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• Low Prevalence of Kingella kingae Infections in UK Children
  Pablo Yagupsky
  Published on: 22 June 2021

• Published on: 22 June 2021

  Low Prevalence of Kingella kingae Infections in UK Children

  • Pablo Yagupsky, Pediatrician and Clinical Microbiologist Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel

  e-Letter

  Low Prevalence of Kingella kingae Infections in UK Children

  Pablo Yagupsky, MD
  Clinical Microbiology Laboratory, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel

  Corresponding Author: Pablo Yagupsky, Clinical Microbiology Laboratory, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel 84101. Phone number: (972) 506264359. Fax number: (972) 86403541. e-mail: PYagupsky@gmail.com

   
  Dear Editor:
  In a recent article, Abeywickrema et al. summarized 10 years of pediatric joint and bone infections in Oxford, and concluded that Staphylococcus aureus was the most common etiology [1]. Although this concept was widely accepted in the past, the increasing use of sensitive nucleic acid amplification tests has demonstrated that Kingella kingae is the leading agent of skeletal system infections in the 6-48 month-old population, causing up to 88% of the cases in this age group [2]. Abeywickrema et al., however, isolated the bacterium in only 3 of the 74 (4%) patients in whom the etiology could be determined [1]. Kingella kingae is notoriously fastidious and the traditional culture methods and microscopy employed by the researchers are usually unable to detect its presence in joint and bone exudates [3]. Invasive K. kingae infections other than endocarditis are characterized by a mild local and systemic inflammation: fev...

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  e-Letter

  Low Prevalence of Kingella kingae Infections in UK Children

  Pablo Yagupsky, MD
  Clinical Microbiology Laboratory, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel

  Corresponding Author: Pablo Yagupsky, Clinical Microbiology Laboratory, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel 84101. Phone number: (972) 506264359. Fax number: (972) 86403541. e-mail: PYagupsky@gmail.com

   
  Dear Editor:
  In a recent article, Abeywickrema et al. summarized 10 years of pediatric joint and bone infections in Oxford, and concluded that Staphylococcus aureus was the most common etiology [1]. Although this concept was widely accepted in the past, the increasing use of sensitive nucleic acid amplification tests has demonstrated that Kingella kingae is the leading agent of skeletal system infections in the 6-48 month-old population, causing up to 88% of the cases in this age group [2]. Abeywickrema et al., however, isolated the bacterium in only 3 of the 74 (4%) patients in whom the etiology could be determined [1]. Kingella kingae is notoriously fastidious and the traditional culture methods and microscopy employed by the researchers are usually unable to detect its presence in joint and bone exudates [3]. Invasive K. kingae infections other than endocarditis are characterized by a mild local and systemic inflammation: fever is often absent, WBC counts in the blood and synovial fluid are frequently normal, and acute phase reactants are within the normal range or only mildly elevated, requiring a high index of suspicion and the use of sensitive detection methods for confirmation [3]. In France, Switzerland, and Israel, where molecular assays are routinely employed, the role of K. kingae as the prime osteoarticular pathogen in young children has been firmly established [2, 4], but the organism is conspicuously underrepresented in UK reports [1, 5]. I believe that many children with K. kingae disease were consistently overlooked in the study and are hidden in the culture-negative category, or were dismissed altogether as unconfirmed cases of septic arthritis or osteomyelitis [3]. It is to be expected that the increasing use of nucleic acid amplification tests will improve the laboratory diagnosis of skeletal system infections in early childhood and contribute to better patients’ management.

   
  References
  1. Abeywickrema M, Liu X, Kelly DF, et al. Bone and joint infections in Oxford: a 10-year retrospective review. Arch Dis Child 2020; 105:515-516.
  2. Juchler C, Spyropoulou V, Wagner N, et al. The contemporary bacteriologic epidemiology of osteoarticular infections in children in Switzerland. J Pediatr 2018;194:190-196.
  3. Yagupsky P. Kingella kingae: carriage, transmission, and disease. Clin Microbiol Rev 2015;28:54-79.
  4. Chometon S, Benito Y, Chaker M, et al. Specific real-time polymerase chain reaction places Kingella kingae as the most common cause of osteoarticular infections in young children. Pediatr Infect Dis J 2007;26:377-381.
  5. de Graaf H, Sukhtankar P, Arch B, et al. Duration of intravenous antibiotic therapy for children with acute osteomyelitis or septic arthritis: a feasibility study. Health Technol Assess 2017;21:1-164.

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  Conflict of Interest:
  None declared.

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