title: Culture-negative prosthetic joint arthritis related to Coxiella burnetii.
abstract: 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.
authors.affiliation: Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Marseille, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Million
authors.affiliation: Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Marseille, France.
authors.forename: Lucile
authors.initials: L
authors.lastname: Bellevegue
authors.affiliation: Service de Maladies Infectieuses, Centre Hospitalier Jacques Coeur, Bourges, France.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Labussiere
authors.affiliation: Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Michal
authors.initials: M
authors.lastname: Dekel
authors.affiliation: Service de Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, Lyon, France; Centre Interrégional de Référence Rhône-Alpes Auvergne des Infections Ostéo-articulaires complexes, Université Claude Bernard Lyon 1, Lyon, France; Centre International de Recherche en Infectiologie, CIRI, Lyon, France.
authors.forename: Tristan
authors.initials: T
authors.lastname: Ferry
authors.affiliation: Centre Orthopédique Médico-chirurgical, Dracy le Fort, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Deroche
authors.affiliation: Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Marseille, France.
authors.forename: Cristina
authors.initials: C
authors.lastname: Socolovschi
authors.affiliation: Département de Médecine Nucléaire, Hôpital de La Timone, APHM, Université d'Aix-Marseille, Marseille, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Cammilleri
authors.affiliation: Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Marseille, France. Electronic address: didier.raoult@gmail.com.
authors.forename: Didier
authors.initials: D
authors.lastname: Raoult
mesh_terms: D001431:Bacteriological Techniques / Q000379:methods; D016997:Coxiella burnetii / Q000302:isolation & purification*; D005260:Female; D006622:Hip Prosthesis / Q000382:microbiology*; D006801:Humans; D008875:Middle Aged; D010003:Osteoarthritis / Q000175:diagnosis* / Q000382:microbiology; D016459:Prosthesis-Related Infections / Q000382:microbiology*; D011778:Q Fever / Q000382:microbiology* / Q000473:pathology
keywords: Coxiella burnetii; Culture-negative prosthetic joint arthritis; Q fever