TY - JOUR
T1 - Vertebral coccidioidomycosis
T2 - Presentation and multidisciplinary management
AU - Szeyko, Larissa A.
AU - Taljanovic, Mihra S.
AU - Dzioba, Robert B.
AU - Rapiejko, Jennifer L.
AU - Adam, Rodney D.
PY - 2012/3
Y1 - 2012/3
N2 - Background: Vertebral involvement is a severe complication of infection caused by Coccidioides species. Methods: We conducted a retrospective review of patients diagnosed with vertebral coccidioidomycosis at an academic medical center between 1996 and 2009. Results: We identified 39 cases of vertebral coccidioidomycosis. Thirty-four patients (79%) were male, and 23 patients (61%) were black. Black patients were overrepresented in comparison with all other patients by a 50-fold odds ratio (95% confidence interval, 26-95). Only 8 patients (20%) were immunocompromised, including 7 who had received systemic steroids. The number of infected vertebrae ranged from 1 to 24; 8 patients (21%) had epidural involvement. All patients received a triazole as part of medical therapy, and 20 patients also received amphotericin B, typically early in the course. Twenty-six patients (67%) required surgery, 18 of whom also required hardware placement. The most common indication for surgery was pain, but 7 patients had neurologic compromise. No patients developed recurrent or refractory infection at the site of surgical debridement, but 6 patients experienced disease relapse after stopping antifungal therapy. Conclusion: Vertebral infection caused by Coccidioides species requires a multispecialty approach that always includes medical therapy and frequently requires surgical intervention for debridement or stabilization. A favorable outcome can usually be achieved, but discontinuation of medical therapy is associated with a high risk of relapse, which can occur years later.
AB - Background: Vertebral involvement is a severe complication of infection caused by Coccidioides species. Methods: We conducted a retrospective review of patients diagnosed with vertebral coccidioidomycosis at an academic medical center between 1996 and 2009. Results: We identified 39 cases of vertebral coccidioidomycosis. Thirty-four patients (79%) were male, and 23 patients (61%) were black. Black patients were overrepresented in comparison with all other patients by a 50-fold odds ratio (95% confidence interval, 26-95). Only 8 patients (20%) were immunocompromised, including 7 who had received systemic steroids. The number of infected vertebrae ranged from 1 to 24; 8 patients (21%) had epidural involvement. All patients received a triazole as part of medical therapy, and 20 patients also received amphotericin B, typically early in the course. Twenty-six patients (67%) required surgery, 18 of whom also required hardware placement. The most common indication for surgery was pain, but 7 patients had neurologic compromise. No patients developed recurrent or refractory infection at the site of surgical debridement, but 6 patients experienced disease relapse after stopping antifungal therapy. Conclusion: Vertebral infection caused by Coccidioides species requires a multispecialty approach that always includes medical therapy and frequently requires surgical intervention for debridement or stabilization. A favorable outcome can usually be achieved, but discontinuation of medical therapy is associated with a high risk of relapse, which can occur years later.
KW - African
KW - African-American
KW - Diabetes
KW - Fungal infections
KW - Immunocompromised patient
KW - Osteomyelitis
KW - Spinal fusion
KW - Vertebral
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U2 - 10.1016/j.amjmed.2011.10.018
DO - 10.1016/j.amjmed.2011.10.018
M3 - Article
C2 - 22340929
AN - SCOPUS:84857197493
SN - 0002-9343
VL - 125
SP - 304
EP - 314
JO - American Journal of Medicine
JF - American Journal of Medicine
IS - 3
ER -