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Review
. 2017 Sep 12;4(4):ofx192.
doi: 10.1093/ofid/ofx192. eCollection 2017 Fall.

Coxiella burnetii Multilevel Disk Space Infection, Epidural Abscess, and Vertebral Osteomyelitis Secondary to Contiguous Spread From Infected Abdominal Aortic Aneurysm or Graft: Report of 4 Cases Acquired in the US and Review of the Literature

Abinash Virk  1 , Maryam Mahmood  1 , Manju Kalra  2 , Thomas C Bower  2 , Douglas R Osmon  1 , Elie F Berbari  1 , Didier Raoult  3
Affiliations
Review

Coxiella burnetii Multilevel Disk Space Infection, Epidural Abscess, and Vertebral Osteomyelitis Secondary to Contiguous Spread From Infected Abdominal Aortic Aneurysm or Graft: Report of 4 Cases Acquired in the US and Review of the Literature

Abinash Virk et al. Open Forum Infect Dis. .

Abstract

Background: Chronic Coxiella burnetii infections such as vertebral osteomyelitis caused by contiguous spread from an infected abdominal aortic graft or aneurysm have been rarely reported and are associated with significant morbidity and mortality.

Methods: We present the first four reported US acquired cases of Coxiella burnetii vertebral osteomyelitis caused by contiguous spread from an infected abdominal aortic graft or aneurysm.

Results: Presenting symptoms included progressive back pain, malaise, and weight loss with recent or remote animal exposure. Typical imaging findings demonstrated a peri-aortic collection with extension to the paraspinal muscles and vertebrae. Antibiotic regimens included doxycycline with either hydroxychloroquine or a quinolone for at least 2 years or as chronic suppression.

Conclusions: C. burnetii vertebral osteomyelitis is rare and can occur by contiguous spread from an abdominal aneurysm or vascular graft infection. It should be suspected in patients where pre-antibiotic cultures are negative with animal/farming exposure.

Keywords: Coxiella burnetti; Q fever; infected abdominal aortic aneurysm; vascular graft; vertebral osteomyelitis.

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Figures

Figure 1.
Figure 1.
Lumbar spine MRI with psoas muscle and T10 to L3 epidural abscess, L1, L2, and L3 osteomyelitis. Images: (A) sagittal T2, (B) sagittal T1, and (C) axial.
Figure 2.
Figure 2.
Thoracolumbar spine MRI with diffuse enhancement of L1-L3, epidural abscess extending from T11 to L3, L2 fracture, paraspinal soft tissue and psoas muscles thickening and enhancement, and right psoas muscle abscess. Images: (A) sagittal T2, (B) sagittal T1, and (C) axial.
Figure 3.
Figure 3.
(A) Vascular debridement and reconstruction with rifampin-soaked graft. (B) Debridement of the vertebrae.
Figure 4.
Figure 4.
(A) Direct immunofluorescence staining with anti-Coxiella polyclonal antiserum used to confirm growth of C. burnetii in human fibroblast cells inoculated with aortic aneurysm tissue. Green fluorescent areas indicate the presence of Coxiella burnetii. (B) Presence of C. brunetti by Gimenez staining in human fibroblast cells inoculated with aortic aneurysm tissue.
See this image and copyright information in PMC

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