Coxiella burnetti prosthetic joint infection in an immunocompromised woman: iterative surgeries, prolonged ofloxacin‑rifampin treatment and complex reconstruction were needed for the cure
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 immunocompromised 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.
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.
Coxiella burnetti PJI is a complex infection that requires dedicated management in an experienced
reference center. Combined use of ofloxacin-rifampin can be effective