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Direct Prosthetic Joint Infection Diagnosis from Sonication Fluid Inoculated in Blood Culture Bottles by Direct MALDI-TOF Mass Spectrometry. Diagnostics (Basel) 2023; 13:diagnostics13050942. [PMID: 36900086 PMCID: PMC10001090 DOI: 10.3390/diagnostics13050942] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/15/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
An accurate and fast microbiological diagnosis is key for a proper management and results when facing prosthetic joint infection (PJI). The purpose of this study is to assess the role of direct Matrix-assisted laser desorption ionization time of flight (MALDI-TOF) mass spectrometry (MS) for early identification of the pathogens causing PJI from sonication fluid inoculated in blood culture bottles (BCB-SF). This prospective multicentric study included 107 consecutive patients from February 2016 to February 2017. Among them, 71 prosthetic joint revision surgeries were undergone for aseptic and 36 for septic reasons. Prostheses were sonicated and the resulting fluid inoculated into blood culture bottles, regardless the suspicion for infection. We assessed the diagnostic performance of direct MALDI-TOF MS identification of the pathogens in BCB-SF and compared it with periprosthetic tissue and conventional sonication fluid cultures. The sensitivity of direct MALDI-TOF MS of BCB-SF (69%) was higher compared to conventional sonication fluid (69% vs. 64%, p > 0.05) or intraoperative tissue cultures (69% vs. 53%, p = 0.04), especially for patients receiving antimicrobial treatment. This approach also reduced the time for identification but the specificity was compromised (100% vs. 94%) and polymicrobial infections were missed. In conclusion, BCB-SF improves the sensitivity and reduces the time of PJI diagnosis when used in combination with conventional cultures under strict sterility conditions.
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Hip periprosthetic joint infection due to Coxiella burnetii in an adult male. IDCases 2022; 31:e01661. [PMID: 36593892 PMCID: PMC9803808 DOI: 10.1016/j.idcr.2022.e01661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/19/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Coxiella burnetii is an obligate intracellular Gram-negative bacterium. "Query fever" (Q fever) first described in 1939 is a disease caused by Coxiella burnetii. This bacterium infects animals including goats, sheep, and cattle, and has been recognized as a pathogen causing acute illness in humans. A patient living on a farm with a history of a right total hip arthroplasty presented with right hip pain. Arthrocentesis revealed a total nucleated count of 4288 (93% neutrophils), however his synovial fluid culture remained negative. His Q fever phase I IgG and phase II IgG were elevated at 1:4096 and 1:2048, respectively. He underwent incision and drainage with exchange of the femoral head and acetabular component, with retention of the femoral stem. PCR of tissue samples returned positive for Coxiella burnettii. He was diagnosed with a persistent localized prosthetic joint infection (PJI) of the right hip. Coxiella burnetii PJI is a rare but increasingly recognized form of persistent localized Q fever infection. Q fever should be considered in the differential diagnosis of culture-negative PJI, especially among patients with exposure to sheep, goats, or cattle. Initial screening for Coxiella burnetii includes serology, but tissue PCR and immunohistochemical staining may be obtained to confirm joint infection.
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Huang C, Ding H, Lin Y, Zhang Z, Fang X, Chen Y, Chen Y, Zhang C, Li W, Zhang W, Huang Z. Diagnosis of Coxiella burnetii Prosthetic Joint Infection Using mNGS and ptNGS: A Case Report and Literature Review. Orthop Surg 2022; 15:371-376. [PMID: 36377682 PMCID: PMC9837287 DOI: 10.1111/os.13600] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Coxiella burnetii (C. burnetii) is the causative agent of Q fever and is found worldwide; however, prosthetic joint infections caused by C. burnetii are rarely seen. Because of advances in molecular diagnostic techniques, prosthetic joint infection (PJI) caused by C. burnetii can now be diagnosed. CASE PRESENTATION A 77-year-old male who had undergone total knee arthroplasty had a displaced prosthesis and periprosthetic osteolysis; he had no obvious signs of infection, and microbiological culture was negative. However, C. burnetii was detected by metagenomic next-generation sequencing (mNGS) and pathogen-targeted next-generation sequencing (ptNGS). Finally, polymerase chain reaction (PCR) confirmed the diagnosis of C. burnetii prosthetic joint infection (PJI). After revision surgery (one-stage revision) and oral antibiotics (doxycycline and moxifloxacin hydrochloride), the patient's symptoms disappeared, and he regained the ability to walk. During the 6-month follow-up, the patient's knee showed no signs of swelling, pain or the recurrence of infection, and he experienced no significant complications. We also present a review of the literature for other cases of C. burnetii PJI. CONCLUSIONS The symptoms of C. burnetii PJI may be different from those of Q fever, which may lead to misdiagnosis. mNGS and ptNGS may be helpful for the identification of C. burnetii. Once the diagnosis of C. burnetii PJI is confirmed, doxycycline in combination with a fluoroquinolone can be effectively administered after revision surgery.
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Affiliation(s)
- Changyu Huang
- Department of Orthopaedic SurgeryThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Haiqi Ding
- Department of Orthopaedic SurgeryThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Yiming Lin
- Department of Orthopaedic SurgeryThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Zeyu Zhang
- Department of Orthopaedic SurgeryThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Xinyu Fang
- Department of Orthopaedic SurgeryThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Yanshu Chen
- Department of Laboratory MedicineThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Yang Chen
- Department of Orthopaedic SurgeryThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Chaofan Zhang
- Department of Orthopaedic SurgeryThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Wenbo Li
- Department of Orthopaedic SurgeryThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Wenming Zhang
- Department of Orthopaedic SurgeryThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina,Fujian Provincial Institute of OrthopedicsThe First Affiliated Hospital, Fujian Medical UniversityFuzhouChina
| | - Zida Huang
- Department of Orthopaedic SurgeryThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina,Fujian Provincial Institute of OrthopedicsThe First Affiliated Hospital, Fujian Medical UniversityFuzhouChina
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Li N, Bai J, Wang W, Liang X, Zhang W, Li W, Lu L, Xiao L, Xu Y, Wang Z, Zhu C, Zhou J, Geng D. Facile and Versatile Surface Functional Polyetheretherketone with Enhanced Bacteriostasis and Osseointegrative Capability for Implant Application. ACS APPLIED MATERIALS & INTERFACES 2021; 13:59731-59746. [PMID: 34886671 DOI: 10.1021/acsami.1c19834] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Implant-associated infections and inadequate osseointegration are two challenges of implant materials in orthopedics. In this study, a lithium-ion-loaded (Li+)/mussel-inspired antimicrobial peptide (AMP) designed to improve the osseointegration and inhibit bacterial infections effectively is prepared on a polyetheretherketone (PEEK) biomaterial surface through the combination of hydrothermal treatment and mussel-inspired chemistry. The results illustrate that the multifunctional PEEK material demonstrated a great inhibitory effect on Escherichia coli and Staphylococcus aureus, which was attributed to irreversible bacterial membrane damage. In addition, the multifunctional PEEK can simultaneously upregulate the expression of osteogenesis-associated genes/proteins via the Wnt/β-catenin signaling pathway. Furthermore, an in vivo assay of an infection model revealed that the multifunctional PEEK implants killed bacteria with an efficiency of 95.03%. More importantly, the multifunctional PEEK implants accelerated the implant-bone interface osseointegration compared with pure PEEK implants in the noninfection model. Overall, this work provides a promising strategy for improving orthopedic implant materials with ideal osseointegration and infection prevention simultaneously, which may have broad application clinical prospects.
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Affiliation(s)
- Ning Li
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
- Department of Orthopedic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Hospital, Heifei, Anhui 230001, China
| | - Jiaxiang Bai
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Wei Wang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Xiaolong Liang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Wei Zhang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Wenming Li
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Liang Lu
- Department of Orthopedic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Hospital, Heifei, Anhui 230001, China
| | - Long Xiao
- Department of Orthopedics, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu 215000, China
| | - Yaozeng Xu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Zhirong Wang
- Department of Orthopedics, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu 215000, China
| | - Chen Zhu
- Department of Orthopedic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Hospital, Heifei, Anhui 230001, China
| | - Jun Zhou
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Dechun Geng
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
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McKew GL, Gottlieb T. Reactivation of Q fever: case report of osteoarticular infection developing at the site of a soft tissue injury. Access Microbiol 2021; 3:000296. [PMID: 35024556 PMCID: PMC8749151 DOI: 10.1099/acmi.0.000296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/25/2021] [Indexed: 11/30/2022] Open
Abstract
Coxiella burnetii, the causative agent of Q fever, is known to cause acute and persistent infection, but reactivation of infection is rarely reported. This case demonstrates reactivation of a distant, untreated Q fever infection after a relatively innocuous soft tissue injury in an adjacent joint without pre-existing pathology. A 52-year-old male abbatoir worker sustained an adductor muscle tear in a workplace injury. He was unable to walk thereafter, and developed a chronic, progressive, destructive septic arthritis of the adjacent hip with surrounding osteomyelitis of the femur and acetabulum. He had evidence of prior Q fever infection, with a positive skin test and serology 15 years beforehand. He was diagnosed with chronic osteoarticular Q fever on the basis of markedly elevated phase I antibodies, and symptomatic and serological response to prolonged antibiotic treatment with doxycycline and hydroxychloroquine. He required a two-stage hip arthroplasty. This case illustrates reactivation of latent C. burnetii infection at the site of a soft tissue injury. Clinicians need to be aware of this possibility in patients with previous Q fever infection, and in the setting of undiagnosed osteoarticular pathology following soft tissue injury.
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Affiliation(s)
- Genevieve L. McKew
- University of Sydney, New South Wales, Australia
- Concord Repatriation and General Hospital, Concord, New South Wales, Australia
| | - Thomas Gottlieb
- University of Sydney, New South Wales, Australia
- Concord Repatriation and General Hospital, Concord, New South Wales, Australia
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6
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Sim BZ, Aaron L, Sim BL, Looke D, Bursle E. Diagnostic challenge of Q fever osteoarticular infection. Intern Med J 2021; 51:142-143. [PMID: 33572020 DOI: 10.1111/imj.15119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/02/2020] [Accepted: 02/11/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Beatrice Z Sim
- Infectious Diseases Department, Brisbane, Queensland, Australia
| | - Luke Aaron
- Physician Training Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Bernice L Sim
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - David Looke
- Infectious Diseases Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Evan Bursle
- Infectious Diseases Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Chenouard R, Hoppé E, Lemarié C, Talha A, Ducellier F, Ferchaud F, Kempf M, Edouard S, Abgueguen P, Rabier V, Pailhoriès H. A rare case of Prosthetic Joint Infection associated with Coxiella burnetii. Int J Infect Dis 2019; 87:166-169. [PMID: 31374343 DOI: 10.1016/j.ijid.2019.07.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/24/2019] [Accepted: 07/24/2019] [Indexed: 01/15/2023] Open
Abstract
We report here the case of a Prosthetic Joint Infection (PJI) associated with Coxiella burnetii in a 62-year-old man with a revised total hip arthroplasty. The diagnosis was performed first by 16S rDNA sequencing on hip fluid aspirate, and confirmed by specific qPCR. Q fever has been reported in few cases of Prosthetic Joint Infections, often associated with chronic evolution and iterative surgeries. This case report alerts about such an unexpected diagnosis in a patient with no known risk factors.
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Affiliation(s)
- Rachel Chenouard
- Laboratoire de Bactériologie, Institut de Biologie en Santé, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Emmanuel Hoppé
- Service de Rhumatologie, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Carole Lemarié
- Laboratoire de Bactériologie, Institut de Biologie en Santé, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Abdelhafid Talha
- Service de Chirurgie Osseuse, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Florian Ducellier
- Service de Chirurgie Osseuse, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - François Ferchaud
- Service de Chirurgie Osseuse, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Marie Kempf
- Laboratoire de Bactériologie, Institut de Biologie en Santé, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Sophie Edouard
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
| | - Pierre Abgueguen
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Valérie Rabier
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Hélène Pailhoriès
- Laboratoire de Bactériologie, Institut de Biologie en Santé, Centre Hospitalier Universitaire d'Angers, Angers, France.
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8
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Gomez-Urena EO, Tande AJ, Osmon DR, Berbari EF. Diagnosis of Prosthetic Joint Infection: Cultures, Biomarker and Criteria. Infect Dis Clin North Am 2018; 31:219-235. [PMID: 28483043 DOI: 10.1016/j.idc.2017.01.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Prosthetic joint infections (PJIs) are devastating complications after joint arthroplasty that continue to pose a diagnostic challenge. Currently, a single, stand-alone test with the adequate accuracy and reliability for diagnosis of PJI is not available; therefore, physicians who care for patients with PJI must rely on a combination of diagnostic tests for the diagnosis of PJI. This article reviews conventional laboratory test modalities, diagnostic accuracy and limitations of current tests, and novel emerging tests for the diagnosis of PJI.
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Affiliation(s)
- Eric O Gomez-Urena
- Division of Infectious Diseases, Mayo Clinic School of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Aaron J Tande
- Division of Infectious Diseases, Mayo Clinic School of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Douglas R Osmon
- Division of Infectious Diseases, Mayo Clinic School of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Elie F Berbari
- Division of Infectious Diseases, Mayo Clinic School of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA
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9
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Virk A, Mahmood M, Kalra M, Bower TC, Osmon DR, Berbari EF, Raoult D. Coxiella burnetii Multilevel Disk Space Infection, Epidural Abscess, and Vertebral Osteomyelitis Secondary to Contiguous Spread From Infected Abdominal Aortic Aneurysm or Graft: Report of 4 Cases Acquired in the US and Review of the Literature. Open Forum Infect Dis 2017; 4:ofx192. [PMID: 30581879 PMCID: PMC6299295 DOI: 10.1093/ofid/ofx192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/31/2017] [Indexed: 11/13/2022] Open
Abstract
Background Chronic Coxiella burnetii infections such as vertebral osteomyelitis caused by contiguous spread from an infected abdominal aortic graft or aneurysm have been rarely reported and are associated with significant morbidity and mortality. Methods We present the first four reported US acquired cases of Coxiella burnetii vertebral osteomyelitis caused by contiguous spread from an infected abdominal aortic graft or aneurysm. Results Presenting symptoms included progressive back pain, malaise, and weight loss with recent or remote animal exposure. Typical imaging findings demonstrated a peri-aortic collection with extension to the paraspinal muscles and vertebrae. Antibiotic regimens included doxycycline with either hydroxychloroquine or a quinolone for at least 2 years or as chronic suppression. Conclusions C. burnetii vertebral osteomyelitis is rare and can occur by contiguous spread from an abdominal aneurysm or vascular graft infection. It should be suspected in patients where pre-antibiotic cultures are negative with animal/farming exposure.
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Affiliation(s)
- Abinash Virk
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Maryam Mahmood
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Manju Kalra
- Division of Vascular Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Thomas C Bower
- Division of Vascular Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Douglas R Osmon
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Elie F Berbari
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota
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10
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Abstract
Coxiella burnetii is the causative pathogen of the zoonotic infection Q fever. Most patients with Q fever experience a non-specific febrile illness, hepatitis or pneumonia. Q fever has recently been described as a cause of prosthetic joint septic arthritis, but remains very uncommonly reported. We present a case of Q fever prosthetic joint septic arthritis that has responded to a combination of two-stage surgical exchange and prolonged medical treatment with doxycycline and hydroxychloroquine.
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Affiliation(s)
- Scott Weisenberg
- Alta Bates Summit Medical Center â€" Summit Campus, Oakland, California, USA
| | - David Perlada
- Alta Bates Summit Medical Center â€" Summit Campus, Oakland, California, USA
| | - Thomas Peatman
- Alta Bates Summit Medical Center â€" Summit Campus, Oakland, California, USA
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11
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Tande AJ, Gomez-Urena EO, Berbari EF, Osmon DR. Management of Prosthetic Joint Infection. Infect Dis Clin North Am 2017; 31:237-252. [PMID: 28366224 DOI: 10.1016/j.idc.2017.01.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Although uncommon, prosthetic joint infection is a devastating complication. This challenging condition requires a coordinated management approach to achieve good patient outcomes. This review details the general principles to consider when managing patients with prosthetic joint infection. The different medical/surgical treatment strategies and how to appropriately select a strategy are discussed. The data to support each strategy are presented, along with discussion of antimicrobial strategies in specific situations.
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Affiliation(s)
- Aaron J Tande
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
| | - Eric O Gomez-Urena
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Elie F Berbari
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Douglas R Osmon
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
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12
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Eldin C, Melenotte C, Million M, Cammilleri S, Sotto A, Elsendoorn A, Thuny F, Lepidi H, Roblot F, Weitten T, Assaad S, Bouaziz A, Chapuzet C, Gras G, Labussiere AS, Landais C, Longuet P, Masseau A, Mundler O, Raoult D. 18F-FDG PET/CT as a central tool in the shift from chronic Q fever to Coxiella burnetii persistent focalized infection: A consecutive case series. Medicine (Baltimore) 2016; 95:e4287. [PMID: 27559944 PMCID: PMC5400310 DOI: 10.1097/md.0000000000004287] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Because Q fever is mostly diagnosed serologically, localizing a persistent focus of Coxiella burnetii infection can be challenging. F-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) could be an interesting tool in this context.We performed a retrospective study on patients diagnosed with C burnetii infection, who had undergone F-FDG PET/CT between 2009 and 2015. When positive F-FDG PET/CT results were obtained, we tried to determine if it changed the previous diagnosis by discovering or confirming a suspected focus of C burnetii infection.One hundred sixty-seven patients benefited from F-FDG PET/CT. The most frequent clinical subgroup before F-FDG PET/CT was patients with no identified focus of infection, despite high IgG1 serological titers (34%). For 59% (n = 99) of patients, a hypermetabolic focus was identified. For 62 patients (62.6%), the positive F-FDG PET/CT allowed the diagnosis to be changed. For 24 of them, (38.7%), a previously unsuspected focus of infection was discovered. Forty-two (42%) positive patients had more than 1 hypermetabolic focus. We observed 21 valvular foci, 34 vascular foci, and a high proportion of osteoarticular localizations (n = 21). We also observed lymphadenitis (n = 27), bone marrow hypermetabolism (n = 11), and 9 pulmonary localizations.We confirmed thatF-FDG PET/CT is a central tool in the diagnosis of C burnetii focalized persistent infection. We proposed new diagnostic scores for 2 main clinical entities identified using F-FDG PET/CT: osteoarticular persistent infections and lymphadenitis.
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Affiliation(s)
- Carole Eldin
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculté de Médecine, CNRS UMR 7278, IRD 198, Aix-Marseille Université, 27 Bd Jean Moulin
| | - Cléa Melenotte
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculté de Médecine, CNRS UMR 7278, IRD 198, Aix-Marseille Université, 27 Bd Jean Moulin
| | - Matthieu Million
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculté de Médecine, CNRS UMR 7278, IRD 198, Aix-Marseille Université, 27 Bd Jean Moulin
| | | | - Albert Sotto
- Service de pathologies infectieuses et tropicales de l’hôpital de Nimes
| | | | - Franck Thuny
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculté de Médecine, CNRS UMR 7278, IRD 198, Aix-Marseille Université, 27 Bd Jean Moulin
- Unité Nord Insuffisance cardiaque et valvulopathies (UNIV), Service de cardiologie CHU de Marseille, Hôpital Nord, AP-HM Chemin des Bourrely, Marseille
| | - Hubert Lepidi
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculté de Médecine, CNRS UMR 7278, IRD 198, Aix-Marseille Université, 27 Bd Jean Moulin
| | - France Roblot
- Service de Pathologies infectieuses et tropicales, CHU de Poitiers
| | | | - Souad Assaad
- Service de Médecine interne, hôpital Saint Luc, Lyon
| | | | - Claire Chapuzet
- Service de Pathologies infectieuses et tropicales, CHU de Rouen
| | - Guillaume Gras
- Service de Pathologies infectieuses et tropicales, CHU de Tours
| | | | | | - Pascale Longuet
- Service mobile d’Infectiologie, CH Victor Dupouy, Argenteuil
| | | | - Olivier Mundler
- Service de médecine nucléaire, Hôpital de La Timone, Marseille
| | - Didier Raoult
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculté de Médecine, CNRS UMR 7278, IRD 198, Aix-Marseille Université, 27 Bd Jean Moulin
- Correspondence: Didier Raoult, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculté de médecine, 27 boulevard Jean Moulin, 13005 Marseille, France (e-mail: )
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13
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Angelakis E, Thiberville SD, Million M, Raoult D. Sternoclavicular joint infection caused by Coxiella burnetii: a case report. J Med Case Rep 2016; 10:139. [PMID: 27246557 PMCID: PMC4888605 DOI: 10.1186/s13256-016-0948-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/11/2016] [Indexed: 12/25/2022] Open
Abstract
Background Few cases of Q fever osteoarticular infection have been reported, with chronic osteomyelitis as the most common manifestation of Q fever osteoarticular infection. Here we present the case of a sternoclavicular joint infection caused by Coxiella burnetii and localized by positron emission tomography scanning. Case presentation A 67-year-old French man from south France was hospitalized for fever and confusion. An examination revealed subclavicular and axillary lymph node enlargement. Computed tomography scanning and transesophageal echocardiogram were normal, and magnetic resonance imaging scanning did not reveal signs of infection. An immunofluorescence assay of an acute serum sample was positive for C. burnetii and he was treated with 200 mg doxycycline for 21 days. An immunofluorescence assay of convalescent serum sampled after 2 months revealed very high C. burnetii antibody titers. To localize the site of the infection, we performed positron emission tomography scanning, which revealed intense fluorodeoxyglucose uptake in his right sternoclavicular joint; treatment with 200 mg oral doxycycline daily and 200 mg oral hydroxychloroquine three times daily for 18 months was initiated. Conclusions Q fever articular infections may be undiagnosed, and we strongly urge the use of positron emission tomography scanning in patients with high C. burnetii antibody titers to localize the site of C. burnetii infection.
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Affiliation(s)
- Emmanouil Angelakis
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix-Marseille Université, 13005, Marseille, France.
| | - Simon-Djamel Thiberville
- UMR190, Aix-Marseille Université / IRD / EHESP French School of Public Health, Marseille, France.,Hospital Louis Raffalli, Medicine D Unit, Infectious Disease and Internal Medicine, Manosque, France
| | - Matthieu Million
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix-Marseille Université, 13005, Marseille, France
| | - Didier Raoult
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix-Marseille Université, 13005, Marseille, France
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Leahey PA, Tahan SR, Kasper EM, Albrecht M. Chronic Q-Fever (Coxiella burnetii) Causing Abdominal Aortic Aneurysm and Lumbar Osteomyelitis: A Case Report. Open Forum Infect Dis 2016; 3:ofv185. [PMID: 26730393 PMCID: PMC4697918 DOI: 10.1093/ofid/ofv185] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 11/24/2015] [Indexed: 11/15/2022] Open
Abstract
Coxiella burnetii is a rare cause of chronic infection that most frequently presents as endocarditis. We report a case of C burnetii causing an infected abdominal aortic aneurysm with contiguous lumbar osteomyelitis resulting in spinal cord compromise. The diagnosis was established by serologic studies consistent with chronic Q-fever (ratio of C burnetii immunoglobulin [Ig]G phase II titer to IgG phase I titer <1) and was confirmed by positive C burnetii polymerase chain reaction of vertebral tissue in addition to pathology of vertebral bone showing intracellular Gram-negative coccobacillary bacteria. The patient clinically improved after surgical decompression and prolonged treatment with doxycycline and hydroxychloroquine.
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Affiliation(s)
| | | | - Ekkehard M. Kasper
- Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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15
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Million M, Raoult D. Recent advances in the study of Q fever epidemiology, diagnosis and management. J Infect 2015; 71 Suppl 1:S2-9. [DOI: 10.1016/j.jinf.2015.04.024] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2015] [Indexed: 01/26/2023]
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16
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Improved diagnosis of orthopedic implant-associated infection by inoculation of sonication fluid into blood culture bottles. J Clin Microbiol 2015; 53:1622-7. [PMID: 25740775 DOI: 10.1128/jcm.03683-14] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 02/26/2015] [Indexed: 12/23/2022] Open
Abstract
Sonication improved the diagnosis of orthopedic implant-associated infections (OIAI). We investigated the diagnostic performance of sonication fluid inoculated into blood culture bottles in comparison with that of intraoperative tissue and sonication fluid cultures. Consecutive patients with removed orthopedic hardware were prospectively included and classified as having OIAI or aseptic failure (AF) according to standardized criteria. The diagnostic procedure included the collection of five intraoperative tissue cultures and sonication of the removed device, followed by conventional culture of the sonication fluid. Cultures were incubated for 7 days (aerobic) or 14 days (anaerobic). In addition, 10 ml of sonication fluid was inoculated into each aerobic and anaerobic BacT/Alert FAN blood culture bottle and incubated in the automated blood culture system for 5 days. Of 75 included patients, 39 had OIAI and 36 AF. The sensitivity of sonication fluid inoculated into blood culture bottles (100%) was higher than that of conventional sonication fluid (87%; P = 0.05) or intraoperative tissue cultures (59%; P < 0.01). Previous antibiotic therapy reduced the culture sensitivity of conventional sonication fluid to 77% and that of intraoperative tissue to 55%, while it remained 100% for blood culture-inoculated sonication fluid. The time to positivity was shorter in blood culture-inoculated sonication fluid, with detection of 72% of microorganisms after 1 day of incubation, than for intraoperative tissue and conventional sonication fluid cultures, with detection of 18% and 28% of microorganisms, respectively. In conclusion, compared to conventional sonication fluid and intraoperative tissue cultures, sonication fluid inoculated into blood culture bottles improved the diagnosis of OIAI and considerably reduced the time to culture positivity.
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Hartley JC, Harris KA. Molecular techniques for diagnosing prosthetic joint infections. J Antimicrob Chemother 2014; 69 Suppl 1:i21-4. [DOI: 10.1093/jac/dku249] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Culture-negative prosthetic joint arthritis related to Coxiella burnetii. Am J Med 2014; 127:786.e7-786.e10. [PMID: 24662624 DOI: 10.1016/j.amjmed.2014.03.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 03/10/2014] [Accepted: 03/11/2014] [Indexed: 11/23/2022]
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.
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Abstract
Prosthetic joint infection (PJI) is a tremendous burden for individual patients as well as the global health care industry. While a small minority of joint arthroplasties will become infected, appropriate recognition and management are critical to preserve or restore adequate function and prevent excess morbidity. In this review, we describe the reported risk factors for and clinical manifestations of PJI. We discuss the pathogenesis of PJI and the numerous microorganisms that can cause this devastating infection. The recently proposed consensus definitions of PJI and approaches to accurate diagnosis are reviewed in detail. An overview of the treatment and prevention of this challenging condition is provided.
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Affiliation(s)
- Aaron J. Tande
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Robin Patel
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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Abstract
We describe the first reported case of Ureaplasma parvum prosthetic joint infection (PJI) detected by PCR. Ureaplasma species do not possess a cell wall and are usually associated with colonization and infection of mucosal surfaces (not prosthetic material). U. parvum is a relatively new species name for certain serovars of Ureaplasma urealyticum, and PCR is useful for species determination. Our patient presented with late infection of his right total knee arthroplasty. Intraoperative fluid and tissue cultures and pre- and postoperative synovial fluid cultures were all negative. To discern the pathogen, we employed PCR coupled with electrospray ionization mass spectrometry (PCR/ESI-MS). Our patient's failure to respond to empirical antimicrobial treatment and our previous experience with PCR/ESI-MS in culture-negative cases of infection prompted us to use this approach over other diagnostic modalities. PCR/ESI-MS detected U. parvum in all samples. U. parvum-specific PCR testing was performed on all synovial fluid samples to confirm the U. parvum detection.
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Abstract
Osteoarticular infection is an uncommon presentation of Q fever. Positron emission tomography (PET) scanning is a valuable tool for the diagnosis of Coxiella burnetii graft prosthesis infection and endocarditis. Our objective was to test a series of culture-negative osteoarticular samples using molecular assays for Coxiella burnetii. We tested for C. burnetii by molecular assays targeting the IS1111 and the IS30A spacer regions, using culture-negative osteoarticular samples obtained in our laboratory between January 2011 and December 2012. We examine a total of 1,410 osteoarticular samples, and we observed two cases of arthritis and subacromial bursitis caused by C. burnetii. The infections were localized using PET scanning, and the diagnosis was confirmed through serology. For one, a C. burnetii strain with a multispacer sequence type 8 genotype was isolated from synovial fluid culture. Q fever articular infections could be undiagnosed because of the long evolution of articular attack, and patients with high antibody titers against C. burnetii should be tested using PET scanning to localize the site of infection.
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Persistence of DNA in a cured patient and positive culture in cases with low antibody levels bring into question diagnosis of Q fever endocarditis. J Clin Microbiol 2013; 51:3012-7. [PMID: 23850956 DOI: 10.1128/jcm.00812-13] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
We evaluated the performance of tools for diagnosing Q fever cardiovascular infection. We retrospectively analyzed 162 cardiovascular samples from 125 patients who were tested serologically by immunofluorescence, quantitative PCR (qPCR), 16S rRNA gene amplification, culture, and immunohistochemistry, and we assessed the viability of Coxiella burnetii by measuring the transcription of the 16S rRNA gene. The qPCR technique was significantly more sensitive than 16S rRNA gene amplification (P < 0.0001), cell culture (P = 0.0002), and immunohistochemistry (P < 0.0001). The sensitivity of these techniques was reduced when applied to patients who had been previously treated. The severity of infection appears to be correlated with phase I IgG levels. We report for the first time 4 cases of endocarditis with positive qPCR and/or culture assay result from patients with a low phase I IgG (IgG I) titer (<800), and we have identified the longest (16 years) persistence of DNA described in a heart valve from a patient cured after being previously treated for endocarditis. The active transcription of the 16S rRNA gene was found in 19/59 tested samples, with a positive predictive value of 100% for a positive culture. In conclusion, the diagnosis of Q fever cardiovascular infection should not be excluded in patients with low titers of phase I IgG when they present with valvulopathy. We recommend testing cardiovascular samples using 3 or 4 different biopsy sections by qPCR evaluation for patients with IgG I titers of ≥200.
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