Chronic prosthetic joint infection caused by Coxiella burnetii diagnosed by metagenomic next-generation sequencing: A case report and literature review
Abstract
Prosthetic joint infection (PJI) caused by Coxiella burnetii (C. burnetii) remains a rare but clinically significant diagnostic challenge due to its culture-negative characteristics and nonspecific clinical manifestations. Metagenomic next-generation sequencing (mNGS) has emerged as a valuable tool for identifying fastidious pathogens in culture-negative PJI cases. A patient with a history of joint arthroplasty presented with persistent joint pain and swelling. Despite multiple surgical interventions and prolonged empirical antibiotic therapy, routine bacterial cultures remained negative and the infection recurred. mNGS performed on periprosthetic tissue detected C. burnetii in two independent specimens, while all conventional cultures remained negative. Targeted antimicrobial therapy with doxycycline combined with levofloxacin was initiated, resulting in gradual symptom resolution and sustained clinical improvement during follow-up. This case highlights C. burnetii as an underrecognized cause of culture-negative PJI and demonstrates the clinical value of mNGS for early pathogen identification when conventional diagnostics fail. Repeated detection in independent specimens strengthened diagnostic confidence and enabled timely targeted therapy. Our findings support the early incorporation of mNGS into the diagnostic algorithm for suspected culture-negative PJI. In the present case, targeted doxycycline-levofloxacin therapy following mNGS-based pathogen identification was…
How strong is the evidence?
Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
Read the paper
Related studies
- Ferulic acid regulates the AKT/GSK-3β/CRMP-2 signaling pathway in a middle cerebral artery occlusion animal model
- Novel Pharmacokinetic/Pharmacodynamic Parameters Quantify the Exposure–Effect Relationship of Levofloxacin against Fluoroquinolone-Resistant Escherichia coli
- Photochemical behavior of levofloxacin
- Correlation Between Dissolution Profiles of Salt-Form Drugs in Biorelevant Bicarbonate Buffer and Oral Drug Absorption: Importance of Dose/ Fluid Volume Ratio
- Evaluation of the synergistic potential and mechanisms of action for de novo designed cationic antimicrobial peptides
- Synthesis of [11C]levofloxacin
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.