Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Marseille, France.
Service de Maladies Infectieuses, Centre Hospitalier Jacques Coeur, Bourges, France.
Am J Med. 2014 Aug;127(8):786.e7-786.e10. doi: 10.1016/j.amjmed.2014.03.013. Epub 2014 Mar 22.
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.
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.
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.
A systematic, comprehensive diagnostic strategy should be used in culture-negative prosthetic joint arthritis, including testing for C. burnetii in endemic areas.
随着预期寿命的延长，髋关节和膝关节置换手术的数量稳步增加。考克斯氏体可能是导致培养阴性假体关节关节炎的原因，并且与抗生素治疗失败和反复手术有关。我们报告了首例考克斯氏体相关的培养阴性假体关节关节炎病例系列。
病例从法国 Q 热国家参考中心中检索。诊断基于（18）氟脱氧葡萄糖正电子发射断层扫描、血清学、广谱聚合酶链反应和考克斯氏体特异性聚合酶链反应。
发现了 4 例考克斯氏体相关的培养阴性假体关节关节炎。在所有病例中，标准细菌学程序都将错过诊断。病因诊断除 1 例外均改善了预后。
在培养阴性的假体关节关节炎中，应采用系统、全面的诊断策略，包括在流行地区检测考克斯氏体。
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