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Yang S, Xue B, Hu X, Zhou W, Zhang M, Zhao M. Spinal infection caused by Coxiella burnetii. BMC Infect Dis 2023; 23:6. [PMID: 36609227 PMCID: PMC9817394 DOI: 10.1186/s12879-022-07938-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 12/08/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Spinal infection caused by Coxiella burnetii is rare and difficult to diagnose. Here we reported a case of spinal infection from Coxiella burnetii detected by the metagenomic next-generation sequencing (mNGS). CASE PRESENTATION A 66-year-old male farmer with no medical history reported severe sharp low back pain, numbness and lower limb weakness for three years. Magnetic resonance imaging (MRI) revealed bone destruction and spinal cord compression within L1 and L2. mNGS testing showed that the inspected specimen collected from spinal lesion was detected positively for Coxiella burnetii. After receiving the combined treatment of antibiotic therapy and surgical intervention, the patient recovered well, and the sagittal MRI showed that vertebral edema signals disappeared and the graft of bone fused 16 months after surgery. CONCLUSION The mNGS may be benefit for early diagnosis and intervention of non-specific spinal infection, and future studies should validate its effectiveness for clinical use in spinal infections. Additionally, antibiotic therapy combined with surgical intervention plays an important role on the treatment of spinal infection caused by Coxiella burnetii.
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Affiliation(s)
- Sumin Yang
- Department of Orthopedics, Qingdao Chest Hospital, No. 896 Chongqing Road, Qingdao City, Shandong Province 266043 China
| | - Bai Xue
- grid.469553.80000 0004 1760 3887Qingdao Municipal Centre for Disease Control and Prevention, Qingdao Institute of Prevention Medicine, Qingdao, Shandong Province China
| | - Xiaowen Hu
- grid.469553.80000 0004 1760 3887Qingdao Municipal Centre for Disease Control and Prevention, Qingdao Institute of Prevention Medicine, Qingdao, Shandong Province China
| | - Weidong Zhou
- Department of Orthopedics, Qingdao Chest Hospital, No. 896 Chongqing Road, Qingdao City, Shandong Province 266043 China
| | - Minglei Zhang
- Department of Orthopedics, Qingdao Chest Hospital, No. 896 Chongqing Road, Qingdao City, Shandong Province 266043 China
| | - Mingwei Zhao
- Department of Orthopedics, Qingdao Chest Hospital, No. 896 Chongqing Road, Qingdao City, Shandong Province 266043 China
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2
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Miailhes P, Conrad A, Sobas C, Laurent F, Lustig S, Ferry T, Ferry T, Valour F, Perpoint T, Ader F, Roux S, Becker A, Triffault-Fillit C, Conrad A, Pouderoux C, Chauvelot P, Chabert P, Lippman J, Braun E, Lustig S, Servien E, Batailler C, Gunst S, Schmidt A, Sappey-Marinier E, Ode Q, Fessy MH, Viste A, Besse JL, Chaudier P, Louboutin L, Van Haecke A, Mercier M, Belgaid V, Gazarian A, Walch A, Bertani A, Rongieras F, Martres S, Trouillet F, Barrey C, Mojallal A, Brosset S, Hanriat C, Person H, Céruse P, Fuchsmann C, Gleizal A, Aubrun F, Dziadzko M, Macabéo C, Patrascu D, Laurent F, Beraud L, Roussel-Gaillard T, Dupieux C, Kolenda C, Josse J, Craighero F, Boussel L, Pialat JB, Morelec I, Tod M, Gagnieu MC, Goutelle S, Mabrut E. Coxiella burnetti prosthetic joint infection in an immunocompromised woman: iterative surgeries, prolonged ofloxacin-rifampin treatment and complex reconstruction were needed for the cure. ARTHROPLASTY 2021; 3:43. [PMID: 35610714 PMCID: PMC8796341 DOI: 10.1186/s42836-021-00097-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/16/2021] [Indexed: 12/04/2022] Open
Abstract
Background Q fever is a zoonotic disease caused by the bacterium Coxiella burnetii, a strictly intracellular pathogen that can cause acute and chronic infection. Chronic Q fever can occur in immunocompetent as well as in immuno-compromised hosts, as a persistent localized infection. The main localizations are endocardial, vascular and, less frequently, osteoarticular. The most frequent osteoarticular form is spondyliscitis. Recommended treatment is combined doxycycline and hydroxychloroquine for 18 months, with cotrimoxazole as another option. Coxiella burnetti infection has been implicated in rare cases of prosthetic joint infection (PJI), and the medical and surgical management and outcome in such cases have been little reported. Case presentation We report an unusual case of chronic Q fever involving a hip arthroplasty in an immunocompromised woman treated with tumor necrosis factor (TNF)-α blockers for rheumatoid arthritis. Numerous surgical procedures (explantation, “second look”, femoral resection and revision by megaprosthesis), modification of the immunosuppressant therapy and switch from doxycycline-hydroxychloroquine to prolonged ofloxacin-rifampin combination therapy were needed to achieve reconstruction and treat the PJI, with a follow-up of 7 years. Conclusions Coxiella burnetti PJI is a complex infection that requires dedicated management in an experienced reference center. Combined use of ofloxacin-rifampin can be effective.
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3
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Miller HK, Priestley RA, Kersh GJ. Q Fever: A troubling disease and a challenging diagnosis. CLINICAL MICROBIOLOGY NEWSLETTER 2021; 43:109-118. [PMID: 37701818 PMCID: PMC10493821 DOI: 10.1016/j.clinmicnews.2021.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
Q fever is a disease caused by the bacterial pathogen Coxiella burnetii. This hardy organism can easily spread long distances in the wind, and only a few infectious aerosolized particles are necessary to cause serious illness. Presentations of Q fever disease can be wide-ranging, allowing it to masquerade as other illnesses and highlight the importance of laboratory testing for diagnosis and treatment. This review summarizes Q fever's epidemiology and clinical presentations and presents classical laboratory diagnostic assays and novel approaches to detecting this troubling disease.
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Affiliation(s)
- Halie K. Miller
- Centers for Disease Control and Prevention, Atlanta, Georgia
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4
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Sim BZ, Aaron L, Sim BL, Looke D, Bursle E. Diagnostic challenge of Q fever osteoarticular infection. Intern Med J 2021; 51:142-143. [PMID: 33572020 DOI: 10.1111/imj.15119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/02/2020] [Accepted: 02/11/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Beatrice Z Sim
- Infectious Diseases Department, Brisbane, Queensland, Australia
| | - Luke Aaron
- Physician Training Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Bernice L Sim
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - David Looke
- Infectious Diseases Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Evan Bursle
- Infectious Diseases Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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5
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Ghanem-Zoubi N, Karram T, Kagna O, Merhav G, Keidar Z, Paul M. Q fever vertebral osteomyelitis among adults: a case series and literature review. Infect Dis (Lond) 2021; 53:231-240. [PMID: 33475036 DOI: 10.1080/23744235.2020.1871508] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Q fever osteoarticular infections are a rare complication of the chronic form of Q fever. We aimed to characterize chronic Q fever vertebral osteomyelitis through our experience and a review of the literature. METHODS Four adult patients with Q fever vertebral osteomyelitis diagnosed in a tertiary hospital in northern Israel between 2016 to 2020 are described. In addition, a 30 years' literature review of Q fever vertebral osteomyelitis, characterizing predisposing factors, clinical presentation, course of disease, treatment and outcomes, was performed. RESULTS Thirty-four adult patients with Q fever vertebral osteomyelitis were identified. The vast majority were male (30/34, 88%) with a mean age of 67.2 ± 10 years. Involvement of the adjacent aorta, likely the origin of the infection, was observed in 23/34 (68%) of the patients, usually among patients with aortic graft or aneurysm. Clinical presentation was insidious and fever was frequently absent. Delayed diagnosis for months to years after symptoms onset was frequently reported. Vascular infections were managed with or without extraction of the infected aneurysm/aorta and graft placement. The outcome was variable with limited follow-up data in most cases. Patients were usually treated with prolonged antimicrobial therapy, most commonly doxycycline and hydroxychloroquine combination therapy. CONCLUSION Q fever should be included in the differential diagnosis of vertebral osteomyelitis in endemic settings, in particular when concomitant adjacent vascular infection exists.
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Affiliation(s)
- Nesrin Ghanem-Zoubi
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Tony Karram
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.,Department of Vascular Surgery, Rambam Medical Center, Haifa, Israel
| | - Olga Kagna
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.,Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel
| | - Goni Merhav
- Department of Radiology, Rambam Health Care Campus, Haifa, Israel
| | - Zohar Keidar
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.,Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel
| | - Mical Paul
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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6
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Abstract
Query (Q) fever is a zoonotic bacterial infection caused by Coxiella burnetii. In a minority of patients, chronic disease can occur after acute infection. Endocarditis and infections of aneurysms or vascular prostheses are the most common forms of chronic Q fever in adults. We report a case of an elderly female patient with chronic Q fever vertebral osteomyelitis at the site of her previous cement vertebroplasty, complicated by paravertebral abscess. Patient treatment required prolonged drainage in addition to the long duration of antibiotic treatment by doxycycline and hydroxychloroquine. Osteomyelitis is a rare clinical presentation in adults with chronic Q fever. However, it is important to consider Q fever in the differential diagnosis of culture-negative osteomyelitis, especially in countries where C. burnetii is endemic, such as Israel.
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Affiliation(s)
- Karina Dorfman
- Radiology Department, Bnai-Zion Medical Center, Haifa, Israel
- To whom correspondence should be addressed. E-mail:
| | - Ayelet Eran
- Department of Radiology, Rambam Health Care Campus, Haifa, Israel
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7
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Vertebral Osteomyelitis or Infected Abdominal Aortic Endograft? A Rare Case of Q Fever. Ann Vasc Surg 2020; 67:568.e9-568.e12. [DOI: 10.1016/j.avsg.2020.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 03/13/2020] [Indexed: 11/17/2022]
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8
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Browning S, Lai K, Pickles R, Graves SR. Q fever vertebral osteomyelitis in the absence of cardiovascular involvement: Two cases and a literature review. CLINICAL INFECTION IN PRACTICE 2020. [DOI: 10.1016/j.clinpr.2020.100019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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9
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Lundy P, Arnold P, Hance K. Coxiella burnetii infection of the spine requiring neurosurgical intervention. Surg Neurol Int 2019; 10:182. [PMID: 31637083 PMCID: PMC6778329 DOI: 10.25259/sni_205_2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 08/30/2019] [Indexed: 12/05/2022] Open
Abstract
Background: Infections from Coxiella burnetii, resulting in what is known as Q fever, are relatively rare and difficult to diagnose. Very few reports of spinal infection from C. burnetii have been reported rarely have these cases required surgical intervention. Case Description: We report a patient with the previous vascular surgery and Q fever spinal osteomyelitis. Previously reported cases with spinal involvement have described initial infection of vascular grafts in proximity to the spine. Literature on spinal infection from C. burnetii reports only one case that required surgical intervention of the spine. We report a patient with L5-S1 diskitis who required surgical intervention and subsequent percutaneous drainage. Conclusion: Spinal infections from C. burnetii are rare; however, in the setting of a patient with osteodiscitis with negative cultures as well as a history of significant vascular disease with stents, the diagnosis of Q fever should be entertained. Operative and interventional procedures should also be considered in these patients to help alleviate pain and maintain neurologic function.
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Affiliation(s)
- Paige Lundy
- Department of Neurosurgery, The University of Kansas Health System, Kansas City, Kansas
| | - Paul Arnold
- Department of Neurosurgery, Carle Illinois College of Medicine, Carle Foundation Hospital, Urbana, Illinois, USA
| | - Kirk Hance
- Department of Division of Vascular Surgery, The University of Kansas Health System, Kansas City, Kansas
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10
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Gonçalves M, Moreira S, Gaspar E, Santos L. Rare case of otomastoiditis due to Coxiella burnetii chronic infection. BMJ Case Rep 2018; 2018:bcr-2018-224315. [PMID: 29680799 DOI: 10.1136/bcr-2018-224315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Q fever is a zoonotic disease caused by Coxiella burnetii that usually presents with non-specific or benign constitutional symptoms. Diagnosis is often challenging and, after acute Q fever, 1%-5% of patients can develop chronic disease. We present an 80-year-old male patient who was admitted due to a 3 months history of fever, productive cough, myalgia, weight loss, headache and hearing loss. Chronic Q fever was confirmed by positive antiphase I immunoglobulin G. Frequent locations of chronic infection was discarded, and ear CT revealed a right mastoid infection. He was treated with doxycycline and hydroxychloroquine for 18 months with significant improvement. This is a rare case of chronic Q fever presenting with otomastoiditis that has never been described.
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Affiliation(s)
- Mariana Gonçalves
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Sónia Moreira
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Elsa Gaspar
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Lèlita Santos
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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11
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Virk A, Mahmood M, Kalra M, Bower TC, Osmon DR, Berbari EF, Raoult D. Coxiella burnetii Multilevel Disk Space Infection, Epidural Abscess, and Vertebral Osteomyelitis Secondary to Contiguous Spread From Infected Abdominal Aortic Aneurysm or Graft: Report of 4 Cases Acquired in the US and Review of the Literature. Open Forum Infect Dis 2017; 4:ofx192. [PMID: 30581879 PMCID: PMC6299295 DOI: 10.1093/ofid/ofx192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/31/2017] [Indexed: 11/13/2022] Open
Abstract
Background Chronic Coxiella burnetii infections such as vertebral osteomyelitis caused by contiguous spread from an infected abdominal aortic graft or aneurysm have been rarely reported and are associated with significant morbidity and mortality. Methods We present the first four reported US acquired cases of Coxiella burnetii vertebral osteomyelitis caused by contiguous spread from an infected abdominal aortic graft or aneurysm. Results Presenting symptoms included progressive back pain, malaise, and weight loss with recent or remote animal exposure. Typical imaging findings demonstrated a peri-aortic collection with extension to the paraspinal muscles and vertebrae. Antibiotic regimens included doxycycline with either hydroxychloroquine or a quinolone for at least 2 years or as chronic suppression. Conclusions C. burnetii vertebral osteomyelitis is rare and can occur by contiguous spread from an abdominal aneurysm or vascular graft infection. It should be suspected in patients where pre-antibiotic cultures are negative with animal/farming exposure.
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Affiliation(s)
- Abinash Virk
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Maryam Mahmood
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Manju Kalra
- Division of Vascular Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Thomas C Bower
- Division of Vascular Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Douglas R Osmon
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Elie F Berbari
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota
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12
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Eldin C, Mélenotte C, Mediannikov O, Ghigo E, Million M, Edouard S, Mege JL, Maurin M, Raoult D. From Q Fever to Coxiella burnetii Infection: a Paradigm Change. Clin Microbiol Rev 2017; 30:115-190. [PMID: 27856520 PMCID: PMC5217791 DOI: 10.1128/cmr.00045-16] [Citation(s) in RCA: 528] [Impact Index Per Article: 75.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Coxiella burnetii is the agent of Q fever, or "query fever," a zoonosis first described in Australia in 1937. Since this first description, knowledge about this pathogen and its associated infections has increased dramatically. We review here all the progress made over the last 20 years on this topic. C. burnetii is classically a strict intracellular, Gram-negative bacterium. However, a major step in the characterization of this pathogen was achieved by the establishment of its axenic culture. C. burnetii infects a wide range of animals, from arthropods to humans. The genetic determinants of virulence are now better known, thanks to the achievement of determining the genome sequences of several strains of this species and comparative genomic analyses. Q fever can be found worldwide, but the epidemiological features of this disease vary according to the geographic area considered, including situations where it is endemic or hyperendemic, and the occurrence of large epidemic outbreaks. In recent years, a major breakthrough in the understanding of the natural history of human infection with C. burnetii was the breaking of the old dichotomy between "acute" and "chronic" Q fever. The clinical presentation of C. burnetii infection depends on both the virulence of the infecting C. burnetii strain and specific risks factors in the infected patient. Moreover, no persistent infection can exist without a focus of infection. This paradigm change should allow better diagnosis and management of primary infection and long-term complications in patients with C. burnetii infection.
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Affiliation(s)
- Carole Eldin
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Cléa Mélenotte
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Oleg Mediannikov
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Eric Ghigo
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Matthieu Million
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Sophie Edouard
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Jean-Louis Mege
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Max Maurin
- Institut de Biologie et de Pathologie, CHU de Grenoble, Grenoble, France
| | - Didier Raoult
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
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13
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Abstract
BACKGROUND Clinical disease caused by Coxiella burnetii occurs infrequently in children. Chronic Q fever is particularly uncommon and endocarditis is rarely seen. A small number of cases of Q fever osteomyelitis have been described but the pathophysiology is not well understood and optimal treatment is unknown. METHODS We describe a series of cases of chronic recurrent multifocal Q fever osteomyelitis cases diagnosed in children from a single region in Australia. RESULTS Between 2011 and 2014, 9 cases of chronic recurrent multifocal Q fever osteomyelitis were diagnosed based on clinical findings, suggestive serology and detection of C. burnetii DNA by polymerase chain reaction testing of biopsy samples (8/9). All required surgical management; antibiotic and adjuvant therapies did not appear to be consistently effective and 2 cases had clinical resolution in the absence of directed antimicrobial therapy. CONCLUSIONS Chronic recurrent multifocal osteomyelitis is a rare manifestation of chronic Q fever infection in children. The pathophysiology of this condition is poorly understood, and effective treatment options have not been established.
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14
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Eldin C, Melenotte C, Million M, Cammilleri S, Sotto A, Elsendoorn A, Thuny F, Lepidi H, Roblot F, Weitten T, Assaad S, Bouaziz A, Chapuzet C, Gras G, Labussiere AS, Landais C, Longuet P, Masseau A, Mundler O, Raoult D. 18F-FDG PET/CT as a central tool in the shift from chronic Q fever to Coxiella burnetii persistent focalized infection: A consecutive case series. Medicine (Baltimore) 2016; 95:e4287. [PMID: 27559944 PMCID: PMC5400310 DOI: 10.1097/md.0000000000004287] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Because Q fever is mostly diagnosed serologically, localizing a persistent focus of Coxiella burnetii infection can be challenging. F-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) could be an interesting tool in this context.We performed a retrospective study on patients diagnosed with C burnetii infection, who had undergone F-FDG PET/CT between 2009 and 2015. When positive F-FDG PET/CT results were obtained, we tried to determine if it changed the previous diagnosis by discovering or confirming a suspected focus of C burnetii infection.One hundred sixty-seven patients benefited from F-FDG PET/CT. The most frequent clinical subgroup before F-FDG PET/CT was patients with no identified focus of infection, despite high IgG1 serological titers (34%). For 59% (n = 99) of patients, a hypermetabolic focus was identified. For 62 patients (62.6%), the positive F-FDG PET/CT allowed the diagnosis to be changed. For 24 of them, (38.7%), a previously unsuspected focus of infection was discovered. Forty-two (42%) positive patients had more than 1 hypermetabolic focus. We observed 21 valvular foci, 34 vascular foci, and a high proportion of osteoarticular localizations (n = 21). We also observed lymphadenitis (n = 27), bone marrow hypermetabolism (n = 11), and 9 pulmonary localizations.We confirmed thatF-FDG PET/CT is a central tool in the diagnosis of C burnetii focalized persistent infection. We proposed new diagnostic scores for 2 main clinical entities identified using F-FDG PET/CT: osteoarticular persistent infections and lymphadenitis.
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Affiliation(s)
- Carole Eldin
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculté de Médecine, CNRS UMR 7278, IRD 198, Aix-Marseille Université, 27 Bd Jean Moulin
| | - Cléa Melenotte
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculté de Médecine, CNRS UMR 7278, IRD 198, Aix-Marseille Université, 27 Bd Jean Moulin
| | - Matthieu Million
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculté de Médecine, CNRS UMR 7278, IRD 198, Aix-Marseille Université, 27 Bd Jean Moulin
| | | | - Albert Sotto
- Service de pathologies infectieuses et tropicales de l’hôpital de Nimes
| | | | - Franck Thuny
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculté de Médecine, CNRS UMR 7278, IRD 198, Aix-Marseille Université, 27 Bd Jean Moulin
- Unité Nord Insuffisance cardiaque et valvulopathies (UNIV), Service de cardiologie CHU de Marseille, Hôpital Nord, AP-HM Chemin des Bourrely, Marseille
| | - Hubert Lepidi
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculté de Médecine, CNRS UMR 7278, IRD 198, Aix-Marseille Université, 27 Bd Jean Moulin
| | - France Roblot
- Service de Pathologies infectieuses et tropicales, CHU de Poitiers
| | | | - Souad Assaad
- Service de Médecine interne, hôpital Saint Luc, Lyon
| | | | - Claire Chapuzet
- Service de Pathologies infectieuses et tropicales, CHU de Rouen
| | - Guillaume Gras
- Service de Pathologies infectieuses et tropicales, CHU de Tours
| | | | | | - Pascale Longuet
- Service mobile d’Infectiologie, CH Victor Dupouy, Argenteuil
| | | | - Olivier Mundler
- Service de médecine nucléaire, Hôpital de La Timone, Marseille
| | - Didier Raoult
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculté de Médecine, CNRS UMR 7278, IRD 198, Aix-Marseille Université, 27 Bd Jean Moulin
- Correspondence: Didier Raoult, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculté de médecine, 27 boulevard Jean Moulin, 13005 Marseille, France (e-mail: )
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15
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Angelakis E, Thiberville SD, Million M, Raoult D. Sternoclavicular joint infection caused by Coxiella burnetii: a case report. J Med Case Rep 2016; 10:139. [PMID: 27246557 PMCID: PMC4888605 DOI: 10.1186/s13256-016-0948-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/11/2016] [Indexed: 12/25/2022] Open
Abstract
Background Few cases of Q fever osteoarticular infection have been reported, with chronic osteomyelitis as the most common manifestation of Q fever osteoarticular infection. Here we present the case of a sternoclavicular joint infection caused by Coxiella burnetii and localized by positron emission tomography scanning. Case presentation A 67-year-old French man from south France was hospitalized for fever and confusion. An examination revealed subclavicular and axillary lymph node enlargement. Computed tomography scanning and transesophageal echocardiogram were normal, and magnetic resonance imaging scanning did not reveal signs of infection. An immunofluorescence assay of an acute serum sample was positive for C. burnetii and he was treated with 200 mg doxycycline for 21 days. An immunofluorescence assay of convalescent serum sampled after 2 months revealed very high C. burnetii antibody titers. To localize the site of the infection, we performed positron emission tomography scanning, which revealed intense fluorodeoxyglucose uptake in his right sternoclavicular joint; treatment with 200 mg oral doxycycline daily and 200 mg oral hydroxychloroquine three times daily for 18 months was initiated. Conclusions Q fever articular infections may be undiagnosed, and we strongly urge the use of positron emission tomography scanning in patients with high C. burnetii antibody titers to localize the site of C. burnetii infection.
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Affiliation(s)
- Emmanouil Angelakis
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix-Marseille Université, 13005, Marseille, France.
| | - Simon-Djamel Thiberville
- UMR190, Aix-Marseille Université / IRD / EHESP French School of Public Health, Marseille, France.,Hospital Louis Raffalli, Medicine D Unit, Infectious Disease and Internal Medicine, Manosque, France
| | - Matthieu Million
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix-Marseille Université, 13005, Marseille, France
| | - Didier Raoult
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix-Marseille Université, 13005, Marseille, France
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Galy A, Decousser JW, El-Anbassi S, Nebbad B, Belzunce C, Cochennec F, Deforges L, Lepeule R. Psoas abscess and chronic Q fever: a contiguous or hematogenous complication? A case report and literature review. Infect Dis (Lond) 2016; 48:626-31. [PMID: 27167531 DOI: 10.1080/23744235.2016.1180709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Few cases of psoas abscesses (PA) during chronic Q fever have been reported, and the route of transmission remains unknown. Here, we report a new case and have performed a systematic literature review to determinate the spreading route of this complication. Medline, EMBASE and Web of Science were searched. Local spreading was supported by endocarditis exclusion, evidence of vascular infection and absence of distantly infected sites. Among 275 retrieved references, 179 were initially rejected, and 85 additional references were rejected after full-text review. A total of 11 studies, reporting 13 cases, were included. Additionally, we reported one new case. A total of 14/14 cases reached Q fever vascular infection diagnostic criteria, and 7/14 provided adequate evidence supporting a causal relationship between Q fever vascular infection and PA. All patients presented aorta defects. In conclusion, Q fever PA results from the spreading of a local infection and occurs specifically in patients presenting a vascular graft or an abdominal aortic aneurysm.
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Affiliation(s)
- Adrien Galy
- a Department of Microbiology , Assistance Publique-Hôpitaux de Paris, University Hospital Henri Mondor , Créteil , France ;,b Antimicrobial Stewardship Team , Assistance Publique-Hôpitaux de Paris, University Hospital Henri Mondor , Créteil , France
| | - Jean Winoc Decousser
- a Department of Microbiology , Assistance Publique-Hôpitaux de Paris, University Hospital Henri Mondor , Créteil , France ;,c University Paris East Créteil , Créteil , France
| | - Sarra El-Anbassi
- a Department of Microbiology , Assistance Publique-Hôpitaux de Paris, University Hospital Henri Mondor , Créteil , France
| | - Biba Nebbad
- a Department of Microbiology , Assistance Publique-Hôpitaux de Paris, University Hospital Henri Mondor , Créteil , France
| | - Carine Belzunce
- d Department of Infectious Diseases , Assistance Publique-Hôpitaux de Paris, University Hospital Henri Mondor , Créteil , France
| | - Frédéric Cochennec
- e Department of Vascular Surgery , Assistance Publique-Hôpitaux de Paris, University Hospital Henri Mondor , Créteil , France
| | - Lionel Deforges
- a Department of Microbiology , Assistance Publique-Hôpitaux de Paris, University Hospital Henri Mondor , Créteil , France
| | - Raphaël Lepeule
- a Department of Microbiology , Assistance Publique-Hôpitaux de Paris, University Hospital Henri Mondor , Créteil , France ;,b Antimicrobial Stewardship Team , Assistance Publique-Hôpitaux de Paris, University Hospital Henri Mondor , Créteil , France
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17
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Gaudé M, Julien S, Laurent F, Ferry T. Disappearance of FDG uptake on PET scan after antimicrobial therapy could help for the diagnosis of Coxiella burnetii spondylodiscitis. BMJ Case Rep 2016; 2016:bcr-2015-214008. [PMID: 27015880 DOI: 10.1136/bcr-2015-214008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Marine Gaudé
- Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Saison Julien
- Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France Université Claude Bernard Lyon 1, Lyon, France
| | - Frédéric Laurent
- Université Claude Bernard Lyon 1, Lyon, France Laboratoire de Bactériologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
| | - Tristan Ferry
- Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France Université Claude Bernard Lyon 1, Lyon, France Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
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18
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Michel M, Cesini J, Michon J, Dargere S, Vergnaud M, Marcelli C. Vertebral fractures and abdominal aortic aneurysm revealing Q fever. Joint Bone Spine 2016; 83:241-2. [DOI: 10.1016/j.jbspin.2015.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2015] [Indexed: 10/22/2022]
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Q Fever Knowledge, Attitudes and Vaccination Status of Australia's Veterinary Workforce in 2014. PLoS One 2016; 11:e0146819. [PMID: 26756210 PMCID: PMC4710533 DOI: 10.1371/journal.pone.0146819] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 12/22/2015] [Indexed: 12/03/2022] Open
Abstract
Q fever, caused by Coxiella burnetii, is a serious zoonotic disease in humans with a worldwide distribution. Many species of animals are capable of transmitting C. burnetii, and consequently all veterinary workers are at risk for this disease. An effective Q fever vaccine has been readily available and used in Australia for many years in at-risk groups, and the European Centre for Disease Prevention and Control has recently also called for the use of this vaccine among at-risk groups in Europe. Little is known about attitudes towards this vaccine and vaccine uptake in veterinary workers. This study aimed to determine the Q fever vaccination status of veterinarians and veterinary nurses in Australia and to assess and compare the knowledge and attitudes towards Q fever disease and vaccination of each cohort. An online cross-sectional survey performed in 2014 targeted all veterinarians and veterinary nurses in Australia. Responses from 890 veterinarians and 852 veterinary nurses were obtained. Binary, ordinal and multinomial logistic regression were used to make comparisons between the two cohorts. The results showed that 74% of veterinarians had sought vaccination compared to only 29% of veterinary nurses. Barriers to vaccination among those not vaccinated did not differ between cohorts, and included a lack of perceived risk, financial expense, time constraints, and difficulty in finding a vaccine provider. Poor knowledge and awareness of Q fever disease and vaccination were additional and notable barriers for the veterinary nursing cohort, suggesting veterinary clinics and veterinarians may not be meeting their legal responsibility to educate staff about risks and risk prevention. Further evaluation is needed to identify the drivers behind seeking and recommending vaccination so that recommendations can be made to improve vaccine uptake.
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20
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Bayard C, Dumoulin A, Ikenberg K, Günthard HF. Subacute, tetracycline-responsive, granulomatous osteomyelitis in an adult man, consistent with Q fever infection. BMJ Case Rep 2015; 2015:bcr-2015-212426. [PMID: 26661283 DOI: 10.1136/bcr-2015-212426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Osteomyelitis due to Coxiella burnetii infection is a rare condition in adults. We report the case of a healthy young man presenting with subacute osteomyelitis of the left cheek bone, evolving gradually after an episode of acute febrile illness. Histological evaluation confirmed subacute granulomatous inflammation. Despite antibody titres not reaching the standard cut-off for chronic Q fever (phase I IgG 1/160, phase II IgG 1/2560), osteomyelitis was radiologically and histologically confirmed. A 6-month course of doxycycline/hydroxychloroquine brought clinical and radiological cure while various conventional antibiotic treatments had failed to improve the clinical condition. Currently, at 6-month follow-up, no relapse has occurred and antibody titres have declined. A shorter course of doxycycline/hydroxychloroquine than that used for chronic Q fever osteomyelitis may be sufficient to treat subacute Q fever osteomyelitis in some cases.
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Affiliation(s)
- Cornelia Bayard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich Switzerland
| | - Alexis Dumoulin
- Infectious Diseases Department, Central Institute of the Valais Hospital, Sion, Switzerland
| | - Kristian Ikenberg
- Department of Pathology, University Hospital Zürich, Zürich, Switzerland
| | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich Switzerland
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21
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Khatami A, Sparks RT, Marais BJ. A Case of Pediatric Q Fever Osteomyelitis Managed Without Antibiotics. Pediatrics 2015; 136:e1629-31. [PMID: 26574586 DOI: 10.1542/peds.2015-0024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2015] [Indexed: 11/24/2022] Open
Abstract
Q fever osteomyelitis, caused by infection with Coxiella burnetti, is rare but should be included in the differential diagnosis of children with culture-negative osteomyelitis, particularly if there is a history of contact with farm animals, and/or granulomatous change on histologic examination of a bone biopsy specimen. We describe a case of Q fever osteomyelitis in a 6-year-old boy in which a decision was made not to treat the patient with combination antimicrobial agents, balancing possible risks of recurrence against potential side effects of prolonged antibiotic treatment. The patient had undergone surgical debridement of a single lesion and was completely asymptomatic after recovery from surgery. This case suggests that a conservative approach of watchful waiting in an asymptomatic patient with chronic Q fever osteomyelitis may be warranted in select cases when close follow-up is possible.
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Affiliation(s)
- Ameneh Khatami
- Department of Microbiology and Infectious Diseases, The Children's Hospital at Westmead, Sydney, Australia; and University of Sydney, School of Medicine, Sydney, Australia
| | | | - Ben J Marais
- Department of Microbiology and Infectious Diseases, The Children's Hospital at Westmead, Sydney, Australia; and University of Sydney, School of Medicine, Sydney, Australia
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22
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Abstract
We report 2 cases of chronic Q fever osteomyelitis in 10- and 5-year-old girls who presented with distal right femoral and left parasternal granulomatous osteomyelitis, respectively. Both were treated with ciprofloxacin and rifampin with good response. Q fever osteomyelitis is a challenging diagnosis in children, and the choice of antimicrobial treatment is difficult because of limited available data.
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Britton PN, Macartney K, Arbuckle S, Little D, Kesson A. A Rare Case of Q Fever Osteomyelitis in a Child From Regional Australia. J Pediatric Infect Dis Soc 2015; 4:e28-31. [PMID: 26407439 DOI: 10.1093/jpids/piu095] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 08/26/2014] [Indexed: 11/14/2022]
Abstract
Q fever osteomyelitis is a rare disease. We report an eighth pediatric case from regional Australia. Serology is the first-line diagnostic test, with confirmation by PCR on tissue specimens. In endemic settings, Q fever should be considered in the differential diagnosis of chronic osteomyelitis; in particular, presumed chronic-recurrent multifocal osteomyelitis should be considered a possible presentation of Q fever osteo-articular disease in children.
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Affiliation(s)
- P N Britton
- Department of Microbiology and Infectious Diseases Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Australia
| | - K Macartney
- Department of Microbiology and Infectious Diseases Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Australia
| | - S Arbuckle
- Department of Anatomical Pathology, Children's Hospital at Westmead, Sydney
| | - D Little
- Department of Orthopaedics Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Australia
| | - A Kesson
- Department of Microbiology and Infectious Diseases Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Australia
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Abstract
Osteoarticular infection is an uncommon presentation of Q fever. Positron emission tomography (PET) scanning is a valuable tool for the diagnosis of Coxiella burnetii graft prosthesis infection and endocarditis. Our objective was to test a series of culture-negative osteoarticular samples using molecular assays for Coxiella burnetii. We tested for C. burnetii by molecular assays targeting the IS1111 and the IS30A spacer regions, using culture-negative osteoarticular samples obtained in our laboratory between January 2011 and December 2012. We examine a total of 1,410 osteoarticular samples, and we observed two cases of arthritis and subacromial bursitis caused by C. burnetii. The infections were localized using PET scanning, and the diagnosis was confirmed through serology. For one, a C. burnetii strain with a multispacer sequence type 8 genotype was isolated from synovial fluid culture. Q fever articular infections could be undiagnosed because of the long evolution of articular attack, and patients with high antibody titers against C. burnetii should be tested using PET scanning to localize the site of infection.
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25
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A case of Q fever prosthetic joint infection and description of an assay for detection of Coxiella burnetii. J Clin Microbiol 2012; 51:66-9. [PMID: 23077126 DOI: 10.1128/jcm.02352-12] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We present the first published case of Coxiella burnetii prosthetic joint infection. Diagnosis was established with PCR and culture of periprosthetic tissue and synovial fluid (and serology). A novel PCR assay is described herein. Q fever should be considered in patients with prosthetic joint infection without an identified pathogen.
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Abstract
Q fever is an ubiquitous zoonosis caused by Coxiella burneti, an intracellular bacterium that can produce acute or chronic infections in humans. These forms are characterized by different evolution, serological profile and treatment that must be very long to achieve a cure in chronic forms. However, the serological profile for diagnosis and the real value of serology for predicting outcome are controversial, and management dilemmas for many patients with Q fever infection are continuously emerging. In this article, we describe in a comprehensive manner the different clinical presentations of the disease, making a critical overview of the evidence for serological predictions. We also take a broad view of new available diagnostic techniques and finally, we give recommendations for treatment.
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Affiliation(s)
- Arístides de Alarcón
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Manuel Siurot s/n, Sevilla, 41013, Spain,
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28
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Merhej V, Tattevin P, Revest M, Le Touvet B, Raoult D. Q fever osteomyelitis: a case report and literature review. Comp Immunol Microbiol Infect Dis 2012; 35:169-72. [PMID: 22285690 DOI: 10.1016/j.cimid.2011.12.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 12/14/2011] [Accepted: 12/19/2011] [Indexed: 11/28/2022]
Abstract
Q fever is a worldwide zoonosis caused by Coxiella burnetii. The clinical manifestations of Q fever include endocarditis, pneumonitis and hepatitis. Disease awareness and evolving diagnostic tests have enabled the recognition of unusual manifestations of Q fever. We report a case of Q fever osteomyelitis. A 51-year-old patient was admitted to hospital because of fever, leg weakness, and asthenia. His past medical history included surgery and a bone graft for the treatment of a giant cell tumor on the distal part of the femur. Blood and bone biopsy cultures were negative. Bone histological examination was consistent with a sub-acute or chronic inflammatory reaction that involved foci of epithelioid and gigantocellular infiltrates and necrosis. Serology testing revealed high antibody titers to C. burnetii antigens (phase I: IgG 3200; IgA 200; phase II: IgG 6400; IgA 400), which is indicative of chronic Q fever. The specific Polymerase Chain Reaction (PCR) of the abscess sample from the femoral region was positive for C. burnetii. The patient was treated for chronic Q fever with doxycycline and hydroxychloroquine for 18 months and recovered gradually without recurrence of pain or functional impairment. Q fever osteomyelitis is a rare and most likely underestimated disease. Epithelioid and gigantocellular granulomatous osteomyelitis in the context of culture-negative bone specimens should raise suspicion of Q fever. Serological tests, specific PCR and cell culture can provide evidence of a C. burnetii infection. Although bone diffusion may be a concern, the currently recommended treatment for Q fever was effective in this case.
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Affiliation(s)
- Vicky Merhej
- University of the Mediterranean, Marseille, France
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Merhej V, Cammilleri S, Piquet P, Casalta JP, Raoult D. Relevance of the positron emission tomography in the diagnosis of vascular graft infection with Coxiella burnetii. Comp Immunol Microbiol Infect Dis 2012; 35:45-9. [DOI: 10.1016/j.cimid.2011.09.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 09/29/2011] [Accepted: 09/29/2011] [Indexed: 10/15/2022]
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Successful management of chronic multifocal Q fever Osteomyelitis with adjuvant interferon-gamma therapy. Pediatr Infect Dis J 2011; 30:810-2. [PMID: 21372749 DOI: 10.1097/inf.0b013e31821487f5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We present a 3-year-old girl who had chronic recurrent multifocal osteomyelitis caused by Coxiella burnetii despite long-term dual antibiotic therapy. Excellent clinical response was achieved and sustained when immunomodulatory therapy with interferon-γ was initiated. This is the case of a first child who was successfully treated with interferon-γ as adjuvant therapy for chronic multifocal Q fever osteomyelitis.
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31
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A case of multifocal chronic Q fever osteomyelitis. Infection 2011; 39:167-9. [DOI: 10.1007/s15010-010-0076-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Accepted: 12/13/2010] [Indexed: 10/18/2022]
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32
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Fernández-Ruiz M, López-Medrano F, Alonso-Navas F, Aguado JM. Coxiella burnetii infection of left atrial thrombus mimicking an atrial myxoma. Int J Infect Dis 2010; 14 Suppl 3:e319-21. [DOI: 10.1016/j.ijid.2010.02.2259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 12/09/2009] [Accepted: 02/26/2010] [Indexed: 10/19/2022] Open
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Gikas A, Kokkini S, Tsioutis C. Q fever: clinical manifestations and treatment. Expert Rev Anti Infect Ther 2010; 8:529-39. [PMID: 20455682 DOI: 10.1586/eri.10.29] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Public awareness and advances in the diagnostic approach to Q fever have provided important information on epidemiological and clinical aspects of this zoonosis. Coxiella burnetii infection exhibits various acute or chronic clinical forms, and infection during pregnancy may jeopardize the integrity of the fetus. The presentation of infection is often nonspecific and this hinders prompt diagnosis. Therapeutic regimens vary, and treating Q fever during pregnancy and childhood is often challenging. Increasing clinical experience with C. burnetii infections has helped create treatment protocols and follow-up algorithms that have considerably improved management and prognosis. Vaccines are available, although their use is still limited.
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Affiliation(s)
- Achilleas Gikas
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, Heraklion 71110, Crete, Greece.
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35
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Kataranovski D, Kataranovski M, Deljanin I. Helminth fauna of Rattus norvegicus Berkenhout, 1769 from the Belgrade area, Serbia. ARCH BIOL SCI 2010. [DOI: 10.2298/abs1004091k] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The aims of this study were to provide baseline knowledge about intestinal
parasites in Norway rats (Rattus norvegicus) that inhabit the Belgrade area,
and to analyze the associations among helminths. Of 302 trapped rats, 52%
were females and 48% males, with 39% and approx. 37% of juvenile-subadult
individuals, per sex, respectively. The following parasites were detected
(with their respective prevalence): Cestoda - Hymenolepis diminuta (30.46%)
and Rodentolepis fraterna (12.58%); Nematoda - Heterakis spumosa (36.75%),
Nippostrongylus brasiliensis (16.22%), Capillaria sp. (5.96%), Trichuris
muris (5.96%), Syphacia muris (4.30%) and Strongylus sp. larvae (0.33%).
Flukes (Trematoda) were not recorded. Of all examined rats, 68.54% were found
to harbor at least one parasite species, with higher prevalence in male hosts
and in adult individuals. There were no age-related differences in the
prevalence of infection with individual helminth species. Multiple infections
occurred with up to four species per rat showing different combinations of
parasite infections. These are the first records of the gastrointestinal
helminth fauna of Norway rats in Serbia.
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Affiliation(s)
- D. Kataranovski
- Department of Ecology, Siniša Stanković Institute for Biological Research, Belgrade + Institute of Zoology, Faculty of Biology, Belgrade
| | - Milena Kataranovski
- Department of Ecology, Siniša Stanković Institute for Biological Research, Belgrade + Institute of Physiology and Biochemistry, Faculty of Biology, Belgrade
| | - Isidora Deljanin
- Department of Ecology, Siniša Stanković Institute for Biological Research, Belgrade
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Million M, Lepidi H, Raoult D. Fièvre Q : actualités diagnostiques et thérapeutiques. Med Mal Infect 2009; 39:82-94. [DOI: 10.1016/j.medmal.2008.07.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Accepted: 07/17/2008] [Indexed: 01/17/2023]
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38
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Sekeyová Z, Kowalczewska M, Decloquement P, Pelletier N, Špitalská E, Raoult D. Identification of protein candidates for the serodiagnosis of Q fever endocarditis by an immunoproteomic approach. Eur J Clin Microbiol Infect Dis 2008; 28:287-95. [DOI: 10.1007/s10096-008-0621-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Accepted: 08/22/2008] [Indexed: 11/29/2022]
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40
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Usefulness of broad-range PCR for the diagnosis of osteoarticular infections. Curr Opin Rheumatol 2008; 20:463-70. [PMID: 18525362 DOI: 10.1097/bor.0b013e3283032030] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Conventional methods such as microbiological cultures may lack the sensitivity and specificity to establish definitive diagnosis of osteoarticular infections. Herein, we review the general principles and the usefulness of broad-range PCR to improve the etiological diagnosis of osteoarticular infections. RECENT FINDINGS Broad-range PCR followed by sequencing has been successfully developed to identify microorganisms involved in infections when patients have previously received antibiotics or in the presence of slow-growing or intracellular microorganisms. For osteoarticular infections, the studies have shown that the use of this molecular tool increased mainly the identification of Kingella kingae, anaerobic bacteria, and Streptococcus spp. However, it is very important to underline that the interpretation of this molecular tool is critical because of several pitfalls, including contamination causing false-positive results. SUMMARY Broad-range PCR followed by sequencing offers several advantages when used to complement culture results for the diagnosis of fastidious bacteria and for patients taking antibiotics. However, its use should be restricted mainly for culture-negative cases when infection is suspected on the basis of clinical signs and symptoms or inflammatory syndrome. Future developments will include the use of real-time PCR in a closed system and pathogen-specific PCR for the molecular diagnosis of osteoarticular infections.
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Abstract
Q fever, a zoonosis caused by Coxiella burnetii, is seen throughout the world. Recent reports suggest that its incidence in the United States is increasing, with more than 30 cases reported in the US military. The disease has many acute and chronic manifestations. Endocarditis is the most common form of chronic disease, and recent studies have led to substantial changes in the approach to its diagnosis and treatment. Military and civilian health care professionals need to consider Q fever when evaluating patients with appropriate geographic exposures and clinical presentations to prevent delays in diagnosis and treatment.
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Affiliation(s)
- Joshua D Hartzell
- Infectious Diseases Service, Walter Reed Army Medical Center, BLD 2, Ward 63, 6900 Georgia Ave NW, Washington, DC 20307, USA.
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43
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Kobbe R, Kramme S, Gocht A, Werner M, Lippert U, May J, Burchard G. Travel-associated Coxiella burnetii infections: Three cases of Q fever with different clinical manifestation. Travel Med Infect Dis 2007; 5:374-9. [DOI: 10.1016/j.tmaid.2007.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Revised: 06/29/2007] [Accepted: 07/09/2007] [Indexed: 01/17/2023]
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44
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Rolain JM, Colson P, Raoult D. Recycling of chloroquine and its hydroxyl analogue to face bacterial, fungal and viral infections in the 21st century. Int J Antimicrob Agents 2007; 30:297-308. [PMID: 17629679 PMCID: PMC7126847 DOI: 10.1016/j.ijantimicag.2007.05.015] [Citation(s) in RCA: 286] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2007] [Accepted: 05/09/2007] [Indexed: 12/17/2022]
Abstract
Chloroquine (CQ) and its hydroxyl analogue hydroxychloroquine (HCQ) are weak bases with a half-century long use as antimalarial agents. Apart from this antimalarial activity, CQ and HCQ have gained interest in the field of other infectious diseases. One of the most interesting mechanisms of action is that CQ leads to alkalinisation of acid vesicles that inhibit the growth of several intracellular bacteria and fungi. The proof of concept of this effect was first used to restore intracellular pH allowing antibiotic efficacy for Coxiella burnetii, the agent of Q fever, and doxycycline plus HCQ is now the reference treatment for chronic Q fever. There is also strong evidence of a similar effect in vitro against Tropheryma whipplei, the agent of Whipple's disease, and a clinical trial is in progress. Other bacteria and fungi multiply in an acidic environment and encouraging in vitro data suggest that this concept may be generalised for all intracellular organisms that multiply in an acidic environment. For viruses, CQ led to inhibition of uncoating and/or alteration of post-translational modifications of newly synthesised proteins, especially inhibition of glycosylation. These effects have been well described in vitro for many viruses, with human immunodeficiency virus (HIV) being the most studied. Preliminary in vivo clinical trials suggest that CQ alone or in combination with antiretroviral drugs might represent an interesting way to treat HIV infection. In conclusion, our review re-emphasises the paradigm that activities mediated by lysosomotropic agents may offer an interesting weapon to face present and future infectious diseases worldwide.
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Affiliation(s)
- Jean-Marc Rolain
- Unité des Rickettsies, CNRS UMR 6020, Université de la Méditerranée, Faculté de Médecine et de Pharmacie, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 5, France.
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