Three Cases of Q Fever Osteomyelitis in Children and a Review of the Literature

Nourse, Clare; Allworth, Anthony; Jones, Andrew; Horvath, Robert; McCormack, J. G.; Bartlett, Jeremy A.; Hayes, D. Neil; Robson, Jennifer

doi:10.1086/424014

Cited by 58 publications

(45 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…30 The paucity of Q fever cases in children has been already reported in Australia, 31,32 but when it does occur, chronic osteomyelitis is the main clinical presentation. 33,34 One important new finding from the current study is the role of macropods (especially kangaroos) in the epidemiology of Q fever in Australia. Several patients appear to have been infected via indirect contact with kangaroos, either via their feces or via their ticks.…”

Section: Discussionmentioning

confidence: 80%

Endemic Q Fever in New South Wales, Australia: A Case Series (2005–2013)

Graves

Islam

2016

The American Society of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

Abstract. Q fever is endemic in Australia, and during the period 2005-2013 our laboratory diagnosed 379 cases in New South Wales. To evaluate clinical symptoms, epidemiology, mode of diagnosis, antibody profiles, and treatment, a subset of 160 (42%) Q fever cases were analyzed in detail following the return of a questionnaire by the patient's doctor and from their laboratory reports. Overall, 82% patients were male and predominantly middle aged. The majority of patients (89%) had animal contact among which 63% were with cattle, 11% with sheep, and 7% with kangaroos. Clinical symptoms were nonspecific: myalgia (94%), fever (91%), headache (80%), acute fatigue (64%), and arthralgia (55%). Most cases (93%) were acute, and serology (immunofluorescence) was the main diagnostic modality. Positive real-time polymerase chain reaction results were useful in the diagnosis of both acute and chronic Q fever, as was the isolation of Coxiella burnetii in cell culture. Doxycycline was the antibiotic most commonly used. BACKGROUND

show abstract

Section: Discussionmentioning

confidence: 80%

Endemic Q Fever in New South Wales, Australia: A Case Series (2005–2013)

Graves

Islam

2016

The American Society of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

show abstract

“…In children, chronic Q fever is extremely rare. Presentations include osteomyelitis, which may be recurrent and multifocal, often associated with a delay in diagnosis, 6 and endocarditis, mainly in children with underlying cardiac…”

Section: Discussionmentioning

confidence: 99%

“…8 Despite these prolonged antibiotic courses, treatment failures have been reported. 6 Given the lack of proven efficacy, the potential for significant side effects associated with prolonged antibiotic treatment, and the lack of symptoms in an otherwise well child, a decision was made to continue close observation without initiating antimicrobial therapy. We postulate that after a reduction in the bacterial load achieved by surgical drainage, the host immune responses in some individuals may be able to control the infection.…”

Section: Figurementioning

confidence: 99%

A Case of Pediatric Q Fever Osteomyelitis Managed Without Antibiotics

2015

View full text Add to dashboard Cite

Q fever osteomyelitis, caused by infection with Coxiella burnetti, is rare but should be included in the differential diagnosis of children with culturenegative osteomyelitis, particularly if there is a history of contact with farm animals, and/or granulomatous change on histologic examination of a bone biopsy specimen. We describe a case of Q fever osteomyelitis in a 6-year-old boy in which a decision was made not to treat the patient with combination antimicrobial agents, balancing possible risks of recurrence against potential side effects of prolonged antibiotic treatment. The patient had undergone surgical debridement of a single lesion and was completely asymptomatic after recovery from surgery. This case suggests that a conservative approach of watchful waiting in an asymptomatic patient with chronic Q fever osteomyelitis may be warranted in select cases when close follow-up is possible.

show abstract

“…6,7 Because of its nonspecific clinical presentation, chronic Q fever is probably underestimated, and the majority of patients experience symptoms for a lengthy period before diagnosis. 3 The range of osseous involvement is broad, from long to short bones.…”

Section: Discussionmentioning

confidence: 99%

“…Polymerase chain reaction (PCR) is commonly used to test for pertussis. [5][6][7][8] PCR is more sensitive than culture and can detect nonviable bacteria 5,6 ; however, similar to culture, PCR accuracy relies heavily on the timing of specimen collection. 7,8 Using PCR during the first 2 weeks of symptoms facilitates effective identification of pertussis, which can often be misdiagnosed as other upper respiratory tract infections.…”

Section: Discussionmentioning

confidence: 99%