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Chronic Recurrent Multifocal Q Fever Osteomyelitis in Children: An Emerging Clinical Challenge

Joshua R Francis1, Jennifer Robson, David Wong

  • 1From 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.

The Pediatric Infectious Disease Journal
|June 14, 2016
PubMed
Abstract

Insights

Chronic recurrent multifocal osteomyelitis caused by Coxiella burnetii is rare in children. This study highlights the challenges in diagnosing and treating this condition, with surgery often required and variable antibiotic effectiveness observed.

Area of Science:

  • Pediatric Infectious Diseases
  • Osteomyelitis Pathophysiology
  • Bacterial Infection Mechanisms

Background:

  • Coxiella burnetii infection (Q fever) is uncommon in children.
  • Chronic Q fever, particularly endocarditis and osteomyelitis, is exceptionally rare.
  • The pathophysiology and optimal treatment for Q fever osteomyelitis remain poorly understood.

Purpose of the Study:

  • To describe a series of pediatric cases of chronic recurrent multifocal Q fever osteomyelitis.
  • To investigate the diagnostic and therapeutic challenges associated with this rare condition.

Main Methods:

  • Retrospective case series of 9 children diagnosed with chronic recurrent multifocal Q fever osteomyelitis between 2011 and 2014.
  • Diagnosis based on clinical presentation, serology, and C. burnetii DNA detection via PCR in biopsy samples.
  • Evaluation of surgical and antimicrobial treatment outcomes.

Main Results:

  • Nine cases of chronic recurrent multifocal Q fever osteomyelitis were identified.
  • All patients required surgical intervention.
  • Antibiotic and adjuvant therapies showed inconsistent effectiveness; two cases resolved without specific antimicrobial treatment.
  • C. burnetii DNA was detected in 8/9 biopsy samples.

Conclusions:

  • Chronic recurrent multifocal osteomyelitis represents a rare pediatric manifestation of Q fever.
  • The underlying pathophysiology requires further investigation.
  • Established effective treatment protocols are lacking, necessitating individualized management strategies.

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