Our current knowledge of the course of invasive K. kingae infections suggests that virulent organisms carried asymptomatically in the pharynx, penetrate the respiratory mucosa and that this penetration is facilitated by non-specific viral infections and stomatitis (Amir and Yagupsky, 1998) (Figure 15.5). Kingella kingae organisms may then propagate to the lower respiratory tract causing pneumonia, or invade the bloodstream. Occult bacteremia may follow, or the bacterium may be seeded to remote sites, such as the skeletal system or the endocardium, for which K. kingae shows a striking and still unexplained affinity, or more rarely to the eyes and meninges. In a minority of cases, the organism is cleared from the skeletal system by an effective immune response resulting in an abortive infection, but the vast majority of patients develop hematogenous arthritis, osteomyelitis, diskitis and other suppurative focal complications (Yagupsky, 2004).
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