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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-Gal p NAc-(1→5)-β-Kdo p -(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 examination of this collection using primers based on the sequence that flanks  csaA  revealed three additional gene clusters (designated the  csb ,  csc , and  csd  loci), all encoding predicted glycosyltransferases. The  csb  locus contains the  csbA ,  csbB , and  csbC  genes and is associated with a capsule that is a polymer of [6)-α-Glc p NAc-(1→5)-β-(8-OAc)Kdo p -(2→] (type b). The  csc  locus contains the  cscA ,  cscB , and  cscC  genes and is associated with a capsule that is a polymer of [3)-β-Rib f -(1→2)-β-Rib f -(1→2)-β-Rib f -(1→4)-β-Kdo p -(2→] (type c). The  csd  locus contains the  csdA ,  csdB , and  csdC  genes and is associated with a capsule that is a polymer of [P-(O→3)[β-Gal p -(1→4)]-β-Glc p NAc-(1→3)-α-Glc p NAc-1-] (type d). Introduction of the  csa ,  csb ,  csc , and  csd  loci into strain KK01Δ csa , a strain 269–492 derivative that lacks the native  csaA  gene, was sufficient to produce the type a capsule, type b capsule, type c capsule, and type d capsule, respectively, indicating that these loci are solely responsible for determining capsule type in  K .  kingae . Further analysis demonstrated that 96% of the invasive isolates express either the type a or type b capsule and that a disproportionate percentage of carrier isolates express the type c or type d capsule. These results establish that there are at least four structurally distinct  K .  kingae  capsule types and suggest that capsule type plays an important role in promoting  K .  kingae  invasive disease.

Kingella kingae Expresses Four Structurally Distinct Polysaccharide Capsules That Differ in Their Correlation with Invasive Disease