Display options
Cite
Williams N, Cooper C, Cundy P. Kingella kingae septic arthritis in children: recognising an elusive pathogen. J Child Orthop. 2014;8(1):91-5doi: 10.1007/s11832-014-0549-4.
Williams, N., Cooper, C., & Cundy, P. (2014). Kingella kingae septic arthritis in children: recognising an elusive pathogen. Journal of children's orthopaedics, 8(1), 91-5. https://doi.org/10.1007/s11832-014-0549-4
Williams, Nicole, et al. "Kingella kingae septic arthritis in children: recognising an elusive pathogen." Journal of children's orthopaedics vol. 8,1 (2014): 91-5. doi: https://doi.org/10.1007/s11832-014-0549-4
Williams N, Cooper C, Cundy P. Kingella kingae septic arthritis in children: recognising an elusive pathogen. J Child Orthop. 2014 Feb;8(1):91-5. doi: 10.1007/s11832-014-0549-4. Epub 2014 Jan 23. PMID: 24488842; PMCID: PMC3935026.
Copy Download .nbib Format: NLM
Share it on

J Child Orthop. 2014 Feb;8(1):91-5. doi: 10.1007/s11832-014-0549-4. Epub 2014 Jan 23.

Kingella kingae septic arthritis in children: recognising an elusive pathogen.

Journal of children's orthopaedics

Nicole Williams, Celia Cooper, Peter Cundy

Affiliations

  1. Department of Orthopaedics, Women's and Children's Hospital, 72 King William Rd, North Adelaide, SA, 5006, Australia, [email protected].

PMID: 24488842 PMCID: PMC3935026 DOI: 10.1007/s11832-014-0549-4

Abstract

PURPOSE: Kingella kingae is an increasingly identified cause of musculoskeletal infections in young children. We report our experience with a recently developed polymerase chain reaction (PCR) method and review the clinical course of children diagnosed with K. kingae septic arthritis in a tertiary referral paediatric hospital.

METHODS: All positive cases of K. kingae identified by PCR analysis of synovial fluid from August 2010 until July 2013 were included. A chart review was undertaken to determine history, presentation and management.

RESULTS: 27 Children (14 male, 13 female) had PCR positive synovial fluid samples for K. kingae with median age of 19 months (range 4 months to 5 years 3 months). The sites of infection were knee (17 cases), hip (2 cases), ankle (5 cases), shoulder (2 cases) and elbow. The median temperature on presentation was 37.1 °C, median peripheral white blood cell count 12.4 (9.9-13.8) × 10(9)/L, erythrocyte sedimentation rate 55 (48-60) mm/h and C-reactive protein 24 (8-47) mg/L. The median synovial fluid white cell count was 21.8 (16.7-45.0) × 10(9)/L. Routine cultures identified K. kingae in only two synovial fluid samples. Two samples were additionally positive for Staphylococcus aureus.

CONCLUSIONS: Kingella kingae is a significant cause of septic arthritis in young children. The authors recommend maintaining a high index of suspicion in young children presenting with joint inflammation, especially if indices of infection are mild. It appears likely that children historically treated with antibiotics for "culture negative" septic arthritis were infected with K. kingae. PCR techniques for detection of K. kingae should be encouraged.

References

  1. Pediatr Infect Dis J. 1994 Dec;13(12):1148-9 - PubMed
  2. J Pediatr Orthop. 2010 Apr-May;30(3):301-4 - PubMed
  3. Pediatr Infect Dis J. 2006 Jun;25(6):526-32 - PubMed
  4. J Child Orthop. 2010 Apr;4(2):173-5 - PubMed
  5. J Clin Microbiol. 2009 Jun;47(6):1837-41 - PubMed
  6. J Pediatr Orthop B. 2006 Jul;15(4):289-92 - PubMed
  7. J Clin Microbiol. 1999 Mar;37(3):878 - PubMed
  8. Lancet Infect Dis. 2004 Jun;4(6):358-67 - PubMed
  9. J Clin Microbiol. 2011 Apr;49(4):1245-50 - PubMed
  10. Eur J Pediatr. 1991 Jul;150(9):612-8 - PubMed
  11. J Bone Joint Surg Am. 2006 Jun;88(6):1251-7 - PubMed
  12. Instr Course Lect. 2005;54:515-28 - PubMed
  13. J Antimicrob Chemother. 2001 Feb;47(2):191-3 - PubMed
  14. Pediatrics. 2005 Aug;116(2):e206-13 - PubMed
  15. J Bone Joint Surg Am. 1999 Dec;81(12):1662-70 - PubMed
  16. Pediatr Infect Dis J. 2011 Oct;30(10):906-9 - PubMed
  17. Pediatr Infect Dis J. 1995 Aug;14(8):673-8 - PubMed
  18. Eur J Clin Microbiol Infect Dis. 2000 Aug;19(8):608-11 - PubMed
  19. Pediatr Infect Dis J. 2007 May;26(5):377-81 - PubMed
  20. Pediatrics. 2011 Mar;127(3):557-65 - PubMed
  21. PCR Methods Appl. 1993 Dec;3(3):S18-29 - PubMed

Publication Types