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      Kingella kingae como agente causal frecuente de artritis séptica en Pediatría Translated title: Kingella kingae as a common cause of arthritis septic in children

      case-report

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          RESUMEN

          Introducción

          Kingella kingae es un colonizador común de la orofaringe en niños pequeños que puede dar lugar a infección invasiva, principalmente infecciones osteoarticulares. La infección invasiva afecta en su mayor parte a niños de corta edad, sobre todo menores de dos años. Las infecciones por K. kingae en niños son probablemente infradiagnosticadas dada la dificultad de crecimiento de esta bacteria en los medios de cultivo habituales y la falta de búsqueda sistemática mediante técnicas moleculares. Según series recientes, es la bacteria que causa con más frecuencia infecciones osteoarticulares en niños y su identificación está aumentando en España en los últimos años. Presentamos nuestra experiencia sobre las características epidemiológicas y clínicas de las artritis sépticas (AS) en niños en los últimos años.

          Pacientes y métodos

          Análisis retrospectivo de AS por K. kingae en niños durante 2010-2016 , identificadas por PCR en líquido articular. Se recogen las características epidemiológicas, clínicas y analíticas.

          Resultados

          Identificadas cinco artritis por K. kingae en ≤6 años. La mediana de leucocitos, PCR y VSG fue 12.950 leucocitos/μL, 4,84 mg/dL y 58 mm/h respectivamente, y en líquido articular 61.322 leucocitos/μL. Todos los pacientes evolucionaron favorablemente.

          Conclusiones

          Las infecciones osteoarticulares por K. kingae, aún siendo invasivas, cursan con escaso aumento de marcadores inflamatorios en niños. El desarrollo de técnicas de PCR en muestras estériles ha mejorado notablemente el diagnóstico en el campo de las infecciones por K. kingae, permitiendo un manejo más adecuado de la osteoartritis en la infancia.

          ABSTRACT

          Introduction

          Kingella kingae is a common colonizer of the oropharynx in children that may lead to invasive infection, mainly osteoarticular infections. Invasive infections occur almost exclusively in young children, fundamentally fewer than two years old. K. kingae infections in children are probably underdiagnosed due to the difficulty in growing in routine cultures and the absence of systematic realization of molecular techniques to identify it. It is the most common bacteria involved in childhood osteoarticular infections in recent series and increasingly being recognized in Spain. We report our experience on the epidemiological and clinical characteristics of osteoarticular infections in children in recent years.

          Patients and methods

          Retrospective analysis of septic arthritis by K. kingae identified by PCR in joint fluid in children during 2010-2016. Epidemiological, clinical and laboratory characteristics are presented.

          Results

          Five arthritis by K. kingae were identified, all of them in ≤6 years old children. Median leukocytes, CRP and ESR were 12950 leukocytes/μL, 4.84 mg/dL and 58 mm/h respectively, and 61,322 leukocytes /μL in joint fluid. All patients evolved favorably.

          Conclusions

          Osteoarticular infections by K. kingae in children usually present low increase of inflammatory markers despite being invasive infections. The development of PCR in sterile samples has greatly improved the diagnostic yield of K. kingae infections improving the management of osteoarthritis in children.

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          Most cited references11

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          Invasive pediatric Kingella kingae Infections: a nationwide collaborative study.

          Kingella kingae is a gram-negative coccobacillus, increasingly recognized as an invasive pediatric pathogen. To date, only few small series of invasive K. kingae infections have been published, mostly from single medical centers. A nationwide multicenter study was performed to investigate the epidemiologic, clinical, and laboratory features of children with culture-proven K. kingae infections. Clinical microbiology laboratories serving all 22 medical centers in Israel were contacted in a search for children aged 0 to 18 years from whom K. kingae was isolated from a normally sterile site, dating from as far back as possible until December 31, 2007. Medical records of identified patients were reviewed using uniform case definitions. A total of 322 episodes of infection were identified in 321 children, of which 96% occurred before the age of 36 months. The annual incidence in children aged <4 years was 9.4 per 100,000. Infections showed a seasonal nadir between February and April. Skeletal system infections occurred in 169 (52.6%) children and included septic arthritis, osteomyelitis, and tenosynovitis. Occult bacteremia occurred in 140 children (43.6%), endocarditis in 8 (2.5%), and pneumonia in 4 (1.2%). With the exception of endocarditis cases, patients usually appeared only mildly ill. About one-quarter of children had a body temperature <38 degrees C, 57.1% had a blood white blood cell count <15,000/mm, 22.0% had normal C-reactive protein values, and 31.8% had nonelevated erythrocyte sedimentation rate. K. kingae infections usually occur in otherwise healthy children aged 6 to 36 months, mainly causing skeletal system infections and bacteremia, and occasionally endocarditis and pneumonia. Clinical presentation is usually mild, except for endocarditis, necessitating a high index of suspicion.
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            Epidemiology and Management of Acute, Uncomplicated Septic Arthritis and Osteomyelitis: Spanish Multicenter Study.

            Acute osteoarticular infection (OAI) is a potentially severe disease. The aim of this study was to evaluate the etiology, clinical characteristics and therapeutic approach of OAI in children in Spain.
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              Differentiating osteoarticular infections caused by Kingella kingae from those due to typical pathogens in young children.

              Osteoarticular infections caused by Kingella kingae are characterized by mild-to-moderate clinical and biologic inflammatory signs that are different from those caused by Gram-positive cocci. A combined score was built to find the best model to predict K. kingae osteoarticular infections by using the following 4 variables: body temperature <38°C, serum C-reactive protein <55 mg/L, white blood cell count <14,000/mm, and band forms <150/mm.
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                Author and article information

                Journal
                Rev Esp Quimioter
                Rev Esp Quimioter
                Sociedad Española de Quimioterapia
                Revista Española de Quimioterapia
                Sociedad Española de Quimioterapia
                0214-3429
                1988-9518
                12 October 2018
                October 2018
                : 31
                : 5
                : 439-442
                Affiliations
                [1 ]Servicio de Pediatría, Hospital Clínico San Carlos, Madrid
                [2 ]Servicio de Pediatría, Hospital de Getafe, Madrid
                [3 ]Servicio de Microbiología, Hospital de Getafe, Madrid
                [4 ]Servicio de Microbiología, Hospital Clínico San Carlos, Madrid
                Author notes
                Correspondencia: Marta Illán Ramos, Hospital Clínico San Carlos, C/Profesor Martín Lagos sn. CP: 28040, Madrid. Servicio de Pediatría (planta 6ª sur). Fax: 91 3303533; Tfno: 670542988. E-mail: marta_illan_ramos@ 123456hotmail.com
                Article
                revespquimioter-31-439
                6194870
                30251525
                86aeafdf-424f-4160-a45a-c776db2e7ccd
                © The Author 2018

                The article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) ( https://creativecommons.org/licenses/by-nc/4.0/)

                History
                : 26 June 2018
                : 06 July 2018
                : 11 July 2018
                : 20 July 2018
                Categories
                Brief Report

                artritis séptica,kingella kingae,patógeno emergente,infección invasiva,pcr universal con secuenciación de 16s rarn,septic arthritis,emergent pathogen,invasive infection,universal 16s rrna gene pcr

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