Kingella kingae is a species of Gram-negative aerobic coccobacilli. First isolated in 1960 by Elizabeth O. King, it was not recognized as a significant cause of infection in young children until the 1990s, when culture techniques had improved enough for it to be recognized. It is best known as a cause of septic arthritis, osteomyelitis, spondylodiscitis, bacteraemia, and endocarditis, and less frequently lower respiratory tract infections and meningitis.
Elizabeth Osborne King was an internationally known American microbiologist who discovered and described bacteria of medical importance at the United States Centers for Disease Control and Prevention from the late 1940s through the early 1960s. The genera Kingella and Elizabethkingia and the species Kingella kingae are named to honor her for her pioneering work.
Septic arthritis, also known as joint infection or infectious arthritis, is the invasion of a joint by an infectious agent resulting in joint inflammation. Symptoms typically include redness, heat, and pain in a single joint associated with a decreased ability to move the joint. Onset is usually rapid. Other symptoms may include fever, weakness, and headache. Occasionally, more than one joint may be involved.
Osteomyelitis (OM) is an infection of bone. Symptoms may include pain in a specific bone with overlying redness, fever, and weakness. The long bones of the arms and legs are most commonly involved in children, while the feet, spine, and hips are most commonly involved in adults.
There are four species of Kingella: K. kingae, the most common, is part of the bacterial flora of the throat in young children and is transmitted from child to child. When it causes disease, the clinical presentation is often subtle and preceded by a recent history of stomatitis or upper respiratory infection. Other species are K. indologenes, K. denitrificans (both causing endocarditis) and K. oralis found in dental plaque.
The pharynx is the part of the throat behind the mouth and nasal cavity and above the oesophagus and larynx, or the tubes going down to the stomach and the lungs. It is found in vertebrates and invertebrates, though its structure varies across species.
Stomatitis is inflammation of the mouth and lips. It refers to any inflammatory process affecting the mucous membranes of the mouth and lips, with or without oral ulceration.
Endocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves. Other structures that may be involved include the interventricular septum, the chordae tendineae, the mural endocardium, or the surfaces of intracardiac devices. Endocarditis is characterized by lesions, known as vegetations, which is a mass of platelets, fibrin, microcolonies of microorganisms, and scant inflammatory cells. In the subacute form of infective endocarditis, the vegetation may also include a center of granulomatous tissue, which may fibrose or calcify.
One notable exception is in cases of endocarditis (heart valve infection), which can be more refractory to treatment. K. kingae is the fifth member of the HACEK group of fastidious Gram-negative bacteria that cause endocarditis. Routine laboratory tests may be normal because the organism is difficult to culture. Inoculating the fluid from infected joints directly into blood culture vials can enhance the chances of an accurate culture, but extended culture times are not helpful.
The organism has also been known as Moraxella kingae.
K. kingae is oxidase-positive, catalase-negative, and beta-hemolytic.
The oxidase test is a test used in microbiology to determine if a bacterium produces certain cytochrome c oxidases. It uses disks impregnated with a reagent such as N,N,N′,N′-tetramethyl-p-phenylenediamine (TMPD) or N,N-dimethyl-p-phenylenediamine (DMPD), which is also a redox indicator. The reagent is a dark-blue to maroon color when oxidized, and colorless when reduced. Oxidase-positive bacteria possess cytochrome oxidase or indophenol oxidase. These both catalyze the transport of electrons from donor compounds (NADH) to electron acceptors . The test reagent, TMPD dihydrochloride acts as an artificial electron donor for the enzyme oxidase. The oxidized reagent forms the colored compound indophenol blue. The cytochrome system is usually only present in aerobic organisms that are capable of using oxygen as the terminal electron acceptor. The end-product of this metabolism is either water or hydrogen peroxide.
Catalase is a common enzyme found in nearly all living organisms exposed to oxygen. It catalyzes the decomposition of hydrogen peroxide to water and oxygen. It is a very important enzyme in protecting the cell from oxidative damage by reactive oxygen species (ROS). Likewise, catalase has one of the highest turnover numbers of all enzymes; one catalase molecule can convert millions of hydrogen peroxide molecules to water and oxygen each second.
Kingella kingae is thought to begin infection by colonizing the pharynx, crossing the epithelium by using an RTX toxin, and entering the circulation and reaching deeper tissues, such as bones and joints.
The RTX toxin superfamily is a group of cytolysins and cytotoxins produced by bacteria. There are over 1000 known members with a variety of functions. The RTX family is defined by two common features: characteristic repeats in the toxin protein sequences, and extracellular secretion by the type I secretion systems (T1SS). The name RTX refers to the glycine and aspartate-rich repeats located at the C-terminus of the toxin proteins, which facilitate export by a dedicated T1SS encoded within the rtx operon.
K. kingae expresses type IV pili, which allow for enhanced adhesion to respiratory epithelial and synovial cells and thus increased likelihood of colonization. These pili have also been shown to be reduced in number as pathogenesis progresses. σ54 regulates the transcription of pilA1, a major pilus subunit. PilS and PilR, regulatory transcription factors best known from the Pseudomonas aeruginosa pilus system, also may regulate pilA expression. High levels of type IV pili on K.kingae are associated with spreading/corroding colony types, while low levels of type IV pili are associated with nonspreading/noncorroding colony types of K. kingae.The three different types of populations are: spreading/corroding (with high-density pilation), nonspreading/noncorroding colonies (low density pilation), and domed colonies (no pilation, and thus no adherence to epithelium). Generally, respiratory and nonendocarditis infections tend to be highly piliated, while joint fluid, bone, and endocarditis blood isolates are less piliated, if at all.
A pilus is a hair-like appendage found on the surface of many bacteria. The terms pilus and fimbria can be used interchangeably, although some researchers reserve the term pilus for the appendage required for bacterial conjugation. All pili in the latter sense are primarily composed of pilin proteins, which are oligomeric.
The synovial membrane is a specialized connective tissue that lines the inner surface of capsules of synovial joints and tendon sheath. It makes direct contact with the fibrous membrane on the outside surface and with the synovial fluid lubricant on the inside surface. In contact with the synovial fluid at the tissue surface are many rounded macrophage-like synovial cells and also type B cells. Type A cells maintain the synovial fluid by removing wear-and-tear debris. As for type B cells, they produce hyaluronan, as well as other extracellular components in the synovial fluid.
Pseudomonas aeruginosa is a common encapsulated, Gram-negative, rod-shaped bacterium that can cause disease in plants and animals, including humans. A species of considerable medical importance, P. aeruginosa is a multidrug resistant pathogen recognized for its ubiquity, its intrinsically advanced antibiotic resistance mechanisms, and its association with serious illnesses – hospital-acquired infections such as ventilator-associated pneumonia and various sepsis syndromes.
Children under three years of age may become infected with K.kingae and develop spondylodiscitis. Typical symptoms include back pain, abdominal pain, and damage to the bones and joints. It generally targets the lumbar region of the spinal cord, and the only true way of diagnosing it is through biopsy or needle aspiration, as blood plate growth gives many false negatives.
Osteomyelitis occurs in previously healthy children. The infection rate is poorly documented, thus the illness tends to go underdiagnosed. K. kingae can be transmitted person to person in rare cases. Diagnostic tools include low-grade fever, elevated inflammatory markers (ESR and CRP), but white blood cell counts are generally unreliable since they vary among infected patients. K. kingae infections are generally comcomitant with upper respiratory diseases or stomatitis, since disrupted respiratory or buccal mucosa is likely to facilitate bacterial invasion and hematogenous dissemination.
The cause of osteoarticular infections is frequently not identified. Less than 15% of K. kingae-positive clinical specimens reveal organisms on Gram stain.Infections due to K. kingae are treatable with a wide variety of antibiotics, such as beta-lactams, tetracyclines, erythromycin, and fluoroquinolones. Minimum inhibitory concentrations of penicillins, rifampicin, and azithromycin are easily achieved. Multiple studies have shown that inoculating synovial fluid or bone samples directly into blood culture bottles substantially increases the detection of K. kingae compared with direct plating of specimens on solid media.
As an oropharyngeal colonizer, K. kingae is transmitted by respiratory secretions, saliva, and potentially oral contact with contaminated objects. Recent studies suggest K. kingae strains may demonstrate varying degrees of pathogenicity, which could support the person-to-person transfer of pathogenic K. kingae. Infection has been shown to have high prevalence in the autumn and winter months.
K.kingae infections are rare in adults, but they occur in immunocompromised patients. Poor oral hygiene, pharyngitis, and mucosal ulceration are also predisposing factors for infection. The infection can occur in the respiratory or urinary tracts, as it is a part of the normal flora in those two areas, and will develop into septicemia or septic arthritis.Most K. kingae are sensitive to beta-lactam antibiotics, but reports describe strains producing beta-lactamases. Options include aminoglycosides, macrolides and fluoroquinolones. K.Kingae can also cause infectious endocarditis, in children as well as in adults.
Neisseria gonorrhoeae, also known as gonococcus (singular), or gonococci (plural) is a species of Gram-negative diplococci bacteria isolated by Albert Neisser in 1879. It causes the sexually transmitted genitourinary infection gonorrhea as well as other forms of gonococcal disease including disseminated gonococcemia, septic arthritis, and gonococcal ophthalmia neonatorum.
Bacteremia is the presence of bacteria in the blood. Blood is normally a sterile environment, so the detection of bacteria in the blood is always abnormal. It is distinct from sepsis, which is the host response to the bacteria.
The HACEK organisms are a group of fastidious gram-negative bacteria that are an unusual cause of infective endocarditis, which is an inflammation of the heart due to bacterial infection. HACEK is an abbreviation of the initials of the genera of this group of bacteria: Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella. The HACEK organisms are a normal part of the human microbiota, living in the oral-pharyngeal region.
Infective endocarditis is an infection of the inner surface of the heart, usually the valves. Symptoms may include fever, small areas of bleeding into the skin, heart murmur, feeling tired, and low red blood cell count. Complications may include valvular insufficiency, heart failure, stroke, and kidney failure.
Haemophilus influenzae is a Gram-negative, coccobacillary, facultatively anaerobic pathogenic bacterium belonging to the Pasteurellaceae family. H. influenzae was first described in 1892 by Richard Pfeiffer during an influenza pandemic.
Staphylococcus lugdunensis is a coagulase-negative member of the genus Staphylococcus, consisting of Gram-positive bacteria with spherical cells that appear in clusters.
Moraxella catarrhalis is a fastidious, nonmotile, Gram-negative, aerobic, oxidase-positive diplococcus that can cause infections of the respiratory system, middle ear, eye, central nervous system, and joints of humans. It causes the infection of the host cell by sticking to the host cell using trimeric autotransporter adhesins.
Subacute bacterial endocarditis is a type of endocarditis. Subacute bacterial endocarditis can be considered a form of type III hypersensitivity.
Flucloxacillin, also known as floxacillin, is a narrow-spectrum beta-lactam antibiotic of the penicillin class. It is used to treat infections caused by susceptible Gram-positive bacteria. Unlike other penicillins, flucloxacillin has activity against beta-lactamase-producing organisms such as Staphylococcus aureus as it is beta-lactamase stable. However, it is ineffective against methicillin-resistant Staphylococcus aureus (MRSA). It is very similar to dicloxacillin; they are considered interchangeable.
Pantoea agglomerans is a Gram-negative bacterium that belongs to the family Enterobacteriaceae.
A pneumococcal infection is an infection caused by the bacterium Streptococcus pneumoniae, which is also called the pneumococcus. S. pneumoniae is a common member of the bacterial flora colonizing the nose and throat of 5–10% of healthy adults and 20–40% of healthy children. However, it is also a cause of significant disease, being a leading cause of pneumonia, bacterial meningitis, and sepsis. The World Health Organization estimate that in 2005 pneumococcal infections were responsible for the death of 1.6 million children worldwide.
Ewingella americana is a Gram-negative rod, and the only species in the genus Ewingella. It was first identified and characterized in 1983. Ewingella is in the family Enterobacteriaceae. The organism is rarely reported as a human pathogen, though it has been isolated from a variety of clinical specimens, including wounds, sputum, urine, stool, blood, synovial fluid, conjunctiva and peritoneal dialysate. The bacterium is named in honor of William H. Ewing, an American biologist who contributed to modern taxonomy.
The PilZ protein family is named after the type IV pilus control protein first identified in Pseudomonas aeruginosa, expressed as part of the pil operon. It has a cytoplasmic location and is essential for type IV fimbrial, or pilus, biogenesis. PilZ is a c-di-GMP binding domain and PilZ domain-containing proteins represent the best studied class of c-di-GMP effectors. C-di-GMP, cyclic diguanosine monophosphate, the second messenger in cells, is widespread in and unique to the bacterial kingdom. Elevated intracellular levels of c-di-GMP generally cause bacteria to change from a motile single-cell state to a sessile, adhesive surface-attached multicellular state called biofilm.
Suttonella indologenes, formerly Kingella indologenes, is a Gram-negative rod-shaped bacterium of the family Cardiobacteriaceae. Like other members of its family, it is a bacterium that is assumed to be normally present in the respiratory tract. It has been found to rarely cause endocarditis, an infection of the heart valves. It also been found in the eye. It may cause eye infections. Little is known about it as a bacterium other than its structure and biochemical composition. Like other members in its family, it has a characteristic 16S ribosomal RNA which consists of 1474 base pairs.
Streptococcus tigurinus is a novel member of the genus Streptococcus that was first discovered in 2012 by Swedish researchers.
Twitching motility is a form of crawling bacterial motility used to move over surfaces. Twitching is mediated by the activity of hair-like filaments called type IV pili which extend from the cell's exterior, bind to surrounding solid substrates and retract, pulling the cell forwards in a manner similar to the action of a grappling hook. The name twitching motility is derived from the characteristic jerky and irregular motions of individual cells when viewed under the microscope. It has been observed in many bacterial species, but is most well studied in Pseudomonas aeruginosa, Neisseria gonorrhoeae and Myxococcus xanthus. Active movement mediated by the twitching system has been shown to be an important component of the pathogenic mechanisms of several species.
Parvimonas micra is a Gram positive anaerobic coccus which is frequently isolated from dental plaque in patients with chronic periodontitis. It is the only species in its genus, and is a common constituent of mixed anaerobic infections such as intra-abdominal abscess. It has rarely been implicated as a sole pathogen in septic arthritis, osteomyelitis and discitis associated with recent dental procedures.