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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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Yagupsky P. Changing aetiology of paediatric septic arthritis. J Paediatr Child Health 2021; 57:1560-1563. [PMID: 34259365 DOI: 10.1111/jpc.15654] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 11/30/2022]
Abstract
The management of septic arthritis in children requires the prompt administration of antibiotic therapy and the identification of the causative pathogen. In the past, Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae and Haemophilus influenzae type b were considered the main causative agents of the disease, but a substantial fraction of presumptive joint infections remained unconfirmed by conventional bacteriologic cultures. In the last two decades, our knowledge of the aetiology of paediatric infectious arthritis has substantially changed as the result of the implementation of vaccination programmes against H. influenzae type b and pneumococci, and by the use of improved detection methods. In 1988, the inoculation of synovial fluid aspirates into blood culture vials revealed that Kingella kingae, a commensal member of the oropharyngeal microbiota, was the prime aetiology of skeletal system infections in children aged 6-48 months. The clinical presentation of K. kingae arthritis is subtle, and the disease is frequently missed by classic clinical and laboratory diagnostic criteria. Many children are afebrile, the acute phase reactants levels and the white blood cell counts in the blood and synovial fluid specimens are frequently normal, requiring a high clinical acumen. Increasing use of sensitive molecular methods in recent years, and particularly nucleic acid amplification tests that target K. kingae-specific genes, has further improved the detection of this elusive pathogen, demonstrated that it is responsible for 30-93% of all cases of septic arthritis below 4 years of age and reduced the fraction of culture-negative infections.
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Affiliation(s)
- Pablo Yagupsky
- Clinical Microbiology Laboratory, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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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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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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Juchler C, Spyropoulou V, Wagner N, Merlini L, Dhouib A, Manzano S, Tabard-Fougère A, Samara E, Ceroni D. The Contemporary Bacteriologic Epidemiology of Osteoarticular Infections in Children in Switzerland. J Pediatr 2018; 194:190-196.e1. [PMID: 29263015 DOI: 10.1016/j.jpeds.2017.11.025] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 11/01/2017] [Accepted: 11/13/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To assess the contemporary bacteriologic epidemiology of pediatric osteoarticular infection with particular regard to children's ages, because Kingella kingae has gained increasing recognition as the predominant pathogen for osteoarticular infection in young children. STUDY DESIGN Retrospective file review of enrolled children from 0 to 15 years of age, admitted to our institution from 2007 to 2015 for suspected osteoarticular infection (217 cases). Information on age, sex, the bone or joint infected, imaging studies, and laboratory data (including bacterial investigations) were collected for analysis. RESULTS Microorganism identification was possible for 138 infected children (63.6%), through blood (cultures or polymerase chain reaction [PCR]) and/or operative samples (cultures or PCR). Thirty-one patients (14.3%) were found to both have positive blood cultures and operative samples. The results of positive bacteriology specimens identified the most common causative pathogen for osteoarticular infection as K kingae (47.8% of microbiologically confirmed osteoarticular infections of all ages, and 87.7% in children between the ages of 6 and 48 months), significantly more common than Staphylococcus aureus (35.5% of microbiologically confirmed osteoarticular infections of all ages, and 78.2% in children >4 years of age). CONCLUSIONS Use of the appropriate PCR assays demonstrated that K kingae currently is the major bacterial cause of pediatric osteoarticular infection, especially in children <4 years of age in whom K kingae is more common than S aureus. PCR assays should be used in routine microbiologic laboratory evaluation to improve diagnostic performance. However, despite the use of molecular methods, there are many osteoarticular infections in which no microorganism is detected, which suggests that these infections may be caused by other as yet unrecognized fastidious microorganisms.
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Affiliation(s)
- Céline Juchler
- Pediatric Surgery Service, Geneva University Hospitals, Geneva 14, Switzerland
| | | | - Noémie Wagner
- Pediatric Service, Geneva University Hospitals, Geneva 14, Switzerland
| | - Laura Merlini
- Department of Radiology, Geneva University Hospitals, Geneva 14, Switzerland
| | - Amira Dhouib
- Department of Radiology, Geneva University Hospitals, Geneva 14, Switzerland
| | - Sergio Manzano
- Pediatric Emergency Service, Geneva University Hospitals, Geneva 14, Switzerland
| | - Anne Tabard-Fougère
- Pediatric Orthopedic Service, Geneva University Hospitals, Geneva 14, Switzerland.
| | - Eleftheria Samara
- Pediatric Orthopedic Service, Geneva University Hospitals, Geneva 14, Switzerland
| | - Dimitri Ceroni
- Pediatric Orthopedic Service, Geneva University Hospitals, Geneva 14, Switzerland
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Abstract
In children, greater than 95% of Kingella kingae infections are diagnosed between 6 and 48 months of age. K. kingae has not been systematically investigated, especially in older children. We describe a case of spondylodiscitis by K. kingae in an 8-year-old child.
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Affiliation(s)
- Romain Basmaci
- Service de Pédiatrie-Urgences (Basmaci), Hôpital Louis-Mourier, Colombes, France; IAME (Basmaci, Bonacorsi), Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Service de Microbiologie (Bonacorsi), Hôpital Robert-Debré, Centre National de Référence associé Escherichia coli, Paris, France
| | - Stéphane Bonacorsi
- Service de Pédiatrie-Urgences (Basmaci), Hôpital Louis-Mourier, Colombes, France; IAME (Basmaci, Bonacorsi), Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Service de Microbiologie (Bonacorsi), Hôpital Robert-Debré, Centre National de Référence associé Escherichia coli, Paris, France
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Yagupsky P. DiagnosingKingella kingaeinfections in infants and young children. Expert Rev Anti Infect Ther 2017; 15:925-934. [DOI: 10.1080/14787210.2017.1381557] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Pablo Yagupsky
- Clinical Microbiology Laboratory, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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de Knegt VE, Kristiansen GQ, Schønning K. Evaluation of dual target-specific real-time PCR for the detection of Kingella kingae in a Danish paediatric population. Infect Dis (Lond) 2017; 50:200-206. [PMID: 28914110 DOI: 10.1080/23744235.2017.1376254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND We aimed to evaluate the relevance of dual target real-time polymerase chain (PCR) assays targeting the rtxA and cpn60 genes of the paediatric pathogen Kingella kingae. We also studied for the first time the clinical and epidemiological features of K. kingae infections in a Danish population. METHOD Children with K. kingae-positive cultures were identified from 11,477 children and 86 children younger than 16 years old from whom blood cultures and joint fluid cultures were obtained between January 2010 and November 2016. Results were then compared to microbiological results obtained from 29 joint fluids (28 children) tested by dual target K. kingae real-time PCR from September 2014 to November 2016. Epidemiological data of all children with microbiologically confirmed K. kingae infections were collected. RESULTS From 2010 to 2016, we diagnosed 17 children with microbiological-proven K. kingae infections. During this period, blood cultures from five children and joint fluid cultures from a single child yielded K. kingae. Dual target K. kingae real-time PCR allowed us to increase the diagnostic yield of K. kingae infections by detecting the organism in 12 of 29 (41.4%) specimens. Notably, the 12 real-time PCR-positive specimens were rtxA-positive whereas only 10 (83.3%) were cpn60-positive. PCR-positive children were significantly younger than PCR-negative children (p-value: .01). A significant seasonal variation was found for patients with proven K. kingae infection (p-value: <.001), with a peak in autumn. CONCLUSION Dual target-specific real-time PCR markedly improved the detection of K. kingae in clinical specimens when compared to culture methods.
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Affiliation(s)
| | - Gitte Qvist Kristiansen
- a Department of Clinical Microbiology , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark
| | - Kristian Schønning
- a Department of Clinical Microbiology , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark.,b Department of Clinical Medicine , University of Copenhagen , Copenhagen , Denmark
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Starr KF, Porsch EA, Seed PC, Heiss C, Naran R, Forsberg LS, Amit U, Yagupsky P, Azadi P, St. Geme JW. Kingella kingae Expresses Four Structurally Distinct Polysaccharide Capsules That Differ in Their Correlation with Invasive Disease. PLoS Pathog 2016; 12:e1005944. [PMID: 27760194 PMCID: PMC5070880 DOI: 10.1371/journal.ppat.1005944] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 09/21/2016] [Indexed: 02/03/2023] Open
Abstract
Kingella kingae is an encapsulated gram-negative organism that is a common cause of osteoarticular infections in young children. In earlier work, we identified a glycosyltransferase gene called csaA that is necessary for synthesis of the [3)-β-GalpNAc-(1→5)-β-Kdop-(2→] polysaccharide capsule (type a) in K. kingae strain 269-492. In the current study, we analyzed a large collection of invasive and carrier isolates from Israel and found that csaA was present in only 47% of the isolates. Further examination of this collection using primers based on the sequence that flanks csaA revealed three additional gene clusters (designated the csb, csc, and csd loci), all encoding predicted glycosyltransferases. The csb locus contains the csbA, csbB, and csbC genes and is associated with a capsule that is a polymer of [6)-α-GlcpNAc-(1→5)-β-(8-OAc)Kdop-(2→] (type b). The csc locus contains the cscA, cscB, and cscC genes and is associated with a capsule that is a polymer of [3)-β-Ribf-(1→2)-β-Ribf-(1→2)-β-Ribf-(1→4)-β-Kdop-(2→] (type c). The csd locus contains the csdA, csdB, and csdC genes and is associated with a capsule that is a polymer of [P-(O→3)[β-Galp-(1→4)]-β-GlcpNAc-(1→3)-α-GlcpNAc-1-] (type d). Introduction of the csa, csb, csc, and csd loci into strain KK01Δcsa, a strain 269-492 derivative that lacks the native csaA gene, was sufficient to produce the type a capsule, type b capsule, type c capsule, and type d capsule, respectively, indicating that these loci are solely responsible for determining capsule type in K. kingae. Further analysis demonstrated that 96% of the invasive isolates express either the type a or type b capsule and that a disproportionate percentage of carrier isolates express the type c or type d capsule. These results establish that there are at least four structurally distinct K. kingae capsule types and suggest that capsule type plays an important role in promoting K. kingae invasive disease.
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Affiliation(s)
- Kimberly F. Starr
- Department of Pediatrics and Department of Molecular Genetics and Microbiology, Duke University Medical Center, Durham, NC
| | - Eric A. Porsch
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Patrick C. Seed
- Department of Pediatrics and Department of Molecular Genetics and Microbiology, Duke University Medical Center, Durham, NC
| | - Christian Heiss
- Complex Carbohydrate Research Center, University of Georgia, Athens, GA
| | - Radnaa Naran
- Complex Carbohydrate Research Center, University of Georgia, Athens, GA
| | - L. Scott Forsberg
- Complex Carbohydrate Research Center, University of Georgia, Athens, GA
| | - Uri Amit
- Radiation Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Pablo Yagupsky
- Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Parastoo Azadi
- Complex Carbohydrate Research Center, University of Georgia, Athens, GA
| | - Joseph W. St. Geme
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- * E-mail:
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The Clinical Usefulness of Polymerase Chain Reaction as a Supplemental Diagnostic Tool in the Evaluation and the Treatment of Children With Septic Arthritis. J Pediatr Orthop 2016; 36:167-72. [PMID: 25887824 DOI: 10.1097/bpo.0000000000000411] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Culture-negative septic arthritis occurs frequently in children. The supplemental use of polymerase chain reaction (PCR) techniques improves the detection of bacteria in the joint fluid. This study evaluates the clinical utility of PCR at a tertiary pediatric medical center. METHODS Children with septic arthritis were studied prospectively from 2012 to 2014. Culture results and clinical infection parameters were recorded. PCR was performed whenever sufficient fluid was available from the joint aspiration. A statistical comparison was made for the rates of identification of the causative organism by these methods. A subgroup analysis was performed to assess the correspondence of clinical and laboratory parameters with the results of joint fluid culture and PCR. RESULTS Ninety-nine children with septic arthritis were enrolled consecutively. A broad range of parameter results was identified among these children with an average of 3.6 of 6 parameters per child that met thresholds of infection. Joint fluid cultures were positive in 34 of 97 (35.1%) children from whom they were sent. Among the 68 children from whom the material was sent for PCR, the result was positive in 32 (47.1%). The combination of blood culture, joint fluid culture, and PCR resulted in bacterial detection in 49 of 97 (50.5%) children. PCR improved the rate of detection of Kingella kingae markedly when compared with joint fluid culture. PCR results were available at an average of 14.6 days after the acquisition of joint fluid. 16S PCR results were reported at an average of 17.5 days, whereas Kingella PCR took 5.1 days. DISCUSSION PCR provides supplemental information for diagnostic confirmation through an increased rate of detection of bacteria. The timing of results and the inability to provide antibiotic sensitivity are factors that limit its clinical usefulness currently.
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Abstract
Kingella kingae is a common etiology of pediatric bacteremia and the leading agent of osteomyelitis and septic arthritis in children aged 6 to 36 months. This Gram-negative bacterium is carried asymptomatically in the oropharynx and disseminates by close interpersonal contact. The colonized epithelium is the source of bloodstream invasion and dissemination to distant sites, and certain clones show significant association with bacteremia, osteoarthritis, or endocarditis. Kingella kingae produces an RTX (repeat-in-toxin) toxin with broad-spectrum cytotoxicity that probably facilitates mucosal colonization and persistence of the organism in the bloodstream and deep body tissues. With the exception of patients with endocardial involvement, children with K. kingae diseases often show only mild symptoms and signs, necessitating clinical acumen. The isolation of K. kingae on routine solid media is suboptimal, and detection of the bacterium is significantly improved by inoculating exudates into blood culture bottles and the use of PCR-based assays. The organism is generally susceptible to antibiotics that are administered to young patients with joint and bone infections. β-Lactamase production is clonal, and the local prevalence of β-lactamase-producing strains is variable. If adequately and promptly treated, invasive K. kingae infections with no endocardial involvement usually run a benign clinical course.
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Affiliation(s)
- Pablo Yagupsky
- Clinical Microbiology Laboratory, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Levy PY, Fournier PE, Fenollar F, Raoult D. Systematic PCR detection in culture-negative osteoarticular infections. Am J Med 2013; 126:1143.e25-33. [PMID: 24135511 DOI: 10.1016/j.amjmed.2013.04.027] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 04/29/2013] [Accepted: 04/30/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Identification of microorganisms is crucial for the successful treatment of osteoarticular infections. Molecular methods are more sensitive than culture-dependent methods but may suffer from lack of specificity. METHODS We studied a large series of 3840 bone and joint culture-negative samples collected from 2308 patients hospitalized in Marseille University Hospitals from November 2007 to October 2009. The samples were systematically cultured for 15 days, and conventional broad-range polymerase chain reaction (PCR) (16S rDNA and 18S rDNA) as well as real-time PCR assays targeting human Bglobin, Staphylococcus aureus, and Kingella kingae were realized on one culture-negative specimen. RESULTS Specimens from 741 patients (32.1%) tested positive by culture, including 38 in which bacteria grew only after 6 days of incubation. PCR was positive in 141 (9%) culture-negative specimens. Microorganisms identified by PCR were classified into 2 groups: fastidious bacteria (n = 35), mostly anaerobes in adult patients, and K. kingae in children; and nonfastidious bacteria (n = 106), mostly S. aureus (32.7%). A discrepancy between a positive PCR result for S. aureus and a negative culture were explained by previous antibiotherapy in 31.4% of cases. Our study highlights the usefulness of systematic 16S rDNA gene PCR for the diagnosis of bone and joint infections in culture-negative patients, thus enabling the administration of specific antibiotic treatments. CONCLUSIONS We recommend the use of conventional broad-range PCR for culture-negative bone and joint specimens, as well as S. aureus-specific PCR for adults and K. kingae-specific PCR for children. 18S rDNA PCR should be reserved only for specific cases.
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Affiliation(s)
- Pierre-Yves Levy
- Faculté de Médecine, Aix-Marseille Université, Marseille, France
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15
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Ceroni D, Dubois-Ferrière V, Cherkaoui A, Lamah L, Renzi G, Lascombes P, Wilson B, Schrenzel J. 30 years of study of Kingella kingae: post tenebras, lux. Future Microbiol 2013; 8:233-45. [DOI: 10.2217/fmb.12.144] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Kingella kingae is a Gram-negative bacterium that is today recognized as the major cause of joint and bone infections in young children. This microorganism is a member of the normal flora of the oropharynx, and the carriage rate among children under 4 years of age is approximately 10%. K. kingae is transmitted from child to child through close personal contact. Key virulence factors of K. kingae include expression of type IV pili, Knh-mediated adhesive activity and production of a potent RTX toxin. The clinical presentation of K. kingae invasive infection is often subtle and may be associated to mild-to-moderate biologic inflammatory responses, highlighting the importance a high index of suspicion. Molecular diagnosis of K. kingae infections by nucleic acid amplification techniques enables identification of this fastidious microorganism. Invasive infections typically respond favorably to medical treatment, with the exception of cases of endocarditis, which may require urgent valve replacement.
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Affiliation(s)
- Dimitri Ceroni
- Paediatric Orthopaedic Service, University of Geneva Hospitals, 6 Rue Willy-Donzé, 1211 Geneva 14, Switzerland
| | - Victor Dubois-Ferrière
- Paediatric Orthopaedic Service, University of Geneva Hospitals, 6 Rue Willy-Donzé, 1211 Geneva 14, Switzerland
| | - Abdessalam Cherkaoui
- Clinical Microbiology Laboratory, Service of Infectious Diseases, University of Geneva Hospitals, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland
| | - Léopold Lamah
- Paediatric Orthopaedic Service, University of Geneva Hospitals, 6 Rue Willy-Donzé, 1211 Geneva 14, Switzerland
| | - Gesuele Renzi
- Clinical Microbiology Laboratory, Service of Infectious Diseases, University of Geneva Hospitals, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland
| | - Pierre Lascombes
- Paediatric Orthopaedic Service, University of Geneva Hospitals, 6 Rue Willy-Donzé, 1211 Geneva 14, Switzerland
| | - Belaieff Wilson
- Paediatric Orthopaedic Service, University of Geneva Hospitals, 6 Rue Willy-Donzé, 1211 Geneva 14, Switzerland
| | - Jacques Schrenzel
- Clinical Microbiology Laboratory, Service of Infectious Diseases, University of Geneva Hospitals, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland
- Genomic Research Laboratory, Service of Infectious Diseases, University of Geneva Hospitals, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland
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Basmaci R, Yagupsky P, Ilharreborde B, Guyot K, Porat N, Chomton M, Thiberge JM, Mazda K, Bingen E, Bonacorsi S, Bidet P. Multilocus sequence typing and rtxA toxin gene sequencing analysis of Kingella kingae isolates demonstrates genetic diversity and international clones. PLoS One 2012; 7:e38078. [PMID: 22693588 PMCID: PMC3365011 DOI: 10.1371/journal.pone.0038078] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 04/30/2012] [Indexed: 12/05/2022] Open
Abstract
Background Kingella kingae, a normal component of the upper respiratory flora, is being increasingly recognized as an important invasive pathogen in young children. Genetic diversity of this species has not been studied. Methods We analyzed 103 strains from different countries and clinical origins by a new multilocus sequence-typing (MLST) schema. Putative virulence gene rtxA, encoding an RTX toxin, was also sequenced, and experimental virulence of representative strains was assessed in a juvenile-rat model. Results Thirty-six sequence-types (ST) and nine ST-complexes (STc) were detected. The main STc 6, 14 and 23 comprised 23, 17 and 20 strains respectively, and were internationally distributed. rtxA sequencing results were mostly congruent with MLST, and showed horizontal transfer events. Of interest, all members of the distantly related ST-6 (n = 22) and ST-5 (n = 4) harboured a 33 bp duplication or triplication in their rtxA sequence, suggesting that this genetic trait arose through selective advantage. The animal model revealed significant differences in virulence among strains of the species. Conclusion MLST analysis reveals international spread of ST-complexes and will help to decipher acquisition and evolution of virulence traits and diversity of pathogenicity among K. kingae strains, for which an experimental animal model is now available.
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Affiliation(s)
- Romain Basmaci
- Univ Paris Diderot, Sorbonne Paris Cité, EA 3105, Paris, France
- AP-HP, Laboratoire de Microbiologie, Hôpital Robert-Debré, Paris, France
| | - Pablo Yagupsky
- Clinical Microbiology Laboratory, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Brice Ilharreborde
- Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
- AP-HP, Service de Chirurgie Orthopédique, Hôpital Robert-Debré, Paris, France
| | - Kathleen Guyot
- Univ Paris Diderot, Sorbonne Paris Cité, EA 3105, Paris, France
| | - Nurith Porat
- Pediatric Infectious Disease Unit, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Marilyn Chomton
- Univ Paris Diderot, Sorbonne Paris Cité, EA 3105, Paris, France
- AP-HP, Laboratoire de Microbiologie, Hôpital Robert-Debré, Paris, France
| | - Jean-Michel Thiberge
- Plate-Forme Génotypage des Pathogènes et Santé Publique, Institut Pasteur, Paris, France
| | - Keyvan Mazda
- Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
- AP-HP, Service de Chirurgie Orthopédique, Hôpital Robert-Debré, Paris, France
| | - Edouard Bingen
- Univ Paris Diderot, Sorbonne Paris Cité, EA 3105, Paris, France
- AP-HP, Laboratoire de Microbiologie, Hôpital Robert-Debré, Paris, France
| | - Stéphane Bonacorsi
- Univ Paris Diderot, Sorbonne Paris Cité, EA 3105, Paris, France
- AP-HP, Laboratoire de Microbiologie, Hôpital Robert-Debré, Paris, France
- * E-mail:
| | - Philippe Bidet
- Univ Paris Diderot, Sorbonne Paris Cité, EA 3105, Paris, France
- AP-HP, Laboratoire de Microbiologie, Hôpital Robert-Debré, Paris, France
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Kingella kingae infections in children: an update. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2012; 719:67-80. [PMID: 22125036 DOI: 10.1007/978-1-4614-0204-6_7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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18
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Abstract
Kingella kingae is being recognized increasingly as a common etiology of pediatric osteoarticular infections, bacteremia, and endocarditis, which reflects improved culture methods and use of nucleic acid-amplification techniques in clinical microbiology laboratories. K kingae colonizes the posterior pharynx of young children and is transmitted from child to child through close personal contact. Day care attendance increases the risk for colonization and transmission, and clusters of K kingae infections among day care center attendees have been reported. Key virulence factors in K kingae include type IV pili and a potent RTX toxin. In previously healthy children, >95% of K kingae infections are diagnosed between the ages of 6 and 48 months. Among children with underlying medical conditions, K kingae disease may occur at older ages as well. The clinical presentation of K kingae disease is often subtle and may be associated with normal levels of acute-phase reactants, which underscores the importance of a high index of suspicion. K kingae is usually susceptible to ß-lactam antibiotics, and infections typically respond well to medical treatment, with the exception of cases of endocarditis.
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Affiliation(s)
- Pablo Yagupsky
- Clinical Microbiology Laboratory, Soroka University Medical Center, Ben-Gurion University of Negev, Beer-Sheva 84101, Israel.
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19
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The rtxA toxin gene of Kingella kingae: a pertinent target for molecular diagnosis of osteoarticular infections. J Clin Microbiol 2011; 49:1245-50. [PMID: 21248099 DOI: 10.1128/jcm.01657-10] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Kingella kingae is an emerging osteoarticular pathogen in young children. Its isolation by traditional culture methods remains difficult, underscoring the need to implement other diagnostic methods for its detection and identification, such as nucleic acid amplification tests. Although the genome of this bacterium has not yet been sequenced, a toxin named RTX has been identified. The goal of this study was to develop sensitive, specific, and rapid molecular methods based on the rtxA toxin gene sequence to diagnose this infection. Two real-time PCR assays (SYBR green and TaqMan chemistries) targeting this gene are reported. Sensitivity and specificity were first evaluated successfully with 67 strains: 31 Kingella kingae isolates and 36 strains from other bacterial species. Then, 52 clinical specimens positive or negative by culture and/or PCR (16S rRNA and cpn60 genes) were tested with these assays. A nested PCR assay with subsequent sequencing was also developed to confirm the presence of Kingella kingae isolates in these clinical specimens. The results obtained demonstrate that these assays are accurate for the diagnosis of Kingella kingae infection.
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20
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Kingella kingae osteoarticular infections in young children: clinical features and contribution of a new specific real-time PCR assay to the diagnosis. J Pediatr Orthop 2010; 30:301-4. [PMID: 20357599 DOI: 10.1097/bpo.0b013e3181d4732f] [Citation(s) in RCA: 164] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Kingella kingae is an emerging pathogen that may be recognized as the most common bacteria responsible for osteoarticular infections (OAI) in young children. However, its diagnosis remains a challenge and thus little evoked in infants, because K. kingae is a difficult germ to isolate on solid medium, and clinical signs are often mild. The main objective of this prospective study is to describe the clinical, biologic, and radiologic features of children with OAI caused by K. kingae. In addition, we describe the usage of a new specific real-time PCR assay in children under 4 years admitted for OAI with a probe that detects 2 independent gene targets from the K. kingae RTX toxin. PATIENTS AND METHODS All children less than 4 years admitted in our institution between January 2007 and November 2009 for suspected OAI were enrolled in this prospective study (43 cases). Age, gender, clinical signs, duration of symptoms, bone or joint involved, imaging studies, and laboratory data, including bacterial investigations, full blood count, erythrocyte sedimentation rate, and serum C-reactive protein were collected for analysis. RESULTS Identification of the microorganism was possible for 28 cases (65.1%) yielding K. kingae in 23 cases (82.1%). Mean age of children with K. kingae OAI was 19.6 months. Less than 15% of these patients were febrile during the admission, but 46% of them presented a history of fever-peak superior to 38.5 degrees C before admission. Thirty-nine percent of the children with K. kingae OAI had normal C-reactive protein; WBC was elevated in only 2 cases, whereas 21 patients had abnormal erythrocyte sedimentation rate, and 13 abnormal platelet counts. Direct Gram staining and classical isolation methods were negative for all cases subsequently detected as K. kingae OAI by specific real-time PCR. CONCLUSION This study confirms that K. kingae is the major bacterial cause of OAI in children less than 4 years. The real-time PCR assay, specific to the K. kingae RTX toxin, provides interesting diagnostic performance when implemented in the routine microbiologic laboratory. Needless to say, a bigger cohort is required to adequately study this new qPCR assay, but the results so far seem promising. The most important additional finding is the mild-to-moderate clinical, radiologic, and biologic inflammatory response to K. kingae infection with the result that these children present few criteria evocative of OAI. LEVEL OF EVIDENCE II.
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21
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Ceroni D, Cherkaoui A, Kaelin A, Schrenzel J. Kingella kingae spondylodiscitis in young children: toward a new approach for bacteriological investigations? A preliminary report. J Child Orthop 2010; 4:173-5. [PMID: 21455474 PMCID: PMC2839857 DOI: 10.1007/s11832-009-0233-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 12/17/2009] [Indexed: 02/03/2023] Open
Abstract
As the result of improved bacteriological techniques, Kingella kingae is a slow-growing Gram-negative coccobacillus that is emerging as an important cause of spondylodiscitis in children younger than 3 years of age. The high pharyngeal carrier rates of this slow-growing Gram-negative coccobacillus combined with the low incidence of identified K. kingae infections is possibly explained by a low virulence of this bacterium. The use of specific real-time polymerase chain reaction (PCR) on blood samples and throat swabs opens new prospects in the bacteriological investigations of young children suspected to have spondylodiscitis, an approach that could prevent, in the future, unnecessary invasive interventions.
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Affiliation(s)
- Dimitri Ceroni
- />Pediatric Orthopedic Service, University Hospital of Geneva, 1211 Geneva 14, Switzerland
| | - Abdessalam Cherkaoui
- />Clinical Microbiology Laboratory, Service of Infectious Diseases, University Hospital of Geneva, 1211 Geneva 14, Switzerland
| | - André Kaelin
- />Pediatric Orthopedic Service, University Hospital of Geneva, 1211 Geneva 14, Switzerland
| | - Jacques Schrenzel
- />Clinical Epidemiology Service, University Hospital of Geneva, 1211 Geneva 14, Switzerland
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New real-time PCR-based method for Kingella kingae DNA detection: application to samples collected from 89 children with acute arthritis. J Clin Microbiol 2009; 47:1837-41. [PMID: 19369442 DOI: 10.1128/jcm.00144-09] [Citation(s) in RCA: 141] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Inoculation of blood culture vials with joint fluid samples has revealed the important pathogenic role of Kingella kingae in pediatric arthritis. However, recent studies based on broad-range 16S ribosomal DNA PCR and real-time PCR without a probe suggest that conventional methods remain suboptimal. We developed a new real-time PCR method with a probe that is highly specific for K. kingae and applied it to joint fluid samples collected from 89 children with suspected arthritis admitted to our institution during a 2-year period. Real-time PCR was also applied to blood samples obtained before surgery and to joint drainage fluid samples obtained during several days after surgery. Thirty-six (40%) of the 89 cases of suspected septic arthritis had positive culture. Staphylococcus aureus was the main isolate (n = 19/36, 53%), followed by K. kingae (n = 7/36, 19%). Specific real-time PCR identified K. kingae in 24 of the 53 culture-negative cases. Thus, K. kingae was present in 31 (52%) of the 60 documented cases, making it the leading pathogen. Real-time PCR on all 15 blood DNA extracts from patients with K. kingae infection was negative, demonstrating that joint fluid positivity did not result from DNA circulating in blood. Real-time PCR amplification of drainage fluid samples showed that the pathogen could be detected for up to 6 days after antibiotic initiation. K. kingae real-time PCR applied to DNA extracted from joint fluid samples, but not from blood samples, markedly improved the etiological diagnosis of septic arthritis in children. Retrospective diagnosis is feasible for up to 6 days after treatment initiation.
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23
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Usefulness of broad-range PCR for the diagnosis of osteoarticular infections. Curr Opin Rheumatol 2008; 20:463-70. [PMID: 18525362 DOI: 10.1097/bor.0b013e3283032030] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Conventional methods such as microbiological cultures may lack the sensitivity and specificity to establish definitive diagnosis of osteoarticular infections. Herein, we review the general principles and the usefulness of broad-range PCR to improve the etiological diagnosis of osteoarticular infections. RECENT FINDINGS Broad-range PCR followed by sequencing has been successfully developed to identify microorganisms involved in infections when patients have previously received antibiotics or in the presence of slow-growing or intracellular microorganisms. For osteoarticular infections, the studies have shown that the use of this molecular tool increased mainly the identification of Kingella kingae, anaerobic bacteria, and Streptococcus spp. However, it is very important to underline that the interpretation of this molecular tool is critical because of several pitfalls, including contamination causing false-positive results. SUMMARY Broad-range PCR followed by sequencing offers several advantages when used to complement culture results for the diagnosis of fastidious bacteria and for patients taking antibiotics. However, its use should be restricted mainly for culture-negative cases when infection is suspected on the basis of clinical signs and symptoms or inflammatory syndrome. Future developments will include the use of real-time PCR in a closed system and pathogen-specific PCR for the molecular diagnosis of osteoarticular infections.
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Chometon S, Benito Y, Chaker M, Boisset S, Ploton C, Bérard J, Vandenesch F, Freydiere AM. Specific real-time polymerase chain reaction places Kingella kingae as the most common cause of osteoarticular infections in young children. Pediatr Infect Dis J 2007; 26:377-81. [PMID: 17468645 DOI: 10.1097/01.inf.0000259954.88139.f4] [Citation(s) in RCA: 194] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The use of universal 16S rDNA polymerase chain reaction (PCR) has recently shown that the place of Kingella kingae in osteoarticular infections (OAI) in young children has been underestimated, but this technique is not the most sensitive or the most rapid method for molecular diagnosis. We developed a specific real-time PCR method to detect K. kingae DNA and applied it to the etiologic diagnosis of OAI. PATIENTS AND METHODS All children admitted to a pediatric unit for OAI between January 2004 and December 2005 were enrolled in this prospective study. Culture-negative osteoarticular specimens were tested by 16S rDNA PCR and by K. kingae-specific real-time PCR when sufficient sample remained. RESULTS By culture alone, a pathogen was identified in 45% of the 131 specimens tested (Staphylococcus aureus, n = 25; K. kingae, n = 17; others, n = 18). 16S rDNA PCR and K. kingae-specific PCR were both applied to 61 of the culture-negative samples. The combination of culture and 16S rDNA PCR identified a pathogen in 61% of cases (K. kingae DNA, n = 16; DNA of other microorganisms, n = 5). Specific real-time PCR identified a further 6 cases caused by K. kingae and confirmed all 16 universal PCR-positive cases, bringing the overall documentation rate to 66%. K. kingae was the leading cause of OAI in this pediatric series (n = 39, 45%), followed by S. aureus (n = 25, 29%) CONCLUSION The K. kingae-specific real-time PCR places K. kingae as the leading cause of OAI in children at our hospital.
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Affiliation(s)
- Sylvia Chometon
- Laboratoire de Bactériologie, Hôpital Cardiologique Louis Pradel, Lyon, France
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25
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Fenollar F, Roux V, Stein A, Drancourt M, Raoult D. Analysis of 525 samples to determine the usefulness of PCR amplification and sequencing of the 16S rRNA gene for diagnosis of bone and joint infections. J Clin Microbiol 2006; 44:1018-28. [PMID: 16517890 PMCID: PMC1393109 DOI: 10.1128/jcm.44.3.1018-1028.2006] [Citation(s) in RCA: 180] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The 16S rRNA gene PCR in the diagnosis of bone and joint infections has not been systematically tested. Five hundred twenty-five bone and joint samples collected from 525 patients were cultured and submitted to 16S rRNA gene PCR detection of bacteria in parallel. The amplicons with mixed sequences were also cloned. When discordant results were observed, culture and PCR were performed once again. Bacteria were detected in 139 of 525 samples. Culture and 16S rRNA gene PCR yielded identical documentation in 475 samples. Discrepancies were linked to 13 false-positive culture results, 5 false-positive PCR results, 9 false-negative PCR results, 16 false-negative culture results, and 7 mixed infections. Cloning and sequencing of 16S rRNA gene amplicons in 6 of 8 patients with mixed infections identified 2 to 8 bacteria per sample. Rarely described human pathogens such as Alcaligenes faecalis, Comamonas terrigena, and 21 anaerobes were characterized. We also detected, by 16S rRNA gene PCR, four previously identified bacteria never reported in human infection, Alkanindiges illinoisensis, dehydroabietic acid-degrading bacterium DhA-73, unidentified Hailaer soda lake bacterium, and uncultured bacterium clone HuCa4. Seven organisms representing new potential species were also detected. PCR followed by cloning and sequencing may help to identify new pathogens involved in mixed bone infection.
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Affiliation(s)
- Florence Fenollar
- Unité des Rickettsies, CNRS UMR 6020, IFR 48, Faculté de Médecine, Université de la Méditerranée, 27 Boulevard Jean Moulin, 13385 Marseille cedex 05, France
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26
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Verdier I, Gayet-Ageron A, Ploton C, Taylor P, Benito Y, Freydiere AM, Chotel F, Bérard J, Vanhems P, Vandenesch F. Contribution of a broad range polymerase chain reaction to the diagnosis of osteoarticular infections caused by Kingella kingae: description of twenty-four recent pediatric diagnoses. Pediatr Infect Dis J 2005; 24:692-6. [PMID: 16094222 DOI: 10.1097/01.inf.0000172153.10569.dc] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Microbiologic diagnosis of septic arthritis and osteomyelitis in children is hindered by the less than optimal yield of blood and osteoarticular fluid cultures. PATIENTS AND METHODS All patients admitted to a pediatric unit for osteoarticular infections (OAI) between January 2001 and February 2004 were enrolled in this prospective study. Osteoarticular fluid and biopsy samples that were negative by conventional culture were tested by polymerase chain reaction (PCR) with universal 16S ribosomal DNA primers. RESULTS We enrolled 171 children. Culture was positive in 64 cases (37.4%), yielding Kingella kingae in 9 cases. The 107 culture-negative specimens were tested by 16S ribosomal DNA PCR. Fifteen samples (14%) were positive, all for Kingella DNA sequences. K. kingae was the second cause of OAI in this population (30.4%), after Staphylococcus aureus (38%). Patients with Kingella infection diagnosed by culture (9 cases) did not differ from those diagnosed by PCR (15 cases) in terms of their clinical characteristics (including prior antibiotic therapy). The characteristics of the 24 children with arthritis (n = 17) or osteomyelitis (n = 7) were similar to those reported elsewhere. Fever (>38 degrees C) and symptom onset shortly before hospitalization (median, 4.5 days) were significantly associated with arthritis. CONCLUSION Use of molecular diagnostic methods increases the identification of K. kingae in osteoarticular infections.
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Affiliation(s)
- Isabelle Verdier
- Laboratoire de Bactériologie, Hôpital Cardiologique Louis Pradel, Lyon, France
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Yagupsky P. Kingella kingae: from medical rarity to an emerging paediatric pathogen. THE LANCET. INFECTIOUS DISEASES 2004; 4:358-67. [PMID: 15172344 DOI: 10.1016/s1473-3099(04)01046-1] [Citation(s) in RCA: 162] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In recent years, Kingella kingae has emerged as an important cause of invasive infections in young children, especially septic arthritis, osteomyelitis, spondylodiscitis, bacteraemia, and endocarditis, and less frequently lower respiratory tract infections and meningitis. The organism is part of the pharyngeal flora of young children and is transmitted from child-to-child. The clinical presentation of invasive K kingae disease is often subtle and laboratory tests are frequently normal. A substantial fraction of children with invasive K kingae infections have a recent history of stomatitis or symptoms of upper-respiratory-tract infection. The organism is susceptible to a wide array of antibiotics that are usually given empirically to young children including beta lactams, and with the exception of cases of endocarditis, the disease runs a benign clinical course. Although isolation and recognition of the organism is not difficult, clinicians and microbiologists should be aware of its fastidious nature. To optimise the recovery of K kingae, inoculation of synovial fluid specimens into blood culture vials is strongly recommended.
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Affiliation(s)
- Pablo Yagupsky
- Clinical Microbiology Laboratories, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Moumile K, Merckx J, Glorion C, Berche P, Ferroni A. Osteoarticular infections caused by Kingella kingae in children: contribution of polymerase chain reaction to the microbiologic diagnosis. Pediatr Infect Dis J 2003; 22:837-9. [PMID: 14515832 DOI: 10.1097/01.inf.0000083848.93457.e7] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Kaoutar Moumile
- Laboratoire de Microbiologie, Hôpital Necker-Enfants Malades, Paris, France
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29
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Gubler JG, Schorr M, Gaia V, Zbinden R, Altwegg M. Recurrent soft tissue abscesses caused by Legionella cincinnatiensis. J Clin Microbiol 2001; 39:4568-70. [PMID: 11724886 PMCID: PMC88590 DOI: 10.1128/jcm.39.12.4568-4570.2001] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Recurrent soft tissue abscesses of the jaw, wrist, and arm developed in a 73-year-old housewife with nephrotic syndrome and immunoglobulin A(kappa) gammopathy of unknown etiology. Conventional cultures remained negative, despite visible gram-negative rods on microscopy. Broad-spectrum PCR revealed Legionella cincinnatiensis, which was confirmed by isolation of the organism on special Legionella medium. Infections due to Legionella species outside the lungs are rare. L. cincinnatiensis has been implicated in only four cases of clinical infection; these involved the lungs in three patients and the central nervous system in one patient. We conclude that broad-spectrum PCR can be a valuable tool for the evaluation of culture-negative infections with a high probability of bacterial origin and that Legionella might be an underdiagnosed cause of pyogenic soft tissue infection.
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Affiliation(s)
- J G Gubler
- Department of Medicine, Stadtspital Triemli, CH-8063 Zürich, Switzerland.
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30
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Abstract
Whipple's disease is a rare bacterial infection that may involve any organ system in the body. It occurs primarily in Caucasian males older than 40 years. The gastrointestinal tract is the most frequently involved organ, with manifestations such as abdominal pain, malabsorption syndrome with diarrhea, and weight loss. Other signs include low-grade fever, lymphadenopathy, skin hyperpigmentation, endocarditis, pleuritis, seronegative arthritis, uveitis, spondylodiscitis, and neurological manifestations, and these signs may occur in the absence of gastrointestinal manifestations. Due to the wide variability of manifestations, clinical diagnosis is very difficult and is often made only years or even decades after the initial symptoms have appeared. Trimethoprim-sulfamethoxazole for at least 1 year is usually considered adequate to eradicate the infection. The microbiological diagnosis of this insidious disease is rendered difficult by the virtual lack of culture and serodiagnostic methods. It is usually based on the demonstration of periodic acid-Schiff-positive particles in infected tissues and/or the presence of bacteria with an unusual trilaminar cell wall ultrastructure by electron microscopy. Recently, the Whipple bacteria have been characterized at the molecular level by amplification of their 16S rRNA gene(s). Phylogenetic analysis of these sequences revealed a new bacterial species related to the actinomycete branch which was named "Tropheryma whippelli." Based on its unique 16S ribosomal DNA (rDNA) sequence, species-specific primers were selected for the detection of the organism in clinical specimens by PCR. This technique is currently used as one of the standard methods for establishing the diagnosis of Whipple's disease. Specific and broad-spectrum PCR amplifications mainly but not exclusively from extraintestinal specimens have significantly improved diagnosis, being more sensitive than histopathologic analysis. However, "T. whippelii" DNA has also been found in persons without clinical and histological evidence of Whipple's disease. It is unclear whether these patients are true asymptomatic carriers or whether differences in virulence exist among strains of "T. whippelii" that might account for the variable clinical manifestations. So far, six different "T. whippelii" subtypes have been found by analysis of their 16S-23S rDNA spacer region. Further studies of the pathogen "T. whippelii" as well as the host immune response are needed to fully understand this fascinating disease. The recent cultivation of the organisms is a promising major step in this direction.
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Affiliation(s)
- F Dutly
- Department of Medical Microbiology, University of Zürich, CH-8028 Zürich, Switzerland.
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31
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Fischer-Romero C, Lüthy-Hottenstein J, Altwegg M. Development and evaluation of a broad-range PCR-ELISA assay with Borrelia burgdorferi and Streptococcus pneumoniae as model organisms for reactive arthritis and bacterial meningitis. J Microbiol Methods 2000; 40:79-88. [PMID: 10739346 DOI: 10.1016/s0167-7012(99)00138-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We have developed an assay based on a 16S rDNA broad-range amplification system followed by species-specific detection with a commercially available PCR-ELISA kit. B. burgdorferi and S. pneumoniae were used as model systems for arthritis and meningitis, respectively. The sensitivity of the B. burgdorferi assay was comparable to that of a species-specific PCR, whereas for S. pneumoniae the detection limit was one to three organisms as determined by plate counts. To specifically differentiate two species, two discontinuously located nucleotide differences in the region complementary to the capture probe are required during the detection step with the PCR-ELISA kit. A preliminary clinical evaluation was performed with eight specimens (joint and cerebrospinal fluids) previously shown to contain B. burgdorferi DNA. Except for one sample which was positive by the broad-range PCR-ELISA system only, the results were in agreement with those obtained by B. burgdorferi species-specific PCR. None of the 23 control samples were positive by either method. Thus, broad-range amplification in combination with the PCR-ELISA kit promises to be a sensitive and specific format for the detection of agents causing reactive arthritis, meningitis or other diseases associated with a limited number of different bacteria.
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MESH Headings
- Arthritis, Reactive/diagnosis
- Arthritis, Reactive/microbiology
- Borrelia burgdorferi Group/genetics
- Borrelia burgdorferi Group/isolation & purification
- Colony Count, Microbial
- DNA, Bacterial/analysis
- DNA, Ribosomal/analysis
- Enzyme-Linked Immunosorbent Assay/methods
- Evaluation Studies as Topic
- Humans
- Lyme Disease/diagnosis
- Lyme Disease/microbiology
- Meningitis, Bacterial/diagnosis
- Meningitis, Bacterial/microbiology
- Meningitis, Pneumococcal/diagnosis
- Meningitis, Pneumococcal/microbiology
- Polymerase Chain Reaction/methods
- RNA, Ribosomal, 16S/genetics
- Reagent Kits, Diagnostic
- Sensitivity and Specificity
- Species Specificity
- Streptococcus pneumoniae/genetics
- Streptococcus pneumoniae/isolation & purification
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Affiliation(s)
- C Fischer-Romero
- Department of Medical Microbiology, University of Zürich, Switzerland
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Abstract
OBJECTIVE To increase awareness of Kingella kingae infections in children by presenting four cases seen at the Gold Coast Hospital, Southport, Queensland, and reviewing the literature. METHODOLOGY Records of the four cases were reviewed and relevant information described. A MEDLINE search of the English literature from 1983 to 1998 was conducted. RESULTS Osteoarticular infections are the commonest type of invasive paediatric infection but bacteraemia and endocarditis also occur. Isolation of the organism is difficult but inoculation of the specimen into enriched blood culture systems improves the recovery rate. The majority of isolates are sensitive to beta-lactam antibiotics but resistance has been described. CONCLUSIONS Kingella kingae infections in children are more common than previously recognized. The organism should be actively sought in any child with suspected osteoarticular infections. Recommended empiric therapy is a third generation cephalosporin until susceptibility to penicillin is confirmed.
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Affiliation(s)
- T Dodman
- Department of Paediatrics, Gold Coast Hospital, Southport, Queensland, Australia
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