Q fever osteoarticular infection: four new cases and a review of the literature

Abstract

Q fever is a worldwide-occurring zoonosis caused by Coxiella burnetii. Better knowledge of the disease and of evolving diagnostics can enable recognition of unusual manifestations. Reported here are four cases of Q fever osteoarticular infections in adults: two cases of Q fever tenosynovitis, which represent the first two reports of this infection, and two cases of Q fever spondylodiscitis complicated by paravertebral abscess. In addition, the literature is reviewed on the 15 previously reported cases of Q fever osteoarticular infection, six of which were vertebral infections. Osteomyelitis is the usual manifestation Q fever osteoarticular infection. Because its onset is frequently insidious, diagnosis is usually delayed. The main differential diagnosis is mycobacterial infection, based on the histological granulomatous presentation of lesions. Whereas serology is the reference diagnostic method for Q fever, detection of C. burnetii in tissue specimens by PCR and cell culture provides useful additional evidence of infection. Culture-negative osteoarticular samples with granulomatous presentation upon histological examination should raise suspicion of Q fever.

Q Fever Chronic Osteomyelitis in Two Children

“…6,7 Because of its nonspecific clinical presentation, chronic Q fever is probably underestimated, and the majority of patients experience symptoms for a lengthy period before diagnosis. 3 The range of osseous involvement is broad, from long to short bones. Single or multifocal involvement, with or without focal abscess collection, and sometimes multiple subcutaneous abscesses and fistulas have been described.…”

“…7,8 Indeed in our patients the mild inflammatory markers and the unspecific clinical complaints, added to the low suspicion rate, deferred diagnosis. Also, in case 1 there was involvement of metaphysis and epiphysis, with growth plate commitment, and in case 2, there was a huge 2 This trend can be attributed, in part, to changes in vaccine formulation, 3 evolution of the bacteria, 4 and improved laboratory testing. Polymerase chain reaction (PCR) is commonly used to test for pertussis.…”

“…2 Infections are asymptomatic in 60% of the cases or present as an acute self-limiting disease, usually characterized by flu-like symptoms, pneumonia and/or hepatitis. 1,3 Progression to chronicity occurs in a small number of cases. 1 Chronic Q fever forms include endocarditis, chronic vascular infections and more rarely, osteoarticular infection.…”

A Case of Pediatric Q Fever Osteomyelitis Managed Without Antibiotics

“…8 Pediatric cases received variable regimens of intracellularly active agents including rifampicin, trimethoprim sulfamethoxazole, ciprofloxacin, and linezolid, as well as doxycycline and hydrochloroquine. 8 A review of the limited number of reported Q fever osteoarticular infections advised combination treatment of at least 18 months, along with serological follow-up. 8 Despite these prolonged antibiotic courses, treatment failures have been reported.…”

“…8 A review of the limited number of reported Q fever osteoarticular infections advised combination treatment of at least 18 months, along with serological follow-up. 8 Despite these prolonged antibiotic courses, treatment failures have been reported. 6 Given the lack of proven efficacy, the potential for significant side effects associated with prolonged antibiotic treatment, and the lack of symptoms in an otherwise well child, a decision was made to continue close observation without initiating antimicrobial therapy.…”