Oropharyngeal Kingella kingae Detection and Spondylodiscitis in Early Childhood—A Causal or Casual Association?

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BACKGROUND: Pediatric spondylodiscitis is a rare condition, primarily affecting children aged 6-48 months. Kingella kingae is the leading pathogen in this age group, often presenting with mild or atypical features, which delay diagnosis. METHODS: We retrospectively reviewed pediatric spondylodiscitis cases discharged from our hospital between January 2010 and May 2026, identifying those attributable to K. kingae. In parallel, we conducted a systematic literature review using PubMed/MEDLINE and Embase (2000-2025) to identify pediatric cases confirmed by culture, nucleic acid amplification or metagenomic sequencing of plasma microbial cell-free DNA. RESULTS: One case of K. kingae spondylodiscitis was identified at our center. The literature review yielded 59 cases (mean age 24 months). Clinical presentation was indolent: refusal to sit, limping, hip/back pain and minimal systemic symptoms. Laboratory findings were nonspecific, with erythrocyte sedimentation rate being the most elevated marker. All blood cultures were negative. Definitive diagnosis was achieved through molecular detection on blood or biopsy/drainage material; oropharyngeal swab-positive cases were considered presumptive. The lumbar spine (L4-L5) was the most involved site. Most patients responded well to antibiotic treatment; surgical intervention was rarely required. CONCLUSIONS: Kingella kingae should be considered in young children with persistent gait disturbance or hip/back pain, even without fever or marked laboratory abnormalities. Early magnetic resonance imaging and molecular diagnostics on blood or infectious tissue enable timely, definitive diagnosis and targeted therapy. When isolation from a sterile site is not possible, K. kingae spondylodiscitis remains likely if age, clinical presentation, laboratory findings and polymerase chain reaction detection on a pharyngeal swab are consistent.

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