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Vertebral coccidioidomycosis: presentation and multidisciplinary management.

Larissa A Szeyko1, Mihra S Taljanovic, Robert B Dzioba

  • 1Infectious Disease Section, University of Arizona College of Medicine, Tucson, 85724-5039, USA.

The American Journal of Medicine
|February 21, 2012
PubMed
Summary

Vertebral coccidioidomycosis, a severe complication of Coccidioides infection, often requires surgery and antifungal therapy. Discontinuation of treatment poses a high risk of relapse, even years later.

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Area of Science:

  • Infectious Diseases
  • Mycology
  • Orthopedic Surgery

Background:

  • Vertebral involvement is a severe complication of Coccidioides fungal infections.
  • Coccidioidomycosis can affect the spine, leading to significant morbidity.

Purpose of the Study:

  • To review cases of vertebral coccidioidomycosis.
  • To analyze treatment outcomes and identify risk factors for relapse.

Main Methods:

  • Retrospective review of patients diagnosed with vertebral coccidioidomycosis.
  • Data collected from 1996 to 2009 at an academic medical center.

Main Results:

  • 39 cases identified; 79% male, 61% Black patients (50-fold increased odds).
  • Most patients (80%) were immunocompetent; 67% required surgery for pain or neurologic compromise.
  • All received triazoles; 20 also received amphotericin B. Relapse occurred in 6 patients after stopping antifungal therapy.

Conclusions:

  • Vertebral coccidioidomycosis necessitates a multidisciplinary approach with medical and often surgical management.
  • Favorable outcomes are achievable, but long-term antifungal therapy is crucial to prevent late relapses.