Culture-negative prosthetic joint arthritis related to Coxiella burnetii

Am J Med. 2014 Aug;127(8):786.e7-786.e10. doi: 10.1016/j.amjmed.2014.03.013. Epub 2014 Mar 22.


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.

Keywords: Coxiella burnetii; Culture-negative prosthetic joint arthritis; Q fever.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bacteriological Techniques / methods
  • Coxiella burnetii / isolation & purification*
  • Female
  • Hip Prosthesis / microbiology*
  • Humans
  • Middle Aged
  • Osteoarthritis / diagnosis*
  • Osteoarthritis / microbiology
  • Prosthesis-Related Infections / microbiology*
  • Q Fever / microbiology*
  • Q Fever / pathology