Q fever osteoarticular infection: four new cases and a review of the literature

  • C. Landais
  • F. Fenollar
  • A. Constantin
  • C. Cazorla
  • C. Guilyardi
  • H. Lepidi
  • A. Stein
  • J. M. Rolain
  • D. Raoult


Q fever is a worldwide-occurring zoonosis caused by Coxiella burnetii. Better knowledge of the disease and of evolving diagnostics can enable recognition of unusual manifestations. Reported here are four cases of Q fever osteoarticular infections in adults: two cases of Q fever tenosynovitis, which represent the first two reports of this infection, and two cases of Q fever spondylodiscitis complicated by paravertebral abscess. In addition, the literature is reviewed on the 15 previously reported cases of Q fever osteoarticular infection, six of which were vertebral infections. Osteomyelitis is the usual manifestation Q fever osteoarticular infection. Because its onset is frequently insidious, diagnosis is usually delayed. The main differential diagnosis is mycobacterial infection, based on the histological granulomatous presentation of lesions. Whereas serology is the reference diagnostic method for Q fever, detection of C. burnetii in tissue specimens by PCR and cell culture provides useful additional evidence of infection. Culture-negative osteoarticular samples with granulomatous presentation upon histological examination should raise suspicion of Q fever.


Osteomyelitis Doxycycline Carpal Tunnel Syndrome Hydroxychloroquine Flexor Tendon 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank Dr. Sally Cutler for reviewing the manuscript.


  1. 1.
    Tissot-Dupont H, Torres S, Nezri M, Raoult D (1999) Hyperendemic focus of Q fever related to sheep and wind. Am J Epidemiol 150:67–74PubMedGoogle Scholar
  2. 2.
    Raoult D, Marrie T (1995) Q fever. Clin Infect Dis 20:489–495PubMedGoogle Scholar
  3. 3.
    Foucault C, Lepidi H, Poujet-Abadie JF, Granel B, Roblot F, Ariga T, Raoult D (2004) Q fever and lymphadenopathy: report of four new cases and review. Eur J Clin Microbiol Infect Dis 23:759–764PubMedCrossRefGoogle Scholar
  4. 4.
    Fenollar F, Fournier PE, Carrieri MP, Habib G, Messana T, Raoult D (2001) Risks factors and prevention of Q fever endocarditis. Clin Infect Dis 33:312–316PubMedCrossRefGoogle Scholar
  5. 5.
    Stein A, Raoult D (1998) Q fever during pregnancy: a public health problem in southern France. Clin Infect Dis 27:592–596PubMedGoogle Scholar
  6. 6.
    Sessa C, Vokrri L, Porcu P, Maurin M, Stahl JP, Magne JL (2005) Abdominal aortic aneurysm and Coxiella burnetii infection: report of three cases and review of the literature. J Vasc Surg 42:153–158PubMedCrossRefGoogle Scholar
  7. 7.
    Piquet P, Raoult D, Tranier P, Mercier C (1994) Coxiella burnetii infection of pseudoaneurysm of an aortic bypass graft with contiguous vertebral osteomyelitis. J Vasc Surg 19:165–168PubMedGoogle Scholar
  8. 8.
    Raoult D, Tissot-Dupont H, Foucault C, Gouvernet J, Fournier PE, Bernit E, Stein A, Nesri M, Harle JR, Weiller PJ (2000) Q fever 1985–1998. Clinical and epidemiologic features of 1,383 infections. Medicine (Baltimore) 79:109–123CrossRefGoogle Scholar
  9. 9.
    Fenollar F, Fournier PE, Raoult D (2004) Molecular detection of Coxiella burnetii in the sera of patients with Q fever endocarditis or vascular infection. J Clin Microbiol 42:4919–4924PubMedCrossRefGoogle Scholar
  10. 10.
    Raoult D, Houpikian P, Tissot DH, Riss JM, Arditi-Djiane J, Brouqui P (1999) Treatment of Q fever endocarditis: comparison of 2 regimens containing doxycycline and ofloxacin or hydroxychloroquine. Arch Intern Med 159:167–173PubMedCrossRefGoogle Scholar
  11. 11.
    Raoult D, Bollini G, Gallais H (1989) Osteoarticular infection due to Coxiella burnetii. J Infect Dis 159:1159–1160PubMedGoogle Scholar
  12. 12.
    Dupont HT, Thirion X, Raoult D (1994) Q fever serology: cutoff determination for microimmunofluorescence. Clin Diagn Lab Immunol 1:189–196PubMedGoogle Scholar
  13. 13.
    Raoult D, Vestris G, Enea M (1990) Isolation of 16 strains of Coxiella burnetii from patients by using a sensitive centrifugation cell culture system and establishment of the strains in HEL cells. J Clin Microbiol 28:2482–2484PubMedGoogle Scholar
  14. 14.
    Lepidi H, Houpikian P, Liang Z, Raoult D (2003) Cardiac valves in patients with Q fever endocarditis: microbiological, molecular, and histologic studies. J Infect Dis 187:1097–1106PubMedCrossRefGoogle Scholar
  15. 15.
    Costa PS, Brigatte ME, Greco DB (2006) Questing one Brazilian query: reporting 16 cases of Q fever from Minas Gerais, Brazil. Rev Inst Med Trop Sao Paulo 48:5–9PubMedGoogle Scholar
  16. 16.
    Nourse C, Allworth A, Jones A, Horvath R, McCormack J, Bartlett J, Hayes D, Robson JM (2004) Three cases of Q fever osteomyelitis in children and a review of the literature. Clin Infect Dis 39:e61–e66PubMedCrossRefGoogle Scholar
  17. 17.
    Cottalorda J, Jouve JL, Bollini G, Touzet P, Poujol A, Kelberine F, Raoult D (1995) Osteoarticular infection due to Coxiella burnetii in children. J Pediatr Orthop B 4:219–221PubMedGoogle Scholar
  18. 18.
    Maltezou HC, Raoult D (2002) Q fever in children. Lancet Infect Dis 2:686–691PubMedCrossRefGoogle Scholar
  19. 19.
    Poujol A, Toesca S, Di Marco JN, Rimet Y, Tissot Dupont H, Mace L, Sudan N, Panuel M, Turcat Y, Kelberine F, Brusquet Y (1998) Recurrent osteitis and Coxiella burnetii: the relation to chronic recurrent multifocal osteomyelitis. Arch Pediatr 5: 291–294PubMedCrossRefGoogle Scholar
  20. 20.
    Pappas G, Akritidis N, Christou L, Mastora M, Tsianos E (2003) Unusual causes of reactive arthritis: Leptospira and Coxiella burnetii. Clin Rheumatol 22:343–346PubMedCrossRefGoogle Scholar
  21. 21.
    Perez OR, Fernandez PG, Cia RJ, Merino AA (1992) Coxiella burnetii osteoarthritis. Rev Clin Esp 191:25–26Google Scholar
  22. 22.
    Ellis ME, Smith CC, Moffat MA (1983) Chronic or fatal Q-fever infection: a review of 16 patients seen in North-East Scotland (1967–80). Q J Med 52:54–66PubMedGoogle Scholar
  23. 23.
    Fournier PE, Casalta JP, Piquet P, Tournigand P, Branchereau A, Raoult D (1998) Coxiella burnetii infection of aneurysms or vascular grafts: report of seven cases and review. Clin Infect Dis 26:116–121PubMedGoogle Scholar
  24. 24.
    Small LN, Ross JJ (2005) Suppurative tenosynovitis and septic bursitis. Infect Dis Clin North Am 19:991–1005PubMedCrossRefGoogle Scholar
  25. 25.
    Delsol G, Pellegrin M, Familiades J, Auvergnat JC (1978) Bone marrow lesions in Q fever. Blood 52:637–638PubMedGoogle Scholar
  26. 26.
    Pellegrin M, Delsol G, Auvergnat JC, Familiades J, Faure H, Guiu M, Voigt JJ (1980) Granulomatous hepatitis in Q fever. Human Pathol 11:51–57CrossRefGoogle Scholar
  27. 27.
    Rolain JM, Boulos A, Mallet MN, Raoult D (2005) Correlation between ratio of serum doxycycline concentration to MIC and rapid decline of antibody levels during reatment of Q fever endocarditis. Antimicrob Agents Chemother 49:2673–2676PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • C. Landais
    • 1
  • F. Fenollar
    • 1
  • A. Constantin
    • 2
  • C. Cazorla
    • 3
  • C. Guilyardi
    • 4
  • H. Lepidi
    • 1
  • A. Stein
    • 1
  • J. M. Rolain
    • 1
  • D. Raoult
    • 1
  1. 1.Unité des Rickettsies, IFR 48, CNRS UMR 6020, Faculté de MédecineUniversité de la MéditerranéeMarseille Cedex 5France
  2. 2.Service de RhumatologieHôpital RangueilToulouseFrance
  3. 3.Service des Maladies InfectieusesHôpital BellevueSaint EtienneFrance
  4. 4.Service de RhumatologieHôpital CaremeauNîmesFrance

Personalised recommendations