Reactivation of Q fever: case report of osteoarticular infection developing at the site of a soft tissue injury

Abstract

Coxiella burnetii , the causative agent of Q fever, is known to cause acute and persistent infection, but reactivation of infection is rarely reported. This case demonstrates reactivation of a distant, untreated Q fever infection after a relatively innocuous soft tissue injury in an adjacent joint without pre-existing pathology. A 52-year-old male abbatoir worker sustained an adductor muscle tear in a workplace injury. He was unable to walk thereafter, and developed a chronic, progressive, destructive septic arthritis of the adjacent hip with surrounding osteomyelitis of the femur and acetabulum. He had evidence of prior Q fever infection, with a positive skin test and serology 15 years beforehand. He was diagnosed with chronic osteoarticular Q fever on the basis of markedly elevated phase I antibodies, and symptomatic and serological response to prolonged antibiotic treatment with doxycycline and hydroxychloroquine. He required a two-stage hip arthroplasty. This case illustrates reactivation of latent C. burnetii infection at the site of a soft tissue injury. Clinicians need to be aware of this possibility in patients with previous Q fever infection, and in the setting of undiagnosed osteoarticular pathology following soft tissue injury.

Chronic Q fever presenting as bilateral extensor tenosynovitis: a case report and review of the literature

“…Moreover, Q fever may present as an asymptomatic disease or with limited systemic symptoms as in the present case (Francis et al, 2016). To our knowledge, there have been 55 reports of Q fever with osteoarticular involvement reported in the literature, including the present case (Table 1) (O'Donnell et al, 2007;Merhej et al, 2012;Galy et al, 2016;Stokes et al, 2016;Virk et al, 2017;Meriglier et al, 2018;Lundy et al, 2019;Dabaja-Younis et al, 2020;Waelbers et al, 2020;Dorfman et al, 2021;McKew and Gottlieb, 2021;Sim et al, 2021). Most cases presented as osteomyelitis or spondylodiscitis.…”

Hip periprosthetic joint infection due to Coxiella burnetii in an adult male

“…We searched for articles about C. burnetii -related joint infections in English using PubMed and Google Scholar with the terms “ Coxiella burnetii, ” “Q fever,” “chronic infection,” “persistent infection,” “prosthetic joint infection,” and “osteoarticular infection.” We excluded diskitis or spinal infection due to Q fever. This revealed 22 cases, including 7 pediatric cases reported in a case series [8] , [9] , [12] , [7] , [10] , [14] , [11] , [15] , [13] , [18] , [19] , [20] . Among them, detailed information was available for 16 cases (summarized in Table 1 ).…”