PMC9837287_01
(A) SPECT showed an abnormal radiolucent shadow around the right knee joint (at the arrow), (B-D) X-ray before operation revealed prosthesis displacement and peripheral osteolysis, (E, F) X-ray after operation
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Single-photon emission CT revealed an abnormal radiolucent shadow around the right knee joint (Fig. 1A). Some specimens underwent mNGS testing (the details of which can be found in the supplementary material), and the results after 48 h revealed C. burnetii infection (Fig. 2B, Table 1). We performed pathogen-targeted next-generation sequencing (ptNGS, a multiple PCR-based targeted NGS technique; the details of which can be found in the supplementary material) on the intraoperative samples, and C. burnetii was detected after 14 h (Fig. 2C, Table 1). The postoperative X-ray is shown in Fig. 1E,F.
(A) The timeline of pathogen investigations, (B) Coxiella burnetii was detected by mNGS of joint fluid before operation (3669 reads), (C) Coxiella burnetii was detected by ptNGS of joint fluid during operation (6423 Copies/ml), (D) Coxiella burnetii primer or probe sequences.
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X-ray revealed a displacement of the right knee prosthesis with severe osteolysis around the prosthesis (Fig. 2B-D). The synovial fluid was subjected to routine microbiological tests, including acid-fast staining, Gram staining, bacterial culture (aerobic and anaerobic) and fungal culture, but the results of all of these tests were negative (Fig. 2A). Some specimens underwent mNGS testing (the details of which can be found in the supplementary material), and the results after 48 h revealed C. burnetii infection (Fig. 2B, Table 1). We performed pathogen-targeted next-generation sequencing (ptNGS, a multiple PCR-based targeted NGS technique; the details of which can be found in the supplementary material) on the intraoperative samples, and C. burnetii was detected after 14 h (Fig. 2C, Table 1). Finally, we performed qPCR and PCR combined with Sanger sequencing, and both detected C. burnetii (primer sequences in Fig. 2D).