Scientific letter
Q fever spondylitis: 2 cases report
Espondilodiscitis por fiebre Q. Descripción de 2 casos
a Departamento de Medicina Interna, Corporació Hospital Parc Taulí de Sabadell, Sabadell, Barcelona, Spain
b Departamento de Geriatría, Corporació Hospital Parc Taulí de Sabadell, Sabadell, Barcelona, Spain
c Departamento d Enfermedades Infecciosas, Corporació Hospital Parc Taulí de Sabadell, Sabadell, Barcelona, Spain
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Descripción de 2 casos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1904 "Ancho" => 2167 "Tamanyo" => 240038 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Lumbar MRI of cases 1 and 2.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Q fever is a zoonosis caused by <span class="elsevierStyleItalic">Coxiella burnetii</span>. This microorganism is an intracellular bacterium and causes acute and chronic infections. The most common manifestations of this entity include endocarditis, chronic vascular and osteoarticular infections.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The diagnosis is based on histological examinations, serology and/or PCR in cell cultures.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1–4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Spondylitis caused by <span class="elsevierStyleItalic">C. burnetii</span> (Q fever) is a rare entity, with few cases reported to date. Therefore, we believe it is of interest to describe the cases of 2 patients assisted in our center with this diagnosis.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case 1</span><p id="par0020" class="elsevierStylePara elsevierViewall">A 49-year-old man with no significant history, suffering from lumbosacral pain for 2 weeks, without fever or any other symptoms. Normal physical examination except for lower back pain on palpation. Blood test with normal complete blood count, liver and kidney biochemistry, ESR and PCR. Normal chest X-ray. Blood cultures, PPD and Quantiferon<span class="elsevierStyleSup">®</span> were negative. In lumbar MRI, signs of L3–L4 spondylodiscitis with peri-vertebral abscesses and abscesses in the left psoas muscle and left anterior intraspinal-epidural abscess (L3–L4 and L4–L5) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Pathological anatomy with signs of chronic granulomatous inflammation and multinucleated giant cells. Kinyoun, Gram, Ziehl–Neelsen staining, Lowenstein and PCR negative for mycobacteria. <span class="elsevierStyleItalic">Brucella</span>, <span class="elsevierStyleItalic">Bartonella</span> serologies and Rose Bengal were negative. Serology for <span class="elsevierStyleItalic">C. burnetii</span> was positive (<span class="elsevierStyleItalic">Coxiella</span> IgG positive phase I 2560; phase II 1/640, IgA phase I 1/800, phase II 1/25). Normal echocardiogram and visceral arterial Doppler ultrasonography. With the diagnosis of Q fever spondylodiscitis, the therapy used was hydroxychloroquine 200<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h, doxycycline 100<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h and rifampicin 600<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h for 2 years. Subsequently, the therapy was changed to doxycycline with levofloxacin 750<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h for 3 years until negative serology.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">During the follow-up, the patient presented good clinical and radiological evolution. In a control MRI in 2010, improvement of peri-vertebral abscesses. In the 2012 control MRI: residual changes in the L3–L4 intervertebral disc space in relation to the old spondylodiscitis without edematous-inflammatory signs at the vertebral bodies.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Case 2</span><p id="par0030" class="elsevierStylePara elsevierViewall">A 59-year-old woman with a history of osteoarthritis and dorsalgia for 4 years of controlled evolution with analgesia. She consulted for back pain worsening, that led to a significant functional impairment, without fever or any other accompanying symptoms. A physical examination highlighted selective pain to palpation of Th7–Th8 vertebrae, the rest being anodyne. Blood test with normal complete blood count, liver and kidney biochemistry, ESR and PCR. Normal chest X-ray. Blood cultures, PPD and Quantiferon were negative. In the bone scintigraphy, signs of spondylodiscitis in Th8–Th9; and in thoracic MRI with ankylosing spondylitis of the Th8–Th9 mid-thoracic segment and spondylodiscitis and right Th6-Th7 vertebral arthritis without involvement of the spinal canal (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><p id="par0035" class="elsevierStylePara elsevierViewall">Biopsy with microbiological study (Gram, Ziehl–Neelsen staining, bacteria culture, Lowenstein and PCR for mycobacteria) showed a negative result. The pathological anatomy was not conclusive (insufficient specimen) and the patient refused to undergo a new puncture. <span class="elsevierStyleItalic">Brucella</span> and <span class="elsevierStyleItalic">Bartonella</span> serologies and Rose Bengal test were negative. Serology for <span class="elsevierStyleItalic">C. burnetii</span> was positive (Anti-<span class="elsevierStyleItalic">Coxiella</span> IgG phase I 1/1280, phase II 1/640, IgA phase I 1/400, phase II 1/50, IgM phase I negative, phase II 1/50). Normal echocardiogram. The patient underwent 9 months of tuberculostatic therapy and doxycycline 100<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h, subsequently maintaining doxycycline 100<span class="elsevierStyleHsp" style=""></span>mg/2<span class="elsevierStyleHsp" style=""></span>h and rifampicin 600<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h along with hydroxychloroquine 200<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h for 2 years. Subsequently, when serology improved, therapy was changed to doxycycline and levofloxacin 750<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h. After 4 years of evolution, the patient presented clinical and radiological improvement. Control MRI at year 2 shows improvement of edema from Th4 toTh10 predominant in Th5.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Although spondylitis due to Q fever is a rare entity in our setting, it should be considered in the differential diagnosis of infectious spondylitis. In the bibliography, there are only 20–30 reported cases.</p><p id="par0045" class="elsevierStylePara elsevierViewall">And, to a greater extent, in patients with subacute forms of presentation, where the pathological anatomy shows granulomatous lesions and the diagnosis of tuberculosis has not been verified. The best methods of microbiological diagnosis are those that allow direct detection of the bacteria (cell culture and polymerase chain reaction, PCR). Indirect immunofluorescence is very sensitive and specific. These diagnostic methods should also be associated with antibody titers (IgG and/or IgM), higher than the cut-off point.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Since it requires antibiotic therapy for months, the patient should undergo clinical, radiological and serological follow-up. The decrease of over 2 antibody titers is considered a good evolution. To consider healing, we require IgG <1:400 and negative IgA, in this case the treatment could be withdrawn.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case 1" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Case 2" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Muñoz N, González B, Font B. Espondilodiscitis por fiebre Q. Descripción de 2 casos. Med Clin (Barc). 2019;153:41–42.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1904 "Ancho" => 2167 "Tamanyo" => 240038 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Lumbar MRI of cases 1 and 2.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Osteoarticular manifestations of Q fever: a case series and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Etienne" 1 => "S. Simon" 2 => "E. Antoine" 3 => "C. Etienne" 4 => "R. Blandine" 5 => "M. Matthieu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Microbiol Infect" "fecha" => "2018" "volumen" => "30" "paginaInicial" => "211" "paginaFinal" => "218" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Natural history and pathophysiology of Q fever" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Raoult" 1 => "T. Marrie" 2 => "J. Mege" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1473-3099(05)70052-9" "Revista" => array:6 [ "tituloSerie" => "Lancet Infect Dis" "fecha" => "2005" "volumen" => "5" "paginaInicial" => "219" "paginaFinal" => "226" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15792739" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Q fever osteomyelitis: a case report and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "V. Merhej" 1 => "P. Tattevin" 2 => "M. Revest" 3 => "B. Le Touvet" 4 => "D. Raoult" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Comp Microbiol Infect Dis" "fecha" => "2012" "volumen" => "35" "paginaInicial" => "169" "paginaFinal" => "172" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic Q fever diagnosis – consensus guideline versus expert opinion" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Dutch Q Fever Consensus Group" "etal" => true "autores" => array:6 [ 0 => "L.M. Kampschreur" 1 => "M.C. Wegdam-Blans" 2 => "P.C. Wever" 3 => "N.H. Renders" 4 => "C.E. Delsing" 5 => "T. Sprong" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3201/eid2107.130955" "Revista" => array:6 [ "tituloSerie" => "Group Emerg Infect Dis" "fecha" => "2015" "volumen" => "21" "paginaInicial" => "1183" "paginaFinal" => "1188" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26277798" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic Q fever: relevance of serology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Sunder" 1 => "G. Gras" 2 => "F. Bastides" 3 => "C. de Gialluly" 4 => "P. Choutet" 5 => "L. Bernard" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/cid/cir438" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2011" "volumen" => "53" "paginaInicial" => "749" "paginaFinal" => "750" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21890784" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015300000001/v1_201906260821/S2387020619302773/v1_201906260821/en/main.assets" "Apartado" => array:4 [ "identificador" => "43311" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015300000001/v1_201906260821/S2387020619302773/v1_201906260821/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020619302773?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 11 | 2 | 13 |
| 2024 September | 18 | 3 | 21 |
| 2024 August | 10 | 3 | 13 |
| 2024 July | 10 | 4 | 14 |
| 2024 June | 6 | 0 | 6 |
| 2024 May | 3 | 0 | 3 |
| 2024 April | 6 | 1 | 7 |
| 2024 March | 8 | 2 | 10 |
| 2024 February | 10 | 0 | 10 |
| 2024 January | 7 | 0 | 7 |
| 2023 December | 6 | 1 | 7 |
| 2023 November | 3 | 0 | 3 |
| 2023 October | 9 | 0 | 9 |
| 2023 September | 7 | 1 | 8 |
| 2023 August | 5 | 4 | 9 |
| 2023 July | 3 | 0 | 3 |
| 2023 June | 3 | 0 | 3 |
| 2023 May | 3 | 0 | 3 |
| 2023 April | 2 | 0 | 2 |
| 2023 March | 2 | 0 | 2 |
| 2023 February | 3 | 0 | 3 |
| 2022 November | 5 | 2 | 7 |
| 2022 October | 3 | 0 | 3 |
| 2022 September | 9 | 0 | 9 |
| 2022 August | 3 | 0 | 3 |
| 2022 July | 2 | 0 | 2 |
| 2022 June | 1 | 0 | 1 |
| 2022 May | 2 | 0 | 2 |
| 2022 April | 4 | 0 | 4 |
| 2022 March | 2 | 0 | 2 |
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