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Septic Arthritis due to Streptococcus dysgalactiae Subspecies equisimilis in a Healthy School Child.

W have read with interest the article of Branson et al about the etiology of the osteoarticular infections (OAIs) in Houston, Texas. We would like to discuss the differences of epidemiology between countries and settings. We performed a retrospective chart review between February 2013 and February 2016 at the Pediatric University Hospital La Paz (Spain). Inclusion criteria were children younger than 14 years with a diagnosis of osteomyelitis (OM) confirmed with magnetic resonance imaging or bone scintigraphy or of septic arthritis (SA) microbiologically confirmed or when the joint fluid had more than 40,000 cells/mm. A total of 90 OAIs were included (41 OM, 7 spondylodiscitis, 31 SA and 11 osteoarthritis). The microbiology was defined in 15 of them: Streptococcus pyogenes was isolated in 2 cases (OM, blood culture), Streptococcus pneumoniae in 1 case of SA (synovial fluid culture) and Kingella kingae in 12 (10 SA and 2 OM) cases. K. kingae was the most frequently identified agent in our series comprising up to 80% of microbiologically confirmed cases [3 blood cultures, 2 synovial fluid culture and 7 polymerase chain reaction (PCR) in synovial fluid]. The mean age of our total cohort was 28 months, and children with K. kingae infection were 15 months of mean age (range, 6–25). The average erythrocyte sedimentation rate was 72 mm/h (range, 20–120) and the C-reactive protein 27 mg/L (range, 2–82). The average white blood cell count was 164,160 ± 75,380/mm (range, 58,800 to 288,000). All patients received antibiotics, and arthrocentesis was performed when necessary. None of them needed surgery. K. kingae is a Gram-negative coccobacillus and a common colonizer of the upper respiratory tract. As several recent studies describe, in some countries, K. kingae has become the most frequent causal agent of OAI in children younger than 4 years. It has been shown that infections