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Clinical presentations of Kingella kingae musculoskeletal infections in South Australian children
Author(s) -
Awwad Elias,
Tolley Morgan,
Antoniou Georgia,
Williams Nicole
Publication year - 2021
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1111/jpc.15422
Subject(s) - medicine , kingella kingae , avascular necrosis , septic arthritis , joint effusion , surgery , soft tissue , effusion , limp , synovial fluid , arthritis , radiology , osteoarthritis , pathology , femoral head , magnetic resonance imaging , alternative medicine
Aim This study aimed to alert clinicians to the spectrum of presentations of Kingella kingae musculoskeletal infections. Methods Between August 2010 and March 2018, 55 children presented with positive K. kingae polymerase chain reaction on joint fluid, bone or deep soft tissue collections involving the limbs and subsequently underwent retrospective medical record, radiological and laboratory review. Demographics and clinical information are presented. Results Median age at presentation was 15.9 months (range 4.3 months–10.7 years) and 64% were male. Septic arthritis was the most common diagnosis (95%), median duration of symptoms was 4 days, 65% had a preceding infection (e.g. upper respiratory or gastrointestinal) and 22% re‐presented to emergency departments after prior discharge. The lower limb was involved in 84%, with the knee being most affected (55%). If the lower limb was involved, 82% of previously weight‐bearing children had a limp or were unable to weight bear. On presentation, median temperature was 36.7°C and inflammatory markers were mildly elevated. No blood cultures grew K. kingae . Five synovial fluid cultures were positive for K. kingae . Plain radiography showed effusion, soft tissue swelling or a lesion in 53% of patients. All 41 ultrasounds showed effusion, soft tissue swelling or synovial thickening. One patient with delayed diagnosis later presented with avascular necrosis of the femoral head. Conclusion Kingella kingae is difficult to diagnose due to non‐specific symptoms, absence of fevers and often unremarkable blood tests. Despite generally having good long‐term outcomes, our case of avascular necrosis suggests accurate diagnosis and treatment are important.