Klein C, Peltier F, Pluquet E, Haraux E, Gouron R, Joseph C
Department of Pediatric Orthopedic Surgery, Amiens University Hospital, Jules-Verne University of Picardie, 80054 Amiens cedex 1, France.
Department of Bacteriology, Amiens University Hospital, Jules-Verne University of Picardie, Microbiology Research Unit EA4294, 80054 Amiens cedex 1, France; AGIR Group, Microbiology Research Unit, EA4294, Jules-Verne University of Picardie, 80054 Amiens cedex 1, France.
Arch Pediatr. 2021 Jan;28(1):12-15. doi: 10.1016/j.arcped.2020.11.005. Epub 2020 Dec 9.
Kingella kingae (Kk) is frequently responsible for invasive skeletal infections in children aged 3-36months. However, few outbreaks of invasive Kk infections in day care centers have been reported. The objective of the present study was to describe (a) the clinical and laboratory data recorded during an outbreak of invasive Kk skeletal infections, and (b) the management of the outbreak.
Four children from the same day care center were included in the study May and June 2019. We retrospectively analyzed the children's clinical presentation and their radiological and laboratory data. We also identified all the disease control measures taken in the day care center.
We observed cases of septic arthritis of the wrist (case #1), shoulder arthritis (case #2), knee arthritis (case #3) ans cervical spondylodiscitis (case #4). All cases presented with an oropharyngeal infection and concomitant fever prior to diagnosis of the skeletal infection. All cases were misdiagnosed at the initial presentation. The mean (range) age at diagnosis was 10.75months (9-12). The three patients with arthritis received surgical treatment. All patients received intravenous and then oral antibiotics. In cases 1 and 2, Kk was detected using real-time PCR and a ST25-rtxA1 clone was identified. The outcome was good in all four cases. Four other children in the day care center presented with scabies during this period and were treated with systemic ivermectin. The Regional Health Agency was informed, and all the parents of children attending the day care center received an information letter. The day care center was cleaned extensively.
Our results highlight the variety of features of invasive skeletal Kk infections in children and (given the high risk of transmission in day care centers) the importance of diagnosing cases as soon as possible.
金氏金杆菌（Kk）常导致3至36个月大儿童发生侵袭性骨骼感染。然而，日托中心侵袭性Kk感染的暴发报告较少。本研究的目的是描述（a）侵袭性Kk骨骼感染暴发期间记录的临床和实验室数据，以及（b）暴发的管理情况。
2019年5月和6月，来自同一日托中心的4名儿童被纳入研究。我们回顾性分析了这些儿童的临床表现及其放射学和实验室数据。我们还确定了日托中心采取的所有疾病控制措施。
我们观察到腕部化脓性关节炎（病例#1）、肩部关节炎（病例#2）、膝关节炎（病例#3）和颈椎间盘炎（病例#4）的病例。所有病例在骨骼感染诊断前均出现口咽感染并伴有发热。所有病例在初次就诊时均被误诊。诊断时的平均（范围）年龄为10.75个月（9 - 12个月）。3例患关节炎的患者接受了手术治疗。所有患者均接受了静脉注射抗生素，随后改为口服抗生素。在病例1和病例2中，通过实时PCR检测到Kk，并鉴定出一个ST25 - rtxA1克隆。所有4例病例的结局均良好。在此期间，日托中心的另外4名儿童出现疥疮，并接受了全身性伊维菌素治疗。已通知地区卫生机构，日托中心所有儿童的家长均收到了一封告知信。对日托中心进行了全面清洁。
我们的结果突出了儿童侵袭性骨骼Kk感染的多种特征，以及（鉴于日托中心传播风险高）尽早诊断病例的重要性。
