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epidemiologic and microbiologic characteristics of occult bacteremia among febrile children in southern israel, before and after initiation of the routine antipneumococcal immunization (2005-2012).little is known about the incidence and dynamics of occult bacteremia (ob) among infants/young children following the introduction of pneumococcal conjugate vaccines (pcvs) into the national immunization program in israel in 2009-2010. the aim of this study was to characterize the epidemiologic and microbiologic picture of ob among febrile infants/children aged 3-36 months in southern israel, before and after pcvs introduction.201626738763
case 2: a toddler with hyperlordosis. 201526744565
inner-membrane protein morc is involved in fimbriae production and biofilm formation in aggregatibacter actinomycetemcomitans.fimbrial subunit synthesis, secretion and assembly on the surface of the periodontal pathogen aggregatibacter actinomycetemcomitans are essential for biofilm formation. a recent quantitative proteomics study employing an afimbriated strain and a developed mutant isogenic for the inner-membrane protein morphogenesis protein c (morc) revealed that the abundance of the proteins of the fimbrial secretion apparatus in the membrane is dependent on morc. to investigate further the relationship between ...201626796329
reassessment of the role of rapid antigen detection tests in diagnosis of invasive group a streptococcal infections.rapid antigen detection tests (radts) for group a streptococci (gas) are widely used for diagnosing acute pharyngitis, which has led to a considerable reduction in antibiotic prescriptions over the past decade. beyond this intended use, their reassessment on invasive samples may be relevant in the management of life-threatening gas infections. to this end, we evaluated the performances of three radts, culture, gas pcr, and 16s rrna gene pcr assays, and compared them with a composite gold standar ...201626818671
neisseria meningitidis translation elongation factor p and its active-site arginine residue are essential for cell viability.translation elongation factor p (ef-p), a ubiquitous protein over the entire range of bacterial species, rescues ribosomal stalling at consecutive prolines in proteins. in escherichia coli and salmonella enterica, the post-translational β-lysyl modification of lys34 of ef-p is important for the ef-p activity. the β-lysyl ef-p modification pathway is conserved among only 26-28% of bacteria. recently, it was found that the shewanella oneidensis and pseudomonas aeruginosa ef-p proteins, containing ...201626840407
kingella kingae-associated pediatric osteoarticular infections: an overview of 566 reported cases.this study aimed to summarize clinical experience with kingella kingae-associated pediatric osteoarticular infections (oais). we reviewed 566 cases in the english literature from 2000 to june 2014. more than 80% of the patients were diagnosed between 4 months and 4 years of age, and the male to female ratio was 1.14:1. the most frequent preceding illness was upper respiratory tract infections (82%). the top 3 oais types were septic arthritis (73.1%), osteomyelitis (15.7%), and spondylodiscitis ( ...201626869328
the brief case: kingella kingae septic arthritis in a 14-month-old child. 201626917458
a retrospective case-series of children with bone and joint infection from northern australia.our clinical workload as infectious diseases pediatricians in northern australia is dominated by complicated bone and joint infections in indigenous children. we reviewed the clinical presentation, microbiology, management, and outcomes of children presenting to royal darwin hospital with bone and joint infections between 2010 and 2013, and aimed to compare severity and incidence with other populations worldwide.a retrospective audit was performed on children aged 0 to 18 years who were admitted ...201626937926
uncommon kingella kingae lytic bone lesions in children. 201626946080
genetic and molecular basis of kingella kingae encapsulation.kingella kingae is a common cause of invasive disease in young children and was recently found to produce a polysaccharide capsule containing n-acetylgalactosamine (galnac) and β-3-deoxy-d-manno-octulosonic acid (βkdo). given the role of capsules as important virulence factors and effective vaccine antigens, we set out to determine the genetic determinants of k. kingae encapsulation. using a transposon library and a screen for nonencapsulated mutants, we identified the previously identified ctra ...201627045037
infectious discitis and spondylodiscitis in children.in children, infectious discitis (d) and infectious spondylodiscitis (sd) are rare diseases that can cause significant clinical problems, including spinal deformities and segmental instabilities. moreover, when the infection spreads into the spinal channel, d and sd can cause devastating neurologic complications. early diagnosis and treatment may reduce these risks. the main aim of this paper is to discuss recent concepts regarding the epidemiology, microbiology, clinical presentation, diagnosis ...201627070599
pediatric clinical microbiology: it's the little things. 201627076655
polymerase chain reaction detection of kingella kingae in children with culture-negative septic arthritis in eastern ontario.the bacterium kingella kingae may be an under-recognized cause of septic arthritis in canadian children because it is difficult to grow in culture and best detected using molecular methods.201627095882
advantages and limitations of direct pcr amplification of bacterial 16s-rdna from resected heart tissue or swabs followed by direct sequencing for diagnosing infective endocarditis: a retrospective analysis in the routine clinical setting.infective endocarditis (ie) is a life-threatening disease that is associated with high morbidity and mortality. its long-term prognosis strongly depends on a timely and optimized antibiotic treatment. therefore, identification of the causative pathogen is crucial and currently based on blood cultures followed by characterization and susceptibility testing of the isolate. however, antibiotic treatment starting prior to blood sampling or ie caused by fastidious or intracellular microorganisms may ...201627110570
hacek endocarditis: a review.the hacek group, referring to haemophilus spp., aggregatibacter actinomycetemcomitans, cardiobacterium hominis, eikenella corrodens, and kingella kingae, is a rare cause of infective endocarditis (ie). it causes the majority of gram-negative endocarditis cases and has an excellent prognosis and simple management if properly identified. however, delay in diagnosis and associated complications can render the infection fatal.201627124204
current data on acute haematogenous osteomyelitis in children in southern israel: epidemiology, microbiology, clinics and therapeutic consequences.acute haematogenous osteomyelities (aho) is the most common form of osteomyelitis, occurring when bone is infected secondary to transient bacteremia. the prevalence, aetiology and outcome of aho may vary from region to region and period to period. the study objectives were to define the epidemiology, clinical, laboratory and imaging characteristics and treatment consequences of aho in children in southern israel.201627169533
primary subacute hematogenous osteomyelitis in children: a clearer bacteriological etiology.this study aimed to describe the spectrum of pediatric primary subacute hematogenous osteomyelitis (psaho) and to investigate its bacterial etiology.201627174185
laboratory predictors for risk of revision surgery in pediatric septic arthritis.reported complications of pediatric septic arthritis range from minor growth abnormalities to potentially life-threatening conditions and death; some children require multiple surgeries for eradication of infection. the purpose of this study is: (1) to determine the failure rate of a single surgical incision and drainage (i&d) in pediatric septic arthritis, (2) to identify risk factors for failure which are detectable at the time of initial presentation, and (3) to trend post-operative c-reactiv ...201627174186
a case of acute osteomyelitis: an update on diagnosis and treatment.osteomyelitis in children is a serious disease in children requiring early diagnosis and treatment to minimize the risk of sequelae. therefore, it is of primary importance to recognize the signs and symptoms at the onset and to properly use the available diagnostic tools. it is important to maintain a high index of suspicion and be aware of the evolving epidemiology and of the emergence of antibiotic resistant and aggressive strains requiring careful monitoring and targeted therapy. hereby we pr ...201627240392
update on the management of pediatric acute osteomyelitis and septic arthritis.acute osteomyelitis and septic arthritis are two infections whose frequencies are increasing in pediatric patients. acute osteomyelitis and septic arthritis need to be carefully assessed, diagnosed, and treated to avoid devastating sequelae. traditionally, the treatment of acute osteoarticular infection in pediatrics was based on prolonged intravenous anti-infective therapy. however, results from clinical trials have suggested that in uncomplicated cases, a short course of a few days of parenter ...201627258258
subacute osteomyelitis by kingella kingae in a 5-year-old boy after chickenpox infection. 201627277204
streptococcus pyogenes associated post-traumatic brodie's abscess of cuboid: a case report and review of literature.brodie's abscess of cuboid bone is one of the rarest diagnosis in children which most often is hematogenous in origin. although streptococcus pyogenes has been uncommonly implicated as causative organism in other bones, it is not yet reported in the cuboid.201527299080
bacillus pumilus septic arthritis in a healthy child.we report a case of septic arthritis caused by a bacillus species, b. pumilus, occurring in a healthy child. this organism rarely causes serious infections and has only been described in newborns and immunocompromised individuals or as a skin infection. this child developed an indolent joint swelling after a minor skin injury, and symptoms were initially thought most consistent with chronic arthritis. the case demonstrates that clinicians should consider joint infection in children presenting wi ...201627366165
a case report of severely damaged hip joint caused by sapho syndrome treated with 2-stage total hip arthroplasty.synovitis, acne, pustulosis, hyperostosis, and osteitis (sapho) syndrome is an increasingly recognized entity. the hip joint is known as a less frequently affected site in sapho syndrome, and there has been limited reports about hip joint diseases caused by sapho syndrome, and as such adequate treatment for this disease spectrum is still not fully elucidated.201627399138
spinal infections in children: a review.spinal infections are uncommon but significant causes of morbidity and hospitalization in the paediatric population. these infections encompass a broad range of conditions, from discitis to osteomyelitis and spinal epidural and intramedullary abscesses. paediatric spinal infections can be caused by a range of bacterial, viral, fungal and parasitic agents. ultrastructural differences of the vertebrae and associated structures result in distinct mechanisms of pathogenesis of spinal infections in c ...201627408498
detection of bacterial pathogens in synovial and pleural fluid with the filmarray blood culture identification system.we report the use of filmarray blood culture identification (bcid) multiplex pcr system for pathogen detection from a child with septic arthritis that streptococcus pyogenes was identified directly from synovial fluid and a child with complicated pneumonia with pleural effusion that streptococcus pneumoniae was identified from pleural fluid.201627419071
identifying reservoirs of infections caused by kingella kingae: a case-control study of oropharyngeal carriage of k. kingae among healthy adults.kingella kingae is currently recognized as a significant pathogen of the pediatric population. nevertheless, the possibility for adults to serve as a reservoir of healthy carriers has not been studied.201627420804
mature biofilm degradation by potential probiotics: aggregatibacter actinomycetemcomitans versus lactobacillus spp.the biofilm degradation of aggregatibacter actinomycetemcomitans is essential as a complete periodontal disease therapy, and here we show the effects of potential probiotic bacteria such as lactobacillus spp. for the biofilm of several serotypes of a. actinomycetemcomitans strains. eight of the 13 species showed the competent biofilm degradation of ≥ 90% reduction in biofilm values in a. actinomycetemcomitans y4 (serotype b) as well as four of the seven species for the biofilm of a. actinomycete ...201627438340
the epidemiologic, microbiologic and clinical picture of bacteremia among febrile infants and young children managed as outpatients at the emergency room, before and after initiation of the routine anti-pneumococcal immunization.we described the occult bacteremia (ob) and bacteremia with diagnosed focus (bwf) picture among children managed as outpatients at the pediatric emergency room (per) in southern israel, before and after the introduction of pneumococcal conjugate vaccines (pcvs) introduction in a retrospective study enrolling all three- to 36-month-old patients with fever >38.0 °c during 2005-2014. of 511 (0.82% of all febrile patients) true bacteremias, 230 (45%) were managed as outpatients; 96 of 230 (41.7%) ha ...201627447651
epidemiology and management of acute, uncomplicated septic arthritis and osteomyelitis: spanish multicenter study.acute osteoarticular infection (oai) is a potentially severe disease. the aim of this study was to evaluate the etiology, clinical characteristics and therapeutic approach of oai in children in spain.201627455444
preclinical studies and prospective clinical applications for bacteria-targeted imaging: the future is bright.bacterial infections are a frequently occurring and major complication in human healthcare, in particular due to the rapid increase of antimicrobial resistance and the emergence of pan-drug-resistant microbes. current anatomical and functional imaging modalities are insufficiently capable of distinguishing sites of bacterial infection from sterile inflammation. therefore, definitive diagnosis of an infection can often only be obtained by tissue biopsy and subsequent culture and, occasionally, a ...201627512688
cardiac implantable electronic device infection due to mycobacterium species: a case report and review of the literature.infection of cardiac implantable electronic devices is a serious cardiovascular disease and it is associated with a high mortality. mycobacterium species may rarely cause cardiac implantable electronic devices infection.201627553460
high rate of oropharyngeal kingella kingae carriage in new zealand children.this study aimed to describe the burden of disease and estimated rates of oropharyngeal carriage of kingella kingae among new zealand children. we compared polymerase chain reaction (pcr) and culture for the detection of this microorganism with a view to further development and implementation of k. kingae pcr in christchurch hospital.201627586302
transitioning antimicrobials from intravenous to oral in pediatric acute uncomplicated osteomyelitis.osteomyelitis is a bone infection that requires prolonged antibiotic treatment and potential surgical intervention. if left untreated, acute osteomyelitis can lead to chronic osteomyelitis and overwhelming sepsis. early treatment is necessary to prevent complications, and the standard of care is progressing to a shorter duration of intravenous (iv) antibiotics and transitioning to oral therapy for the rest of the treatment course. we systematically reviewed the current literature on pediatric pa ...201627610339
unusual case of paediatric septic arthritis of the lumbar facet joints due to kingella kingae.a 32-month-old boy presented with febrile limping that had developed over 6days, associated with right lumbosacral inflammatory swelling. magnetic resonance imaging (mri) showed joint effusion of the right l5-s1 zygapophyseal joint, complicated by destructive osteomyelitis of the l5 articular process and paraspinal abscess. surgery was decided to evacuate the fluid accumulation and rule out differential diagnoses. the diagnosis of septic arthritis of the facet joint was confirmed intraoperativel ...201627639784
low prevalence of kingella kingae carriage in children aged 6-48 months in sydney, australia.a prospective observational study was conducted to estimate the prevalence of oropharyngeal carriage of kingella kingae in healthy australian pre-school children.201727669685
in vitro characterization of biofilms formed by kingella kingae.the gram-negative bacterium kingella kingae is part of the normal oropharyngeal mucosal flora of children <4 years old. k. kingae can enter the submucosa and cause infections of the skeletal system in children, including septic arthritis and osteomyelitis. the organism is also associated with infective endocarditis in children and adults. although biofilm formation has been coupled with pharyngeal colonization, osteoarticular infections, and infective endocarditis, no studies have investigated b ...201627714987
[treatment and progression of acute communautary osteoarticular infections in healthy children: a retrospective monocentric study of 64 patients].the prognosis of osteoarticular infections has improved over the past 20 years but it still remains potentially severe. the treatment of these infections has been simplified and shortened. in 2008, the pediatric infectious disease group (gpip) established new therapeutic guidelines in order to standardize treatment in france. the aim of this study is to analyze practices in a parisian hospital and assess the efficacy of this treatment in short and medium terms.201627745829
kingella kingae expresses four structurally distinct polysaccharide capsules that differ in their correlation with invasive disease.kingella kingae is an encapsulated gram-negative organism that is a common cause of osteoarticular infections in young children. in earlier work, we identified a glycosyltransferase gene called csaa that is necessary for synthesis of the [3)-β-galpnac-(1→5)-β-kdop-(2→] polysaccharide capsule (type a) in k. kingae strain 269-492. in the current study, we analyzed a large collection of invasive and carrier isolates from israel and found that csaa was present in only 47% of the isolates. further ex ...201627760194
ischemic stroke and septic shock after subacute endocarditis caused by haemophilus parainfluenzae: case report.haemophilus parainfluenzae, which belongs to the hacek (haemophilus ssp, actinobacillus actinomycetemcomitans, cardiobacterium hominis, eikenella corrodens, and kingella kingae) group, is a rare cause of subacute endocarditis and may lead to ischemic stroke. a 65-year-old female patient previously diagnosed with rheumatic valve disease was submitted to surgical mitral valve repair in 1996. physical examination did not reveal any murmurs; physical examination of the lungs and abdomen was normal. ...201627924179
ischemic stroke and septic shock after subacute endocarditis caused by haemophilus parainfluenzae: case report.haemophilus parainfluenzae, which belongs to the hacek (haemophilus ssp, actinobacillus actinomycetemcomitans, cardiobacterium hominis, eikenella corrodens, and kingella kingae) group, is a rare cause of subacute endocarditis and may lead to ischemic stroke. a 65-year-old female patient previously diagnosed with rheumatic valve disease was submitted to surgical mitral valve repair in 1996. physical examination did not reveal any murmurs; physical examination of the lungs and abdomen was normal. ...201627924179
outbreaks of invasive kingella kingae infections in daycare facilities: approach to investigation and management. 201727939255
kingella kingae microbial keratitis in a human immunodeficiency virus patient with orthokeratology lens wear. 201627943526
kingella kingae chest mass mimicking a tumor in an 11-month-old baby.kingella kingae has been recognized as a common etiology of pediatric osteoarticular infections, especially among children younger than 5 years of age. in recent years, there have been reported cases of unusual manifestations. we report a rare case of a chest mass mimicking a tumor in an 11-month-old baby.201727956728
pediatric sacroiliitis: clinical and microbiologic differences between infants and children-adolescents.the aim of this study was to improve knowledge of pediatric pyogenic sacroiliitis (psi) in the pediatric population based on a consecutive case series.201628002357
an outbreak of kingella kingae infections complicating a severe hand, foot, and mouth disease outbreak in nice, france, 2016.we report the investigative methods for the diagnosis of an epidemic and culture-negative k. kingae endocarditis complicating a severe outbreak of hand, foot, and mouth disease in a childcare center. the diagnosis was confirmed by pcr testings performed from cardiac tissue. our findings argue for the systematic investigation of k. kingae outbreaks by using molecular tools in such context.201628002358
a rare case of clavicle osteomyelitis in a child and literature review.acute clavicle osteomyelitis in children is rare representing <3% of osteomyelitis cases. we treated a 12-year-old boy who presented with acute pain in the right clavicle and high fever for 4 days. mri showed abnormal signal in the right clavicle with periosteal reaction. staphylococcus aureus isolated from blood was susceptible to methicillin, clindamycin, and macrolides. clindamycin was given intravenously for 3 wks and orally for another 3 wks with no recurrence. we reviewed clavicle osteomye ...201628050301
paediatric bone and joint infections in french guiana: a 6 year retrospective review.the epidemiology of paediatric bone and joint infections from south america is poorly known. we herein report a retrospective study conducted in whole french guiana from january 2010 to december 2015. medical charts of 55 previously healthy children were analysed, identifying 27 with osteomyelitis, 22 with septic arthritis and 6 with multifocal infections and/or osteoarthritis. the male:female ratio was 2.2:1, and the mean age was 7.5 years. eighty percent children were ≥36 months old who had pr ...201728204806
the type a and type b polysaccharide capsules predominate in an international collection of invasive kingella kingae isolates.kingella kingae is an encapsulated gram-negative bacterium and an important etiology of osteoarticular infections in young children. a recent study examining a diverse collection of carrier and invasive k. kingae isolates from israel revealed four distinct polysaccharide capsule types. in this study, to obtain a global view of k. kingae capsule type diversity, we examined an international collection of isolates using a multiplex pcr approach. the collection contained all four previously identifi ...201728317027
clinical presentation and treatment of septic arthritis in children.the aim of this study is to determine the epidemiological features, clinical presentation, and treatment of children with septic arthritis.201728373088
brodie abscess of the femoral capital epiphysis in a 2-year-old child caused by kingella kingae.we report the case of a brodie abscess of the femoral capital epiphysis from which kingella kingae was isolated. this is to the best of our knowledge the first report of a brodie abscess of the femoral capital epiphysis from which k. kingae was isolated.201728432046
[kingella kingae septicemia in a patient with coxsackievirus infection].kingella kingae is a gram-negative cocci present in the oral flora ; this organism is difficult to isolate by conventional culture techniques ; it can be detected after longer incubation period (more than 6 days) in blood culture. it is responsible of various infectious diseases, especially in children below 3 years-old where it is a cause of arthritis and osteomyeli tis. it is included in hacek organisms responsible of 2 to 3 % of all cases of native endocarditis. the case report is the case of ...201628525210
investigation of kingella kingae invasive infection outbreaks in day care facilities: assessment of a rapid genotyping tool targeting the dna uptake sequence.outbreaks of kingella kingae invasive infections have recently been reported in day care centers. pulsed-field gel electrophoresis (pfge) and multilocus sequence typing (mlst) revealed that although the invasive strains had widespread dissemination in the day care population, less virulent strains were also circulating in the facilities. however, these typing tools are costly, time-consuming, and labor-intensive and provide delayed results. a study was conducted to assess the performance of a ra ...201728539344
kingella kingae keratitis in a child with underlying vernal keratoconjunctivitis.kingella kingae had rarely been reported as a causative organism for corneal ulcer and had not been described before in vernal keratoconjunctivitis (vkc). generally regarded as commensals of respiratory tract particularly in young children, it had however been isolated from the corneal ulcer scraping of both adult and children. we report a case of bacterial ulcer with isolation of kingella kingae from the corneal scraping in a young child with underlying vkc.201728546880
oropharyngeal carriage rates of kingella kingae in young children in new zealand and australia. 201728573812
paediatric bone and joint infection.despite advances in understanding and management, paediatric osteoarticular infections continue to pose diagnostic difficulties for clinicians. delays in diagnosis can lead to potentially devastating morbidity.no single investigation, including joint aspiration, is sufficiently reliable to diagnose conclusively paediatric bone and joint infection. diagnosis should be based on a combination of clinical signs, imaging and laboratory investigations. algorithms should supplement, and not replace, cl ...201728607765
spondylodiscitis by kingella kingae: an emerging pathogen in an older pediatric population.in children, greater than 95% of kingella kingae infections are diagnosed between 6 and 48 months of age. kingella kingae has not been systematically investigated, especially in older children. we describe a case of spondylodiscitis by kingella kingae in an 8-year-old child.201728650419
pyogenic tenosynovitis in infants: a case series.pyogenic tenosynovitis is an uncommon condition in children and there are few published case reports. we present a series of 11 cases who were treated in the geneva's children hospital in the last 10 years. kingella kingae was the main pathogen and the characteristics of infection (inflammatory indices, clinical findings and severity) are similar to other osteoarticular k kingae's infections in infants.201728661965
isolation and characterization of kingella negevensis sp. nov., a novel kingella species detected in a healthy paediatric population.we herein report the isolation and characterization of 21 gram-stain-negative strains cultivated from the oropharynx of healthy children in israel and switzerland. initially described as small colony variants of kingella kingae, phenotypic analysis, biochemical analysis, phylogenetic analysis based on sequencing of the partial 16s rrna gene and five housekeeping genes (abcz, adk, g6pd, groel and reca), and whole genome sequencing and comparison between members of the genera kingella and neisseri ...201728699877
antimicrobial susceptibility testing of kingella kingae with broth microdilution and disk diffusion using eucast recommended media.due to the increasing use of improved culture techniques and sensitive nucleic acid amplification assays, kingella kingae was recognized as an important cause of invasive infections in young children, especially in septic arthritis, osteomyelitis, bacteremia and endocarditis. in 2016, eucast established clinical mic breakpoints for k. kingae (published in eucast clinical breakpoint tables v 7.0, 2017). the present study was carried out to produce mic-zone diameter correlations for k. kingae on a ...201728760709
molecular tests that target the rtx locus do not distinguish between kingella kingae and the recently described kingella negevensis species.kingella kingae is an important invasive pathogen in early childhood. the organism elaborates a rtx toxin presumably restricted to this species. consequently, real-time pcr (qpcr) assays targeting the rtx locus have been developed in recent years and are gaining increasing use for the molecular diagnosis of k. kingae infections. however, this study shows that kingella negevensis, a kingella species newly identified in young children, harbors an identical kingella rtx locus, raising the question ...201728794176
genomics of the new species kingella negevensis: diagnostic issues & identification of a locus encoding a rtx toxin.kingella kingae, producing the cytotoxic rtx protein, is a causative agent of serious infections in humans such as bacteremia, endocarditis and osteoarticular infection, especially in young children. recently, kingella negevensis, a related species, has been isolated from the oral cavity of healthy children. in this study, we report the isolation of k. negevensis strain eburonensis, initially misidentified as k. kingae with maldi-tof ms, from a vaginal specimen of a patient suffering of vaginosi ...201728802585
review of pediatric osteoarticular infections.pediatric osteoarticular infections are relatively rare but important diseases to identify early and treat appropriately in order to avoid associated acute complications or long-term morbidity.201728847286
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