Coxiella burnetti prosthetic joint infection in an immunocompromised woman: iterative surgeries, prolonged ofloxacin-rifampin treatment and complex reconstruction were needed for the cure

Abstract Background Q fever is a zoonotic disease caused by the bacterium Coxiella burnetii, a strictly intracellular pathogen that can cause acute and chronic infection. Chronic Q fever can occur in immunocompetent as well as in immuno-compromised hosts, as a persistent localized infection. The mai...

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Autores principales:	Patrick Miailhes, Anne Conrad, Chantal Sobas, Frederic Laurent, Sebastien Lustig, Tristan Ferry, on behalf of the Lyon BJI study group
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Q fever Prosthetic joint infection Rheumatoid arthritis Anti-TNF-α Coxiella burnetii Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/8035980b521b451e80a1d5df8019f4be
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spelling	oai:doaj.org-article:8035980b521b451e80a1d5df8019f4be2021-12-05T12:26:26ZCoxiella burnetti prosthetic joint infection in an immunocompromised woman: iterative surgeries, prolonged ofloxacin-rifampin treatment and complex reconstruction were needed for the cure10.1186/s42836-021-00097-12524-7948https://doaj.org/article/8035980b521b451e80a1d5df8019f4be2021-12-01T00:00:00Zhttps://doi.org/10.1186/s42836-021-00097-1https://doaj.org/toc/2524-7948Abstract Background Q fever is a zoonotic disease caused by the bacterium Coxiella burnetii, a strictly intracellular pathogen that can cause acute and chronic infection. Chronic Q fever can occur in immunocompetent as well as in immuno-compromised hosts, as a persistent localized infection. The main localizations are endocardial, vascular and, less frequently, osteoarticular. The most frequent osteoarticular form is spondyliscitis. Recommended treatment is combined doxycycline and hydroxychloroquine for 18 months, with cotrimoxazole as another option. Coxiella burnetti infection has been implicated in rare cases of prosthetic joint infection (PJI), and the medical and surgical management and outcome in such cases have been little reported. Case presentation We report an unusual case of chronic Q fever involving a hip arthroplasty in an immunocompromised woman treated with tumor necrosis factor (TNF)-α blockers for rheumatoid arthritis. Numerous surgical procedures (explantation, “second look”, femoral resection and revision by megaprosthesis), modification of the immunosuppressant therapy and switch from doxycycline-hydroxychloroquine to prolonged ofloxacin-rifampin combination therapy were needed to achieve reconstruction and treat the PJI, with a follow-up of 7 years. Conclusions Coxiella burnetti PJI is a complex infection that requires dedicated management in an experienced reference center. Combined use of ofloxacin-rifampin can be effective.Patrick MiailhesAnne ConradChantal SobasFrederic LaurentSebastien LustigTristan Ferryon behalf of the Lyon BJI study groupBMCarticleQ feverProsthetic joint infectionRheumatoid arthritisAnti-TNF-αCoxiella burnetiiOrthopedic surgeryRD701-811ENArthroplasty, Vol 3, Iss 1, Pp 1-7 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Q fever Prosthetic joint infection Rheumatoid arthritis Anti-TNF-α Coxiella burnetii Orthopedic surgery RD701-811
spellingShingle	Q fever Prosthetic joint infection Rheumatoid arthritis Anti-TNF-α Coxiella burnetii Orthopedic surgery RD701-811 Patrick Miailhes Anne Conrad Chantal Sobas Frederic Laurent Sebastien Lustig Tristan Ferry on behalf of the Lyon BJI study group Coxiella burnetti prosthetic joint infection in an immunocompromised woman: iterative surgeries, prolonged ofloxacin-rifampin treatment and complex reconstruction were needed for the cure
description	Abstract Background Q fever is a zoonotic disease caused by the bacterium Coxiella burnetii, a strictly intracellular pathogen that can cause acute and chronic infection. Chronic Q fever can occur in immunocompetent as well as in immuno-compromised hosts, as a persistent localized infection. The main localizations are endocardial, vascular and, less frequently, osteoarticular. The most frequent osteoarticular form is spondyliscitis. Recommended treatment is combined doxycycline and hydroxychloroquine for 18 months, with cotrimoxazole as another option. Coxiella burnetti infection has been implicated in rare cases of prosthetic joint infection (PJI), and the medical and surgical management and outcome in such cases have been little reported. Case presentation We report an unusual case of chronic Q fever involving a hip arthroplasty in an immunocompromised woman treated with tumor necrosis factor (TNF)-α blockers for rheumatoid arthritis. Numerous surgical procedures (explantation, “second look”, femoral resection and revision by megaprosthesis), modification of the immunosuppressant therapy and switch from doxycycline-hydroxychloroquine to prolonged ofloxacin-rifampin combination therapy were needed to achieve reconstruction and treat the PJI, with a follow-up of 7 years. Conclusions Coxiella burnetti PJI is a complex infection that requires dedicated management in an experienced reference center. Combined use of ofloxacin-rifampin can be effective.
format	article
author	Patrick Miailhes Anne Conrad Chantal Sobas Frederic Laurent Sebastien Lustig Tristan Ferry on behalf of the Lyon BJI study group
author_facet	Patrick Miailhes Anne Conrad Chantal Sobas Frederic Laurent Sebastien Lustig Tristan Ferry on behalf of the Lyon BJI study group
author_sort	Patrick Miailhes
title	Coxiella burnetti prosthetic joint infection in an immunocompromised woman: iterative surgeries, prolonged ofloxacin-rifampin treatment and complex reconstruction were needed for the cure
title_short	Coxiella burnetti prosthetic joint infection in an immunocompromised woman: iterative surgeries, prolonged ofloxacin-rifampin treatment and complex reconstruction were needed for the cure
title_full	Coxiella burnetti prosthetic joint infection in an immunocompromised woman: iterative surgeries, prolonged ofloxacin-rifampin treatment and complex reconstruction were needed for the cure
title_fullStr	Coxiella burnetti prosthetic joint infection in an immunocompromised woman: iterative surgeries, prolonged ofloxacin-rifampin treatment and complex reconstruction were needed for the cure
title_full_unstemmed	Coxiella burnetti prosthetic joint infection in an immunocompromised woman: iterative surgeries, prolonged ofloxacin-rifampin treatment and complex reconstruction were needed for the cure
title_sort	coxiella burnetti prosthetic joint infection in an immunocompromised woman: iterative surgeries, prolonged ofloxacin-rifampin treatment and complex reconstruction were needed for the cure
publisher	BMC
publishDate	2021
url	https://doaj.org/article/8035980b521b451e80a1d5df8019f4be
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Coxiella burnetti prosthetic joint infection in an immunocompromised woman: iterative surgeries, prolonged ofloxacin-rifampin treatment and complex reconstruction were needed for the cure

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