Outbreaks of Invasive Kingella kingae Infections in Daycare Facilities: Approach to Investigation and Management

摘要

In recent decades, the number of young children attending out-of-home daycare has increased in Western countries. 1 This shift to out-of-home childcare had a substantial public health impact because transmission of agents of human disease, and particularly of pathogens of respiratory origin, is enhanced greatly in this setting. Clusters of severe Streptococcus pneumoniae, Haemophilus influenzae type b, and Neisseria meningitidis diseases have occurred in daycare facilities.(2-4) Over the last few years, outbreaks of bacteremia, skeletal system infections, endocarditis, and fatal meningitis caused by the emerging pediatric pathogen Kingella kingae have been detected in daycare centers.(5-11) This Gram-negative coccobacillary member of the upper respiratory tract microbiota increasingly is being recognized as the most common agent of skeletal system infections in children aged 6-36 months in countries in which improved culture methods and sensitive nucleic acid amplification tests (NAATs) routinely are used for detecting the organism.(12-15) The aims of this review are to describe the clinical and epidemiologic features of K kingae outbreaks in daycare centers, to delineate the microbiologic tools available for detecting the organism, and to summarize the current approach to investigate and manage these events.