Diagnosis and Initial Management of Musculoskeletal Coccidioidomycosis in Children

Ho, Aaron Kwun Hang; Shrader, M. Wade; Falk, Miranda; Segal, Lee S.

doi:10.1097/bpo.0000000000000147

Cited by 14 publications

(19 citation statements)

References 66 publications

(90 reference statements)

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“…As previously reported, initial presentations are often variable with nonspecific symptoms. 10,13 However, in this study 66% of patients presented with limb swelling followed by bone pain. Concurrent pulmonary disease was seen in 59% of our patient population, which is higher than what has been reported.…”

Section: Coccidioides Complement Fixation Tierscontrasting

confidence: 52%

Pediatric Musculoskeletal Coccidioidomycosis in Central California: A Single Center Experience

Naeem¹,

Gerardi

Gholve

et al. 2022

Pediatric Infectious Disease Journal

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Background: Published literature on musculoskeletal coccidioidomycosis is sparse and limited to case reports and case series. This is one of the largest case series to describe the clinical presentation, diagnosis, medical and surgical management and outcomes of pediatric musculoskeletal coccidioidomycosis at a tertiary care hospital. Method: A retrospective case review was performed on patients ≤ 21 years old who were followed at a tertiary care center with a diagnosis of musculoskeletal coccidioidomycosis from January 1, 2007, to December 31, 2020. Descriptive data are expressed as medians and interquartile range (IQR) for continuous variables or as frequency and percentage for categorical variables. Categorical values were compared using the χ2 test. Results: Forty-one patients were identified. The median age was 12.8 years, and most were male (71%), Latinx (66%) and healthy (71%). Limb swelling (66%), bone pain (54%) and joint pain (46%) were the most common presenting symptoms. Multiple bone involvement was present in 29% while 12% had the joint disease, and craniofacial (n = 10) and metacarpal/metatarsal bones (n=9) were the most commonly involved sites. Elevated Coccidioides complement fixation (CF) titers ≥1:32 were seen in 90% of the patients. Thirty-three patients (81%) required surgical interventions and of these 16 (48%) required additional surgical procedures. Eleven patients (27%) had disease relapse. Children >13 years of age were more likely to have > 1 organ involvement (16 vs. 7, P = 0.04), multiple bone involvement (10 vs. 2, P = 0.004) and maximum Coccidioides CF titers >1:128 (13 vs. 6, P = 0.02). Conclusions: In endemic areas, musculoskeletal coccidioidomycosis causes a substantial disease burden in children and should be considered in the differential diagnosis of those presenting with bone and joint pain or swelling. Early diagnosis and treatment are essential to minimize long-term morbidity and mortality.

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Section: Coccidioides Complement Fixation Tierscontrasting

confidence: 52%

Pediatric Musculoskeletal Coccidioidomycosis in Central California: A Single Center Experience

Naeem¹,

Gerardi

Gholve

et al. 2022

Pediatric Infectious Disease Journal

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“…to determine the interreviewer agreement of the screening process, which was found to be 98.5%. The full text of 50 articles was assessed to confirm eligibility . Of those, 16 articles reporting the results of 13 studies comprising 795 participants met the inclusion criteria and were critically appraised.…”

Section: Resultsmentioning

confidence: 99%

Assessment of Studies Evaluating Spinal Manipulative Therapy and Infectious Disease and Immune System Outcomes

et al. 2021

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Key Points Question Is spinal manipulative therapy associated with changes in the immune system? Findings In this systematic review of 13 studies comprising 795 participants, no clinical studies investigated the efficacy or effectiveness of spinal manipulative therapy in preventing or improving disease-specific outcomes among patients with infectious disease. Preliminary laboratory experiments indicated that spinal manipulative therapy may, in the short term, be associated with levels of change in immunological biomarkers among asymptomatic participants. Meaning These findings suggest that, given the limitations of the evidence, claims that spinal manipulative therapy is associated with changes in the immune system are premature and further clinical studies should be completed.

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“…Differentiating coccidioidomycosis infection from those other diseases is of utmost importance given the therapeutic and prognostic implications. Accurate diagnosis of skeletal coccidioidomycosis requires a very high level of rigor and a multidisciplinary approach combining laboratory analysis (histopathology, immunology, and microbiology) and imaging (such as Radiographs and MRI), especially in immunocompetent patients, and people from endemic areas [9,31,55,60].…”

Section: Diagnosismentioning

confidence: 99%

“…Culture and/or serological testing are considered the gold standard for the diagnosis and confirmation of coccidioidomycosis in suspected Valley Fever patients [14,55,60]. Culture of clinical specimens from any location can confirm the fungal infection.…”

Section: Diagnosismentioning

confidence: 99%

“…While radiographs can show bony lesions at late stage of the disease progression, CT scan instead can visualize bone abnormalities with more specificity at any stage of the disease. MRI is generally used to orient the decision of surgical debridement by identifying the areas of abnormalities with more precision and clarity, the damage of soft tissues as well as the abscess formation [4,28,60]. In the case of radiography and MRI failure, technetium Tc 99m bone scan is the imaging method of choice, due to its high sensitivity and ability to determine multicentric osteomyelitis [4,62].…”

Section: Diagnosismentioning

confidence: 99%

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Coccidioidomycosis Osteoarticular Dissemination

Moni¹,

Loots²,

Weilhammer³

2023

Preprint

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Valley fever or coccidioidomycosis is a pulmonary infection caused by several species of coccidi-oides (Cocci) fungi that is endemic to California and Arizona. Skeletal coccidioidomycosis ac-counts for about half of disseminated infections, with the vertebral spine being the preferred site of dissemination. Most cases of skeletal coccidioidomycosis progress to bone destruction or spread to adjacent structures such as joints, tendons, and other soft tissues causing significant pain and restricting mobility. Manifestations of such cases are usually non-specific, making di-agnosis very challenging, especially in non-endemic areas. In this review, we explore case reports of dissemination of coccidioidomycosis to bones and/or joints to highlight key differential fea-tures with other conditions or diseases and highlight opportunities for mechanistic and pre-clinical studies that can help improve diagnostics, prognostics, and treatments.

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Diagnosis and Initial Management of Musculoskeletal Coccidioidomycosis in Children

Cited by 14 publications

References 66 publications

Pediatric Musculoskeletal Coccidioidomycosis in Central California: A Single Center Experience

Pediatric Musculoskeletal Coccidioidomycosis in Central California: A Single Center Experience

Assessment of Studies Evaluating Spinal Manipulative Therapy and Infectious Disease and Immune System Outcomes

Coccidioidomycosis Osteoarticular Dissemination

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