Chronic Recurrent Multifocal Q Fever Osteomyelitis in Children: An Emerging Clinical Challenge.
Clinical disease caused by Coxiella burnetii occurs infrequently in children. Chronic Q fever is particularly uncommon and endocarditis is rarely seen. A small number of cases of Q fever osteomyelitis have been described but the pathophysiology is not well understood and optimal treatment is unknown.



We describe a series of cases of chronic recurrent multifocal Q fever osteomyelitis cases diagnosed in children from a single region in Australia.



Between 2011 and 2014, 9 cases of chronic recurrent multifocal Q fever osteomyelitis were diagnosed based on clinical findings, suggestive serology and detection of C. burnetii DNA by polymerase chain reaction testing of biopsy samples (8/9). All required surgical management; antibiotic and adjuvant therapies did not appear to be consistently effective and 2 cases had clinical resolution in the absence of directed antimicrobial therapy.



Chronic recurrent multifocal osteomyelitis is a rare manifestation of chronic Q fever infection in children. The pathophysiology of this condition is poorly understood, and effective treatment options have not been established.
From the *Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia; †Northern Territory Medical Program, Flinders University, Darwin, Northern Territory, Australia, ‡Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia; §Department of Microbiology, Sullivan Nicolaides Pathology, Brisbane, Queensland, Australia; ¶Department of Histopathology, Mater Pathology, Brisbane, Queensland, Australia; ‖Department of Radiology, **Department of Orthopaedics, Lady Cilento Children's Hospital, Brisbane, Queensland; ††Department of Orthopaedics, John Hunter Hospital, Newcastle, New South Wales, Australia; ‡‡Paediatric Infection Management and Prevention, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia; and §§Faculty of Paediatrics and Child Health, University of Queensland, Brisbane, Queensland, Australia.
Joshua R
JR
Francis
Jennifer
J
Robson
David
D
Wong
Mark
M
Walsh
Ivan
I
Astori
David
D
Gill
Clare
C
Nourse
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016997:Coxiella burnetii; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D010019:Osteomyelitis / Q000175:diagnosis* / Q000628:therapy*; D011778:Q Fever / Q000175:diagnosis* / Q000628:therapy*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents