Clinical features of Q fever vertebral osteomyelitis: case reports and literature review.

Background: This study aims to characterize Q fever vertebral osteomyelitis based on our experience and literature review. Methods: By reviewing all reported cases of Q fever vertebral osteomyelitis since the 21st century, we characterized the exposure history, clinical presentations, treatment strategies, and prognostic outcomes. Results: Fifty cases of Q fever vertebral osteomyelitis were identified. The mean age was 63.4 ± 15.7 years, and 86% (43/50) of the participants were male. Of the 50 patients, 21 had a history of contact with cattle, sheep, or wild animals, and of the 43 patients, 26 had vascular comorbidities. Low back pain (39/45) was the most common symptom. The lumbar spine was the most susceptible region, with the L4-L5 segment being the most frequently involved site. Of the 47 patients, 39 had multivertebral infections, and the majority also had psoas abscesses (25/41). The positive rate of next-generation sequencing (NGS; 7/7) in spinal lesion tissues was the highest, followed by that of polymerase chain reaction (PCR) detection (26/30). The most common treatment regimen was doxycycline combined with hydroxychloroquine (31/49). The proportions of patients with fever (36% vs. 5.9%) and elevated C-reactive protein (CRP; 90% vs. 41.7%) levels were higher in the group of patients with vertebral osteomyelitis and those with concurrent vascular defects ( Conclusion: Q fever vertebral osteomyelitis should be included in the differential diagnosis, particularly in older men and patients with concurrent vascular defects. PCR or NGS performed on local specimens provides critical advantages for rapid pathogen identification. Doxycycline combined with hydroxychloroquine remains the most used treatment regimen at present.