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Kingella kingae Case report: Patient History, Lab Diagnosis and Treatment

achaurasiya
Kingella kingae in gram stain

Kingella kingae in gram stain

Kingella kingae case report

Patient history 

A patient, 69 years old male having diabetes mellitus past 10 years since two years in insulin. Having a history of mild fever, cough, chest pain with sputum and also throat itching took part in ENT-OPD and the doctor suggested for chest X-ray and sputum culture and sensitivity and requested to follow up after three days with reports.

Kingella, which belongs to the family Neisseriaceae, is short, nonmotile, oxidase-positive but catalase-negative gram-negative coccobacilli, that occur in pairs or short chains. The organism is slow-growing and fastidious. Beta hemolytic colony on 5% sheep blood agar. It is recovered from the human respiratory tract and is a rare cause of human disease. Among Kingella species, K. kingae is the most frequent human pathogen. It frequently colonizes the respiratory mucous membranes. Children with 4-6 years of age have the highest rates of colonization and invasive disease from this respiratory tract pathogen. K. kingae is transmitted from child to child through close personal contact.

Pathogenicity 

Kingella comes in the HACEK group and this group contains Haemophilus (species aphrophilus and   parainfluenzae), Aggregatibacter, Cardiobacterium, Eikenella, and Kingella), that includes fastidious gram-negative bacteria capable of causing endocarditis. Kingella also causes skeletal infections and bacteremia and, rarely pneumonia, epiglottitis, abscesses, meningitis, and ocular infections.

Lab Diagnosis

X-ray report: Normal

Sputum C/S: Kingella kingae isolates

Sensitivity:  Sensitive- Ciprofloxacin

  Amoxycillin

Ceftriaxone

 Amikacin

 Amoxycillin clavulanic acid

 Resistant-    Co-trimoxazole

Kingella kingae supporting features:

Gram stain finding–

pus cell plenty ( pus cells>25 LPF, epithelial cells<10LPF)

Gram-negative rods with square ends, lying in pairs and also in chains.

Growth on blood agar–

Beta-hemolytic colonies

Biochemical tests–

Catalase- Negative

Oxidase- Positive

Nitrate to nitrite reduction-Negative

Maltose acid- Positive

Photos:

 

Gram stain from sputum showing Gram negative rods with square ends, lying in pairs and also in chains
K. kingae on blood agar
Beta-haemolytic colony on blood agar of K. kingae
Gram stain from culture of K. kingae
K. kingae on MHA
Catalase test-Negative and oxidase test-Positive – K. kingae
Antibiogram of K. kingae

Treatment

Finally patient benefited after oral medication of Ciprofloxacin. Penicillin and cephalosporin are useful to treat even though antimicrobial sensitivity testing is necessary to provide a selective drug of choice. Recommended drugs are aminoglycosides, tetracycline, fluoroquinolones, erythromycin, and trimethoprim-sulfamethoxazole.

 

Bibliography

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  7.  Text book of Diagnostic Microbiology. Editors: Connie R. Mahon, Donald G. Lehman & George Manuselis, 3rd edition2007, Publisher Elsevier.