Robert L. Horvath

Three Cases of Q Fever Osteomyelitis in Children and a Review of the Literature

Q fever is a common zoonosis worldwide. Awareness of the disease and newer diagnostic modalities have resulted in increasing recognition of unusual manifestations. We report 3 cases of Q fever osteomyelitis in children and review the literature on 11 other reported cases. The cases demonstrate that Coxiella burnetii can cause granulomatous osteomyelitis that presents without systemic symptoms and frequently results in a chronic, relapsing, multifocal clinical course. Optimal selection and duration of antimicrobial therapy and methods of monitoring therapy are currently uncertain.

A case of Aggregatibacter actinomycetemcomitans endocarditis presenting as quadriceps myositis.

An 80 year old female was admitted with an eight week history of fever associated with painful swelling of her right thigh, and a long history of poor dentition. Culture of blood stained fluid aspirated from the abscess grew Aggregatibacter actinomycetemcomitans (Aa) sensitive to ampicillin and cephalosporins. Transoesophageal echocardiography indicated endocarditis. Four weeks treatment with intravenous ceftriaxone and appropriate dental care was followed by full recovery.

A case of cephalothin-associated urolithiasis

We present a case of osteomyelitis requiring prolonged intravenous cephalothin complicated by symptomatic calcium oxalate urocalculi formation. Patients on long-term β-lactam antibiotics with lower urinary tract symptoms may have urolithiasis rather than a urinary tract infection.

A contemporary 16-year review of Coxiella burnetii infective endocarditis in a tertiary cardiac center in Queensland, Australia

Abstract Background: Coxiella burnetii endocarditis can be difficult to diagnose leading to delays in treatment. This retrospective case series study was undertaken to understand the epidemiologic trends and clinical features of Q fever endocarditis in Southeast Queensland, Australia. Methods: Clinical records of patients from a single center with coding diagnosis of C. burnetii, or serology consistent with chronic Q fever, were reviewed from 1999 to 2015. Data from patients with probable or confirmed Q fever endocarditis was abstracted. Results: Thirteen patients had confirmed and 5 had probable Q fever endocarditis. Median age at diagnosis in confirmed cases was 60 years. In confirmed cases, 92% (12/13) of patients had an underlying valvular defect. Two patients in the confirmed cases had serology not consistent with a diagnosis of Q fever endocarditis. Eight patient records noted retrospective diagnosis of Q fever endocarditis after surgery. Conclusions: As pre-existing valve pathology is a major risk for developing endocarditis, prophylactic strategies such as targeted echocardiography and Q fever vaccination could be considered to reduce the incidence of Q fever endocarditis.

Electromagnetic navigation bronchoscopy for the diagnosis of Aspergillus infection.

Electromagnetic navigation bronchoscopy (ENB) is a new diagnostic tool for the evaluation of pulmonary lesions inaccessible by conventional bronchoscopy. Most often, ENB is used for the diagnosis of lung cancer, but can be used to evaluate fungal conditions and other diseases. We present the case of a 44‐year‐old woman who was diagnosed with Aspergillus via ENB.

Necrotic Ulceration of the Skin and Fascia

Diagnosis: Pyoderma gangrenosum. A biopsy was performed, which revealed neutrophilic infiltration with epidermal and dermal ulceration characteristic of pyoderma gangrenosum (figure 1). Cultures were sterile. The patient commenced therapy with intravenously administered hydrocortisone. This was followed within 2 days by defervescence and reduction in the inflammatory changes. His therapy, which included a reducing dose of prednisolone, was continued for the subsequent 3 months, and further improvement was noted (figure 2). Skin grafting was not required. Figure 2. Pyoderma gangrenosum after administration of hydrocortisone and prednisolone therapy.