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Culture-negative Prosthetic Joint Arthritis Related to Coxiella burnetii
Authors:Matthieu Million  Lucile Bellevegue  Anne-Sophie Labussiere  Michal Dekel  Tristan Ferry  Philippe Deroche  Cristina Socolovschi  Serge Cammilleri  Didier Raoult
Institution: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;5. Centre Interrégional de Référence Rhône-Alpes Auvergne des Infections Ostéo-articulaires complexes, Université Claude Bernard Lyon 1, Lyon, France;6. Centre International de Recherche en Infectiologie, CIRI, Lyon, France;g Centre Orthopédique Médico-chirurgical, Dracy le Fort, France;h Département de Médecine Nucléaire, Hôpital de La Timone, APHM, Université d’Aix-Marseille, Marseille, France
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 18fluorodeoxyglucose 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.
Keywords:Coxiella burnetii  Culture-negative prosthetic joint arthritis  Q fever
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