Abstract
During the past decade, transmission of the bacterium Kingella kingae has caused clusters of serious infections, including osteomyelitis, septic arthritis, bacteremia, endocarditis, and meningitis, among children in daycare centers in the United States, France, and Israel. These events have been characterized by high attack rates of disease and prevalence of the invasive strain among asymptomatic classmates of the respective index patients, suggesting that the causative organisms benefitted from enhanced colonization fitness, high transmissibility, and high virulence. After prophylactic antibacterial drugs were administered to close contacts of infected children, no further cases of disease were detected in the facilities, although test results showed that some children still carried the bacterium. Increased awareness of this public health problem and use of improved culture methods and sensitive nucleic acid amplification assays for detecting infected children and respiratory carriers are needed to identify and adequately investigate outbreaks of K. kingae disease.
Highlights
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Emerging Infectious Diseases
Surveillance studies have showed that K. kingae organisms colonizing attendees of a given daycare center are frequently identical, but have demonstrated that carried strains differ between facilities located close together, indicating that each daycare center is like an independent epidemiologic unit [35,37,38,39]
The epidemiologic investigation of these outbreaks revealed that the K. kingae colonization rate among asymptomatic attendees to the daycare centers where clinical cases were detected was unusually high (Table 2), and all pharyngeal isolates detected in the classrooms where disease occurred were genotypically identical and indistinguishable from the patients’ clinical isolates
Summary
LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to earn CME credit. Surveillance studies have showed that K. kingae organisms colonizing attendees of a given daycare center are frequently identical, but have demonstrated that carried strains differ between facilities located close together, indicating that each daycare center is like an independent epidemiologic unit [35,37,38,39] Considering these findings, it is not surprising that clusters of proven and presumptive cases of invasive K. kingae disease have been detected in daycare centers in France [35], the United States [37,38], and Israel [39], including 2 recent and still unreported outbreaks The 3 patients in the 2005 cluster in Israel [39] and 4 of the 5 patients reported in France [35] had bone infections, supporting the concept that certain K. kingae clones exhibit specific tissue tropism [25]
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