M. Lefebvre

Rickettsia sibirica mongolitimonae in traveler from Egypt.

To the Editor: Tick-borne rickettsioses are zoonoses caused by spotted fever group (SFG) Rickettsia spp (1), which have been reported as a frequent cause of fever in international travelers (2). In Egypt, Mediterranean spotted fever caused by Rickettsia conorii transmitted by the brown dog tick, Rhipicephalus sanguineus, is known to be present, although cases are rarely documented. Moreover, an emerging pathogen, R. aeschlimannii, has been detected in Hyalomma dromedarii ticks, collected from camels, and in H. impeltatum and H. marginatum rufipes, collected from cows (3). We report a case of Rickettsia sibirica mongolitimonae infection in a French traveler who returned from Egypt

Vertebral Osteomyelitis: An Unusual Presentation of Bartonella henselae Infection

OBJECTIVES To report cases of cat scratch disease with vertebral osteomyelitis. METHODS We describe clinical features, diagnostic, treatment, and outcome of 2 patients with vertebral osteomyelitis due to Bartonella henselae and provide a review of the relevant literature. RESULTS A 47-year-old man was investigated for fever, splenomegaly, and cervical adenopathy. A lymphoma was suspected on the clinical picture, the laboratory tests, and the computed tomographic scan. [(18)F]-fluoro-2-deoxy-d-glucose-positron emission tomography detected splenic nodules and a hypermetabolic focus of C7 vertebral body compatible with a vertebral osteomyelitis on magnetic resonance imaging. B henselae infection was confirmed by polymerase chain reaction performed on lymph node biopsy. A 34-year-old woman was investigated for fever and right upper quadrant abdominal pain. She had consulted 2 weeks before for a unique lesion of right index and an axillar adenopathy that have improved spontaneously. A technetium bone scan performed 1 week later because of a thoracic backache demonstrated an increased uptake of the T6 vertebra. Vertebral magnetic resonance imaging was compatible with a T6 osteomyelitis. B henselae infection was confirmed by serology (seroconversion). Both patients were treated with rifampin and doxycycline and recovered within 3 months. CONCLUSIONS B henselae vertebral osteomyelitis can involve immunocompetent adults. In the case of vertebral osteomyelitis with negative blood cultures, recent history of local lymphadenopathy and cat exposure must be investigated and B henselae serology must be performed. Nevertheless, even if serology is positive, vertebral biopsy is required to rule out other pathogens or malignancy. B henselae infection can be confirmed by polymerase chain reaction performed on vertebral or lymph node biopsy.

Systemic Immune Presentations of Coxiella burnetii Infection (Q Fever)

OBJECTIVES Q fever is a worldwide zoonosis caused by Coxiella burnetii. Its presentation can be atypical, delaying and complicating the diagnosis. We report 7 cases of Q fever mimicking vasculitis, systemic inflammatory disease, or auto-immune disorder. METHODS Seven cases of Q fever diagnosed between 1995 and 2007 in Nantes University Hospital (France) are described. They occurred in a nonendemic region and were selected on the basis of initial clinical presentation suggesting systemic immune disease. C. burnetii was detected using indirect immunofluorescence serology. RESULTS Q fever was acute in 4 of the 7 patients and chronic in 3. None had endocarditis. The initial presentations suggested Crohns disease, Goodpastures syndrome, polymyalgia rheumatica, adult-onset Stills disease, polyarteritis nodosa, giant-cell arteritis, and essential type II cryoglobulinemia. Two patients had antiphospholipid antibodies, 1 had transient IgG kappa monoclonal gammopathy, and 1 had polyclonal T CD8+ large granular lymphocyte expansion. CONCLUSION Clinicians must be aware of the potential diagnosis of Q fever, and C. burnetii serology is a helpful diagnostic tool in the investigation of fever of unknown origin with atypical systemic symptoms suggesting vasculitis or inflammatory disease.