Viral coinfection with Kingella kingae (with a focus on osteomyelitis)

Kingella kingae: an emerging pathogen in young children.

Pediatrics. 2011 Mar;127(3):557-65. PMID: 21321033

“After colonization of the posterior pharynx, K kingae must breach the epithelium to enter the bloodstream. Patients with invasive K kingae disease frequently present with symptoms of a viral respiratory infection, evidence of herpetic gingivostomatitis, or concomitant buccal aphthous ulcers, which suggests that viral-induced damage to the respiratory mucosa facilitates K kingae invasion of the bloodstream. Beyond the role of viral coinfection, K kingae produces a potent extracellular toxin that belongs to the RTX family of toxins and is capable of lysing epithelial, synovial, and macrophage cells. This toxin may facilitate disruption of the respiratory epithelium, perhaps with an enhanced effect in the setting of viral coinfection.”

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Kingella kingae: from medical rarity to an emerging paediatric pathogen.

Lancet Infect Dis. 2004 Jun;4(6):358-67. PMID: 15172344

“Although the current knowledge of the pathogenesis of invasive K kingae is incomplete, available evidence suggests an interaction with viral infections. Concomitant stomatitis, including varicella-induced buccal ulcers, and symptoms of upper-respiratory-tract infection have frequently been found in affected patients. 7,8, 9, 10, 22 and 61 In a prospective study in which therapy with acyclovir for primary herpetic gingivostomatitis was evaluated, K kingae was isolated from the blood in four of 29 (13·8%) affected children.61 It seems that K kingae organisms colonising the oropharynx penetrate the mucosal layer already damaged by a viral disease. The organism might then progress throughout the airways causing lower-respiratory-tract infection and/or invade the blood stream. Transient benign bacteraemia may follow or the organism might be seeded in the endocardium, joint space, bone, or intervertebral discs, resulting in a focal suppurative infection. The reasons for the striking predilection of K kingae for these sites remain beyond our current understanding.”

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Kingella kingae infections of the skeletal system in children: diagnosis and therapy.

“As the result of improved bacteriological techniques, Kingella kingae is emerging as an important cause of infections of the skeletal system in children younger than 2 years of age. This review details the bacteriological features and detection methods of this pathogen, as well as the epidemiology, clinical presentation, treatment and prognosis of septic arthritis, osteomyelitis and diskitis caused by the organism.”

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Epidemiological features of invasive Kingella kingae infections and respiratory carriage of the organism.

J Clin Microbiol. 2002 Nov;40(11):4180-4. PMID: 12409394

“Recent reports have shown that specific viral infections may also predispose individuals to acquisition of invasive K. kingae infections. In a study by Amir and Yagupsky, K. kingae bacteremia was documented in 4 of 29 young children with culture-proven herpetic gingivostomatitis (2). In addition, occurrence of K. kingae endocarditis following chicken pox was also described in another report (21). These reports suggest that viral infections causing damage to the respiratory mucosa or buccal aftae facilitate local invasion by K. kingae organisms residing in the pharynx, followed by penetration of the bacterium into the bloodstream and seeding to remote sites. It is suggested that the peculiar epidemiological features of invasive K. kingae infections result from the interplay of the respiratory carriage of the organism with viral infections and possibly other, still-unidentified factors.”

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More PubMed results on viral coinfection with K. kingae.

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