Vasiliki Spyropoulou

The Contemporary Bacteriologic Epidemiology of Osteoarticular Infections in Children in Switzerland

Objectives To assess the contemporary bacteriologic epidemiology of pediatric osteoarticular infection with particular regard to childrens ages, because Kingella kingae has gained increasing recognition as the predominant pathogen for osteoarticular infection in young children. Study design Retrospective file review of enrolled children from 0 to 15 years of age, admitted to our institution from 2007 to 2015 for suspected osteoarticular infection (217 cases). Information on age, sex, the bone or joint infected, imaging studies, and laboratory data (including bacterial investigations) were collected for analysis. Results Microorganism identification was possible for 138 infected children (63.6%), through blood (cultures or polymerase chain reaction [PCR]) and/or operative samples (cultures or PCR). Thirty‐one patients (14.3%) were found to both have positive blood cultures and operative samples. The results of positive bacteriology specimens identified the most common causative pathogen for osteoarticular infection as K kingae (47.8% of microbiologically confirmed osteoarticular infections of all ages, and 87.7% in children between the ages of 6 and 48 months), significantly more common than Staphylococcus aureus (35.5% of microbiologically confirmed osteoarticular infections of all ages, and 78.2% in children >4 years of age). Conclusions Use of the appropriate PCR assays demonstrated that K kingae currently is the major bacterial cause of pediatric osteoarticular infection, especially in children <4 years of age in whom K kingae is more common than S aureus. PCR assays should be used in routine microbiologic laboratory evaluation to improve diagnostic performance. However, despite the use of molecular methods, there are many osteoarticular infections in which no microorganism is detected, which suggests that these infections may be caused by other as yet unrecognized fastidious microorganisms.

Identifying Reservoirs of Infections Caused by Kingella kingae: A Case-Control Study of Oropharyngeal Carriage of K. kingae Among Healthy Adults.

Background: 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. Method: We conducted a monocentric transversal study on 228 healthy adults to define the carriage rate. Participants were recruited among the staff of a children’s hospital, a population exposed to aerosolized droplets from children. A secondary analysis using a case–control method was conducted to assess risk factors for carriage. Results: We demonstrated an oropharyngeal carriage rate of 2.2% in this population. However, there was a striking similarity in the carriage rate among children younger than 4 years of age and adults living with children of that age group (8.8%). Use of day-care facilities for their own children was also demonstrated as a risk factor for adult carriage. Conclusions: We were able to demonstrate the existence of adult carriage of K. kingae but our results point to transmission from children to adults. Our results do not allow us to conclude that professional exposure in a hospital setting is a risk factor for oropharyngeal carriage.

A transversal pilot study of oropharyngeal carriage of Kingella kingae in healthy children younger than 6 months

BackgroundThe aim of this pilot study was to investigate the extent of oropharyngeal Kingella kingae carriage during the first 6 months of life.MethodsWe conducted a monocentric transversal pilot study on healthy children younger than 6 months in order to define the oropharyngeal carriage rate. Participants were recruited between December 2013 and September 2015 among children without symptoms or signs of invasive infections.ResultsWe demonstrated an oropharyngeal carriage rate of 0.67% in children younger than 6 months. Due to the really low carriage rate, it was not possible to draw statistically significant conclusion about any other characteristic of our population.ConclusionsThe present study suggests that the oropharyngeal carriage of Kingella kingae among a Swiss population of healthy infants younger than 6 months is exceptional. The scarcity of colonization and disease in the early months of life suggests thus that defense against mucosal carriage and invasive infection is above all provided by vertically acquired immunity. Limited exposure of the neonates due to limited social contacts may also represent another factor avoiding neonates’ mucosal Kingella kingae carriage.

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 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 infections in infants.

Progression of Infection after Surgical CT Navigation-Assisted Aspiration Biopsy of a Vertebral Abscess

Background Context. Computed tomography- (CT-) guided fine-needle aspiration biopsy of the vertebral body is an important tool in the diagnostic evaluation of vertebral osteomyelitis. The procedure is considered simple to perform and it is considered a safe procedure with few complications. Purpose. The purpose of this study was to describe an unusual complication due to a CT-guided fine-needle aspiration biopsy of the vertebral body of L3, to better understand the relationship between surgical procedure and complication, and to reflect on how to avoid it. Study Design/Setting. Case report and literature review. Methods. The medical records, laboratory findings, and radiographic imaging studies of an 11-year-old boy, with an unusual complication due to a CT-guided fine-needle aspiration biopsy of the vertebral body of L3, were reviewed. Results. We report a case of vertebral osteomyelitis of L3 caused by methicillin-sensitive Staphylococcus aureus (MSSA). Following a computed tomography-guided aspiration biopsy of the vertebral body of L3, vertebral osteomyelitis rapidly progressed into the vertebral body of L4 as well as the L3-L4 disk. Conclusions. Based on the present case, one should consider that a CT-guided fine-needle aspiration biopsy of the vertebral body may be complicated by a progression of a vertebral osteomyelitis into both the intervertebral disk and also the adjacent vertebral body.

Kingella kingae: from oropharyngeal carriage to paediatric osteoarticular infections

Advances in knowledge about Kingella kingae, and, above all, the dedication of Pablo Yagupsky for studying this pathogen, have drastically clarified the role of K. kingae as a predominant cause of invasive infections in paediatrics. Kingella kingae is currently considered as the primary etiology of osteoarticular infections (OAI) in children aged 6– 48 months [1], and a novel agent of outbreaks of invasive disease in day care centers [2]. Osteoarticular infections caused by K. kingae remain difficult to identify with classical diagnostic strategies, because this organism is notoriously fastidious to cultivate. Considering the recent medical advances and innovative approaches for the diagnosis of the disease, partly based on the significantly high detection rate of the organism in the oropharynx of ill children [3], an increase in the number of identified cases could be established worldwide [4].

Patellar Subacute Hematogenous Osteomyelitis in Children Due To K. Kingae: AReport of Two Cases

Isolated osteomyelitis of the patella is a rare condition mainly occurring in the pediatric population. Diagnosis is often delayed as clinical presentation manifests with vague anterior knee pain, sometimes with mild local signs of inflammation but frequently without any local signs at all. While falls on the knee can explain mild knee pain, erythema, swelling and persistent peripatellar pain should raise a high index of suspicion for local infection. We present two cases of subacute osteomyelitis of the patella in young children. In both cases bone lesions presented as an osteolytic lesion of the patella. After open biopsy of the lesion, bacteriological analysis confirmed infection with Kingella kingae.