Yagupsky Pablo
Clinical Microbiology Laboratory, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Clin Microbiol Rev. 2015 Jan;28(1):54-79. doi: 10.1128/CMR.00028-14.
Kingella kingae is a common etiology of pediatric bacteremia and the leading agent of osteomyelitis and septic arthritis in children aged 6 to 36 months. This Gram-negative bacterium is carried asymptomatically in the oropharynx and disseminates by close interpersonal contact. The colonized epithelium is the source of bloodstream invasion and dissemination to distant sites, and certain clones show significant association with bacteremia, osteoarthritis, or endocarditis. Kingella kingae produces an RTX (repeat-in-toxin) toxin with broad-spectrum cytotoxicity that probably facilitates mucosal colonization and persistence of the organism in the bloodstream and deep body tissues. With the exception of patients with endocardial involvement, children with K. kingae diseases often show only mild symptoms and signs, necessitating clinical acumen. The isolation of K. kingae on routine solid media is suboptimal, and detection of the bacterium is significantly improved by inoculating exudates into blood culture bottles and the use of PCR-based assays. The organism is generally susceptible to antibiotics that are administered to young patients with joint and bone infections. β-Lactamase production is clonal, and the local prevalence of β-lactamase-producing strains is variable. If adequately and promptly treated, invasive K. kingae infections with no endocardial involvement usually run a benign clinical course.
金氏金杆菌是儿童菌血症的常见病因，也是6至36个月大儿童骨髓炎和化脓性关节炎的主要病原体。这种革兰氏阴性菌在口咽部无症状携带，并通过密切的人际接触传播。定植的上皮细胞是血流侵袭和向远处部位播散的来源，某些克隆与菌血症、骨关节炎或心内膜炎有显著关联。金氏金杆菌产生一种具有广谱细胞毒性的RTX（毒素重复序列）毒素，这可能有助于该菌在黏膜定植以及在血流和深部身体组织中持续存在。除了有心内膜受累的患者外，患有金氏金杆菌疾病的儿童通常仅表现出轻微的症状和体征，这就需要临床敏锐性。在常规固体培养基上分离金氏金杆菌效果欠佳，将渗出物接种到血培养瓶中并使用基于聚合酶链反应的检测方法可显著提高该菌的检出率。该菌通常对用于治疗关节和骨骼感染的年轻患者的抗生素敏感。β-内酰胺酶的产生具有克隆性，产β-内酰胺酶菌株的局部流行率各不相同。如果得到充分及时的治疗，则无心脏受累的侵袭性金氏金杆菌感染通常会有良性的临床病程。
