CLINICAL-FEATURES AND EPIDEMIOLOGY OF INVASIVE KINGELLA-KINGAE INFECTIONS IN SOUTHERN ISRAEL

Objective. To characterize the clinical spectrum and epidemiology of i nvasive Kingella kingae infections in children living in southern Isra el. Design. Five-year observational, descriptive study. Population. Ch ildren in whom K. kingae was isolated from blood or other normally ste rile body fluid. Results. Twenty-five patients with invasive K. kingae infection (13 male and 12 female) were identified. Twenty-four of the se children were younger than 2 years. The annual incidence was 14.3, 27.4, and 31.9 cases per 100 000 children less-than-or-equal-to 4 year s, less-than-or-equal-to 24 months, and less-than-or-equal-to 12 month s, respectively. Seventeen (68%) of 25 patients sought treatment betwe en July and December. Concomitant upper respiratory tract infection or stomatitis was observed in 14 (56%) of the patients, suggesting a res piratory or buccal source for the infection. Four children were bacter emic: 2 of them suffered from a lower respiratory tract infection, and the remaining 2 had bacteremia with no evident focal infection. Twent y-one children had skeletal infections and none of them was bacteremic ; 16 had septic arthritis, 3 had osteomyelitis, 1 had both osteomyelit is and septic arthritis of the adjacent joint, and 1 had dactylitis of the hand. Involvement of the ankle was unusually frequent among child ren with septic arthritis, whereas the calcaneus was involved in 3 of the 4 children with osteomyelitis. Antibiotic treatment resulted in fu ll recovery in all cases, and only 2 patients with septic arthritis re quired surgical drainage. Conclusion. Kingella kingae is a much more c ommon cause of invasive infection in young children than has been prev iously recognized. The disease has a clear seasonal pattern, usually a ffects the skeletal system, frequently involves unusual bones and join ts, and follows a benign course.