae is a common bacterial cause of these infections. Moreover, this study furthers the use of broad-range bacterial PCR as an effective additional diagnostic tool along with current bacterial culture methods. As diagnostic methods for K kingae improve and molecular techniques are introduced for the enhanced detection of all bacteria, we look forward to understanding further the epidemiology of these pathogens and their contributory role in pediatric skeletal infections.
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PEDIATRICS (ISSN 1098-4275). ©2006 by the American Academy of Pediatrics
Related articles in Pediatrics:
- Kingella kingae: An Emerging Pathogen of Acute Osteoarticular Infections in Children
- Phisit Saphyakhajon and Gerald Greene
Pediatrics 2006 117: 249.
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