title: Clinical features and epidemiology of invasive Kingella kingae infections in southern Israel.
abstract: OBJECTIVE
  To characterize the clinical spectrum and epidemiology of invasive Kingella kingae infections in children living in southern Israel.
  
  
  METHODS
  Five-year observational, descriptive study.
  
  
  METHODS
  Children in whom K. kingae was isolated from blood or other normally sterile body fluid.
  
  
  RESULTS
  Twenty-five patients with invasive K. kingae infection (13 male and 12 female) were identified. Twenty-four of these children were younger than 2 years. The annual incidence was 14.3, 27.4, and 31.9 cases per 100,000 children < or = 4 years, < or = 24 months, and < or = 12 months, respectively. Seventeen (68%) of 25 patients sought treatment between July and December. Concomitant upper respiratory tract infection or stomatitis was observed in 14 (56%) of the patients, suggesting a respiratory or buccal source for the infection. Four children were bacteremic: 2 of them suffered from a lower respiratory tract infection, and the remaining 2 had bacteremia with no evident focal infection. Twenty-one children had skeletal infections and none of them was bacteremic; 16 had septic arthritis, 3 had osteomyelitis, 1 had both osteomyelitis and septic arthritis of the adjacent joint, and 1 had dactylitis of the hand. Involvement of the ankle was unusually frequent among children with septic arthritis, whereas the calcaneus was involved in 3 of the 4 children with osteomyelitis. Antibiotic treatment resulted in full recovery in all cases, and only 2 patients with septic arthritis required surgical drainage.
  
  
  CONCLUSIONS
  Kingella kingae is a much more common cause of invasive infection in young children than has been previously recognized. The disease has a clear seasonal pattern, usually affects the skeletal system, frequently involves unusual bones and joints, and follows a benign course.
authors.affiliation: Clinical Microbiology Laboratory, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel.
authors.forename: P
authors.initials: P
authors.lastname: Yagupsky
authors.forename: R
authors.initials: R
authors.lastname: Dagan
authors.forename: C B
authors.initials: CB
authors.lastname: Howard
authors.forename: M
authors.initials: M
authors.lastname: Einhorn
authors.forename: I
authors.initials: I
authors.lastname: Kassis
authors.forename: A
authors.initials: A
authors.lastname: Simu
mesh_terms: D001170:Arthritis, Infectious / Q000453:epidemiology / Q000382:microbiology; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007557:Israel / Q000453:epidemiology; D017882:Kingella kingae / Q000302:isolation & purification; D008297:Male; D016870:Neisseriaceae Infections / Q000453:epidemiology*; D010019:Osteomyelitis / Q000453:epidemiology / Q000382:microbiology; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000382:microbiology; D013280:Stomatitis / Q000453:epidemiology / Q000382:microbiology