Matthieu Million1, Lucile Bellevegue1, Anne-Sophie Labussiere2, Michal Dekel3, Tristan Ferry4, Philippe Deroche5, Cristina Socolovschi1, Serge Cammilleri6, Didier Raoult7. 1. Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Marseille, France. 2. Service de Maladies Infectieuses, Centre Hospitalier Jacques Coeur, Bourges, France. 3. Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel. 4. Service de Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, Lyon, France; Centre Interrégional de Référence Rhône-Alpes Auvergne des Infections Ostéo-articulaires complexes, Université Claude Bernard Lyon 1, Lyon, France; Centre International de Recherche en Infectiologie, CIRI, Lyon, France. 5. Centre Orthopédique Médico-chirurgical, Dracy le Fort, France. 6. Département de Médecine Nucléaire, Hôpital de La Timone, APHM, Université d'Aix-Marseille, Marseille, France. 7. Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Marseille, France. Electronic address: didier.raoult@gmail.com.
Abstract
BACKGROUND: The number of hip and knee arthroplasty procedures is steadily increasing as life expectancy increases. Coxiella burnetii may be responsible for culture-negative prosthetic joint arthritis and is associated with antibiotic failure and repeated surgeries. We report the first case series of C. burnetii-related culture-negative prosthetic joint arthritis. METHODS: Cases were retrieved from the French National Referral center for Q fever. Diagnosis was based on (18)fluorodeoxyglucose positron emission tomography, serology, broad-range polymerase chain reaction, and C. burnetii-specific polymerase chain reaction. RESULTS: Four cases of C. burnetii-related culture-negative prosthetic joint arthritis were found. Standard bacteriologic procedures would have missed the diagnosis in all cases. Etiologic diagnosis improved the outcome in all but 1 case. CONCLUSIONS: A systematic, comprehensive diagnostic strategy should be used in culture-negative prosthetic joint arthritis, including testing for C. burnetii in endemic areas.
BACKGROUND: The number of hip and knee arthroplasty procedures is steadily increasing as life expectancy increases. Coxiella burnetii may be responsible for culture-negative prosthetic joint arthritis and is associated with antibiotic failure and repeated surgeries. We report the first case series of C. burnetii-related culture-negative prosthetic joint arthritis. METHODS: Cases were retrieved from the French National Referral center for Q fever. Diagnosis was based on (18)fluorodeoxyglucose positron emission tomography, serology, broad-range polymerase chain reaction, and C. burnetii-specific polymerase chain reaction. RESULTS: Four cases of C. burnetii-related culture-negative prosthetic joint arthritis were found. Standard bacteriologic procedures would have missed the diagnosis in all cases. Etiologic diagnosis improved the outcome in all but 1 case. CONCLUSIONS: A systematic, comprehensive diagnostic strategy should be used in culture-negative prosthetic joint arthritis, including testing for C. burnetii in endemic areas.
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