Kingella kingae is increasingly recognized as a pathogen of osteoarticular infections (OAI) below the age of 2 years. It was reported that bones and joints which are rarely infected by other pathogens were frequently invaded by K. kingae. Based on a series of six cases, we present the typical clinical and paraclinical manifestation of K. kingae infections of the sternum and sterno-manubrial joint.
A review of the clinical, laboratory, radiological, microbiological, and molecular data of six consecutive children admitted to a paediatric unit for OAI of the sternum was done.
Culture alone allowed for the detection of K. kingae as the responsible pathogen in three cases, molecular methods in the three other cases. Clinical and laboratory findings, as well as imaging methods, proved to be useful in the diagnostic process.
Our findings suggest that infections of the lower sternum and the junction between the manubrium and the xyphoid process are typical, if not pathognomonic, for the organism. A respective diagnostic and therapeutic protocol was established.
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"CT-scan has a greater sensitivity in precising the extension of the infection, especially retrosternal or mediastinal abscess and bone irregularities, but is performed under general anaesthesia in infants and should be considered only if ultrasound evaluation does not provide sufficient information for accurate diagnosis [5, 6]. The most common microorganism found in osteoarticular infections is Staphylococcus aureus, while Streptococcus pneumoniae and Kingella kingae are also found in infants especially between the ages of 2 months and 5 years [3, 7, 8]. Therefore, antibiotics against Staphylococcus aureus should be the empiric treatment of first choice . "
[Show abstract][Hide abstract]ABSTRACT: Primary arthritis of chondrosternal joint is very rare and occurs in infants less than 18 months of age. Presentation is most often subacute but may be acute. Child presents with a parasternal mass with history of fever and/or local signs of infection. Clinical symptoms vary from a painless noninflammatory to a painful mass with local tenderness and swelling, while fever may be absent. Laboratory data show low or marginally raised levels of white blood cells and C-reactive protein, reflecting, respectively, the subacute or acute character of the infection. It is a self-limiting affection due to the adequate immune response of the patient. Evolution is generally good without antibiotherapy with a progressive spontaneous healing. A wait-and-see approach with close follow-up in the first weeks is the best therapeutic option.
[Show abstract][Hide abstract]ABSTRACT: As a result of the use of blood culture vials for seeding joint and bone exudates, and the development of nucleic acid amplification methods, Kingella kingae is being increasingly recognized as an emerging invasive pathogen and the most common etiology of septic arthritis in children aged 6-36 months. K. kingae is carried asymptomatically in the pharynx, and is transmitted from child-to-child by close contact between family members and playmates. K. kingae organisms enter the bloodstream through breaches in the respiratory mucosa and disseminate to remote sites. Skeletal system infections are the most common presentations of K. kingae disease, followed by bacteremia, pneumonia and endocarditis. Children with invasive K. kingae infections frequently show a mild clinical picture and normal acute-phase reactants, requiring a high index of suspicion. The organism is usually susceptible to antibiotics and, with the exception of endocarditis cases, most patients promptly respond to adequate antimicrobial therapy with no permanent sequelae.
No preview · Article · Jun 2010 · Pediatric Health
[Show abstract][Hide abstract]ABSTRACT: Klebsiella oxytoca is known to be a pathogen in immunodeficient adults and children. Here we report the first case of a K. oxytoca infection associated with spontaneous arthritis of the knee in a child with no history of immunosuppressive therapy or previous
bacterial infections. Despite an initial antibiotic treatment failure, a second treatment led to a cure of the infection with
no joint sequelae.
Full-text · Article · Aug 2010 · Journal of clinical microbiology