Osteoarticular infection in children

Abstract

Aims We aimed to describe the epidemiological, biological, and bacteriological characteristics of osteoarticular infections (OAIs) caused by Kingella kingae. Methods The medical charts of all children presenting with OAIs to our institution over a 13-year period (January 2007 to December 2019) were reviewed. Among these patients, we extracted those which presented an OAI caused by K. kingae and their epidemiological data, biological results, and bacteriological aetiologies were assessed. Results K. kingae was the main reported microorganism in our paediatric population, being responsible for 48.7% of OAIs confirmed bacteriologically. K. kingae affects primarily children aged between six months and 48 months. The highest prevalence of OAI caused by K. kingae was between seven months and 24 months old. After the patients were 27 months old, its incidence decreased significantly. The incidence though of infection throughout the year showed no significant differences. Three-quarters of patients with an OAI caused by K. kingae were afebrile at hospital admission, 11% had elevated WBCs, and 61.2% had abnormal CRPs, whereas the ESR was increased in 75%, constituting the most significant predictor of an OAI. On MRI, we noted 53% of arthritis affecting mostly the knee and 31% of osteomyelitis located primarily in the foot. Conclusion K. kingae should be recognized currently as the primary pathogen causing OAI in children younger than 48 months old. Diagnosis of an OAI caused by K. kingae is not always obvious, since this infection may occur with a mild-to-moderate clinical and biological inflammatory response. Extensive use of nucleic acid amplification assays improved the detection of fastidious pathogens and has increased the observed incidence of OAI, especially in children aged between six months and 48 months. We propose the incorporation of polymerase chain reaction assays into modern diagnostic algorithms for OAIs to better identify the bacteriological aetiology of OAIs. Cite this article: Bone Joint J 2021;103-B(3):578–583.

Kingella kingae Osteoarticular Infections Approached through the Prism of the Pediatric Orthopedist

“…Currently, K. kingae must be considered as the main germ of hematogenous infections of bones, joints, intervertebral discs, and tendon sheaths in children aged between 6 and 48 months. This gives a glimpse into the role of K. kingae in osteoarticular infection, which has been underestimated in the past [3][4][5]. The current evidence indicates that most OAI caused by K. kingae occur in children less than 4 years of age; this specific period of children's life corresponds to the period of maximal oropharyngeal colonization by the germ.…”

“…The crucial contribution of these diagnostic assays resulted in a drastic improvement in the competence of clinicians to reliably recognize infectious diseases. In this regard, the wide-scale use of NAAAs has remarkably improved the recognition of OAI, and thus changed both the incidence of pediatric OAI and their actual bacteriologic epidemiology [3][4][5]. Thus, the pediatric orthopedist can now know the germ responsible for most OAI that remained culture-negative before the advent of NAAAs.…”

“…The dramatic increase in the detected cases must be credited to the widespread use of nucleic acid amplification assays. The use of NAAAs has provided irrefutable evidence that K. kingae has become the most common pathogen responsible for osteoarticular, infection in children aged less than 4 years [3][4][5]18]. This verdict has, above all, highlighted the necessity to use specific real-time quantitative polymerase chain reaction (qPCR) assays targeting K. kingae to detect, more efficiently, OAI caused by this pathogen [19].…”

“…Osteoarticular infections (OAI) represent serious affections, which may perturb subsequent bone development and may have severe consequences for articular function [1]. For pediatric orthopedists, implementing the proper etiology of OAI is crucial to confirm the diagnosis, to prescribe adjusted antibiotic therapy [2], and to improve the outcome [3][4][5]. The prognostic value also regards the epidemiological vigilance as identifying the causative pathogen has public health and infection control ramifications.…”

Proinflammatory Microenvironment During Kingella kingae Infection Modulates Osteoclastogenesis

“…The bacterial infection localized in bones or contiguous tissue is a serious complication that causes bone loss. The presence of bacteria within or near the bone is associated with an inflammatory process that results in osteolysis, and K. kingae appears not to be an exception ( 4 – 6 ). The number of children colonized by this bacteria is more than those with clinical disease ( 7 ).…”