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Feng W, Wang Q, Yao Z, Zhu D, Song B, Zhang X. Analysis of poor prognostic factors for septic arthritis of the hip in children: a case series of 76 patients. J Pediatr Orthop B 2024; 33:379-386. [PMID: 38047567 DOI: 10.1097/bpb.0000000000001148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
The clinical characteristics, treatment and outcomes of children with septic arthritis of the hip in our hospital were analyzed to identify the risk factors for a poor prognosis. The clinical data of 76 children with septic arthritis of the hip who were treated at our hospital from January 2010 to December 2020 were retrospectively analyzed. According to the most recent follow-up data, the patients were classified as good prognosis or poor prognosis. The differences between the two groups were analyzed. From January 2010 to December 2020, a total of 76 children with septic arthritis of the hip were admitted to our hospital, comprising 52 (68.4%) with a good prognosis and 24 (31.6%) with a poor prognosis. The risk of a poor prognosis was significantly higher in the group with time from onset to surgery >22 days than in the group with time from onset to surgery <11 days. The risk of poor prognosis in the group with C-reactive protein (CRP) > 100 mg/L was significantly higher than that in the group with CRP < 20 mg/L. Time from onset to surgery >14 days and CRP > 93 mg/L were the cutoff values for a poor prognosis. Significant elevation of CRP and prolonged time from onset to surgery in children with septic arthritis of the hip are risk factors for a poor prognosis. Early diagnosis and effective treatment are very important because delays in these factors can lead to a poor prognosis. Level of Evidence: Level II, retrospective study.
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Affiliation(s)
- Wei Feng
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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2
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Joye R, Cousin VL, Malaspinas I, Mwizerwa L, Bouhabib M, Nalecz T, Sologashvili T, Beghetti M, L’Huillier AG, Wacker J. Infective Endocarditis Due to Kingella kingae. Microorganisms 2024; 12:164. [PMID: 38257992 PMCID: PMC10819173 DOI: 10.3390/microorganisms12010164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/07/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Infective endocarditis due to Kingella kingae is a rare but serious invasive infection that occurs mostly in children. Recent advances in nucleic acid amplification testing as well as in cardiac imaging have enabled more accurate diagnosis. A good understanding of the epidemiology and virulence factors remains crucial to guide the therapeutic approach. Here, we synthesize the current state of knowledge on epidemiological features, pathophysiological insights, complications, and therapy regarding Kingella kingae endocarditis in children and adults. Finally, throughout this comprehensive review, knowledge gaps and areas for future research are also identified.
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Affiliation(s)
- Raphael Joye
- Pediatric Cardiology Unit, Department of Woman, Child, and Adolescent Medicine, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (V.L.C.); (I.M.); (L.M.); (M.B.); (J.W.)
| | - Vladimir L. Cousin
- Pediatric Cardiology Unit, Department of Woman, Child, and Adolescent Medicine, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (V.L.C.); (I.M.); (L.M.); (M.B.); (J.W.)
- Pediatric Intensive Care Unit, Department of Woman, Child, and Adolescent Medicine, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Iliona Malaspinas
- Pediatric Cardiology Unit, Department of Woman, Child, and Adolescent Medicine, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (V.L.C.); (I.M.); (L.M.); (M.B.); (J.W.)
| | - Leonce Mwizerwa
- Pediatric Cardiology Unit, Department of Woman, Child, and Adolescent Medicine, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (V.L.C.); (I.M.); (L.M.); (M.B.); (J.W.)
| | - Maya Bouhabib
- Pediatric Cardiology Unit, Department of Woman, Child, and Adolescent Medicine, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (V.L.C.); (I.M.); (L.M.); (M.B.); (J.W.)
| | - Tomasz Nalecz
- Pediatric Cardiac Surgery Unit, Department of Surgery, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (T.N.); (T.S.)
| | - Tornike Sologashvili
- Pediatric Cardiac Surgery Unit, Department of Surgery, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (T.N.); (T.S.)
| | - Maurice Beghetti
- Pediatric Cardiology Unit, Department of Woman, Child, and Adolescent Medicine, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (V.L.C.); (I.M.); (L.M.); (M.B.); (J.W.)
| | - Arnaud G. L’Huillier
- Pediatric Infectious Disease Unit, Department of Woman, Child, and Adolescent Medicine, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland;
| | - Julie Wacker
- Pediatric Cardiology Unit, Department of Woman, Child, and Adolescent Medicine, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (V.L.C.); (I.M.); (L.M.); (M.B.); (J.W.)
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Elgart M, Zhang Y, Zhang Y, Yu B, Kim Y, Zee PC, Gellman MD, Boerwinkle E, Daviglus ML, Cai J, Redline S, Burk RD, Kaplan R, Sofer T. Anaerobic pathogens associated with OSA may contribute to pathophysiology via amino-acid depletion. EBioMedicine 2023; 98:104891. [PMID: 38006744 PMCID: PMC10709109 DOI: 10.1016/j.ebiom.2023.104891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND The human microbiome is linked to multiple metabolic disorders such as obesity and diabetes. Obstructive sleep apnoea (OSA) is a common sleep disorder with several metabolic risk factors. We investigated the associations between the gut microbiome composition and function, and measures of OSA severity in participants from a prospective community-based cohort study: the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). METHODS Bacterial-Wide Association Analysis (BWAS) of gut microbiome measured via metagenomics with OSA measures was performed adjusting for clinical, lifestyle and co-morbidities. This was followed by functional analysis of the OSA-enriched bacteria. We utilized additional metabolomic and transcriptomic associations to suggest possible mechanisms explaining the microbiome effects on OSA. FINDINGS Several uncommon anaerobic human pathogens were associated with OSA severity. These belong to the Lachnospira, Actinomyces, Kingella and Eubacterium genera. Functional analysis revealed enrichment in 49 processes including many anaerobic-related ones. Severe OSA was associated with the depletion of the amino acids glycine and glutamine in the blood, yet neither diet nor gene expression revealed any changes in the production or consumption of these amino acids. INTERPRETATION We show anaerobic bacterial communities to be a novel component of OSA pathophysiology. These are established in the oxygen-poor environments characteristic of OSA. We hypothesize that these bacteria deplete certain amino acids required for normal human homeostasis and muscle tone, contributing to OSA phenotypes. Future work should test this hypothesis as well as consider diagnostics via anaerobic bacteria detection and possible interventions via antibiotics and amino-acid supplementation. FUNDING Described in methods.
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Affiliation(s)
- Michael Elgart
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA.
| | - Ying Zhang
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Yuan Zhang
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Bing Yu
- Human Genetics Centre, The University of Texas Health Science Centre at Houston, Houston, TX, USA; Human Genome Sequencing Centre, Baylor College of Medicine, Houston, TX, USA
| | - Youngmee Kim
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Phyllis C Zee
- Department of Neurology and Sleep Medicine Centre, Northwestern University, Chicago, IL, USA
| | - Marc D Gellman
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Eric Boerwinkle
- Human Genetics Centre, The University of Texas Health Science Centre at Houston, Houston, TX, USA; Human Genome Sequencing Centre, Baylor College of Medicine, Houston, TX, USA
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Jianwen Cai
- Collaborative Studies Coordinating Centre, University of North Carolina at Chapel Hill, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Robert D Burk
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA
| | - Robert Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA; Fred Hutchinson Cancer Research Centre, Division of Public Health Sciences, Seattle, WA, USA
| | - Tamar Sofer
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA; CardioVascular Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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4
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Fukayama H, Myojin S, Funaki T, Fukuda Y, Nakamura T, Ishiguro A, Ogimi C. Septic Arthritis Caused by Haemophilus parainfluenzae : A Pediatric Case Report and Literature Review. Pediatr Infect Dis J 2023; 42:e336-e340. [PMID: 37235760 DOI: 10.1097/inf.0000000000003979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We report a healthy 5-year-old boy without apparent risk factors who developed septic arthritis of the hip from Haemohilus parainfluenzae infection. A literature review revealed only 4 pediatric cases of osteoarticular infection caused by this pathogen. To our knowledge, our case may be the first pediatric case of septic arthritis of the hip caused by H. parainfluenzae .
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Affiliation(s)
- Haruka Fukayama
- From the Division of Infectious Diseases, Department of Medical Subspecialties
- Center for Postgraduate Education and Training
| | - Shota Myojin
- From the Division of Infectious Diseases, Department of Medical Subspecialties
| | - Takanori Funaki
- From the Division of Infectious Diseases, Department of Medical Subspecialties
| | | | - Tomoo Nakamura
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | | | - Chikara Ogimi
- From the Division of Infectious Diseases, Department of Medical Subspecialties
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Cochard B, Gurbanov E, Bazin L, De Marco G, Vazquez O, Di Laura Frattura G, Steiger CN, Dayer R, Ceroni D. Pediatric Osteoarticular Kingella kingae Infections of the Hand and Wrist: A Retrospective Study. Microorganisms 2023; 11:2123. [PMID: 37630683 PMCID: PMC10460026 DOI: 10.3390/microorganisms11082123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/17/2023] [Accepted: 08/19/2023] [Indexed: 08/27/2023] Open
Abstract
Our understanding of pediatric osteoarticular infections (OAIs) has improved significantly in recent decades. Kingella kingae is now recognized as the most common pathogen responsible for OAIs in pediatric populations younger than 4 years old. Research has provided a better understanding of the specific types, clinical characteristics, biological repercussions, and functional outcomes of these infections. Hands and wrists are rarely infected, with few reports available in the literature. The present study aimed to examine this specific condition in a large patient cohort, explore the implications for each anatomical area using magnetic resonance imaging (MRI), and critically evaluate the evolution of therapeutic management.
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Affiliation(s)
- Blaise Cochard
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, CH-1211 Geneva, Switzerland; (B.C.); (O.V.); (C.N.S.); (R.D.)
- Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, CH-1211 Geneva, Switzerland; (E.G.); (L.B.)
| | - Elvin Gurbanov
- Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, CH-1211 Geneva, Switzerland; (E.G.); (L.B.)
| | - Ludmilla Bazin
- Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, CH-1211 Geneva, Switzerland; (E.G.); (L.B.)
| | - Giacomo De Marco
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, CH-1211 Geneva, Switzerland; (B.C.); (O.V.); (C.N.S.); (R.D.)
| | - Oscar Vazquez
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, CH-1211 Geneva, Switzerland; (B.C.); (O.V.); (C.N.S.); (R.D.)
- Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, CH-1211 Geneva, Switzerland; (E.G.); (L.B.)
| | - Giorgio Di Laura Frattura
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, CH-1211 Geneva, Switzerland; (B.C.); (O.V.); (C.N.S.); (R.D.)
| | - Christina N. Steiger
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, CH-1211 Geneva, Switzerland; (B.C.); (O.V.); (C.N.S.); (R.D.)
| | - Romain Dayer
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, CH-1211 Geneva, Switzerland; (B.C.); (O.V.); (C.N.S.); (R.D.)
| | - Dimitri Ceroni
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, CH-1211 Geneva, Switzerland; (B.C.); (O.V.); (C.N.S.); (R.D.)
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6
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Feng W, Yao Z, Liu H, Zhu D, Song B, Wang Q. Clinical characteristics of and risk factors for poor outcomes in children with bacterial culture-negative septic arthritis of the hip. J Orthop Sci 2023:S0949-2658(23)00218-X. [PMID: 37597975 DOI: 10.1016/j.jos.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Septic arthritis of the hip is a serious infection in children. However, blood and joint fluid cultures are often negative, which makes the diagnosis and treatment challenging. We analyzed the clinical features of children with septic arthritis of the hip with negative bacterial cultures and identified the risk factors for poor outcomes. METHODS The clinical data of children with septic arthritis of the hip with negative bacterial cultures who were treated at our hospital from January 2010 to December 2020 were retrospectively analyzed. The clinical characteristics and outcomes of the culture-negative cohort were compared with those of children with positive bacterial cultures treated during the same period. Culture-negative patients were divided into a group with good outcomes and a group with poor outcomes. The differences between the two groups were compared. RESULTS Thirty-nine children with culture-negative septic arthritis of the hip were compared with 37 children with culture-positive sepsis. Compared with the culture-positive group, the culture-negative group had a significantly younger mean age and a significantly lower mean serum C-reactive protein concentration. Logistic regression analysis of culture-negative patients with good versus poor outcomes revealed that the independent risk factors for poor outcomes were an increased serum C-reactive protein concentration and prolonged time from onset to surgery. The cut-off values for predicting a poor outcome in the culture-negative group were a time from onset to surgery of greater than 21 days and a C-reactive protein concentration of greater than 23 mg/L. CONCLUSIONS Culture-negative septic arthritis of the hip has similar clinical features to culture-positive septic arthritis of the hip and can result in sequelae of varying severity. Therefore, active anti-infective and hip drainage therapy should be performed when children present with clinical symptoms, inflammatory marker concentrations, and imaging findings that are clinically diagnostic for septic arthritis of the hip. LEVEL OF EVIDENCE Level II, retrospective study.
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Affiliation(s)
- Wei Feng
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nalishi Road, Beijing 100045, PR China
| | - Ziming Yao
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nalishi Road, Beijing 100045, PR China
| | - Haonan Liu
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nalishi Road, Beijing 100045, PR China
| | - Danjiang Zhu
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nalishi Road, Beijing 100045, PR China
| | - Baojian Song
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nalishi Road, Beijing 100045, PR China
| | - Qiang Wang
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nalishi Road, Beijing 100045, PR China.
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Rahman WU, Fiser R, Osicka R. Kingella kingae RtxA toxin interacts with sialylated gangliosides. Microb Pathog 2023:106200. [PMID: 37315629 DOI: 10.1016/j.micpath.2023.106200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 06/16/2023]
Abstract
The membrane-damaging RTX family cytotoxin RtxA is a key virulence factor of the emerging pediatric pathogen Kingella kingae, but little is known about the mechanism of RtxA binding to host cells. While we have previously shown that RtxA binds cell surface glycoproteins, here we demonstrate that the toxin also binds different types of gangliosides. The recognition of gangliosides by RtxA depended on sialic acid side groups of ganglioside glycans. Moreover, binding of RtxA to epithelial cells was significantly decreased in the presence of free sialylated gangliosides, which inhibited cytotoxic activity of the toxin. These results suggest that RtxA utilizes sialylated gangliosides as ubiquitous cell membrane receptor molecules on host cells to exert its cytotoxic action and support K. kingae infection.
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Affiliation(s)
- Waheed Ur Rahman
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Radovan Fiser
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic; Department of Genetics and Microbiology, Faculty of Science, Charles University in Prague, Prague, Czech Republic
| | - Radim Osicka
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic.
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8
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Ramadani A, Coulin B, De Marco G, Vazquez O, Tabard-Fougère A, Gavira N, Steiger CN, Dayer R, Ceroni D. Clinical and Biologic Characteristics of Kingella kingae -Induced Septic Arthritis of the Knee in Young Children. Pediatr Infect Dis J 2023; 42:195-198. [PMID: 36729984 PMCID: PMC9935552 DOI: 10.1097/inf.0000000000003797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Septic arthritis of the knee is presumed to be the most frequent form of Kingella kingae -induced osteoarticular infection. This study aimed to report on the clinical course, biological parameters, and results of microbiological investigations among children with K. kingae -induced septic arthritis of the knee. It also assessed the modified Kocher-Caird criteria's ability to predict K. kingae -induced septic arthritis of the knee. METHODS The medical charts of 51 children below 4 years old with confirmed or highly probable K. kingae -induced arthritis of the knee were reviewed. Data were gathered on the five variables in the commonly-used Kocher-Caird prediction algorithm (body temperature, refusal to bear weight, leukocytosis, erythrocyte sedimentation rate, and C-reactive protein level). RESULTS Patients with K. kingae -induced arthritis of the knee usually presented with a mildly abnormal clinical picture and normal or near-normal serum levels of acute-phase reactants. Data on all five variables were available for all the children: 7 children had zero predictors; 8, 20, 12, and 4 children had 1, 2, 3, and 4 predictors, respectively; no children had 5 predictors. This gave an average of 1.96 predictive factors and a subsequent probability of ≤ 62.4% of infectious arthritis in this pediatric cohort. CONCLUSIONS Because the clinical features of K. kingae -induced arthritis of the knee overlap with many other conditions affecting this joint, the Kocher-Caird prediction algorithm is not sensitive enough to effectively detect K. kingae -induced septic arthritis of the knee. Excluding K. kingae -induced arthritis of the knee requires performing nucleic acid amplification assays on oropharyngeal swabs and joint fluid from those young children presenting with effusion of the knee, even in the absence of fever, leukocytosis, or a high Kocher-Caird score.
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Affiliation(s)
- Ardian Ramadani
- Paediatric Orthopaedics Service, Geneva Children’s Hospital, Geneva University Hospitals, Switzerland
| | - Benoit Coulin
- Paediatric Orthopaedics Service, Geneva Children’s Hospital, Geneva University Hospitals, Switzerland
| | - Giacomo De Marco
- Paediatric Orthopaedics Service, Geneva Children’s Hospital, Geneva University Hospitals, Switzerland
| | - Oscar Vazquez
- Paediatric Orthopaedics Service, Geneva Children’s Hospital, Geneva University Hospitals, Switzerland
| | - Anne Tabard-Fougère
- Paediatric Orthopaedics Service, Geneva Children’s Hospital, Geneva University Hospitals, Switzerland
| | - Nathaly Gavira
- Paediatric Orthopaedics Service, Geneva Children’s Hospital, Geneva University Hospitals, Switzerland
| | - Christina N. Steiger
- Paediatric Orthopaedics Service, Geneva Children’s Hospital, Geneva University Hospitals, Switzerland
| | - Romain Dayer
- Paediatric Orthopaedics Service, Geneva Children’s Hospital, Geneva University Hospitals, Switzerland
| | - Dimitri Ceroni
- Paediatric Orthopaedics Service, Geneva Children’s Hospital, Geneva University Hospitals, Switzerland
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9
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Xiao M, Liu R, Du J, Liu R, Zhai L, Wang H, Yao S, Xu YC. Kingella pumchi sp. nov., an organism isolated from human vertebral puncture tissue. Antonie Van Leeuwenhoek 2023; 116:143-151. [PMID: 36309905 DOI: 10.1007/s10482-022-01786-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 10/21/2022] [Indexed: 02/03/2023]
Abstract
A Gram-negative, non-motile rod and strictly aerobic bacterium, designated as 18B16333T, was isolated from vertebral puncture tissue of a patient at Peking union medical college hospital in China. Growth occurred in NaCl concentrations of 0-1% (w/v) (optimum growth at 0% NaCl), at temperatures of 25-40 °C (optimum growth at 37 °C) and at pH 6.0-9.0 (optimum growth at pH 8.0). Diphosphatidylglycerol, phosphatidylglycerol and phosphatidylethanolamine were the predominant polar lipids, and the major fatty acids were C16:0, C18:1 ω7c/C18:1 ω6c and C16:1 ω7c/C16:1 ω6c. Phylogenetic analysis based on 16S rRNA gene sequence comparisons indicated that strain 18B16333T was most closely related to Kingella potus CCUG 49773 T (97.3%, 16S rRNA gene sequence identity) and Neisseria bacilliformis CCUG 50858 T (96.8%). The ANI values between strain 18B16333T and the type strains K. potus CCUG 49773 T, N. bacilliformis CCUG 50858 T, Kingella kingae CCUG 352 T and Neisseria gonorrhoeae CCUG 26876 T were 77.3%, 79.1%, 72.1% and 75.4%, respectively. The dDDH values between strain 18B16333T and the four reference strains mentioned above were 24.8%, 26.9%, 24.2% and 20.7%. Further core gene analysis distinctively clustered strain 18B16333T with four Kingella species but not with Neisseria species. Based on the phenotypic, chemotaxonomic, and phylogenetic properties, strain 18B16333T represents a novel species of the genus Kingella, for which the name Kingella pumchi sp. nov. is proposed. The type strain is Kingella pumchi 18B16333T (= CICC 24913 T = CCUG 75125 T).
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Affiliation(s)
- Meng Xiao
- Department of Laboratory Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.,Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, 100730, China
| | - Ruina Liu
- China Center of Industrial Culture Collection (CICC), China National Research Institute of Food and Fermentation Industries, Beijing, 100015, China
| | - Juan Du
- Department of Laboratory Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, 100730, China
| | - Rui Liu
- China Center of Industrial Culture Collection (CICC), China National Research Institute of Food and Fermentation Industries, Beijing, 100015, China
| | - Lei Zhai
- China Center of Industrial Culture Collection (CICC), China National Research Institute of Food and Fermentation Industries, Beijing, 100015, China
| | - He Wang
- Department of Laboratory Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.,Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, 100730, China
| | - Su Yao
- China Center of Industrial Culture Collection (CICC), China National Research Institute of Food and Fermentation Industries, Beijing, 100015, China.
| | - Ying-Chun Xu
- Department of Laboratory Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China. .,Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China. .,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, 100730, China.
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10
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The Kingella kingae PilC1 MIDAS Motif Is Essential for Type IV Pilus Adhesive Activity and Twitching Motility. Infect Immun 2023; 91:e0033822. [PMID: 36537792 PMCID: PMC9872652 DOI: 10.1128/iai.00338-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Kingella kingae is an emerging pathogen that has recently been identified as a leading cause of osteoarticular infections in young children. Colonization with K. kingae is common, with approximately 10% of young children carrying this organism in the oropharynx at any given time. Adherence to epithelial cells represents the first step in K. kingae colonization of the oropharynx, a prerequisite for invasive disease. Type IV pili and the pilus-associated PilC1 and PilC2 proteins have been shown to mediate K. kingae adherence to epithelial cells, but the molecular mechanism of this adhesion has remained unknown. Metal ion-dependent adhesion site (MIDAS) motifs are commonly found in integrins, where they function to promote an adhesive interaction with a ligand. In this study, we identified a potential MIDAS motif in K. kingae PilC1 which we hypothesized was directly involved in mediating type IV pilus adhesive interactions. We found that the K. kingae PilC1 MIDAS motif was required for bacterial adherence to epithelial cell monolayers and extracellular matrix proteins and for twitching motility. Our results demonstrate that K. kingae has co-opted a eukaryotic adhesive motif for promoting adherence to host structures and facilitating colonization.
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Coulin B, DeMarco G, Vazquez O, Spyropoulou V, Gavira N, Vendeuvre T, Tabard-Fougère A, Dayer R, Steiger C, Ceroni D. Osteoarticular Infections in Children: Accurately Distinguishing between MSSA and Kingella kingae. Microorganisms 2022; 11:microorganisms11010011. [PMID: 36677303 PMCID: PMC9866358 DOI: 10.3390/microorganisms11010011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/17/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction: Osteoarticular infections (OAIs) constitute serious paediatric conditions that may cause severe complications. Identifying the causative organism is one of the mainstays of the care process, since its detection will confirm the diagnosis, enable adjustments to antibiotic therapy and thus optimize outcomes. Two bacteria account for the majority of OAIs before 16 years of age: Staphylococcus aureus is known for affecting the older child, whereas Kingella kingae affects infants and children younger than 4 years old. We aimed to better define clinical characteristic and biological criteria for prompt diagnosis and discrimination between these two OAI. Materials and methods: We retrospectively studied 335 children, gathering 100 K. kingae and 116 S. aureus bacteriologically proven OAIs. Age, gender, temperature at admission, involved bone or joint, and laboratory data including bacterial cultures were collected for analysis. Comparisons between patients with OAI due to K. kingae and those with OAI due to S. aureus were performed using the Mann−Whitney and Kruskal−Wallis tests. Six cut-off discrimination criteria (age, admission’s T°, WBC, CRP, ESR and platelet count) were defined, and their respective ability to differentiate between OAI patients due to K. kingae versus those with S. aureus was assessed by nonparametric receiver operating characteristic (ROC) curves. Results: Univariate analysis demonstrated significant differences between the two populations for age of patients, temperature at admission, CRP, ESR, WBC, and platelet count. AUC assessed by ROC curves demonstrated an exquisite ability to discriminate between the two populations for age of the patients; whereas AUC for CRP (0.79), temperature at admission (0.76), and platelet count (0.76) indicated a fair accuracy to discriminate between the two populations. Accuracy to discriminate between the two subgroups of patients was considered as poor for WBC (AUC = 0.62), and failed for ESR (AUC = 0.58). On the basis of our results, the best model to predict K. kingae OAI included of the following cut-offs for each parameter: age < 43 months, temperature at admission < 37.9 °C, CRP < 32.5 mg/L, and platelet count > 361,500/mm3. Conclusions: OAI caused by K. kingae affects primarily infants and toddlers aged less than 4 years, whereas most of the children with OAI due to MSSA were aged 4 years and more. Considering our experience on the ground, only three variables were very suggestive of an OAI caused by K. kingae, i.e., age of less than 4 years, platelet count > 400,000, and a CRP level below 32.5 mg/L, whereas WBC and ESR were relatively of limited use in clinical practice.
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12
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Diagnostic Utility of Synovial Fluid Cell Counts and CRP in Pediatric Knee Arthritis: A 10-Year Monocentric, Retrospective Study. CHILDREN 2022; 9:children9091367. [PMID: 36138676 PMCID: PMC9498181 DOI: 10.3390/children9091367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/01/2022] [Accepted: 09/05/2022] [Indexed: 11/17/2022]
Abstract
Background: Orthopedic surgeons often use the intra-articular white blood counts (WBCs) and the percentage of polymorphonuclear cells (PMN) in the diagnosis of an acute swollen and painful knee joint in children. Today, there is no established threshold for the synovial WBC, and their differentiation, as indicative of native joint knee bacterial arthritis. We determine the sensitivity and specificity of synovial WBCs and PMN percentages in the prediction of a community-acquired, acute bacterial native joint septic arthritis (SA) in the pediatric population. Methods: A retrospective study on healthy children 0–16 years of age who underwent knee joint aspiration for a community-acquired, acute irritable knee effusion in our tertiary-care children’s hospital between May 2009 and April 2019 was conducted. We divided the study population into two groups according to the detection of bacterial arthritis in the synovial fluid (bacterial arthritis versus its absence) and compared the intra-articular leukocyte and C-reactive protein (CRP) levels. Results: Overall, we found a statistically significant difference regarding the total CRP (p = 0.017), leukocyte or PMN counts (p ≤ 0.001 in favor of a bacterial arthritis). In contrast, the percentage of the neutrophils was not determinant for the later confirmation of bacterial pathogens, and we were unable to establish diagnostically determining minimal thresholds of the intra-articular CRP and leukocyte levels. Conclusions: This pilot study suggests that either the leukocyte or PMN counts may be associated with a bacterial origin of knee arthritis in children. We plan a larger prospective interventional study in the future to confirm these findings including the investigation of other joint aspirate biomarkers.
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Distinguishing Kingella kingae from Pyogenic Acute Septic Arthritis in Young Portuguese Children. Microorganisms 2022; 10:microorganisms10061233. [PMID: 35744752 PMCID: PMC9227297 DOI: 10.3390/microorganisms10061233] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/12/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022] Open
Abstract
(1) Background: We aim to identify clinical and laboratorial parameters to distinguish Kingella kingae from pyogenic septic arthritis (SA). (2) Methods: A longitudinal, observational, single-centre study of children < 5 years old with microbiological positive SA admitted to a paediatric hospital from 2013−2020 was performed. Clinical and laboratorial data at admission and at 48 h, as well as on treatment and evolution, were obtained. (3) Results: We found a total of 75 children, 44 with K. kingae and 31 with pyogenic infections (mostly MSSA, S. pneumoniae and S. pyogenes). K. kingae affected younger children with low or absent fever, low inflammatory markers and a favourable prognosis. In the univariate analyses, fever, septic look, CRP and ESR at admission and CRP at 48 h were significantly lower in K. kingae SA. In the multivariate analyses, age > 6 months ≤ 2 years, apyrexy and CRP ≤ 100 mg/L were significative, with an overall predictive positive value of 86.5%, and 88.4% for K. kingae. For this model, ROC curves were capable of differentiating (AUC 0.861, 95% CI 0.767−0.955) K. kingae SA from typical pathogens. (4) Conclusions: Age > 6 months ≤ 2 years, apyrexy and PCR ≤ 100 mg/L were the main predictive factors to distinguish K. kingae from pyogenic SA < 5 years. These data need to be validated in a larger study.
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Samara E, Lutz N, Zambelli PY. Kingella kingae Spinal Infections in Children. CHILDREN 2022; 9:children9050705. [PMID: 35626882 PMCID: PMC9139591 DOI: 10.3390/children9050705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/10/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022]
Abstract
Nowadays, Kingella kingae is considered an important cause of primary spinal infections in children aged between 6 and 48 months. The presentation of the disease is often characterized by mild clinical features and a moderate biological inflammatory response, requiring a high index of suspicion. Performing magnetic resonance imaging (MRI) and obtaining an oropharyngeal specimen and subjecting it to a K. kingae-specific nucleic acid amplification test are recommended for its diagnosis. Most patients respond promptly to conservative treatment after administration of antibiotic therapy, which is prolonged for up to 3 months according to the individual clinical and biological response. Invasive surgical procedures are not required except for children who do not improve with antibiotic treatment, develop signs of cord compression, or if the presence of atypical microorganisms is suspected. Kingella kingae spinal infections usually run an indolent and benign clinical course, living no permanent sequelae.
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15
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Guarch-Ibáñez B, Cabacas A, González-López JJ, García-González MDM, Mora C, Villalobos P. First documented outbreak of arthritis caused by Kingella kingae in a Spanish childcare center. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:187-189. [PMID: 35241399 DOI: 10.1016/j.eimce.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/03/2020] [Indexed: 06/14/2023]
Abstract
BACKGROUND Recently, Kingella kingae (K. kingae) has been described as the most common agent of skeletal system infections in children 6 months-2 years of age. More exceptional is the clinical presentation in clusters of invasive K. kingae infections. We describe the investigation of the first outbreak of 3 cases of arthritis caused by K. kingae documented in Spain detected in a daycare center in Roses, Girona. PATIENTS AND METHODS In December of 2015 surveillance throat swabs obtained from all attendees from the same class of the index daycare center were assessed to study the prevalence of K. kingae colonization. The sample was composed of 9 toddlers (range: 16-23 months of age). Investigation was performed by culture and K. kingae-specific RT-PCR. Combined amoxicillin-rifampicin prophylaxis was offered to all attendees who were colonized by K. kingae. Following antimicrobial prophylaxis, a new throat swab was taken to confirm bacterial eradication. RESULTS K. kingae was detected by RT-PCR throat swabs in the 3 index cases and 5 of the 6 daycare attendees. Cultures were negative in all cases. After administration of prophylactic antibiotics, 3 toddlers were still positive for K. kingae-specific RT-PCR. CONCLUSIONS Clusters of invasive K. kingae infections can occur in daycare facilities and closed communities. Increased awareness and use of sensitive detection methods are needed to identify and adequately investigate outbreaks of K. kingae disease. In our experience, the administration of prophylactic antibiotics could result in partial eradication of colonization. No further cases of disease were detected after prophylaxis.
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Affiliation(s)
- Borja Guarch-Ibáñez
- Servicio de Pediatría, Hospital Universitari de Girona Dr. Josep Trueta, Universitat de Girona, Girona, Spain.
| | - Alicia Cabacas
- Servicio de Pediatría, Fundació Salut Empordà, Figueres, Girona, Spain
| | - Juan José González-López
- Servicio de Microbiología, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - María Del Mar García-González
- Servicio de Pediatría, Hospital Universitari de Girona Dr. Josep Trueta, Universitat de Girona, Girona, Spain; Servicio de Pediatría, Fundació Salut Empordà, Figueres, Girona, Spain
| | - Carme Mora
- Sección de Microbiología, Fundació Salut Empordà, Figueres, Girona, Spain
| | - Pilar Villalobos
- Servicio de Pediatría, Fundació Salut Empordà, Figueres, Girona, Spain
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16
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Sacharok AL, Porsch EA, Yount TA, Keenan O, St. Geme JW. Kingella kingae PilC1 and PilC2 are adhesive multifunctional proteins that promote bacterial adherence, twitching motility, DNA transformation, and pilus biogenesis. PLoS Pathog 2022; 18:e1010440. [PMID: 35353876 PMCID: PMC9000118 DOI: 10.1371/journal.ppat.1010440] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 04/11/2022] [Accepted: 03/13/2022] [Indexed: 11/18/2022] Open
Abstract
The gram-negative bacterium Kingella kingae is a leading cause of osteoarticular infections in young children and initiates infection by colonizing the oropharynx. Adherence to respiratory epithelial cells represents an initial step in the process of K. kingae colonization and is mediated in part by type IV pili. In previous work, we observed that elimination of the K. kingae PilC1 and PilC2 pilus-associated proteins resulted in non-piliated organisms that were non-adherent, suggesting that PilC1 and PilC2 have a role in pilus biogenesis. To further define the functions of PilC1 and PilC2, in this study we eliminated the PilT retraction ATPase in the ΔpilC1ΔpilC2 mutant, thereby blocking pilus retraction and restoring piliation. The resulting strain was non-adherent in assays with cultured epithelial cells, supporting the possibility that PilC1 and PilC2 have adhesive activity. Consistent with this conclusion, purified PilC1 and PilC2 were capable of saturable binding to epithelial cells. Additional analysis revealed that PilC1 but not PilC2 also mediated adherence to selected extracellular matrix proteins, underscoring the differential binding specificity of these adhesins. Examination of deletion constructs and purified PilC1 and PilC2 fragments localized adhesive activity to the N-terminal region of both PilC1 and PilC2. The deletion constructs also localized the twitching motility property to the N-terminal region of these proteins. In contrast, the deletion constructs established that the pilus biogenesis function of PilC1 and PilC2 resides in the C-terminal region of these proteins. Taken together, these results provide definitive evidence that PilC1 and PilC2 are adhesins and localize adhesive activity and twitching motility to the N-terminal domain and biogenesis to the C-terminal domain. Kingella kingae is an emerging pediatric pathogen that is a leading cause of osteoarticular infections in children under the age of four. Adherence to epithelial cells is thought to be the first step in K. kingae colonization of the host and a prerequisite for invasive disease. Previous work has established that type IV pili are responsible for K. kingae adherence to host cells. In this work we identify the K. kingae pilus adhesins and localize the adhesive region to the N-terminal domain of these two proteins. We further establish that the two adhesins have distinct binding specificities and also influence other biologic processes. Our study provides new insights into the adherence mechanisms of an increasingly recognized pediatric pathogen and furthers our understanding of K. kingae interactions with host cells, identifying new potential therapeutic targets.
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Affiliation(s)
- Alexandra L. Sacharok
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Eric A. Porsch
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Taylor A. Yount
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Orlaith Keenan
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Joseph W. St. Geme
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- * E-mail:
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17
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Filipi K, Rahman WU, Osickova A, Osicka R. Kingella kingae RtxA Cytotoxin in the Context of Other RTX Toxins. Microorganisms 2022; 10:microorganisms10030518. [PMID: 35336094 PMCID: PMC8953716 DOI: 10.3390/microorganisms10030518] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 12/04/2022] Open
Abstract
The Gram-negative bacterium Kingella kingae is part of the commensal oropharyngeal flora of young children. As detection methods have improved, K. kingae has been increasingly recognized as an emerging invasive pathogen that frequently causes skeletal system infections, bacteremia, and severe forms of infective endocarditis. K. kingae secretes an RtxA cytotoxin, which is involved in the development of clinical infection and belongs to an ever-growing family of cytolytic RTX (Repeats in ToXin) toxins secreted by Gram-negative pathogens. All RTX cytolysins share several characteristic structural features: (i) a hydrophobic pore-forming domain in the N-terminal part of the molecule; (ii) an acylated segment where the activation of the inactive protoxin to the toxin occurs by a co-expressed toxin-activating acyltransferase; (iii) a typical calcium-binding RTX domain in the C-terminal portion of the molecule with the characteristic glycine- and aspartate-rich nonapeptide repeats; and (iv) a C-proximal secretion signal recognized by the type I secretion system. RTX toxins, including RtxA from K. kingae, have been shown to act as highly efficient ‘contact weapons’ that penetrate and permeabilize host cell membranes and thus contribute to the pathogenesis of bacterial infections. RtxA was discovered relatively recently and the knowledge of its biological role remains limited. This review describes the structure and function of RtxA in the context of the most studied RTX toxins, the knowledge of which may contribute to a better understanding of the action of RtxA in the pathogenesis of K. kingae infections.
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18
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Alcobendas RM, Núñez E, Calvo C. Minimally invasive management of pediatric osteoarticular infections. Front Pediatr 2022; 10:1017035. [PMID: 36440331 PMCID: PMC9692125 DOI: 10.3389/fped.2022.1017035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Esmeralda Núñez
- Pediatrics Department, Hospital Materno-Infantil, Málaga, Spain
| | - Cristina Calvo
- Pediatric Infectious Diseases Department, Hospital Universitario La Paz, Fundación IdiPaz, Madrid, Spain.,Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain.,CIBER Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
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19
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Porsch EA, Hernandez KA, Morreale DP, Montoya NR, Yount TA, St Geme JW. Pathogenic determinants of Kingella kingae disease. Front Pediatr 2022; 10:1018054. [PMID: 36304526 PMCID: PMC9592894 DOI: 10.3389/fped.2022.1018054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/16/2022] [Indexed: 01/18/2023] Open
Abstract
Kingella kingae is an emerging pediatric pathogen and is increasingly recognized as a leading etiology of septic arthritis, osteomyelitis, and bacteremia and an occasional cause of endocarditis in young children. The pathogenesis of K. kingae disease begins with colonization of the upper respiratory tract followed by breach of the respiratory epithelial barrier and hematogenous spread to distant sites of infection, primarily the joints, bones, and endocardium. As recognition of K. kingae as a pathogen has increased, interest in defining the molecular determinants of K. kingae pathogenicity has grown. This effort has identified numerous bacterial surface factors that likely play key roles in the pathogenic process of K. kingae disease, including type IV pili and the Knh trimeric autotransporter (adherence to the host), a potent RTX-family toxin (epithelial barrier breach), and multiple surface polysaccharides (complement and neutrophil resistance). Herein, we review the current state of knowledge of each of these factors, providing insights into potential approaches to the prevention and/or treatment of K. kingae disease.
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Affiliation(s)
- Eric A Porsch
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Kevin A Hernandez
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Daniel P Morreale
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Nina R Montoya
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Taylor A Yount
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Joseph W St Geme
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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20
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Trobisch A, Schweintzger NA, Kohlfürst DS, Sagmeister MG, Sperl M, Grisold AJ, Feierl G, Herberg JA, Carrol ED, Paulus SC, Emonts M, van der Flier M, de Groot R, Cebey-López M, Rivero-Calle I, Boeddha NP, Agapow PM, Secka F, Anderson ST, Behrends U, Wintergerst U, Reiter K, Martinon-Torres F, Levin M, Zenz W. Osteoarticular Infections in Pediatric Hospitals in Europe: A Prospective Cohort Study From the EUCLIDS Consortium. Front Pediatr 2022; 10:744182. [PMID: 35601438 PMCID: PMC9114665 DOI: 10.3389/fped.2022.744182] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pediatric osteoarticular infections (POAIs) are serious diseases requiring early diagnosis and treatment. METHODS In this prospective multicenter cohort study, children with POAIs were selected from the European Union Childhood Life-threatening Infectious Diseases Study (EUCLIDS) database to analyze their demographic, clinical, and microbiological data. RESULTS A cohort of 380 patients with POAIs, 203 with osteomyelitis (OM), 158 with septic arthritis (SA), and 19 with both OM and SA, was analyzed. Thirty-five patients were admitted to the Pediatric Intensive Care Unit; out of these, six suffered from shock, one needed an amputation of the right foot and of four left toes, and two had skin transplantation. According to the Pediatric Overall Performance Score, 36 (10.5%) showed a mild overall disability, 3 (0.8%) a moderate, and 1 (0.2%) a severe overall disability at discharge. A causative organism was detected in 65% (247/380) of patients. Staphylococcus aureus (S. aureus) was identified in 57.1% (141/247) of microbiological confirmed cases, including 1 (0.7%) methicillin-resistant S. aureus (MRSA) and 6 (4.2%) Panton-Valentine leukocidin (PVL)-producing S. aureus, followed by Group A Streptococcus (18.2%) and Kingella kingae (8.9%). K. kingae and PVL production in S. aureus were less frequently reported than expected from the literature. CONCLUSION POAIs are associated with a substantial morbidity in European children, with S. aureus being the major detected pathogen. In one-third of patients, no causative organism is identified. Our observations show an urgent need for the development of a vaccine against S. aureus and for the development of new microbiologic diagnostic guidelines for POAIs in European pediatric hospitals.
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Affiliation(s)
- Andreas Trobisch
- Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria.,Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,Research Group for Neonatal Infectious Diseases, Medical University of Graz, Graz, Austria
| | - Nina A Schweintzger
- Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Daniela S Kohlfürst
- Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Manfred G Sagmeister
- Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Matthias Sperl
- Department of Orthopedics and Traumatology, Pediatric Orthopedic Unit, Medical University of Graz, Graz, Austria
| | - Andrea J Grisold
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Gebhard Feierl
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Jethro A Herberg
- Section of Pediatric Infectious Disease, Imperial College London, London, United Kingdom
| | - Enitan D Carrol
- Department of Clinical Infection Microbiology and Immunology, University of Liverpool Institute of Infection, Veterinary and Ecological Sciences, Liverpool, United Kingdom
| | - Stephane C Paulus
- Department of Clinical Infection Microbiology and Immunology, University of Liverpool Institute of Infection, Veterinary and Ecological Sciences, Liverpool, United Kingdom
| | - Marieke Emonts
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.,National Institute for Health Research (NIHR) Newcastle Biomedical Research Centre Based at Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, United Kingdom.,Pediatric Infectious Diseases and Immunology Department, Newcastle upon Tyne Hospitals Foundation Trust, Great North Children's Hospital, Newcastle upon Tyne, United Kingdom
| | - Michiel van der Flier
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology and Laboratory of Infectious Diseases, Radboud Institute of Molecular Life Sciences, Nijmegen, Netherlands.,Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital University Medical Center Utrecht, Utrecht, Netherlands
| | - Ronald de Groot
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology and Laboratory of Infectious Diseases, Radboud Institute of Molecular Life Sciences, Nijmegen, Netherlands
| | - Miriam Cebey-López
- Translational Pediatrics and Infectious Diseases Section- Pediatrics Department, Santiago de Compostela, Spain.,Instituto de Investigación Sanitaria de Santiago (IDIS), Genetics- Vaccines- Infectious Diseases and Pediatrics Research Group (GENVIP), Santiago de Compostela, Spain
| | - Irene Rivero-Calle
- Translational Pediatrics and Infectious Diseases Section- Pediatrics Department, Santiago de Compostela, Spain.,Instituto de Investigación Sanitaria de Santiago (IDIS), Genetics- Vaccines- Infectious Diseases and Pediatrics Research Group (GENVIP), Santiago de Compostela, Spain
| | - Navin P Boeddha
- Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Paul-Michael Agapow
- Section of Pediatric Infectious Disease, Imperial College London, London, United Kingdom
| | - Fatou Secka
- Medical Research Council Unit the Gambia, Banjul, Gambia
| | | | - Uta Behrends
- Department of Pediatrics and of Pediatric Surgery, Technische Universität München, Munich, Germany
| | - Uwe Wintergerst
- Department of Pediatrics, Hospital St. Josef, Braunau, Austria
| | - Karl Reiter
- Department of Pediatric Intensive Care, University Children's Hospital at Dr. von Haunersche Kinderklinik, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Federico Martinon-Torres
- Translational Pediatrics and Infectious Diseases Section- Pediatrics Department, Santiago de Compostela, Spain.,Instituto de Investigación Sanitaria de Santiago (IDIS), Genetics- Vaccines- Infectious Diseases and Pediatrics Research Group (GENVIP), Santiago de Compostela, Spain
| | - Michael Levin
- Section of Pediatric Infectious Disease, Imperial College London, London, United Kingdom
| | - Werner Zenz
- Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria
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21
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DeMarco G, Chargui M, Coulin B, Borner B, Steiger C, Dayer R, Ceroni D. Kingella kingae Osteoarticular Infections Approached through the Prism of the Pediatric Orthopedist. Microorganisms 2021; 10:microorganisms10010025. [PMID: 35056474 PMCID: PMC8778174 DOI: 10.3390/microorganisms10010025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 12/30/2022] Open
Abstract
Nowadays, Kingella kingae (K. kingae) is considered as the main bacterial cause of osteoarticular infections (OAI) in children aged less than 48 months. Next to classical acute hematogenous osteomyelitis and septic arthritis, invasive K. kingae infections can also give rise to atypical osteoarticular infections, such as cellulitis, pyomyositis, bursitis, or tendon sheath infections. Clinically, K. kingae OAI are usually characterized by a mild clinical presentation and by a modest biologic inflammatory response to infection. Most of the time, children with skeletal system infections due to K. kingae would not require invasive surgical procedures, except maybe for excluding pyogenic germs' implication. In addition, K. kingae's OAI respond well even to short antibiotics treatments, and, therefore, the management of these infections requires only short hospitalization, and most of the patients can then be treated safely as outpatients.
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22
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Diagnosis and Management of Osteomyelitis in Children. Curr Infect Dis Rep 2021. [DOI: 10.1007/s11908-021-00763-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Boriani L, Zamparini E, Albrizio M, Serani F, Ciani G, Marconi L, Vommaro F, Greggi T, Fanti S, Nanni C. Spine Infections: the role of Fluorodeoxyglucose Positron Emission Tomography (FDG PET) in the context of the actual diagnosis guideline. Curr Med Imaging 2021; 18:216-230. [PMID: 34530718 PMCID: PMC9241079 DOI: 10.2174/1573405617666210916121046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 07/22/2021] [Accepted: 08/01/2021] [Indexed: 11/25/2022]
Abstract
Spondylodiscitis is an infectious process that requires numerous health care professionals to be clearly diagnosed and eventually successfully treated. It implies a variety of microbiological agents and conditions; during the diagnostic workup, it is difficult to correctly identify them, and the clinician has to rapidly choose the correct treatment to avoid permanent injuries to the patient. In this context, we conducted a review to better understand the most suitable use of Positron Emission Tomography with 18-Fluoro-deossi-glucose (FDG PET) in a patient suspected of spondylodiscitis, based on current guidelines and literature.. We wanted to review the role of FDG PET in the spondylodiscitis diagnosis and follow up in the context of the current guidelines.
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Affiliation(s)
- Luca Boriani
- Spine Deformity Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
| | - Eleonora Zamparini
- Infection Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna. Italy
| | - Mauro Albrizio
- Head of service- Muscuoloskeletal Radiology, Nottingham University Hospitals. 0
| | - Francesca Serani
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna. Italy
| | - Giovanni Ciani
- Spine Deformity Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
| | - Lorenzo Marconi
- Infection Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna. Italy
| | - Francesco Vommaro
- Spine Deformity Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
| | - Tiziana Greggi
- Spine Deformity Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
| | - Stefano Fanti
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna. Italy
| | - Cristina Nanni
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna. Italy
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Metagenomic analysis of the salivary microbiota in patients with caries, periodontitis and comorbid diseases. J Dent Sci 2021; 16:1264-1273. [PMID: 34484595 PMCID: PMC8403802 DOI: 10.1016/j.jds.2020.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 11/30/2020] [Indexed: 11/24/2022] Open
Abstract
Background/purpose Previous studies have suggested that there is a mutual antagonism between caries and periodontitis. This research aimed to investigate the ecological connection and bacterial interaction of these two diseases. Materials and methods We profiled and analyzed the salivary microbiota from 124 individuals (including 38 caries patients, 34 periodontitis patients, 15 comorbid diseases patients, and 37 healthy controls) by using 16 S rRNA gene sequencing and bioinformatics approaches, and also quantified their salivary bacteria loads via quantitative real-time PCR. The putative biological functions of the salivary microbiome of the different groups were predicted by PICRUSt. Results We observed that both the total bacteria loads and the overall microbial richness in the saliva of the periodontitis group were higher than that in the healthy group. The principal coordinate analysis (PCoA) showed that the caries, periodontitis and healthy groups were separated from each other, and that the samples from comorbid diseases were located at the overlap of caries and periodontitis groups. Using LEfSe analysis, 20 differentially abundant genera were identified as potential biomarkers. These genera also performed complicated interactions among the four groups. Additionally, the PICRUSt analysis indicated caries-related and periodontitis-related functions (e.g., carbohydrate metabolism and bacteria proliferation) respectively. Conclusion We disclosed the significant differences in the salivary bacterial community under caries, periodontitis and comorbid diseases. The periodontitis group was marked by the increased complexity of the salivary microbiota. The result may have vital clinical significance to the screening and early treatment of caries-active and periodontitis-active individuals.
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Awwad E, Tolley M, Antoniou G, Williams N. Clinical presentations of Kingella kingae musculoskeletal infections in South Australian children. J Paediatr Child Health 2021; 57:1196-1200. [PMID: 33655677 DOI: 10.1111/jpc.15422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/11/2021] [Accepted: 02/14/2021] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to alert clinicians to the spectrum of presentations of Kingella kingae musculoskeletal infections. METHODS Between August 2010 and March 2018, 55 children presented with positive K. kingae polymerase chain reaction on joint fluid, bone or deep soft tissue collections involving the limbs and subsequently underwent retrospective medical record, radiological and laboratory review. Demographics and clinical information are presented. RESULTS Median age at presentation was 15.9 months (range 4.3 months-10.7 years) and 64% were male. Septic arthritis was the most common diagnosis (95%), median duration of symptoms was 4 days, 65% had a preceding infection (e.g. upper respiratory or gastrointestinal) and 22% re-presented to emergency departments after prior discharge. The lower limb was involved in 84%, with the knee being most affected (55%). If the lower limb was involved, 82% of previously weight-bearing children had a limp or were unable to weight bear. On presentation, median temperature was 36.7°C and inflammatory markers were mildly elevated. No blood cultures grew K. kingae. Five synovial fluid cultures were positive for K. kingae. Plain radiography showed effusion, soft tissue swelling or a lesion in 53% of patients. All 41 ultrasounds showed effusion, soft tissue swelling or synovial thickening. One patient with delayed diagnosis later presented with avascular necrosis of the femoral head. CONCLUSION Kingella kingae is difficult to diagnose due to non-specific symptoms, absence of fevers and often unremarkable blood tests. Despite generally having good long-term outcomes, our case of avascular necrosis suggests accurate diagnosis and treatment are important.
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Affiliation(s)
- Elias Awwad
- Department of Orthopaedic Surgery and Paediatric Trauma Service, Women's and Children's Hospital, Adelaide, South Australia, Australia.,Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, South Australia, Australia
| | - Morgan Tolley
- Department of Orthopaedic Surgery and Paediatric Trauma Service, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Georgia Antoniou
- Department of Orthopaedic Surgery and Paediatric Trauma Service, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Nicole Williams
- Department of Orthopaedic Surgery and Paediatric Trauma Service, Women's and Children's Hospital, Adelaide, South Australia, Australia.,Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, South Australia, Australia
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Wu Y, Cheng X, Jiang G, Tang H, Ming S, Tang L, Lu J, Guo C, Shan H, Huang X. Altered oral and gut microbiota and its association with SARS-CoV-2 viral load in COVID-19 patients during hospitalization. NPJ Biofilms Microbiomes 2021; 7:61. [PMID: 34294722 PMCID: PMC8298611 DOI: 10.1038/s41522-021-00232-5] [Citation(s) in RCA: 108] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 07/01/2021] [Indexed: 02/06/2023] Open
Abstract
The human oral and gut commensal microbes play vital roles in the development and maintenance of immune homeostasis, while its association with susceptibility and severity of SARS-CoV-2 infection is barely understood. In this study, we investigated the dynamics of the oral and intestinal flora before and after the clearance of SARS-CoV-2 in 53 COVID-19 patients, and then examined their microbiome alterations in comparison to 76 healthy individuals. A total of 140 throat swab samples and 81 fecal samples from these COVID-19 patients during hospitalization, and 44 throat swab samples and 32 fecal samples from sex and age-matched healthy individuals were collected and then subjected to 16S rRNA sequencing and viral load inspection. We found that SARS-CoV-2 infection was associated with alterations of the microbiome community in patients as indicated by both alpha and beta diversity indexes. Several bacterial taxa were identified related to SARS-CoV-2 infection, wherein elevated Granulicatella and Rothia mucilaginosa were found in both oral and gut microbiome. The SARS-CoV-2 viral load in those samples was also calculated to identify potential dynamics between COVID-19 and the microbiome. These findings provide a meaningful baseline for microbes in the digestive tract of COVID-19 patients and will shed light on new dimensions for disease pathophysiology, potential microbial biomarkers, and treatment strategies for COVID-19.
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Affiliation(s)
- Yongjian Wu
- grid.452859.7Center for Infection and Immunity, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong China ,grid.12981.330000 0001 2360 039XSchool of Public Health, Sun Yat-sen University, Guangzhou, Guangdong China ,grid.452859.7Guangdong Provincial Engineering Research Center of Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Imaging, and Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong China ,grid.511004.1Southern Marine Science and Engineering Guangdong Laboratory, Zhuhai, Guangdong China ,grid.410741.7National Clinical Research Center for Infectious Disease, Shenzhen Third People’ s Hospital; The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong China
| | - Xiaomin Cheng
- grid.12981.330000 0001 2360 039XSchool of Public Health, Sun Yat-sen University, Guangzhou, Guangdong China
| | - Guanmin Jiang
- grid.452859.7Center for Infection and Immunity, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong China ,grid.452859.7Guangdong Provincial Engineering Research Center of Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Imaging, and Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong China ,grid.452859.7Department of Clinical Laboratory, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong China
| | - Huishu Tang
- grid.452859.7Center for Infection and Immunity, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong China ,grid.452859.7Guangdong Provincial Engineering Research Center of Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Imaging, and Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong China
| | - Siqi Ming
- grid.452859.7Center for Infection and Immunity, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong China ,grid.452859.7Guangdong Provincial Engineering Research Center of Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Imaging, and Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong China ,grid.410741.7National Clinical Research Center for Infectious Disease, Shenzhen Third People’ s Hospital; The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong China
| | - Lantian Tang
- grid.452859.7Center for Infection and Immunity, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong China ,grid.452859.7Guangdong Provincial Engineering Research Center of Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Imaging, and Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong China
| | - Jiahai Lu
- grid.12981.330000 0001 2360 039XSchool of Public Health, Sun Yat-sen University, Guangzhou, Guangdong China
| | - Cheng Guo
- grid.21729.3f0000000419368729Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, NY USA
| | - Hong Shan
- grid.452859.7Guangdong Provincial Engineering Research Center of Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Imaging, and Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong China ,grid.511004.1Southern Marine Science and Engineering Guangdong Laboratory, Zhuhai, Guangdong China
| | - Xi Huang
- grid.452859.7Center for Infection and Immunity, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong China ,grid.452859.7Guangdong Provincial Engineering Research Center of Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Imaging, and Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong China ,grid.511004.1Southern Marine Science and Engineering Guangdong Laboratory, Zhuhai, Guangdong China ,grid.410741.7National Clinical Research Center for Infectious Disease, Shenzhen Third People’ s Hospital; The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong China
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Moutaouakkil K, Oumokhtar B, Abdellaoui H, El Fakir S, Arhoune B, Mahmoud M, Atarraf K, Afifi MA. First report of Kingella kingae diagnosed in pediatric bone and joint infections in Morocco. BMC Infect Dis 2021; 21:697. [PMID: 34284735 PMCID: PMC8293485 DOI: 10.1186/s12879-021-06361-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 06/14/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The progress of diagnostic strategies and molecular methods improved the detection of Kingella kingae in bone and joint infections, and now, Kingella kingae is being increasingly recognized as the most frequent cause of bone and joint infection BJI in early childhood. The main objective of this prospective study is to report the frequency of Kingella Kingae in negative culture bone and joint pediatric infections, and to describe the clinical and biologic features of these children. METHODS From December 2016 to June 2019, we selected all hospitalized patients with suspected BJI. When culture was negative on the fifth day, children under 10 years were subsequently included in the study, and PCR assay was performed systematically for researching K. kingae specific gene cpn60. Microbial culture and identification were made using standard bacteriological methods. The demographics, clinical, laboratory, radiographic and clinical features were reviewed from medical records. RESULTS We enrolled 65 children with culture negative BJI, 46 of them having under 10 years old have been screened for the cpn60 gene. Thus, the gene encoding Kingella kingae was positive for 27 BJI cases (58.7%). The mean age of children was 3.02 years, 55.6% were aged 6 months-4 years and 29.6% of them were aged 5-10 years. The male to female ratio was 1.7 and 16 cases (59.26%) occurred during the fall-winter period. The most frequent BJI type was septic arthritis (77.8%) and the most affected sites were knee (51.9%) and hip (37.0%). We recorded a mild clinical picture with normal to mildly raised inflammatory markers. All patients had good clinical and functional outcomes, with no serious orthopedic sequelae.. CONCLUSION K kingae is an important pathogen of culture-negative BJI in Moroccan children. PCR testing should be performed in culture-negative cases of children not only in the typical age range of 6 months to 4 years. When implemented in the routine clinical microbiology laboratory, a specific K. kingae PCR assay can provide a better diagnostic performance of BJI.
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Affiliation(s)
- Kaoutar Moutaouakkil
- Laboratoire Pathologie Humaine Biomédecine et Environnement, Faculté de Médecine et de Pharmacie de Fès (FMPF), Université Sidi Mohammed Ben Abdellah (USMBA), Fès, Morocco
| | - Bouchra Oumokhtar
- Laboratoire Pathologie Humaine Biomédecine et Environnement, Faculté de Médecine et de Pharmacie de Fès (FMPF), Université Sidi Mohammed Ben Abdellah (USMBA), Fès, Morocco.
| | - Hicham Abdellaoui
- Service de traumato-orthopédie pédiatrique, CHU Hassan II. Laboratoire Pathologie humaine Biomédecine et Environnement. Faculté de Médecine et de Pharmacie, Université Sidi Mohamemd Ben Abdellah, Fès, Morocco
| | - Samira El Fakir
- Laboratoire Epidémiologie, Recherche Clinique et Santé Communautaire. Faculté de Médecine et de Pharmacie, Université Sidi Mohammed Ben Abdellah, Fès, Morocco
| | - Btissam Arhoune
- Laboratoire Pathologie Humaine Biomédecine et Environnement, Faculté de Médecine et de Pharmacie de Fès (FMPF), Université Sidi Mohammed Ben Abdellah (USMBA), Fès, Morocco
| | - Mustapha Mahmoud
- Laboratoire Centrale d´analyses médicales, CHU Hassan II. Faculté de Médecine et de Pharmacie, Université Sidi Mohammed Ben Abdellah, Fès, Morocco
| | - Karima Atarraf
- Service de traumato-orthopédie pédiatrique, CHU Hassan II. Laboratoire Pathologie humaine Biomédecine et Environnement. Faculté de Médecine et de Pharmacie, Université Sidi Mohamemd Ben Abdellah, Fès, Morocco
| | - Moulay Abderrahmane Afifi
- Service de traumato-orthopédie pédiatrique, CHU Hassan II. Laboratoire Pathologie humaine Biomédecine et Environnement. Faculté de Médecine et de Pharmacie, Université Sidi Mohamemd Ben Abdellah, Fès, Morocco
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28
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Olijve L, Amarasena L, Best E, Blyth C, van den Boom M, Bowen A, Bryant PA, Buttery J, Dobinson HC, Davis J, Francis J, Goldsmith H, Griffiths E, Hung TY, Huynh J, Kesson A, Meehan A, McMullan B, Nourse C, Palasanthiran P, Penumarthy R, Pilkington K, Searle J, Stephenson A, Webb R, Williman J, Walls T. The role of Kingella kingae in pre-school aged children with bone and joint infections. J Infect 2021; 83:321-331. [PMID: 34265316 DOI: 10.1016/j.jinf.2021.06.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/20/2021] [Accepted: 06/28/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The Pre-school Osteoarticular Infection (POI) study aimed to describe the burden of disease, epidemiology, microbiology and treatment of acute osteoarticular infections (OAI) and the role of Kingella kingae in these infections. METHODS Information about children 3-60 months of age who were hospitalized with an OAI to 11 different hospitals across Australia and New Zealand between January 2012 and December 2016 was collected retrospectively. RESULTS A total of 907 cases (73%) were included. Blood cultures grew a likely pathogen in only 18% (140/781). The peak age of presentation was 12 to 24 months (466/907, 51%) and Kingella kingae was the most frequently detected microorganism in this age group (60/466, 13%). In the majority of cases, no microorganism was detected (517/907, 57%). Addition of PCR to culture increased detection rates of K. kingae. However, PCR was performed infrequently (63/907, 7%). CONCLUSIONS This large multi-national study highlights the need for more widespread use of molecular diagnostic techniques for accurate microbiological diagnosis of OAI in pre-school aged children. The data from this study supports the hypothesis that a substantial proportion of pre-school aged children with OAI and no organism identified may in fact have undiagnosed K. kingae infection. Improved detection of Kingella cases is likely to reduce the average length of antimicrobial treatment.
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Affiliation(s)
- Laudi Olijve
- Department of Paediatrics, University of Otago, Christchurch School of Medicine, New Zealand; Sheffield Teaching Hospitals, UK; Sydney Children's Hospital Randwick, 61 High Street, Randwick, NSW 2031, Australia
| | - Lahiru Amarasena
- Department of Paediatrics; Child and Youth Health, National Immunisation Advisory Centre, The University of Auckland, New Zealand
| | - Emma Best
- Paediatric Infectious Diseases, Starship Children's Health, Auckland, New Zealand; Paediatric Infectious Diseases, Starship Children's Health, Auckland, New Zealand; Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Grafton, Auckland, New Zealand; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Australia
| | - Christopher Blyth
- School of Medicine, University of Western Australia, Australia; School of Medicine, University of Western Australia, Australia; Perth Children's Hospital, Hospital Avenue, Nedlands, WA 6009, Australia; Department of Microbiology, Pathwest Laboratory Medicine, QEII Medical Centre, Australia; Department of Paediatrics, Christchurch Hospital, Canterbury District Health Board, University of Otago, PO Box 4345, Christchurch Mail Centre, Christchurch 8140, New Zealand
| | - Mirjam van den Boom
- Starship Children's Hospital, Auckland, New Zealand; Starship Children's Hospital, Auckland, New Zealand; Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Avenue, Nedlands WA 6009, Locked Bag 2010, Nedlands WA 6909, Australia
| | - Asha Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Australia; National Health and Medical Research Council, Australia; Division of Paediatrics, School of Medicine, University of Western Australia, Australia; Menzies School of Health Research, Charles Darwin University, Australia; Institute for Health Research, The University of Notre Dame Australia, Australia; Dept of General Medicine, The Royal Children's Hospital Melbourne, Victoria, Australia
| | - Penelope A Bryant
- Infectious Diseases and Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Australia; Infectious Diseases and Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Australia; Infection, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia; Department of Infection and Immunity, Monash Children's Hospital, Australia
| | - Jim Buttery
- Monash Centre for Health Care Research and Implementation, Department of Paediatrics, Monash University, Melbourne, 246 Clayton Rd, Clayton 3168, Victoria, Australia; Monash Centre for Health Care Research and Implementation, Department of Paediatrics, Monash University, Melbourne, 246 Clayton Rd, Clayton 3168, Victoria, Australia; Wellington Regional Hospital, Capital and Coast District Health Board, Department of Paediatrics and Child Health, Wellington Regional Hospital, Capital and Coast District Health Board, Wellington, New Zealand
| | - Hazel C Dobinson
- Global Health Division, Menzies School of Health Research, Darwin, Australia
| | - Joshua Davis
- Infectious Diseases, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle, NSW 2300, Australia; Infectious Diseases, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle, NSW 2300, Australia; Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Joshua Francis
- Department of Paediatrics, Royal Darwin Hospital, 105 Rocklands Dr Tiwi NT 0810, Darwin, Australia; Department of Paediatrics, Royal Darwin Hospital, 105 Rocklands Dr Tiwi NT 0810, Darwin, Australia; John Hunter Children's Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia
| | - Heidi Goldsmith
- Queensland Children's Hospital, 501 Stanley Street, South Brisbane 4101, Australia
| | - Elle Griffiths
- Department of Paediatrics, Royal Darwin Hospital, 105 Rocklands Drive, Tiwi 0810, Northern Territory, Australia
| | - Te-Yu Hung
- Departments of Infectious Disease and Microbiology, The Children's Hospital at Westmead, Westmead New South Wales, Australia
| | - Julie Huynh
- Discipline of Child and Adolescent health, University of Sydney, Australia; Discipline of Child and Adolescent health, University of Sydney, Australia; Centre for tropical medicine, 764 Vo Van Kiet, District 5 Ho Chi Minh City, Viet Nam; Departments of Infectious Disease and Microbiology, The Children's Hospital at Westmead, Westmead New South Wales, Locked Bag 4001, Westmead 2145, Australia
| | - Alison Kesson
- Discipline of Child and Adolescent health, University of Sydney, Australia; Discipline of Child and Adolescent health, University of Sydney, Australia; The Marie Bashir Institute of Infectious Diseases and Biosecurrity, University of Sydney, Australia; Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Locked Bag 2010, Nedlands WA 6909, Australia
| | - Andrea Meehan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, Randwick, NSW 2031, Australia
| | - Brendan McMullan
- National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia; National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, Australia; Queensland Children's Hospital, Children's Health Queensland, Level 12, South Brisbane, QLD 4101, Australia
| | - Clare Nourse
- Faculty of Medicine, University of Queensland, Australia; Faculty of Medicine, University of Queensland, Australia; Department of Immunology and Infectious Diseases, Sydney Children's Hospital Network, Randwick, High Street, Randwick, NSW 2031, Australia
| | - Pamela Palasanthiran
- University of New South Wales, UNSW, Kensington, NSW, Australia; University of New South Wales, UNSW, Kensington, NSW, Australia; Counties manukau district health board, Middlemore Hospital, 100 hospital road, Otahuhu 2025, Auckland, New Zealand
| | - Rushi Penumarthy
- Monash Children's Hospital, Monash Health, 101/71 Abinger Street, Richmond, VIC 3121, Australia
| | - Katie Pilkington
- Department of Paediatrics, the University of Melbourne, Australia; Department of Paediatrics, the University of Melbourne, Australia; Department of General Medicine, The Royal Children's Hospital Melbourne, 50 Flemington Road, Melbourne 3052, Australia
| | - Janine Searle
- Starship Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand
| | - Anya Stephenson
- University of Auckland, Middlemore Hospital, 100 hospital road, Otahuhu, 2025 Auckland, New Zealand
| | - Rachel Webb
- Starship Children's Hospital and KidzFirst Children's Hospital, Counties Manukau District Health Board, New Zealand; Starship Children's Hospital and KidzFirst Children's Hospital, Counties Manukau District Health Board, New Zealand; Biostatistics and Computation Biology Unit, University of Otago, 2 Riccarton Avenue, Christchurch, 8140, New Zealand
| | - Jonathan Williman
- Department of Paediatrics, University of Otago, Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - Tony Walls
- Department of Paediatrics, University of Otago, Christchurch School of Medicine, New Zealand.
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Septic Arthritis of Facet Joint in Children: A Systematic Review and a 10-year Consecutive Case Series. Pediatr Infect Dis J 2021; 40:411-417. [PMID: 33538543 DOI: 10.1097/inf.0000000000003031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Due to the low resolution of historical imaging technologies, descriptions of Septic Arthritis of Facet Joint (SAFJ) in children are scarce, though severe cases are known. We first aimed to estimate the incidence rate of SAFJ in children; we further aimed to specify SAFJ clinical, imaging and laboratory findings, and identify avenues for appropriate management. METHODS A 10-year consecutive SAFJ case series using our imaging center database combined with a 50-year systematic review of literature cases. RESULTS The mean ± SD incidence of pediatric SAFJ was 0.23 ± 0.4/100,000 children-years. The key symptoms were potty refusal (in toddlers) or painful sitting (78%) and lateralized signs (paravertebral tenderness and/or swelling, 88%). SAFJ diagnosis and extension were obtained using magnetic resonance imaging (MRI) (94%), and found an epidural extension in 8/16 cases. The mean duration of antibiotic treatment was 5.1 weeks. The compliance with guidelines was 79% for empiric and 62% for targeted antibiotic therapies. CONCLUSIONS SAFJ incidence in children is much greater than expected from the literature. Half of cases were complicated by an epidural infection. Simple clinical symptoms detected as early as the bedside allow a strong suspicion of SAFJ, justifying the use of a first-line MRI to confirm the diagnosis and precisely describe the extension. Focusing on simple clinical signs is key to justify the transfer of a child or the shortening of the delay to obtain an MRI. However, as MRI availability increases in most Western countries, and the capacity for diagnosis increases, the awareness of SAFJ must be spread to avoid missed cases.
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Mohamad M, Steiger C, Spyropoulou V, Coulin B, Vendeuvre T, Habre C, Dhouib A, De Marco G, Dayer R, Ceroni D. Clinical, biological and bacteriological characteristics of osteoarticular infections in infants less than 12 months of age. Future Microbiol 2021; 16:389-397. [PMID: 33847142 DOI: 10.2217/fmb-2020-0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This retrospective study's objective was to evaluate osteoarticular infection in infants less than 12 months of age, with a particular focus on biological features and bacteriological etiology. Material & methods: We retrospectively reviewed the medical records of every infant younger than 12 months old admitted in our institution for a suspected osteoarticular infection between January 1980 and December 2016. Results: Sixty-nine patients records were reviewed, including eight neonates, 16 infants from 1 to 5 months old, and 45 from 6 to 12 months old. Conclusion: Neonates and infants aged from 6 to 12 months old were more exposed to infections. Staphylococcus aureus remained the main pathogen in children <6 months, whereas Kingella kingae has become the most frequently isolated microorganism in infants aged from 6 to 12 months old.
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Affiliation(s)
- Morad Mohamad
- Pediatric Orthopedic Service, Geneva University Hospitals, CH-1211, Geneva 14, Switzerland
| | - Christina Steiger
- Pediatric Orthopedic Service, Geneva University Hospitals, CH-1211, Geneva 14, Switzerland
| | - Vasiliki Spyropoulou
- Pediatric Orthopedic Service, Geneva University Hospitals, CH-1211, Geneva 14, Switzerland
| | - Benoit Coulin
- Pediatric Orthopedic Service, Geneva University Hospitals, CH-1211, Geneva 14, Switzerland
| | - Tanguy Vendeuvre
- Pediatric Orthopedic Service, Geneva University Hospitals, CH-1211, Geneva 14, Switzerland
| | - Céline Habre
- Department of Radiology, Geneva University Hospitals, CH-1211, Geneva 14, Switzerland
| | - Amira Dhouib
- Department of Radiology, Geneva University Hospitals, CH-1211, Geneva 14, Switzerland
| | - Giacomo De Marco
- Pediatric Orthopedic Service, Geneva University Hospitals, CH-1211, Geneva 14, Switzerland
| | - Romain Dayer
- Pediatric Orthopedic Service, Geneva University Hospitals, CH-1211, Geneva 14, Switzerland
| | - Dimitri Ceroni
- Pediatric Orthopedic Service, Geneva University Hospitals, CH-1211, Geneva 14, Switzerland
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Native joint septic arthritis due to Kingella kingae in an adult. IDCases 2021; 24:e01106. [PMID: 33889495 PMCID: PMC8047495 DOI: 10.1016/j.idcr.2021.e01106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/29/2021] [Accepted: 03/29/2021] [Indexed: 11/20/2022] Open
Abstract
A 65-year-old woman with chronic osteoarthritis of the knees presented with a one-week history of acutely worsening right knee pain and swelling. Arthrocentesis was performed and synovial fluid was indicative of septic arthritis with a negative Gram stain for bacteria. Magnetic Resonance Imaging (MRI) was obtained, revealing a large anterior periarticular abscess with concomitant septic arthritis. Orthopedic surgeons performed urgent incision and drainage of the abscess and washout of the joint. Synovial fluid culture grew Kingella kingae and the patient was treated with four weeks of ceftriaxone with improvement in both clinical symptoms and laboratory values. Kingella kingae is a common cause of pediatric bone and joint infection but remains an exceedingly rare cause of native joint septic arthritis among immunocompetent adults. Kingella spp are largely susceptible to beta-lactam antimicrobials.
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Coulin B, Demarco G, Spyropoulou V, Juchler C, Vendeuvre T, Habre C, Tabard-Fougère A, Dayer R, Steiger C, Ceroni D. Osteoarticular infection in children. Bone Joint J 2021; 103-B:578-583. [PMID: 33641416 DOI: 10.1302/0301-620x.103b3.bjj-2020-0936.r2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS We aimed to describe the epidemiological, biological, and bacteriological characteristics of osteoarticular infections (OAIs) caused by Kingella kingae. METHODS The medical charts of all children presenting with OAIs to our institution over a 13-year period (January 2007 to December 2019) were reviewed. Among these patients, we extracted those which presented an OAI caused by K. kingae and their epidemiological data, biological results, and bacteriological aetiologies were assessed. RESULTS K. kingae was the main reported microorganism in our paediatric population, being responsible for 48.7% of OAIs confirmed bacteriologically. K. kingae affects primarily children aged between six months and 48 months. The highest prevalence of OAI caused by K. kingae was between seven months and 24 months old. After the patients were 27 months old, its incidence decreased significantly. The incidence though of infection throughout the year showed no significant differences. Three-quarters of patients with an OAI caused by K. kingae were afebrile at hospital admission, 11% had elevated WBCs, and 61.2% had abnormal CRPs, whereas the ESR was increased in 75%, constituting the most significant predictor of an OAI. On MRI, we noted 53% of arthritis affecting mostly the knee and 31% of osteomyelitis located primarily in the foot. CONCLUSION K. kingae should be recognized currently as the primary pathogen causing OAI in children younger than 48 months old. Diagnosis of an OAI caused by K. kingae is not always obvious, since this infection may occur with a mild-to-moderate clinical and biological inflammatory response. Extensive use of nucleic acid amplification assays improved the detection of fastidious pathogens and has increased the observed incidence of OAI, especially in children aged between six months and 48 months. We propose the incorporation of polymerase chain reaction assays into modern diagnostic algorithms for OAIs to better identify the bacteriological aetiology of OAIs. Cite this article: Bone Joint J 2021;103-B(3):578-583.
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Affiliation(s)
- Benoit Coulin
- Pediatric Orthopedics Service, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Giacomo Demarco
- Pediatric Orthopedics Service, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Vanessa Spyropoulou
- Pediatric Orthopedics Service, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Celine Juchler
- Pediatric Orthopedics Service, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Tanguy Vendeuvre
- Pediatric Orthopedics Service, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Céline Habre
- Pediatric Radiology Unit, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Anne Tabard-Fougère
- Pediatric Orthopedics Service, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Romain Dayer
- Pediatric Orthopedics Service, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Christina Steiger
- Pediatric Orthopedics Service, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Dimitri Ceroni
- Pediatric Orthopedics Service, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
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Villani MC, Hamilton EC, Klosterman MM, Jo C, Kang LH, Copley LAB. Primary Septic Arthritis Among Children 6 to 48 Months of Age: Implications for PCR Acquisition and Empiric Antimicrobial Selection. J Pediatr Orthop 2021; 41:190-196. [PMID: 33417393 DOI: 10.1097/bpo.0000000000001744] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Primary septic arthritis requires unique evaluation and treatment considerations for children in the 6- to 48-month age range because of the spectrum of identified pathogens and high rate of negative cultures. The purpose of this study is to evaluate primary septic arthritis in this age group in order to differentiate children with infection caused by Kingella kingae from those with other confirmed pathogens and those with no identified pathogen. METHODS Preschool children who underwent multidisciplinary evaluation and treatment for septic arthritis between 2009 and 2019 were retrospectively studied. Three cohorts were established for comparison of clinical and laboratory features of primary septic arthritis: (1) confirmed K. kingae, (2) confirmed other pathogen, and (3) presumed (without identified pathogen). RESULTS Among 139 children with septic arthritis, 40 (29%) were confirmed K. kingae, 29 (21%) other pathogen, and 70 (50%) presumed. Children with Kingella and those with presumed septic arthritis had significantly lower initial C-reactive protein (4.8 and 4.5 vs. 9.3 mg/dL) and fewer febrile hospital days (0.2 and 0.4 vs. 1.3 d) than children with other confirmed pathogens. Children with other pathogens had higher rates of bacteremia (38% vs. 0%) and positive joint fluid cultures (86% vs. 15%) than that of children with Kingella. The rate of polymerase chain reaction (PCR) acquisition was 38 of 40 (95.0%) Kingella cases, 18 of 29 (62.1%) other pathogen cases, and 33 of 70 (47.1%) presumed cases. CONCLUSIONS K. kingae was the most commonly identified pathogen among 6-month to 4-year-old children. The Kingella and other identified pathogens in this study serve to guide empiric antimicrobial recommendations for this age range. Because of similarities between children with septic arthritis because of K. kingae and those with no identified pathogen, it is likely that an unrecognized burden of Kingella resides in culture negative cases, particularly if no PCR is sent. Systematic evaluation, including PCR acquisition, and a high index of suspicion for K. kingae are recommended to thoroughly evaluate septic arthritis in preschool children. LEVEL OF EVIDENCE Level III-Retrospective cohort comparison.
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Affiliation(s)
| | | | | | - Chanhee Jo
- Texas Scottish Rite Hospital for Children
| | - Lisa H Kang
- Department of Radiology, UC Davis, Sacramento, CA
| | - Lawson A B Copley
- Children's Health System of Texas
- Texas Scottish Rite Hospital for Children
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX
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Isolation and Characterization of Kingella bonacorsii sp. nov., A Novel Kingella Species Detected in a Stable Periodontitis Subject. Pathogens 2021; 10:pathogens10020240. [PMID: 33669894 PMCID: PMC7923279 DOI: 10.3390/pathogens10020240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/13/2021] [Accepted: 02/16/2021] [Indexed: 11/24/2022] Open
Abstract
Members of the genus Kingella are mostly commensals of the oral cavity, but some of them are involved in invasive infections, especially in young children. This study provides new knowledge on the diversity of this genus by describing a novel species of Kingella isolated from a dental plaque sample from a 51-year-old man with a history of periodontitis. Morphological and chemotaxonomic characteristic were investigated using different growth conditions, pH and temperature. Cellular fatty acid methyl ester (FAME) analysis was performed by gas chromatography/mass spectrometry (GC/MS). Phylogenetic analysis based on 16S rRNA, orthologous average nucleotide identity (OrthoANI) and digital DNA–DNA hybridization (dDDH) relatedness were also performed. Strain Marseille-Q4569T was found to be a facultative aerobic, nonmotile and non-spore-forming rod-shaped bacterium that grows at 28–41.5 °C (optimum 37 °C), pH 5.5–8.5 (optimum pH 7.5) and 5–15 g/L of NaCl. The major fatty acids were Hexadecanoic acid (32.7%), 11-Octadecenoic acid (26.1 %) and 9-Hexadecenoic acid (21.3 %). Despite high 16S rRNA gene sequence similarity (98.72%) between strain Marseille-Q4569T and Kingella oralis strain UB-38T, the degree of OrthoANI was at the limit of the cutoff (95.83%), and the degree of dDDH was lower (63.6%) than thresholds used to delineate prokaryotic species. Therefore, it is proposed that strain Marseille-Q4569T represents a novel species of the genus Kingella, for which the name Kingella bonacorsii sp. nov. is proposed (=CSUR Q4569).
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Guarch-Ibáñez B, Cabacas A, González-López JJ, García-González MDM, Mora C, Villalobos P. First documented outbreak of arthritis caused by Kingella kingae in a Spanish childcare center. Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(20)30407-9. [PMID: 33413991 DOI: 10.1016/j.eimc.2020.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/26/2020] [Accepted: 11/03/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Recently, Kingella kingae (K. kingae) has been described as the most common agent of skeletal system infections in children 6 months-2 years of age. More exceptional is the clinical presentation in clusters of invasive K. kingae infections. We describe the investigation of the first outbreak of 3cases of arthritis caused by K. kingae documented in Spain detected in a daycare center in Roses, Girona. PATIENTS AND METHODS In December of 2015 surveillance throat swabs obtained from all attendees from the same class of the index daycare center were assessed to study the prevalence of K. kingae colonization. The sample was composed of 9 toddlers (range: 16-23 months of age). Investigation was performed by culture and K. kingae-specific RT-PCR. Combined amoxicillin-rifampicin prophylaxis was offered to all attendees who were colonized by K. kingae. Following antimicrobial prophylaxis, a new throat swab was taken to confirm bacterial eradication. RESULTS K. kingae was detected by RT-PCR throat swabs in the 3index cases and 5of the 6daycare attendees. Cultures were negative in all cases. After administration of prophylactic antibiotics, 3toddlers were still positive for K. kingae-specific RT-PCR. CONCLUSIONS Clusters of invasive K. kingae infections can occur in daycare facilities and closed communities. Increased awareness and use of sensitive detection methods are needed to identify and adequately investigate outbreaks of K. kingae disease. In our experience, the administration of prophylactic antibiotics could result in partial eradication of colonization. No further cases of disease were detected after prophylaxis.
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Affiliation(s)
- Borja Guarch-Ibáñez
- Servicio de Pediatría, Hospital Universitari de Girona Dr. Josep Trueta, Universitat de Girona, Girona, España.
| | - Alicia Cabacas
- Servicio de Pediatría, Fundació Salut Empordà, Figueres, Girona, España
| | - Juan José González-López
- Servicio de Microbiología, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona. Barcelona, España
| | - María Del Mar García-González
- Servicio de Pediatría, Hospital Universitari de Girona Dr. Josep Trueta, Universitat de Girona, Girona, España; Servicio de Pediatría, Fundació Salut Empordà, Figueres, Girona, España
| | - Carme Mora
- Sección de Microbiología, Fundació Salut Empordà, Figueres, Girona, España
| | - Pilar Villalobos
- Servicio de Pediatría, Fundació Salut Empordà, Figueres, Girona, España
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Joye R, Ceroni D, Beghetti M, Aggoun Y, Sologashvili T. Fulminant Infective Endocarditis Due to Kingella Kingae and Several Complications in a 6-Year-Old Girl: A Case Report. Front Pediatr 2021; 9:707760. [PMID: 34291021 PMCID: PMC8287094 DOI: 10.3389/fped.2021.707760] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/03/2021] [Indexed: 11/13/2022] Open
Abstract
Kingella kingae is a gram-negative coccobacillus belonging to the HACEK group (Haemophilus species, Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella species) and is a common oropharyngeal colonizer of healthy young children. Osteoarticular infection is the most commonly reported invasive Kingella kingae infection in children, usually presenting a mild clinical picture. However, it can also cause severe invasive infections, especially infective endocarditis, with a high complication rate. We report the case of a 6-year-old girl, with no past medical history, who presented with fulminant infective endocarditis due to Kingella kingae. She received emergency venoarterial extracorporeal membrane oxygenation support, rapidly underwent cardiac surgery, and was then treated using ceftriaxone for 4 weeks as recommended by the American Heart Association. The patient's postoperative course was marked by a cerebral ischemic stroke consistent with septic embolism. She also presented with a para-aortic pseudoaneurysm that required a secondary surgical procedure, with a good postoperative result. This report illustrates a case of fulminant infective endocarditis due to Kingella kingae and responsible for two major complications. We also describe the preventive valve surgery performed to ensure the preservation of valve function and its capacity for growth.
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Affiliation(s)
- Raphael Joye
- Pediatric Cardiology Unit, Geneva University Hospitals, Geneva, Switzerland
| | - Dimitri Ceroni
- Pediatric Orthopedic and Traumatology Unit, Geneva University Hospitals, Geneva, Switzerland
| | - Maurice Beghetti
- Pediatric Cardiology Unit, Geneva University Hospitals, Geneva, Switzerland
| | - Yacine Aggoun
- Pediatric Cardiology Unit, Geneva University Hospitals, Geneva, Switzerland
| | - Tornike Sologashvili
- Pediatric Cardiac Surgery Unit, Geneva University Hospitals, Geneva, Switzerland
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Management of an outbreak of invasive Kingella kingae skeletal infections in a day care center. Arch Pediatr 2020; 28:12-15. [PMID: 33309121 DOI: 10.1016/j.arcped.2020.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 08/04/2020] [Accepted: 11/15/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Kingella kingae (Kk) is frequently responsible for invasive skeletal infections in children aged 3-36months. However, few outbreaks of invasive Kk infections in day care centers have been reported. The objective of the present study was to describe (a) the clinical and laboratory data recorded during an outbreak of invasive Kk skeletal infections, and (b) the management of the outbreak. METHOD Four children from the same day care center were included in the study May and June 2019. We retrospectively analyzed the children's clinical presentation and their radiological and laboratory data. We also identified all the disease control measures taken in the day care center. RESULTS We observed cases of septic arthritis of the wrist (case #1), shoulder arthritis (case #2), knee arthritis (case #3) ans cervical spondylodiscitis (case #4). All cases presented with an oropharyngeal infection and concomitant fever prior to diagnosis of the skeletal infection. All cases were misdiagnosed at the initial presentation. The mean (range) age at diagnosis was 10.75months (9-12). The three patients with arthritis received surgical treatment. All patients received intravenous and then oral antibiotics. In cases 1 and 2, Kk was detected using real-time PCR and a ST25-rtxA1 clone was identified. The outcome was good in all four cases. Four other children in the day care center presented with scabies during this period and were treated with systemic ivermectin. The Regional Health Agency was informed, and all the parents of children attending the day care center received an information letter. The day care center was cleaned extensively. CONCLUSION Our results highlight the variety of features of invasive skeletal Kk infections in children and (given the high risk of transmission in day care centers) the importance of diagnosing cases as soon as possible.
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Pendela VS, Kudaravalli P, Chhabria M, Lesho E. Case Report: A Polymicrobial Vision-Threatening Eye Infection Associated with Polysubstance Abuse. Am J Trop Med Hyg 2020; 103:672-674. [PMID: 32431277 DOI: 10.4269/ajtmh.20-0202] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
We report a patient with risk factors for both microbial keratitis and endophthalmitis, which were initially challenging to distinguish. Cultures of corneal scrapings yielded several organisms, including an uncultivable Gram-negative rod, eventually identified as Kingella negevensis. Kingella negevensis is so named because most strains have been isolated in the Negev, a desert region of southern Israel. The epidemiology of K. negevensis remains incompletely understood. We found no other reports in the literature of this organism causing microbial keratitis.
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Affiliation(s)
| | | | | | - Emil Lesho
- Rochester Regional Health, Rochester, New York
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Abstract
Osteoarticular infections of the chest wall are relatively uncommon in pediatric patients and affect primarily infants and toddlers. Clinical presentation is often vague and nonspecific. Laboratory findings may be unremarkable in osteoarticular chest wall infections and not suggestive of an osteoarticular infection. Causative microbes are frequently identified if specific nucleic acid amplification assays are carried out. In the young pediatric population, there is evidence that Kingella kingae is 1 of the main the main causative pathogens of osteoarticular infections of the chest wall.
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40
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Swarup I, LaValva S, Shah R, Sankar WN. Septic Arthritis of the Hip in Children: A Critical Analysis Review. JBJS Rev 2020; 8:e0103. [PMID: 32224630 DOI: 10.2106/jbjs.rvw.19.00103] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Septic arthritis of the hip is a common and potentially devastating condition in children. Septic arthritis is most commonly caused by Staphylococcus aureus, but other pathogens should be considered on the basis of patient age and presence of risk factors. Diagnosis of septic arthritis is based on history and physical examination, laboratory tests, radiographs, ultrasound, and arthrocentesis. Treatment comprises empiric antibiotics and joint debridement, and antibiotics are subsequently tailored on the basis of culture data, local resistance patterns, and clinical response. Late sequelae of septic arthritis include osteonecrosis, chondrolysis, growth disturbance, subluxation or dislocation, and progressive ankylosis. Surgical treatments to address these issues have been described.
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Affiliation(s)
- Ishaan Swarup
- UCSF Benioff Children's Hospital, Oakland, California
| | - Scott LaValva
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ronit Shah
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Manz N, Krieg AH, Buettcher M, Ritz N, Heininger U. Long-Term Outcomes of Acute Osteoarticular Infections in Children. Front Pediatr 2020; 8:587740. [PMID: 33335875 PMCID: PMC7737431 DOI: 10.3389/fped.2020.587740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/05/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Acute hematogenous osteomyelitis (OM) and septic arthritis require immediate diagnosis and treatment by an interdisciplinary team of pediatric infectious disease specialists and pediatric orthopedic surgeons. Adverse outcomes such as growth disturbance, bone deformity, and chronic infections have been described in older studies. However, there is only little known about long-term follow-up of patients of the last two decades. Therefore, we aimed to evaluate subjective and objective long-term outcomes of these children with osteoarticular infections treated in the millennial years. Methods: Cross-sectional study performed in two pediatric centers including patients admitted for OM and/or SA between 2005 and 2014 and follow-up consultations in 2019. Patients with symptoms of ≤2 weeks duration at initial presentation were contacted. Subjective outcomes were assessed by standardized interview, objective outcomes by clinical examination. Medical charts were used to extract data from the initial presentations. Statistical analysis was performed by non-parametric tests and Fisher's exact test. Results: Of 147 eligible patients 77 (52%) agreed to participate, of which 68 (88%) had an interview and physical examination and 9 (12%) an interview only. Thirty-three (39%) had OM, 26 (34%) SA, and 21 (27%) combined OM/SA. Median (IQR) age at follow-up was 13.3 (10.5-18.0) years with a median (IQR) follow-up of 7.1 (6.1-8.6) years. Persistent complaints including pain, functional differences and scar paresthesia, reported by 21 (28%) patients, were generally mild and only 3 (5%) required ongoing medical care. Objective sequelae including pain, limited range of motion, unilateral axis deformity or asymmetric gait were found in 8 (12%) participants. Older age, female sex, joint involvement, surgical intervention, persistent fever, and C-reactive protein elevation were associated with adverse clinical outcome. Conclusions: Adverse outcomes were observed in a considerable number of patients, most of which were minor, and only few required ongoing medical care. Long-term follow up is advisable for patients with risk factors identified during the initial presentation. This study was registered on ClinicalTrials.gov (NCT03827980).
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Affiliation(s)
- Nora Manz
- Infectious Diseases and Vaccinology Unit, University of Basel Children's Hospital, Basel, Switzerland
| | - Andreas H Krieg
- Orthopaedic Department, University of Basel Children's Hospital, Basel, Switzerland
| | - Michael Buettcher
- Infectious Diseases Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Nicole Ritz
- Infectious Diseases and Vaccinology Unit, University of Basel Children's Hospital, Basel, Switzerland
| | - Ulrich Heininger
- Infectious Diseases and Vaccinology Unit, University of Basel Children's Hospital, Basel, Switzerland
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Samara E, Spyropoulou V, Tabard-Fougère A, Merlini L, Valaikaite R, Dhouib A, Manzano S, Juchler C, Dayer R, Ceroni D. Kingella kingae and Osteoarticular Infections. Pediatrics 2019; 144:peds.2019-1509. [PMID: 31722963 DOI: 10.1542/peds.2019-1509] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES In this study, we aimed to contrast the bacteriologic epidemiology of osteoarticular infections (OAIs) between 2 patient groups in successive 10-year periods, before and after the extensive use of nucleic acid amplification assays in the diagnostic process. METHODS Epidemiologic data and bacteriologic etiologies of all children presenting with OAIs on admission to our institution over 20 years (1997-2016) were assessed retrospectively. The population was divided into 2 cohorts, using the standardized use of polymerase chain reaction as the cutoff point (2007). The conventional cohort included children with OAIs mainly investigated by using classic cultures, whereas the molecular cohort referred to patients also investigated by using molecular assays. RESULTS Kingella kingae was the most frequently isolated pathogen, responsible for 51% of OAIs, whereas other classic pathogens were responsible for 39.7% of cases in the molecular cohort. A statistically significant increase in the mean incidence of OAIs was observed, as was a decrease in the mean age at diagnosis after 2007. After 2007, the pathogen remained unidentified in 21.6% of OAIs in our pediatric population. CONCLUSIONS Extensive use of nucleic acid amplification assays improved the detection of fastidious pathogens and has increased the observed incidence of OAI, especially in children aged between 6 and 48 months. We propose the incorporation of polymerase chain reaction assays into modern diagnostic algorithms for OAIs to better identify the bacteriologic etiology of OAIs.
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Affiliation(s)
| | | | | | | | | | | | - Sergio Manzano
- Paediatric Emergency, Geneva University Hospitals, Geneva, Switzerland
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Murphy C, Islam S, Lyons K, Thomas R, Hicar M. A Toddler With Subacute Shoulder Immobility. Clin Infect Dis 2019; 67:1951-1953. [PMID: 30496470 DOI: 10.1093/cid/ciy269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Catherine Murphy
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York
| | - Shamim Islam
- Division of Pediatric Infectious Diseases, University at Buffalo, State University of New York
| | - Kelly Lyons
- Combined Internal Medicine and Pediatrics Residency Program, University at Buffalo, State University of New York
| | - Richard Thomas
- Department of Radiology, John R. Oishei Children's Hospital, Buffalo, New York
| | - Mark Hicar
- Division of Pediatric Infectious Diseases, University at Buffalo, State University of New York
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Spyridakis E, Gerber JS, Schriver E, Grundmeier RW, Porsch EA, St Geme JW, Downes KJ. Clinical Features and Outcomes of Children with Culture-Negative Septic Arthritis. J Pediatric Infect Dis Soc 2019; 8:228-234. [PMID: 29718310 DOI: 10.1093/jpids/piy034] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/17/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Septic arthritis is a serious infection, but the results of blood and joint fluid cultures are often negative in children. We describe here the clinical features and management of culture-negative septic arthritis in children at our hospital and their outcomes. METHODS We performed a retrospective review of a cohort of children with septic arthritis who were hospitalized at Children's Hospital of Philadelphia between January 2002 and December 2014. Culture-negative septic arthritis was defined as a joint white blood cell count of >50000/μL with associated symptoms, a clinical diagnosis of septic arthritis, and a negative culture result. Children with pretreatment, an intensive case unit admission, Lyme arthritis, immunodeficiency, or surgical hardware were excluded. Treatment failure included a change in antibiotics, surgery, and/or reevaluation because of a lack of improvement/worsening. RESULTS We identified 157 children with septic arthritis. The patients with concurrent osteomyelitis (n = 28) had higher inflammatory marker levels at presentation, had a longer duration of symptoms (median, 4.5 vs 3 days, respectively; P < .001), and more often had bacteremia (46.4% vs 6.2%, respectively; P < .001). Among children with septic arthritis without associated osteomyelitis, 69% (89 of 129) had negative culture results. These children had lower C-reactive protein levels (median, 4.0 vs 7.3 mg/dL, respectively; P = .001) and erythrocyte sedimentation rates (median, 39 vs 51 mm/hour, respectively; P = .01) at admission and less often had foot/ankle involvement (P = .02). Among the children with culture-negative septic arthritis, the inpatient treatment failure rate was 9.1%, and treatment failure was more common in boys than in girls (17.1% vs 3.8%, respectively; P = .03). We found no association between treatment failure and empiric antibiotics or patient age. No outpatient treatment failures occurred during the 6-month follow-up period, although 17% of the children discharged with a peripherally inserted central catheter line experienced complications, including 3 with bacteremia. CONCLUSIONS The majority of septic arthritis infections at our institution were culture negative. Among patients with culture-negative infection, empiric antibiotics failed for 9% and necessitated a change in therapy. More sensitive diagnostic testing should be implemented to elucidate the causes of culture-negative septic arthritis in children.
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Affiliation(s)
- Evangelos Spyridakis
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Pennsylvania
| | - Jeffrey S Gerber
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Pennsylvania.,Division of Infectious Diseases, Children's Hospital of Philadelphia, Pennsylvania.,Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Pennsylvania
| | - Emily Schriver
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Pennsylvania
| | - Robert W Grundmeier
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Pennsylvania
| | - Eric A Porsch
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Pennsylvania
| | - Joseph W St Geme
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Pennsylvania.,Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Pennsylvania
| | - Kevin J Downes
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Pennsylvania.,Division of Infectious Diseases, Children's Hospital of Philadelphia, Pennsylvania.,Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Pennsylvania
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45
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Kingella-kingae-Infektionen im Kindesalter. Monatsschr Kinderheilkd 2019. [DOI: 10.1007/s00112-018-0471-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Noguera-Julian A, Monsonis M, Ludwig G, Moreno-Romo D, Gené-Giralt A. Osteoarticular infections: Blood as a determinant factor in the isolation of Kingella kingae. J Microbiol Methods 2019; 161:8-11. [PMID: 30986431 DOI: 10.1016/j.mimet.2019.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 04/11/2019] [Accepted: 04/11/2019] [Indexed: 11/20/2022]
Abstract
We assessed the capacity of Kingella kingae to grow in blood culture bottles (BCB), taking into account the concentrations of the microorganism and blood in the culture medium. An initial suspension (McFarland 0.5) of 32 strains of K. kingae was serially diluted. One mL of the initial suspension and 1 mL of the subsequent dilutions were inoculated in two BCB, together with 1 mL of human blood in the 2nd BCB. Also, 1mL serial dilutions of human blood were added to BCBs previously inoculated with 1 mL of K. kingae dilution 1/104. In non-blood-supplemented BCB, 23 strains grew with the initial suspension and only one with the first processed dilution, as compared to all strains with the initial suspension and the 3 first dilutions, 22 with the 4th dilution, and one with the 5th dilution in blood-supplemented BCB. In BCB inoculated with K. kingae dilution 1/104 and decreasing concentrations of human blood, all strains grew with blood dilutions 1/2 and 1/4, 26 with dilution 1/8, 19 with dilution 1/16, 10 with dilution 1/32, and none with dilution 1/64. Increasing time to positivity was observed with both decreasing bacterial (p = .001) and blood concentrations (r = -0.632, p < .0001). The addition of human blood was essential to boost the growth of K. kingae in BCB. If replicated in vivo, these findings would increase the isolation of fastidious K. kingae organisms from pediatric osteoarticular exudates.
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Affiliation(s)
- Antoni Noguera-Julian
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d'Infeccions, Servei de Pediatria, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain; Red de Investigación Translacional en Infectología Pediátrica, RITIP, Madrid, Spain.
| | - Manuel Monsonis
- Servei de Microbiologia, Hospital Sant Joan de Déu, Barcelona, Spain.
| | - Guillermo Ludwig
- Servei de Microbiologia, Hospital Sant Joan de Déu, Barcelona, Spain.
| | - David Moreno-Romo
- Servei de Cirurgia Ortopèdica i Traumatologia, Hospital Sant Joan de Déu, Barcelona, Spain.
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Li H, Li T, Qu J. Stochastic processes govern bacterial communities from the blood of pikas and from their arthropod vectors. FEMS Microbiol Ecol 2019; 94:4990947. [PMID: 29722798 DOI: 10.1093/femsec/fiy082] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 05/01/2018] [Indexed: 02/06/2023] Open
Abstract
Vector-borne microbes influence pathogen transmission and blood microbiomes, thereby affecting the emergence of infectious diseases. Thus, understanding the relationship between host and vector microbiomes is of importance. In this study, we investigated the bacterial community composition, diversity and assembly of the flea (Rhadinopsylla dahurica vicina), torsalo (Hypoderma curzonial), and the blood and gut of their shared pika host, Ochotona curzoniae. Bartonella, Sphingomonas and Bradyrhizobium were enriched in blood, while Wolbachia and Fusobacterium were more abundant in fleas and torsaloes. Most of potential pathogenic microbes (belonging to Fusobacterium, Rickettsia, Kingella, Porphyromonas, Bartonella and Mycoplasma) were present in the blood of pikas and their vectors. Blood communities were more similar to those from fleas than other sample types and were independent of host factors or geographical sites. Notably, blood microbes originate mainly from fleas rather than gut or torsaloes. Interestingly, the community assembly of blood, fleas or torsaloes was primarily governed by stochastic processes, while the gut microbiome was determined by deterministic processes. Ecological drift plays a dominant role in the assembly of blood and flea microbiomes. These results reflect the difficulty for predicting and regulating the microbial ecology of fleas for the prevention of potential microbiome-associated diseases.
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Affiliation(s)
- Huan Li
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou 730000, China
| | - Tongtong Li
- Department of Applied Biology, College of Biotechnology and Bioengineering, Zhejiang University of Technology, Hangzhou 310014, China
| | - Jiapeng Qu
- Key Laboratory of Adaptation and Evolution of Plateau Biota, Northwest Institute of Plateau Biology, Chinese Academy of Sciences, Xining, Qinghai 810008, China.,Qinghai Provincial Key Laboratory of Restoration Ecology in Cold Region, Qinghai 810008, China
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Abstract
BACKGROUND Kingella kingae is an emergent pathogen causing septic arthritis (SA) in children.The objective of this study was to analyze the etiology of SA in children before and after the implementation of universal 16S rRNA gene polymerase chain reaction and sequencing (16SPCR) in synovial fluid. METHODS Children ≤14 years with acute SA from a Madrid cohort (2002-2013) were reviewed. Differences in etiology were analyzed before (period 1) and after (period 2) the implementation of bacterial 16SPCR in 2009. A comparison in epidemiology, clinical syndromes, therapy and outcome between infections caused by K. kingae and other bacteria was performed. RESULTS Bacteria were detected from 40/81 (49.4%) children, with a higher proportion of diagnosis after 16SPCR establishment (period 2, 63% vs. period 1, 31.4%; P = 0.005). The main etiologies were Staphylococcus aureus (37.5%) and K. kingae (35%), although K. kingae was the most common microorganism in P2 (48.3%). Children with K. kingae SA were less likely to be younger than 3 months (0 vs. 42.3%; P < 0.001), had less anemia (21.4 vs. 50%; P = 0.010), lower C-reactive protein (3.8 vs. 8.9 mg/dL; P = 0.039), less associated osteomyelitis (0 vs. 26.9%; P = 0.033), shorter intravenous therapy (6 vs. 15 days; P < 0.001), and had a nonsignificant lower rate of sequelae (0 vs. 30%; P = 0.15) than children with SA caused by other bacteria. However, they tended to have higher rate of fever (86 vs. 57%; P = 0.083). CONCLUSIONS K. kingae was frequently recovered in children with SA after the implementation of bacterial 16SPCR, producing a milder clinical syndrome and better outcome. Therefore, the use of molecular techniques may be important for the management of these children.
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Prudent E, Raoult D. Fluorescence in situ hybridization, a complementary molecular tool for the clinical diagnosis of infectious diseases by intracellular and fastidious bacteria. FEMS Microbiol Rev 2018; 43:88-107. [DOI: 10.1093/femsre/fuy040] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 11/07/2018] [Indexed: 12/16/2022] Open
Affiliation(s)
- Elsa Prudent
- Aix Marseille Université, IRD, APHM, MEPHI, IHU-Méditerranée Infection, 19–21 Boulevard Jean Moulin, 13005 Marseille, France
| | - Didier Raoult
- Aix Marseille Université, IRD, APHM, MEPHI, IHU-Méditerranée Infection, 19–21 Boulevard Jean Moulin, 13005 Marseille, France
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50
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Manz N, Krieg AH, Heininger U, Ritz N. Evaluation of the current use of imaging modalities and pathogen detection in children with acute osteomyelitis and septic arthritis. Eur J Pediatr 2018; 177:1071-1080. [PMID: 29728840 DOI: 10.1007/s00431-018-3157-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/12/2018] [Accepted: 04/16/2018] [Indexed: 12/22/2022]
Abstract
UNLABELLED Diagnostic tools for the management of acute osteomyelitis (OM) and septic arthritis (SA) have improved over the last decade. To investigate the influence and availability of magnetic resonance imaging (MRI) and nucleic acid testing (NAT), a retrospective cohort study was done. Patients admitted with acute OM or SA between 2005 and 2014 were identified using ICD-10 discharge codes. Ninety-six children were identified: OM, n = 45; SA, n = 42; and OM + SA, n = 9. Diagnostic imaging was performed in 100% of OM or OM + SA and 95% of SA patients. MRI was performed in 85% of OM patients, 26% of SA patients and 100% OM + SA patients. In patients with OM or SA, concomitant joint/bone involvement was detected in 24 and 36% of patients, respectively. In 58% of patients, a pathogen was detected (Staphylococcus aureus, Streptococcus pyogenes and Streptococcus pneumoniae being most common). Blood and tissue culture were positive in 41 and 86% for OM patients and in 14 and 41%, respectively, for SA patients. In 42% of patients, no pathogen was identified, of which 40% had no material for blood or tissue culture/NAT taken. CONCLUSION Optimal use of imaging modalities including MRI and systematic pathogen detection including NAT should be advocated to limit use of broad spectrum antibiotics and treatment duration. What is Known: • Magnetic resonance imaging and sonography have the best sensitivity for detection of acute osteomyelitis and septic arthritis in children. • Systematic use of blood cultures, tissue cultures and nucleic acid testing improves pathogen detection in children with acute osteomyelitis and septic arthritis. What is New: • The added value of imaging modalities other than magnetic resonance and sonography for detection of osteomyelitis and septic arthritis is limited, and their routine use should be questioned. • Despite availability of optimal pathogen detection methods, missed opportunities to improve pathogen detection are frequent.
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Affiliation(s)
- Nora Manz
- Infectious Diseases Unit, University of Basel Children's Hospital, Basel, Switzerland
| | - Andreas H Krieg
- Orthopaedic Unit, University of Basel Children's Hospital, Basel, Switzerland
| | - Ulrich Heininger
- Infectious Diseases Unit, University of Basel Children's Hospital, Basel, Switzerland
| | - Nicole Ritz
- Infectious Diseases Unit, University of Basel Children's Hospital, Basel, Switzerland.
- Paediatric Pharmacology, University of Basel Children's Hospital, Basel, Switzerland.
- Department of Paediatrics, The University of Melbourne, and Infectious Diseases Unit, Royal Children's Hospital Melbourne, Parkville, Australia.
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