Epidemiology and Clinical Manifestations of Kingella kingae Disease

Kingella kingae infective endocarditis in a healthy adult

“…K. kingae can be a normal inhabitant of the oropharynx with rates of colonization that peak at rates of 3–12% between the ages of 6–48 months old [1]. It is believed that disrupted respiratory or buccal mucosa (through upper respiratory tract infections, aphthous stomatitis, or acute gastroenteritis) may facilitate bacterial invasion and hematogenic disseminations [2,4,5].…”

“…Poor dental hygiene or dental extractions have been reported frequently in adolescents and adult patients prior to initial infection. In children osteoarticular infections (OAIs) are the most common form of K. kingae invasive disease [1]. Likely because of the prevalence of vaccination for H. influenzae type b, K. kingae has now become the most common gram-negative bacterium causing osteoarticular infections in children less than 3 years of age [3].…”

“…Likely because of the prevalence of vaccination for H. influenzae type b, K. kingae has now become the most common gram-negative bacterium causing osteoarticular infections in children less than 3 years of age [3]. Of the endocardial infections in children those that were secondary to K. Kingae have been reported by some case series to be approximately 7% [1,6]. It usually affects previously healthy children aged less than 4 years, whereas older children and adults frequently have predisposing conditions [6].…”

“…Established treatment for K. Kingae endocarditis consists of a high dose intravenous β-lactam antimicrobial as monotherapy or combined with an aminoglycoside drug for 4–7 weeks duration [6]. Despite K. kingae ’s remarkable susceptibility to antimicrobial drugs, serious complications such as mycotic aneurisms, pericarditis, valvular insufficiency, congestive heart failure, CVAs, embolic arthritis and cellulitis are common complications [1,6]. …”

“…In a limited single center study, Brandle et al reported that parents of young children, less than 4 years of age, had a colonization rate (8.8%) similar to that of children younger than 4 years [8]. While pharyngeal carriage has been thought to be universal across countries, a report from Amit et al which compared Jewish children and Bedouin children in Southern Israel showed that Jewish children had a significantly higher incidence of invasive disease [1]. Given these two reports it is likely that our patient had transmission of a virulent strain from his young child.…”