Kingella kingae is being recognized increasingly as a common etiology of pediatric osteoarticular infections, bacteremia, and endocarditis, which reflects improved culture methods and use of nucleic acid–amplification techniques in clinical microbiology laboratories. K kingae colonizes the posterior pharynx of young children and is transmitted from child to child through close personal contact. Day care attendance increases the risk for colonization and transmission, and clusters of K kingae infections among day care center attendees have been reported. Key virulence factors in K kingae include type IV pili and a potent RTX toxin. In previously healthy children, >95% of K kingae infections are diagnosed between the ages of 6 and 48 months. Among children with underlying medical conditions, K kingae disease may occur at older ages as well. The clinical presentation of K kingae disease is often subtle and may be associated with normal levels of acute-phase reactants, which underscores the importance of a high index of suspicion. K kingae is usually susceptible to ß-lactam antibiotics, and infections typically respond well to medical treatment, with the exception of cases of endocarditis.
Kingella kingae: An Emerging Pathogen in Young Children
FLIGHT PATTERNS: Last week I spent a lot of time building a fairly complex flight itinerary between Burlington, San Diego, Addis Ababa, Ethiopia and Kampala, Uganda. Remarkably, over the space of 48 hours, the price fluctuated by hundreds of dollars, and even over the course of a few minutes, some flights became unavailable or cost a few dollars more. As reported in The Wall Street Journal (January 27, 2011: Life & Culture), finding cheap airfare is all about timing. Travel experts report that Tuesdays and Wednesdays are the best days to buy tickets. Airline ticket discounts are typically announced on Monday nights. Airlines in the same market may match prices on Tuesday. By the end of the week, the promotion may have expired or all seats taken. Conversely, when airlines want to raise ticket prices, they do so on Thursday evenings and wait to see if their competitors match the price. If not, the fares can be rolled back the following Monday. Computers track ticket sales and can add seats at a price point if sales are slow or remove them if sales are brisk. Monitoring fare tends to be more brisk on the weekdays. The airline and travel consolidators all report far more tickets are sold midweek than on weekends. This pattern may be remnant of the days when business travelers booked through travel agents who tended to work Monday through Friday. With more and more people booking directly online, and many Americans on social media outlets such as Twitter and Facebook, some carriers are breaking the pattern and experimenting with tweeting very short duration sales. According to the article, while purchase dates clearly can impact the cost of a ticket, the departure date selected has greater impact. Tuesday, Wednesday, and Saturday departures tend to be less expensive than Monday, Friday, or Sunday flights. As for me, I was quite happy that a non-stop flight from San Diego to Washington, DC suddenly became available and with my flexible schedule, I could depart Kampala on a Tuesday saving almost $400.
Noted by WVR, MD
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
Pablo Yagupsky, Eric Porsch, Joseph W. St Geme; Kingella kingae: An Emerging Pathogen in Young Children. Pediatrics March 2011; 127 (3): 557–565. 10.1542/peds.2010-1867
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