Pharyngeal Colonization by Kingella kingae, Transmission, and Pathogenesis of Invasive Infections: A Narrative Review

Abstract

With the appreciation of Kingella kingae as a prime etiology of osteoarticular infections in young children, there is an increasing interest in the pathogenesis of these diseases. The medical literature on K. kingae's colonization and carriage was thoroughly reviewed. Kingella kingae colonizes the oropharynx after the second life semester, and its prevalence reaches 10% between the ages of 12 and 24 months, declining thereafter as children reach immunological maturity. Kingella kingae colonization is characterized by the periodic substitution of carried organisms by new strains. Whereas some strains frequently colonize asymptomatic children but are rarely isolated from diseased individuals, others are responsible for most invasive infections worldwide, indicating enhanced virulence. The colonized oropharyngeal mucosa is the source of child-to-child transmission, and daycare attendance is associated with a high carriage rate and increased risk of invasive disease. Kingella kingae elaborates a potent repeat-in-toxin (RTXA) that lyses epithelial, phagocytic, and synovial cells. This toxin breaches the epithelial barrier, facilitating bloodstream invasion and survival and the colonization of deep body tissues. Kingella kingae colonization and carriage play a crucial role in the person-to-person transmission of the bacterium, its dissemination in the community, and the pathogenesis of invasive infections.

Keywords: Kingella kingae; carriage; children; colonization; invasive disease; pili; transmission.

Figure 1

Dissemination of K. kingae clones among two cohorts of attendees at an Israeli daycare center. Horizontal lanes: individual attendees. Each star represents a positive pharyngeal culture, while the different colors represent distinct PFGE clones.

Figure 2

Oropharyngeal specimen seeded onto selective BAV medium exhibiting growth of β-hemolytic K. kingae colonies.

Figure 3

Age-related prevalence of oropharyngeal K. kingae colonization.

Figure 4

Kingella kingae clones carried in a Bedouin town neighborhood, as determined by PFGE with restriction enzyme EagI. (A) Capital letters: individual clones; l: size marker; ATCC: ATCC 23,330 K. kingae strain; Yellow arrows: clones that exhibit differences in DNA band patterns. (B) Spatial distribution of the clones. Each star represents a positive pharyngeal culture, while the different colors represent distinct PFGE clones.