Chronic Sternal Wound Infection and Endocarditis withCoxiella burnetii

Abstract

Chronic Q fever is most commonly associated with culture-negative endocarditis and less frequently with infection of vascular grafts, infection of aneurysms, hepatitis, pulmonary disease, osteomyelitis, and neurological abnormalities. We report a case of chronic sternal wound infection, polyclonal gammopathy, and mixed cryoglobulinemia in which Q fever endocarditis was subsequently diagnosed. Polymerase chain reaction analysis of the wound tissue was positive for Coxiella burnetii DNA, and treatment of the endocarditis resulted in prompt healing of the wound. Chronic Q fever can occur without epidemiological risk factors for C. burnetii exposure and can produce multisystem inflammatory dysfunction, aberrations of the immune system, and persistent wound infections.Q fever is a zoonotic infection caused by the intracellular aortic aneurysm repair in Houston. He recovered from his surgery uneventfully and did well until early 1994, when he develpathogen Coxiella burnetii. This infection has been reported worldwide, and the most common animal reservoirs for oped intermittent fevers (temperatures up to 102ЊF), weight loss, malaise, and night sweats. Physical examination revealed C. burnetii are cattle, goats, and sheep [1], although transmission to humans by parturient cats or wild rabbits has also been moderate hepatosplenomegaly, and laboratory evaluations showed microcytic anemia, polygammopathy, and elevated reported [2 -4]. Two forms of the infection, acute and chronic, have been recognized [5]. The acute illness is commonly manierythrocyte sedimentation rates of 120 mm/h. Between early 1995 and January 1997 he developed renal fested as self-limited febrile illness, granulomatous hepatitis, or pneumonia [6 -12]. The chronic form, frequently misdiaginsufficiency with mild proteinuria, progressively enlarging splenomegaly, purpuric skin eruptions, leukopenia, severe headaches, nosed, may have a variety of presentations, the most common of which is culture-negative endocarditis [13 -16].and intermittent fevers. Diagnostic evaluations over the 3-year period included a liver biopsy, positive for granulomatous hepatiOther reported presentations of chronic Q fever are infection of a vascular prosthesis, infection of aneurysms, osteomyelitis, tis; three bone marrow biopsies, showing diminished iron stores and nonspecific increases in cellularity and plasma cells; a tempohepatitis, purpuric skin eruptions, and interstitial pulmonary fibrosis [16 -19]. To our knowledge there has never been a ral artery biopsy, negative for giant-cell arteritis; an abdominal CT, confirming splenomegaly; a skin biopsy, revealing leukocyreported case of surgical wound infection by C. burnetii. We report a case of chronic Q fever with a surgical (sternotomy) toclastic vasculitis; serum electrophoresis, of which findings were consistent with polyclonal gammopathy; analysis of cryoglobulwound infection, granulomatous hepatitis, and endocarditis.ins, which were positive for mixed type; transesophageal echocardiography (TEE), showing no valvular ...

Diagnosis of Coxiella burnetii infection via metagenomic next-generation sequencing: a case report

“…Q fever is a zoonotic infection caused by the intracellular surpathogen Coxiella burnetii [ 1 ]. Coxiella burnetii is a classic strict intracellular, Gram-negative bacterium, which can usually be isolated from domestic animals including cattle, sheep, goats, cats, and dogs [ 2 ].…”

The first case of chronic Q fever endocarditis and aortitis from Turkey: A 5-year infection before diagnosis with drain in sternum

“…There is 1 other case report of sternal osteomyelitis and aortitis in patient who underwent prosthetic aortic valve and graft replacement. That patient also had very subtle progression and infection that was diagnosed 4 years after first signs ( 3 ). Especially in countries where the disease is not known, such as Turkey, diagnosis may be delayed for years.…”

Culture-Negative Surgical Site Infections

“…Coxiella burnetii was identified as a cause of chronic sternal SSI and endocarditis following valve replacement. Identification of the organism in surgical site specimens relied on polymerase chain reaction analysis in this case [88]. Gordona (Rhodococcus) sputi and G. bronchialis have been reported to cause sternal SSIs and mediastinitis after cardiac surgery [89,90].…”