title: Invasive pediatric Kingella kingae Infections: a nationwide collaborative study.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israel. gal.dubnov-raz@sheba.health.gov.il
authors.forename: Gal
authors.initials: G
authors.lastname: Dubnov-Raz
authors.forename: Moshe
authors.initials: M
authors.lastname: Ephros
authors.forename: Ben-Zion
authors.initials: BZ
authors.lastname: Garty
authors.forename: Yechiel
authors.initials: Y
authors.lastname: Schlesinger
authors.forename: Ayala
authors.initials: A
authors.lastname: Maayan-Metzger
authors.forename: Joseph
authors.initials: J
authors.lastname: Hasson
authors.forename: Imad
authors.initials: I
authors.lastname: Kassis
authors.forename: Orna
authors.initials: O
authors.lastname: Schwartz-Harari
authors.forename: Pablo
authors.initials: P
authors.lastname: Yagupsky
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001170:Arthritis, Infectious / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D004697:Endocarditis, Bacterial / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007557:Israel / Q000453:epidemiology; D017882:Kingella kingae / Q000302:isolation & purification*; D008297:Male; D016870:Neisseriaceae Infections / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology*; D010019:Osteomyelitis / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology; D018410:Pneumonia, Bacterial / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology; D012621:Seasons; D013717:Tenosynovitis / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology