Primer brote documentado de artritis séptica por Kingella kingae en una guardería de España / First documented outbreak of arthritis caused by Kingella kingae in a Spanish childcare center

IntroducciónRecientemente, Kingella kingae (K. kingae) se ha descrito como el principal agente causal de infecciones osteoarticulares entre los 6 meses y 2 años de vida. Más excepcional es su presentación en forma de clúster de infección invasiva por K. kingae. Se describe la investigación del primer brote de 3casos de artritis séptica causada por K. kingae documentado en España en una guardería de Roses, Girona.Pacientes y métodosEn diciembre del 2015, se realizó frotis faríngeo a todos los niños de la misma clase de la guardería. La muestra estaba compuesta por 9 lactantes (rango de edad: 16-23 meses), que incluía los 3casos índice. El estudio microbiológico se realizó mediante cultivo y RT-PCR específicos a K. kingae. Se administró amoxicilina y rifampicina profilácticas a todos los que presentaron colonización por K. kingae. Después de finalizar la profilaxis, se tomó un nuevo frotis faríngeo para confirmar la erradicación.ResultadosSe detectó K. kingae por RT-PCR en los 3casos índices y 5/6 compañeros de clase. Los cultivos fueron negativos en todos los casos. Después de recibir profilaxis, 3lactantes aún presentaban positividad a K. kingae en RT-PCR.ConclusionesK. kingae puede causar brotes de enfermedad invasiva en comunidades cerradas. Para una adecuada investigación, se requiere un mayor conocimiento de su existencia, así como una mejoría de la sensibilidad de las pruebas diagnósticas. En nuestra experiencia, la administración de profilaxis antibiótica puede erradicar parcialmente la colonización orofaríngea por K. kingae. Después de la profilaxis no se detectaron nuevos casos.

BackgroundRecently, Kingella kingae (K. kingae) has been described as the most common agent of skeletal system infections in children 6 months-2 years of age. More exceptional is the clinical presentation in clusters of invasive K. kingae infections. We describe the investigation of the first outbreak of 3cases of arthritis caused by K. kingae documented in Spain detected in a daycare center in Roses, Girona.Patients and methodsIn December of 2015 surveillance throat swabs obtained from all attendees from the same class of the index daycare center were assessed to study the prevalence of K. kingae colonization. The sample was composed of 9 toddlers (range: 16-23 months of age). Investigation was performed by culture and K. kingae-specific RT-PCR. Combined amoxicillin-rifampicin prophylaxis was offered to all attendees who were colonized by K. kingae. Following antimicrobial prophylaxis, a new throat swab was taken to confirm bacterial eradication.ResultsK. kingae was detected by RT-PCR throat swabs in the 3index cases and 5of the 6daycare attendees. Cultures were negative in all cases. After administration of prophylactic antibiotics, 3toddlers were still positive for K. kingae-specific RT-PCR.ConclusionsClusters of invasive K. kingae infections can occur in daycare facilities and closed communities. Increased awareness and use of sensitive detection methods are needed to identify and adequately investigate outbreaks of K. kingae disease. In our experience, the administration of prophylactic antibiotics could result in partial eradication of colonization. No further cases of disease were detected after prophylaxis.

First documented outbreak of arthritis caused by Kingella kingae in a Spanish childcare center.

BACKGROUND: Recently, Kingella kingae (K. kingae) has been described as the most common agent of skeletal system infections in children 6 months-2 years of age. More exceptional is the clinical presentation in clusters of invasive K. kingae infections. We describe the investigation of the first outbreak of 3 cases of arthritis caused by K. kingae documented in Spain detected in a daycare center in Roses, Girona. PATIENTS AND METHODS: In December of 2015 surveillance throat swabs obtained from all attendees from the same class of the index daycare center were assessed to study the prevalence of K. kingae colonization. The sample was composed of 9 toddlers (range: 16-23 months of age). Investigation was performed by culture and K. kingae-specific RT-PCR. Combined amoxicillin-rifampicin prophylaxis was offered to all attendees who were colonized by K. kingae. Following antimicrobial prophylaxis, a new throat swab was taken to confirm bacterial eradication. RESULTS: K. kingae was detected by RT-PCR throat swabs in the 3 index cases and 5 of the 6 daycare attendees. Cultures were negative in all cases. After administration of prophylactic antibiotics, 3 toddlers were still positive for K. kingae-specific RT-PCR. CONCLUSIONS: Clusters of invasive K. kingae infections can occur in daycare facilities and closed communities. Increased awareness and use of sensitive detection methods are needed to identify and adequately investigate outbreaks of K. kingae disease. In our experience, the administration of prophylactic antibiotics could result in partial eradication of colonization. No further cases of disease were detected after prophylaxis.

First documented outbreak of arthritis caused by Kingella kingae in a Spanish childcare center. / Primer brote documentado de artritis séptica por Kingella kingae en una guardería de España.

BACKGROUND: Recently, Kingella kingae (K. kingae) has been described as the most common agent of skeletal system infections in children 6 months-2 years of age. More exceptional is the clinical presentation in clusters of invasive K. kingae infections. We describe the investigation of the first outbreak of 3cases of arthritis caused by K. kingae documented in Spain detected in a daycare center in Roses, Girona. PATIENTS AND METHODS: In December of 2015 surveillance throat swabs obtained from all attendees from the same class of the index daycare center were assessed to study the prevalence of K. kingae colonization. The sample was composed of 9 toddlers (range: 16-23 months of age). Investigation was performed by culture and K. kingae-specific RT-PCR. Combined amoxicillin-rifampicin prophylaxis was offered to all attendees who were colonized by K. kingae. Following antimicrobial prophylaxis, a new throat swab was taken to confirm bacterial eradication. RESULTS: K. kingae was detected by RT-PCR throat swabs in the 3index cases and 5of the 6daycare attendees. Cultures were negative in all cases. After administration of prophylactic antibiotics, 3toddlers were still positive for K. kingae-specific RT-PCR. CONCLUSIONS: Clusters of invasive K. kingae infections can occur in daycare facilities and closed communities. Increased awareness and use of sensitive detection methods are needed to identify and adequately investigate outbreaks of K. kingae disease. In our experience, the administration of prophylactic antibiotics could result in partial eradication of colonization. No further cases of disease were detected after prophylaxis.

Prenatal programming of renal function: the estimated glomerular filtration rate is influenced by size at birth in apparently healthy children.

Prenatal growth is known to affect glomerular function in adult life. It is unknown, however, whether this association is also present in children. In a cross-sectional study, we examined whether birth weight (BW) is associated with serum creatinine (measured by an improved Jaffe method) and GFR (estimated by the Haycock-Schwartz formula; eGFR) in 73 apparently healthy school-age children (35 boys and 38 girls; age 9.5 +/- 0.4 yr). All children were born after singleton term pregnancies (gestational age 39.6 +/- 0.2 wk) with normal BW (3.2 +/- 0.04 kg). A significant decrease in serum creatinine and increase in the eGFR was evident by tertiles of BW-SD score (SDS) (p = 0.001 and p < 0.0001). eGFR was correlated with BW-SDS (r = 0.45; p < 0.0001), so that each unit increase in BW-SDS was associated with an increase in eGFR of 10 (95% CI 5-14) ml/min per 1.73 m. In summary, estimates of glomerular function are in apparently healthy school-age children influenced by size at birth. These findings suggest early effects for the prenatal programming of renal function in humans.

Variabilidad intra e interlaboratorios en la determinaciónde la glucosa plasmática. Implicaciones para los estudiosepidemiológicos y la práctica clínica / Intra- and inter-laboratory variability in determining plasma glucose. Implications for epidemiological studies and clinical practice

Fundamentos: La precisión de las determinaciones de glucemia es esencial para el correcto diagnóstico de la diabetes, y la variabilidad intra e interlaboratorios podría tener implicaciones relevantes desde el punto de vista clínico y epidemiológico. Métodos: Evaluación de la exactitud y la precisión intra e interlaboratorios de las determinaciones de glucemia en cinco laboratorios hospitalarios de la red pública de Cataluña. Cada laboratorio analizó 20 diluciones duplicadas (40 muestras) de suero control líquido valorado, ciego a las titulaciones, a la existencia de muestras duplicadas y manteniendo las condiciones usuales de práctica. Se analizó la existencia de diferencias entre laboratorios y con los valores de referencia, entre muestras duplicadas del mismo laboratorio y las diferencias en el porcentaje de titulaciones que serían clasificadas en las diferentes categorías diagnósticas de diabetes. Resultados: La concordancia de categorías diagnósticas entre los hospitales y las titulaciones valoradas fue muy elevada (estadísticos > 0,80). Los valores medios de cada lote fueron muy próximos entre sí y muy próximos a los de la titulación original estimada, con variaciones, entre 1 y 3 mg/dl, carentes de relevancia clínica. Tampoco existieron diferencias relevantes en el análisis intralaboratorio de las muestras duplicadas. El porcentaje de muestras de cada hospital en las diferentes categorías diagnósticas no demostró diferencias significativas. Conclusión: La excelente exactitud y la precisión en la determinación de glucemia en los laboratorios de los centros analizados permite las comparaciones en los estudios epidemiológicos y reasegura a los clínicos en la calidad y exactitud de los datos ofrecidos por estos laboratorios (AU)