• Matthieu Million, Lucile Bellevegue, Anne-Sophie Labussiere, Michal Dekel, Tristan Ferry, Philippe Deroche, Cristina Socolovschi, Serge Cammilleri, and Didier Raoult.
• Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Marseille, France.
• Am. J. Med. 2014 Aug 1; 127 (8): 786.e7-786.e10.

BackgroundThe 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.MethodsCases 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.ResultsFour 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.ConclusionsA systematic, comprehensive diagnostic strategy should be used in culture-negative prosthetic joint arthritis, including testing for C. burnetii in endemic areas.Copyright © 2014 Elsevier Inc. All rights reserved.

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