Vertebral coccidioidomycosis: Presentation and multidisciplinary management

Larissa A. Szeyko, Mihra S. Taljanovic, Robert B. Dzioba, Jennifer L. Rapiejko, Rodney D. Adam

Research output: Contribution to journalArticle

29 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)304-314
Number of pages11
JournalAmerican Journal of Medicine
Volume125
Issue number3
DOIs
StatePublished - Mar 2012

Keywords

  • African
  • African-American
  • Diabetes
  • Fungal infections
  • Immunocompromised patient
  • Osteomyelitis
  • Spinal fusion
  • Vertebral

ASJC Scopus subject areas

  • Medicine(all)

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