Endocarditis Due to Kingella kingae: A Patient Report

Brachlow, Allison; Chatterjee, Archana; Stamato, Teresa

doi:10.1177/000992280404300311

Cited by 10 publications

(8 citation statements)

References 9 publications

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“…A native valve is af-fected in 95% of children (138,168,(245)(246)(247)(248)(249)(250)(251)(252), whereas native (133,245,(252)(253)(254)(255) and prosthetic (21,23,243,(256)(257)(258)(259) valve involvement have been reported with approximately similar frequency in adult patients. The mitral valve is affected in over 90% of cases (113,124,130,133,168,244,245,247,248,250,252,255,257,(260)(261)(262)(263)(264)(265)(266), followed by the aortic valve (6, 23, 243, 246, 249, 253-256, 259, 267, 268), while tricuspid (269) or pulmonary (130) valve endocarditis is exceptional. Involvement of multiple valves has been also described (255,…”

Section: Endocarditismentioning

confidence: 99%

“…Despite K. kingae's remarkable susceptibility to antimicrobial drugs, serious complications, such as embolism or mycotic aneurism to the femoral (9,130,251), brachial (124), or ophthalmic (9) arteries, valvular insufficiency (113,242,245,247,249,250,264,269), congestive heart failure (133,249,272) or cardiogenic shock (21,130,258), pulmonary infarction (269), mitral valve rupture (244) or perforation (242,250,263), paravalvular abscess formation (249,259,265), cerebrovascular accidents (113, 168, 242, 255, 257, 261-263, 265, 266, 272, 273), meningitis (113,138,242,245), brain abscess (251), and embolic arthritis (138) and cellulitis (252), are common. Emergency cardiac surgery has been prescribed for life-threatening complications that do not respond to conservative medical treatment (9, 130, 244, 248-250, 259, 263, 267, 271, 272), many patients require late valvuloplasty (269) or valve replacement (242,247,259), and the overall mortality rate of the disease is Ͼ10% (9,18,…”

Section: Endocarditismentioning

confidence: 99%

“…Emergency cardiac surgery has been prescribed for life-threatening complications that do not respond to conservative medical treatment (9, 130, 244, 248-250, 259, 263, 267, 271, 272), many patients require late valvuloplasty (269) or valve replacement (242,247,259), and the overall mortality rate of the disease is Ͼ10% (9,18,21,113,133,242,266). This unusual clinical aggressiveness is probably related, in part, to delays in the identification of the bacterium (51) rather than failure to isolate the organism because of insufficient length of incubation (273).…”

Section: Endocarditismentioning

confidence: 99%

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Kingella kingae: Carriage, Transmission, and Disease

2015

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SUMMARY Kingella kingae is a common etiology of pediatric bacteremia and the leading agent of osteomyelitis and septic arthritis in children aged 6 to 36 months. This Gram-negative bacterium is carried asymptomatically in the oropharynx and disseminates by close interpersonal contact. The colonized epithelium is the source of bloodstream invasion and dissemination to distant sites, and certain clones show significant association with bacteremia, osteoarthritis, or endocarditis. Kingella kingae produces an RTX (repeat-in-toxin) toxin with broad-spectrum cytotoxicity that probably facilitates mucosal colonization and persistence of the organism in the bloodstream and deep body tissues. With the exception of patients with endocardial involvement, children with K. kingae diseases often show only mild symptoms and signs, necessitating clinical acumen. The isolation of K. kingae on routine solid media is suboptimal, and detection of the bacterium is significantly improved by inoculating exudates into blood culture bottles and the use of PCR-based assays. The organism is generally susceptible to antibiotics that are administered to young patients with joint and bone infections. β-Lactamase production is clonal, and the local prevalence of β-lactamase-producing strains is variable. If adequately and promptly treated, invasive K. kingae infections with no endocardial involvement usually run a benign clinical course.

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Section: Endocarditismentioning

confidence: 99%

Section: Endocarditismentioning

confidence: 99%

Section: Endocarditismentioning

confidence: 99%

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Kingella kingae: Carriage, Transmission, and Disease

2015

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“…Also of interest is that our patient suffered from a stroke 4 weeks after diagnosis of K. kingae peritonitis and bacteremia. Because he did not have a transesophageal echocardiogram, we cannot prove that his stroke was the direct result of a cardiac vegetation, but this remains a possibility, since stroke is a commonly reported complication of K. kingae endocarditis (1,3,6,7,9,12). Further supporting this notion was the radiologist's interpretation that the lesion on magnetic resonance imaging was embolic in nature.…”

mentioning

confidence: 98%

“…In contrast to arthritis and osteomyelitis, however, K. kingae endocarditis usually occurs in school-age children and adults (who are not as prone to hematogenous seeding of the bones); more than 60% of patients are 16 years of age or older (1,3). Approximately 75% of cases involve structurally abnormal heart valves, and 31% have a history of antecedent disruption of the oropharyngeal mucosa (1, 3, 6).…”

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confidence: 99%

Bacterial Peritonitis Caused by Kingella kingae

2007

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Kingella kingae is a commensal of the upper respiratory tract that occasionally causes skeletal infections in children and endocarditis in children and adults. We report a case of a 55-year-old man with liver disease and tense ascites who performed a paracentesis on himself and developed K. kingae peritonitis and bacteremia. CASE REPORTA 55-year-old man with a history of advanced hepatic cirrhosis related to hepatitis B and C and of past alcohol and intravenous drug use developed progressively worsening abdominal distension, diffuse abdominal pain, and dyspnea with exertion over a 4-week period. To relieve these symptoms, he procured a syringe with a needle and inserted it into his umbilicus, draining enough yellow fluid to soak three shirts. He felt better initially, but 3 days later, he noticed that the injection site was tender and red and his abdomen was more painful and distended. His brothers brought him to the emergency department because he was more confused than usual. At the time of presentation he reported fevers and chills but no headache, rhinorrhea, sore throat, cough, dysuria, or change in bowel habits. He was not actively using drugs or alcohol and had been compliant with his medications, which included a proton pump inhibitor, diuretics, and lactulose. When asked about the needle which he had used for paracentesis, he reported that he had taken it from a hospital and that it was not wrapped in a sterile package but did have an intact needle cap in place.On examination, the patient was febrile (100.5°F) but hemodynamically stable. He was in mild distress due to dyspnea and abdominal pain. His sclerae were icteric, and his mucous membranes were dry, but there were no oral ulcers or pharyngeal erythema. The patient was edentulous. The heart sounds were regular, and there were decreased lung sounds at the bases. The abdomen was firm, distended, and diffusely tender. The umbilicus was erythematous, tender, and indurated, but there was no discharge. Mild edema of the lower extremities was noted, and there were a few spider angiomata on the skin of the upper chest. Asterixis was present on neurological exam.On admission, the peripheral leukocyte count was 19,300/mm 3 with 89% neutrophils and 8% band forms. The platelet count was 103,000/mm 3 . The serum creatinine level was 1.7 mg/dl, and the sodium level was 120 mmol/liter. The total bilirubin was elevated at 8.1 mg/dl, as were alanine aminotransferase and aspartate transaminase (113 and 225 U/liter, respectively) and international normalized ratio values (1.7). The clinical impression was one of acute decompensation of severe underlying chronic liver disease. Since these events are often triggered by infections, specimens of blood, urine, and peritoneal fluid were submitted for culture before he was started on antibiotics: ceftriaxone and vancomycin.A large volume of peritoneal fluid was removed (5.5 liters), and a sample sent for analysis showed a white blood cell count of 5,725/mm 3 with a differential of 87% neutrophils and 8% lymphocytes. Gram st...

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Epidemiology and Clinical Manifestations of Kingella kingae Disease

Downes

2016

Advances in Understanding Kingella Kingae

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Endocarditis Due to Kingella kingae: A Patient Report

Cited by 10 publications

References 9 publications

Kingella kingae: Carriage, Transmission, and Disease

Kingella kingae: Carriage, Transmission, and Disease

Bacterial Peritonitis Caused by Kingella kingae

Epidemiology and Clinical Manifestations of Kingella kingae Disease

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