{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T15:48:58Z","timestamp":1762876138235},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2020,1,11]],"date-time":"2020-01-11T00:00:00Z","timestamp":1578700800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,12,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Although Kingella kingae is recognized as an important pediatric pathogen, our knowledge of the virulence factors involved in the invasion of specific host\u2019s tissues is limited. Outbreaks of K kingae infections in daycare centers represent natural experiments in which a single virulent strain, introduced into a cohort of susceptible young children, causes multiple infections. If K kingae strains exhibit tissue tropism, the syndromes observed in a given cluster of cases would be relatively homogeneous.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Clinical data of all the K kingae outbreaks known to date were gathered and analyzed. The clinical syndromes diagnosed in the affected attendees were classified as septic arthritis, osteomyelitis, tenosynovitis, soft tissue infection, bacteremia with no focal disease, endocarditis, and meningitis, and computed separately. To assess the similarity of the clinical syndromes detected within outbreaks, we used the Cramer V statistic, which is a measure of the association between 2 nominal variables and, for the purposes of the study, between the detected clinical syndromes and the outbreaks.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 23 outbreaks involving 61 attendees were identified. The mean\u00b1SD attack rate in the affected classrooms was 15.8% \u00b1 4.8%, and the K kingae colonization rate among the attendees was 54.8% \u00b1 25.3%. Seventy-two separate foci of infection were diagnosed. Osteomyelitis and septic arthritis were the most common clinical syndromes and were diagnosed in 26 children each, followed by tenosynovitis in 4 children. The clinical syndromes diagnosed among attendees to the same classroom showed a statistically significant tendency to be similar (P = .015).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The distribution of clinical syndromes in clusters of K kingae infections differs from that of sporadic cases. The causative strains combine enhanced virulence and high transmissibility, and show tropism toward bones, joints, and tendon sheaths. This information can be used to identify virulence factors associated with invasion of these specific host tissues.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jpids\/piz099","type":"journal-article","created":{"date-parts":[[2019,12,30]],"date-time":"2019-12-30T20:10:27Z","timestamp":1577736627000},"page":"695-700","source":"Crossref","is-referenced-by-count":7,"title":["Outbreaks of <i>Kingella kingae<\/i> Infections in Daycare Centers Suggest Tissue Tropism of the Causative Strains"],"prefix":"10.1093","volume":"9","author":[{"given":"Pablo","family":"Yagupsky","sequence":"first","affiliation":[{"name":"Clinical Microbiology Laboratory, Soroka University Medical Center, Beer-Sheva, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nawal","family":"El Houmami","sequence":"additional","affiliation":[{"name":"Unit\u00e9 Mixte de Recherche Vecteurs - Infections Tropicales et M\u00e9diterran\u00e9ennes Institut pour la Recherche et le D\u00e9veloppement, Marseille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronen","family":"Fluss","sequence":"additional","affiliation":[{"name":"Biostatistics Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,1,11]]},"reference":[{"key":"2021020516553286600_CIT0001","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1128\/CMR.00028-14","article-title":"Kingella kingae: carriage, transmission, and disease","volume":"28","author":"Yagupsky","year":"2015","journal-title":"Clin Microbiol Rev"},{"key":"2021020516553286600_CIT0002","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/j.jpeds.2017.11.025","article-title":"The contemporary bacteriologic epidemiology of osteoarticular infections in children in Switzerland","volume":"194","author":"Juchler","year":"2018","journal-title":"J Pediatr"},{"key":"2021020516553286600_CIT0003","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1097\/INF.0b013e318184dbb8","article-title":"Pharyngeal colonization by Kingella kingae in children with invasive disease","volume":"28","author":"Yagupsky","year":"2009","journal-title":"Pediatr Infect Dis J"},{"key":"2021020516553286600_CIT0004","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1097\/INF.0b013e31819f1f36","article-title":"Dissemination of Kingella kingae in the community and long-term persistence of invasive clones","volume":"28","author":"Yagupsky","year":"2009","journal-title":"Pediatr Infect Dis J"},{"key":"2021020516553286600_CIT0005","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1093\/cid\/cis622","article-title":"Genotyping of invasive Kingella kingae isolates reveals predominant clones and association with specific clinical syndromes","volume":"55","author":"Amit","year":"2012","journal-title":"Clin Infect Dis"},{"key":"2021020516553286600_CIT0006","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1097\/INF.0000000000001010","article-title":"Patterns of Kingella kingae disease outbreaks","volume":"35","author":"El Houmami","year":"2016","journal-title":"Pediatr Infect Dis J"},{"key":"2021020516553286600_CIT0007","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.jpeds.2016.11.016","article-title":"Outbreaks of invasive Kingella kingae infections in daycare facilities: approach to investigation and management","volume":"182","author":"Yagupsky","year":"2017","journal-title":"J Pediatr"},{"key":"2021020516553286600_CIT0008","doi-asserted-by":"crossref","first-page":"e230","DOI":"10.1542\/peds.2012-0810","article-title":"Detection of Kingella kingae osteoarticular infections in children by oropharyngeal swab PCR","volume":"131","author":"Ceroni","year":"2013","journal-title":"Pediatrics"},{"key":"2021020516553286600_CIT0009","volume-title":"Haut Conseille de la Sant\u00e9 Publique. 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