Spinal infection caused by Coxiella burnetii

Epidemiological and molecular survey of Coxiella burnetii from the serum of patients suspected of brucellosis in west of Iran

Q fever is a global bacterial disease that affects both humans and animals. The etiological agent of the disease is Coxiella burnetii. The aim of the investigation was to detect the existence of C. burneti in the serum samples of patients with symptoms of fever and suspicion of brucellosis in the west of Iran. In the current survey, 150 Wright agglutination assay were collected from health centers in Lorestan, Hamadan, Ilam, Kermanshah, and Kurdistan provinces in 2023. DNA was extracted from all these samples, which were taken from individuals suspected of having brucellosis. Then, a nested PCR reaction was applied to diagnose C. burnetii for the transposon gene IS1111. The IS1111 gene replication assays, indicated that 3.3 % (95 % CI: 1.43 %-3.33 %) of the tested serum samples, were positive for C. burnetii. The highest prevalence of C. burnetii infection was found in the Kurdistan province at 6.67 % (95 % CI: 1.85 %-21.33 %). Additionally, a high affinity (ranging from 99 % to 100 %) was recognized among the IS1111 gene sequenced in the present study and those from different area around the world. These results provide strong evidence that individuals with brucellosis in west of Iran may also have C. burnetii co-infection with coxiellosis. Therefore, it is important to consider Q fever as a co-infection in patients suspected of brucellosis.

Abscesses of the spine and iliac fossa caused by infection with the opportunistic bacterium Fusobacterium nucleatum

We present a case of spinal and iliac fossa infection caused by Fusobacterium nucleatum in a 52-year-old male patient with unexplained back pain. Notably, the patient had no history of periodontal infections.Magnetic resonance imaging (MRI) revealed abscesses at the L3-4 vertebrae and hip, with dura mater and cauda equina compression.Next-generation sequencing (NGS) of the aspirate confirmed the presence of Fusobacterium nucleatum. The patient was treated with antibiotics (carbapenems, and metronidazole) and underwent surgical procedures for abscess drainage and internal fixation, resulting in the removal of 1000 ml of pus. Following a 46-day recovery period, the patient made a full recovery.This rare infection poses a significant diagnostic challenge due to its insidious onset and low blood culture sensitivity. The role of next-generation sequencing (NGS) in this context is paramount, as it has been instrumental in arriving at an accurate diagnosis and formulating an effective treatment plan. In view of the challenges posed by this infection, NGS emerges as a crucial tool for the diagnosis and management of unexplained infections.

Metagenomic next-generation sequencing for the clinical identification of spinal infection-associated pathogens

Background

This study aimed to evaluate the efficacy of metagenomic next-generation sequencing (mNGS) technology for identifying pathogens associated with spinal infection (SI).

Methods

A retrospective analysis was conducted on clinical data from 193 patients with suspected SI between August 2020 and September 2024. Based on histopathological results, the patients were divided into the SI group (n=162) and the non-SI group (n=31). The diagnostic performance of mNGS technology was compared with that of laboratory examination, imaging examination, and microbial culture.

Results

Among SI group, mNGS detected 135 pathogens in 77.78% (126/162) of the cases, including nine cases of multiple infections. One or more pathogens were detected using mNGS in 86 patients with SI and negative microbial cultures. Staphylococcus aureus (22.22%, n=30) and Mycobacterium tuberculosis (22.22%, n=30) were the major pathogens, while various rare pathogens such as anaerobes, Brucella, and Coxiella burnetii were also detected. For the 40 cases with positive results for both culture- and mNGS-based identification, high consistency (77.50%) was observed. Antibiotic use did not significantly affect the mNGS detection rate (P = 0.45). There was no significant difference in the positivity rate of mNGS between CT-guided needle biopsy (80.00%) and surgical sampling (77.17%) (P = 0.72). The sensitivity of mNGS (77.78%) was significantly higher than that of traditional microbial culture (27.16%), and the specificity was similar (90.32% vs. 96.77%). Although the sensitivities of erythrocyte sedimentation rate-based assay (91.36%), magnetic resonance imaging (88.27%), and C-reactive protein-based assay (87.65%) were better than those of mNGS, their specificities were generally low (20%-40%).

Conclusion

The pathogens responsible for SI are complex and diverse. As a novel diagnostic method, mNGS exhibits a high sensitivity and extensive pathogen coverage for SI diagnosis. When combined with imaging and laboratory indicators, mNGS can significantly improve the accuracy of SI diagnosis and provide strong support for clinical treatment.

Coxiella burnetii caused lumbar infection: A case report and literature review

Coxiella burnetii (C. burnetii)is a significant microbe linked to the zoonotic disease Q fever, known for its atypical clinical manifestations and sporadic cases. It can cause lumbar infections. In this report, we present a 66-year-old male sheep farmer who experienced low back pain for five months, with worsening numbness in both lower limbs over two months. Several standard diagnostic tests were negative. Metagenomic next-generation sequencing (mNGS) was performed on lumbar spine tissue obtained via biopsy, identifying C. burnetii infection. After surgical excision of the lesion, the patient received a combination of levofloxacin, doxycycline, rifampicin, and supportive medications. Postoperatively, the patient's condition stabilized, showing a significant reduction in low back pain. This case highlights mNGS as a valuable tool for diagnosing rare infections, especially in patients with a history of animal exposure. It underscores the importance of considering zoonotic infections and the need for combined antibiotic and surgical management in suspected cases.

Expanding the diagnostic scope of paleopathology: Identification of Q fever (Coxiella burnetii) using a One Paleopathology approach

OBJECTIVES

This project is an application of the One Paleopathology approach to the study of Q fever (C. burnetii infection), a disease which is underdiagnosed and largely unknown in paleopathology.

MATERIALS

Clinical and veterinary pathological case reports and reviews, bioarcheological and zooarchaeological data, veterinary and environmental studies of wild and domestic animal pathology, clinical molecular pathogen data METHODS: One Paleopathology approach which combines data from people, animals, and their environment to understand disease in the past.

RESULTS

Q fever in animals presents as reproductive failure, with no typical skeletal manifestations seen in animals. Persistent Q fever (C. burnetii) focalized infection affects the human skeleton in predictable ways, including spondylodiscitis and extravertebral osteomyelitis or osteitis which can occur more commonly in children. Evidence of skeletal involvement suggests C. burnetii infection in the past is underestimated and underdiagnosed in humans.

CONCLUSION

Using the One Paleopathology approach can improve the study of C. burnetii infection in the past, where both animal and human paleopathology and environmental factors are assessed in developing potential diagnoses.

SIGNIFICANCE

This project is the first paleopathological study to specifically focus awareness on identification of C. burnetii in past skeletal samples, both animal and human.

LIMITATIONS

Lack of paleopathological studies and existing reference literature identifying skeletal involvement associated with C. burnetii infection.

SUGGESTIONS FOR FUTURE RESEARCH

Future paleopathological genomic studies should focus on identification of C. burnetii genotypes.

Multiple spacer sequence typing of Coxiella burnetii carried by ticks in Gansu, China

Background

Coxiella burnetii is a zoonotic pathogen that causes Q fever and is found worldwide. Ticks serve as the primary reservoir, playing an important role in maintaining the natural cycle of C. burnetii. C. burnetii is transmitted to animals when ticks feed on their blood. However, information on C. burnetii infection in ticks remains limited, despite the widespread prevalence of the infection in humans and animals across China.

Methods

In this study, 192 engorged ticks were collected from Baiyin City of Gansu Province, China. The presence of Coxiella burnetii in ticks was specifically identified by detecting the IS1111 gene using nested polymerase chain reaction (nPCR). In addition, the 16S rRNA gene of C. burnetii was molecularly characterized using nPCR. A total of 10 spacer sequences (Cox 2, 5, 18, 20, 22, 37, 51, 56, 57, and 61) were amplified using PCR against positive specimens for MST analysis.

Results

All collected ticks were identified as Hyalomma marginatum, and 90 of them tested positive for C. burnetii, with a positive rate of 46.9% (90/192). The 16S rRNA gene analysis showed that the novel C. burnetii variants detected in this study were closely related to other C. burnetii strains in the world. The allele codes found in the present study for loci Cox2-Cox5-Cox18-Cox20-Cox22-Cox37-Cox51-Cox56-Cox57-Cox61 were 8-4-9-5-7-5-2-3-11-6. This represents a novel combination of allele values, similar to MST28, currently designated as MST85 in the Multi Spacers Typing (MST) database.

Conclusion

Our results revealed the circulation of a novel MST genotype of C. burnetii in Baiyin City, Gansu Province, China. The detection of C. burnetii in ticks suggests a potential public health risk to the local human population.

A case report of the metagenomic next-generation sequencing for timely diagnosis of a traveler with nonspecific febrile Q fever

Q fever is a worldwide distribution disease caused by Coxiella burnetii（C. burnetii）, an obligate intracellular, Gram-negative acidophilic bacterium belonging to γ-proteobacterium. Most patients present with acute Q-fever accompanied by atypical flu-like symptoms, with only 1%-5% of cases may develop into persistent and focally infected foci, mainly manifest as endocarditis, osteomyelitis and prosthetic arthritis. In this case, the patient experienced an unexplained and uninterrupted fever up to 39.2 °C for a week, accompanied by chills and headaches, as well as abnormal liver function. The laboratory reported negative results for blood culture and respiratory-associated pathogens, however, the metagenomic next-generation sequencing (mNGS) reported that detection of 20 sequence reads of C. burnetii in the patient's peripheral blood. In addition, the patient had traveled to Sri Lanka, Iraq and Saudi Arabia before illness. In clinical, the treatment regimen was adjusted from empirically intravenous moxifloxacin 400 mg a day for 1 week to continuously oral minocyline 100 mg twice daily for 2 weeks. The patient was in good health without any adverse sequelae during outpatient visitation and the phone calls follow-up. In conclusion, the mNGS does provide an early and timely diagnostic basis for rare and difficult to culture pathogens, which contributes to the success of clinical anti-infection.

Molecular epidemiology of Coxiella burnetii infection in sheep and goats in Henan province, China

Q fever is a significant zoonotic disease caused by Coxiella burnetii, an obligate intracellular gram-negative bacterium. Although C. burnetii infection has been identified in various animal species, domestic ruminants serve as the primary reservoirs and main sources of human infection. Understanding of the epidemiology of C. burnetii in domestic ruminants is crucial for preventing and controlling of C. burnetii infection in humans. In this study, spleen tissues from sheep and goats were collected in Hennan province, China. Through PCR screening, C. burnetii was detected in sheep and goats in Henan province with an overall infection rate of 6.8 %. Sequence comparison and phylogenetic analysis revealed that all newly identified C. burnetii strains shared a close genetic relationship with those found in humans worldwide. These findings highlight the high risk of C. burnetii infection among slaughterhouse workers and emphasize the importance of epidemiological studies that investigate samples from both humans and animals within the "One Health" framework. Such surveillance will contribute to a better understanding of the epidemic situation and aid in the development of effective prevention and control strategies for C. burnetii infections in humans.

A retrospective analysis of Q fever osteomyelitis in children, with recommendations

Osteomyelitis in children due to Q fever is a rare occurrence. In this study, we review 25 pediatric cases of this disease entity. The mean age of these 25 patients was 3.7years (range, 2-7 years). The risk factor for infection was history of contact with animals, such as cattle and sheep (23/25, 92.0%). The most common sites of infection were foot and ankle (12/25, 48.0%). The diagnosis of Q fever was confirmed by serologic testing in 25 children. On PCR, Coxiella burnetii was detected in 17 cases and it was not detected in the remaining five cases. A total of 22 children were treated with antibiotics, of which 15 received surgical treatment. The composition and duration of treatment varied greatly. Only 18 patients achieved significant recovery of joint mobility after drug and/or surgical treatment. Our current literature review show that the clinical manifestations of Q fever osteomyelitis in children are atypical. In the absence of serological test results, mNGS identification may be a good option. Compared with the guidelines that recommend doxycycline combined with hydroxychloroquine, we recommend that ciprofloxacin-based treatment combined with rifampicin or sulfamethoxazole/trimethoprim should be preferred in children under the age of 8 years, and the need for performing combined surgical debridement and determining the treatment duration should be evaluated according to their actual clinical situation.

Emerging bacterial infectious diseases/pathogens vectored by human lice

Human lice have always been a major public health concern due to their vector capacity for louse-borne infectious diseases, like trench fever, louse-borne relapsing fever, and epidemic fever, which are caused by Bartonella quintana, Borrelia recurrentis, and Rickettsia prowazekii, respectively. Those diseases are currently re-emerging in the regions of poor hygiene, social poverty, or wars with life-threatening consequences. These louse-borne diseases have also caused outbreaks among populations in jails and refugee camps. In addition, antibodies and DNAs to those pathogens have been steadily detected in homeless populations. Importantly, more bacterial pathogens have been detected in human lice, and some have been transmitted by human lice in laboratories. Here, we provide a comprehensive review and update on louse-borne infectious diseases/bacterial pathogens.