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Patterns of Kingella kingae Disease Outbreaks

El Houmami, Nawal MD; Minodier, Philippe MD; Dubourg, Grégory MD, PhD; Mirand, Audrey MD, PhD; Jouve, Jean-Luc MD, PhD; Basmaci, Romain MD, PhD; Charrel, Rémi MD, PhD; Bonacorsi, Stéphane MD, PhD; Yagupsky, Pablo MD; Raoult, Didier MD, PhD; Fournier, Pierre-Edouard MD, PhD

The Pediatric Infectious Disease Journal: March 2016 - Volume 35 - Issue 3 - p 340–346
doi: 10.1097/INF.0000000000001010
Review Article

Background: Kingella kingae outbreaks occur sporadically in childcare centers but remain poorly understood and difficult to identify.

Methods: To provide the basis of a better knowledge of K. kingae outbreaks patterns that may help to guide identification and management strategies, we collected epidemiological, clinical and laboratory data from all reported K. kingae outbreaks, and those from 2 new Israel outbreaks in 2014.

Results: Nine outbreaks were identified in the USA, Israel and France from 2003 to 2014. Twenty-seven children with a median age of 14 ± 4.1 months were affected, male:female ratio of 1.4:1. Outbreaks demonstrated seasonal patterns from the 10th to the 45th weeks, a mean duration of 13.1 ± 8.4 days, a mean attack rate of 17.3 ± 5.1% and a case-fatality rate of 3.7% (1/27). Seventy-four percentage of children had fever (20/27), and the mean values of white blood cell count and C-reactive protein level were 14.6 ± 4.5 × 109/L and 23.8 ± 24.1 mg/L, respectively. Osteoarticular infections accounted for 88.9% of cases (24/27), bacteremia 7.4% (2/27), endocarditis 3.7% (1/27) and meningitis 3.7% (1/27). Specific real-time polymerase chain reaction demonstrated higher performance than culture methods in the diagnosis of case patients and investigations of oropharyngeal K. kingae carriage among close contacts, and multilocus sequence typing methods revealed that ST-6 and ST-25 invasive strains were responsible for multiple country-dependent outbreaks. Coviral infections were identified in the majority of K. kingae outbreaks, notably those causing oral ulcers.

Conclusions: K. kingae outbreaks displayed severe K. kingae diseases that were poorly confirmed with culture methods. We argue for the use of genomic technologies to investigate further K. kingae outbreaks.

Supplemental Digital Content is available in the text.

From the *Department of Pediatric Orthopedics, University La Timone Children’s Hospital; URMITE “Unité de Recherche sur les Maladies Infectieuses Tropicales Emergentes”, UM63, CNRS 7278, IRD 198, Inserm 1095, Institut Hospitalo-Universitaire Méditerranée-Infection, Aix-Marseille University; Department of Pediatric Emergency Medicine, University North Hospital, Marseille, France; §Laboratoire de Virologie, Centre National de Référence des Enterovirus et Parechovirus-laboratoire associé, CHU de Clermont-Ferrand, Clermont-Ferrand, France; Laboratoire de Microbiologie, Hôpital Robert Debré, AP-HP, Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France; Aix Marseille Université, IRD French Institute of Research for Development, EHESP French School of Public Health, EPV UMR_D 190 “Emergence des Pathologies Virales”, & Institut Hospitalo-Universitaire Méditerranée-Infection, Marseille, France; and **Clinical Microbiology Laboratory, Soroka University Medical Center, Beer-Sheva, Israel.

Accepted for publication September 30, 2015.

The study was funded by the Institut Hospitalo-Universitaire Méditerranée-Infection foundation.

The authors have no conflicts of interest to disclose.

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Address for correspondence: Nawal El Houmami, MD, URMITE “Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes”, UM63, CNRS 7278, IRD 198, Inserm 1095, Faculté de Médecine, 27 Boulevard Jean Moulin, 13385 Marseille, France. E-mail:

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