Mallet Cindy, Ceroni Dimitri, Litzelmann Estelle, Dubois-Ferriere Victor, Lorrot Mathie, Bonacorsi Stéphane, Mazda Keyvan, Ilharreborde Brice
From the *Pediatric Orthopedic Department, Robert Debré University Hospital, Paris, France; †Pediatric Orthopedic Department, University Hospital of Geneva, Geneva, Switzerland; ‡Pediatric Department; and §Microbiology Department, Robert Debré University Hospital, Paris, France.
Pediatr Infect Dis J. 2014 Jan;33(1):1-4. doi: 10.1097/INF.0b013e3182a22cc6.
With the development of molecular biology and specific polymerase chain reaction, Kingella kingae has become the primary diagnosis of osteoarticular infections in young children. Clinical features of these osteoarticular infections are typically mild, and outcome is almost always favorable. We report a series of unusually severe cases of K. kingae osteoarticular infections.
All patients with severe osteoarticular infections at presentation were reviewed retrospectively in 2 European pediatric centers. K. kingae was identified using real-time polymerase chain reaction in blood, fluid joint or osseous samples. Clinical, laboratory tests and radiographic data during hospitalization and follow-up were analyzed.
Ten children (mean age 21 ± 12 months) with severe osteoarticular infections caused by K. kingae were identified between 2008 and 2011. Diagnostic delay averaged 13.2 ± 8 days. Only 1 patient was febrile at admission, and 50% children had normal C-reactive protein values (≤10 mg/dL) at presentation. Surgical treatment was performed in all cases. Intravenous antibiotic therapy by cephalosporins for an average of 8 ± 6 days was followed by oral treatment for 27 ± 6 days. Mean follow-up was 24.8 ± 9 months, and satisfactory outcomes were reported in all cases. Two patients (20%) developed a central epiphysiodesis of the proximal humerus during follow-up, but without significant clinical consequence for the moment.
Because of their mild clinical features at onset, diagnosis of K. kingae osteoarticular infections can be delayed. Care should be taken for early detection and treatment of these infections because bony lytic lesions and potentially definitive growth cartilage damage can occur.
随着分子生物学和特异性聚合酶链反应的发展，金氏金杆菌已成为幼儿骨关节炎感染的主要诊断病原体。这些骨关节炎感染的临床特征通常较为轻微，且预后几乎总是良好。我们报告了一系列异常严重的金氏金杆菌骨关节炎感染病例。
对欧洲两家儿科中心所有初诊为严重骨关节炎感染的患者进行回顾性研究。通过实时聚合酶链反应在血液、关节液或骨样本中鉴定金氏金杆菌。分析住院期间及随访期间的临床、实验室检查和影像学数据。
2008年至2011年间，共确定了10名（平均年龄21±12个月）由金氏金杆菌引起的严重骨关节炎感染患儿。诊断延迟平均为13.2±8天。入院时仅有1例发热，50%的患儿就诊时C反应蛋白值正常（≤10mg/dL）。所有病例均接受了手术治疗。先用头孢菌素静脉抗生素治疗平均8±6天，随后口服治疗27±6天。平均随访24.8±9个月，所有病例预后均良好。2例（20%）患儿在随访期间出现肱骨近端中央骺板早闭，但目前尚无明显临床后果。
由于金氏金杆菌骨关节炎感染起病时临床特征轻微，其诊断可能会延迟。应注意早期发现和治疗这些感染病例，因为可能会出现骨质溶解病变以及潜在的确定性生长软骨损伤。
