Extensive spinal disease from disseminated coccidioidomycosis

Kim, Jani M; Pervaiz, Sarah; Sivasubramanian, Geetha

doi:10.1016/j.amjms.2021.10.021

Cited by 4 publications

(4 citation statements)

References 3 publications

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“…Skeletal sites of infection do not have a location bias, as any bone could be involved in dissemination, but the reported sites with the most severe disease manifestation have been in the axial skeleton, including the skull, sternum, ribs, and vertebrae [4,27,31,32], with the latter being slightly favored (especially the lumbar and thoracic areas), where C. immitis frequently disseminates [5,27,31]. Most clinical cases describe vertebral coccidioidomycosis as osteomyelitis (limited to the vertebral bodies) and discitis (intervertebral disc space involvement), with symptoms including vertebral body compression and height loss, worsening back and neck pain, lower extremities weakness, weight loss, night sweats [27,29,[33][34][35][36][37], epidural enhancement and abscess [27,29,35,37], paraspinal abscess [37] vertebral body complete destruction with focal kyphosis as well as retropharyngeal abscess [34].…”

Section: Clinical Reportsmentioning

confidence: 99%

“…When the infection of the skull occurs from vertebral coccidioidomycosis [39], it can spread to the pachymeninges and the subarachnoid space and cause neurologic compromise characterized by symptoms such as motor deficits, mechanical instability, neural compression, sensory disturbances, leptomeningeal enhancement, and arachnoiditis. The clinical studies reporting neurologic symptoms in patients with vertebral coccidioidomycosis cases have also highlighted the necessity of surgical management to prevent further spread in addition to pharmacological therapy [33][34][35]40] due to the fatal nature of coccidioidal infection in the brain. Some rare reported cases of coccidioidal osteomyelitis included infection of the first toe in a young patient with a medical history of diabetes insipidus and obesity [38], the facial bone involvement such as the jaw osteomyelitis in an infant [31], infection of the patella (anterior bone of the knee) in immunocompetent males [41], and orbital bone osteomyelitis with associated periorbital abscess [42].…”

Section: Clinical Reportsmentioning

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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Section: Clinical Reportsmentioning

confidence: 99%

Section: Clinical Reportsmentioning

confidence: 99%

Coccidioidomycosis Osteoarticular Dissemination

Moni¹,

Loots²,

Weilhammer³

2023

Preprint

View full text Add to dashboard Cite

show abstract

“…frequently disseminate [5,18,37,41]. Most clinical cases describe vertebral coccidioidomycosis as osteomyelitis (limited to the vertebral bodies) and discitis (intervertebral disc space involvement), with symptoms including vertebral body compression and height loss, worsening back and neck pain, lower extremities weakness, weight loss, night sweats [37,39,[43][44][45][46][47], epidural enhancement and abscess [37,39,45,47], paraspinal abscess [47], complete vertebral body destruction with focal kyphosis, and retropharyngeal abscess [44].…”

Section: Clinical Reportsmentioning

confidence: 99%

“…When the infection of the skull occurs from vertebral coccidioidomycosis [49], it can spread to the pachymeninges and the subarachnoid space and cause neurologic compromise characterized by symptoms such as motor deficits, mechanical instability, neural compression, sensory disturbances, leptomeningeal enhancement, and arachnoiditis. The clinical studies reporting neurologic symptoms in patients with vertebral coccidioidomycosis cases have also highlighted the necessity of surgical management to prevent further spread in addition to pharmacological therapy [43][44][45]50] due to the fatal nature of coccidioidal infection in the brain.…”

Section: Clinical Reportsmentioning

confidence: 99%

Coccidioidomycosis Osteoarticular Dissemination

Moni,

Wise,

Loots

et al. 2023

JoF

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Valley fever or coccidioidomycosis is a pulmonary infection caused by species of Coccidioides fungi that are endemic to California and Arizona. Skeletal coccidioidomycosis accounts 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 nonspecific, making diagnosis very challenging, especially in non-endemic areas. The lack of basic knowledge and research data on the mechanisms defining susceptibility to extrapulmonary infection, especially when it involves bones and joints, prompted us to survey available clinical and animal data to establish specific research questions that remain to be investigated. In this review, we explore published literature reviews, case reports, and case series on the dissemination of coccidioidomycosis to bones and/or joints. We highlight key differential features with other conditions and opportunities for mechanistic and basic research studies that can help develop novel diagnostic, prognostic, and treatment strategies.

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Diagnosis, Treatment, and Outcome of Coccidioidal Osseous Infections: A Systematic Review

Tsantes,

Koutserimpas,

Naoum

et al. 2024

JoF

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Extrapulmonary infections by Coccidioides spp., though rare, can occur via dissemination, affecting singular or multiple sites, including the skin and musculoskeletal system. Skeletal involvement often manifests as osteomyelitis, particularly in the axial skeleton. The present systematic review evaluates all documented cases of skeletal coccidioidomycosis to assess the diagnostic and treatment strategies alongside the outcomes, drawing insights from an analysis of 163 verified cases. A systematic review following PRISMA guidelines identified all studies reporting skeletal infections by Coccidioides spp. up to 2023 from the PubMed and Scopus databases. Eligible studies evaluated osteoarticular infections from Coccidioides spp. Data extraction included demographics, microbiological data, diagnostic methods, and treatment outcomes. Of the 501 initially identified records, a total of 163 patients from 69 studies met the inclusion criteria. Most cases were from the USA, predominantly males, while the median age of the population was 36 years. Diabetes mellitus was the common comorbidity (14.7%). C. immitis was the most prevalent pathogen. The spine and hand were common sites of infection (17.5% and 15.1%, respectively). Osteomyelitis by Coccidioides spp. was diagnosed, in most cases, by positive cultures (n = 68; 41.7%), while, in 49 (30.9%), both the histological examination and cultures yielded the fungus. Surgical debridement was performed in 80.9% of cases. A total of 118 (72.3%) patients were treated with monotherapy, while combination therapy with two or more antifungal agents was reported in 45 (17.7%). Amphotericin B (either liposomal or deoxycholate) was the most commonly given agent as monotherapy in 51 (31.2%) patients, while 30 (18.4%) patients received itraconazole as monotherapy. The rate of infection’s resolution was higher in patients undergoing surgical debridement (79.5%), compared to those treated only with antifungal agents (51.6%, p = 0.003). Treatment outcomes showed complete resolution in 74.2% of patients, with a mortality rate of 9.2%. Coccidioidal osseous infections present diagnostic and therapeutic challenges. Surgical intervention is often necessary, complementing antifungal therapy. Vigilance for Coccidioides spp. infections, especially in regions with endemicity, is crucial, particularly when bacterial cultures yield negative results.

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Extensive spinal disease from disseminated coccidioidomycosis

Cited by 4 publications

References 3 publications

Coccidioidomycosis Osteoarticular Dissemination

Coccidioidomycosis Osteoarticular Dissemination

Coccidioidomycosis Osteoarticular Dissemination

Diagnosis, Treatment, and Outcome of Coccidioidal Osseous Infections: A Systematic Review

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