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Q fever osteomyelitis: a case report and literature review.
Comp Immunol Microbiol Infect Dis. 2012 Mar; 35(2):169-72.CI

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.

Authors+Show Affiliations

University of the Mediterranean, Marseille, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

22285690

Citation

Merhej, Vicky, et al. "Q Fever Osteomyelitis: a Case Report and Literature Review." Comparative Immunology, Microbiology and Infectious Diseases, vol. 35, no. 2, 2012, pp. 169-72.
Merhej V, Tattevin P, Revest M, et al. Q fever osteomyelitis: a case report and literature review. Comp Immunol Microbiol Infect Dis. 2012;35(2):169-72.
Merhej, V., Tattevin, P., Revest, M., Le Touvet, B., & Raoult, D. (2012). Q fever osteomyelitis: a case report and literature review. Comparative Immunology, Microbiology and Infectious Diseases, 35(2), 169-72. https://doi.org/10.1016/j.cimid.2011.12.008
Merhej V, et al. Q Fever Osteomyelitis: a Case Report and Literature Review. Comp Immunol Microbiol Infect Dis. 2012;35(2):169-72. PubMed PMID: 22285690.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Q fever osteomyelitis: a case report and literature review. AU - Merhej,Vicky, AU - Tattevin,Pierre, AU - Revest,Matthieu, AU - Le Touvet,Bastien, AU - Raoult,Didier, Y1 - 2012/01/27/ PY - 2011/09/20/received PY - 2011/12/14/revised PY - 2011/12/19/accepted PY - 2012/1/31/entrez PY - 2012/1/31/pubmed PY - 2012/6/14/medline SP - 169 EP - 72 JF - Comparative immunology, microbiology and infectious diseases JO - Comp Immunol Microbiol Infect Dis VL - 35 IS - 2 N2 - 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. SN - 1878-1667 UR - https://www.unboundmedicine.com/medline/citation/22285690/Q_fever_osteomyelitis:_a_case_report_and_literature_review_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0147-9571(11)00127-5 DB - PRIME DP - Unbound Medicine ER -