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Charles-Lozoya S, Ruíz-Zenteno G, Lizcano-Martínez ME, Cobos-Aguilar H, León-Ruíz J, Domínguez-Delgado J. Vertebral coccidioidomycosis with mechanical instability treated solely with antifungals: A case report. Med Mycol Case Rep 2023; 42:100615. [PMID: 38022891 PMCID: PMC10656722 DOI: 10.1016/j.mmcr.2023.100615] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/19/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Surgical treatment of vertebral coccidioidomycosis presents a challenge, with an unpredictable course and uncertain results. We present a 52-year-old man with disseminated infection due to coccidioidomycosis in the thoracolumbar spine, with vertebral instability, and deferral surgical treatment due to SARS-CoV-2 contingency. Treatment with itraconazole was initiated, followed by liposomal amphotericin B and fluconazole due to a relapse. The patient was discharged long-term with voriconazole. The axial pain improved without neurological deficits. Surgical treatment was not required. 2012 Elsevier Ltd. All rights reserved.
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Affiliation(s)
- Sergio Charles-Lozoya
- Health Science Division, Unit of Spine Orthopedic Surgery, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social (IMSS), Av. José Ma. Pino Suárez y Juan Ignacio Ramón s/n, Centro, 64300, Monterrey, NL., Mexico
- Health Science Division, Vice-rectory of Health Sciences, Universidad de Monterrey, Av. Ignacio Morones Prieto 4500 Pte.col. Jesus M. Garza, 66238, San Pedro Garza García, N.L., Mexico
| | - Gibran Ruíz-Zenteno
- Health Science Division, Unit of Spine Orthopedic Surgery, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social (IMSS), Av. José Ma. Pino Suárez y Juan Ignacio Ramón s/n, Centro, 64300, Monterrey, NL., Mexico
| | - María E. Lizcano-Martínez
- Health Science Division, Unit of Spine Orthopedic Surgery, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social (IMSS), Av. José Ma. Pino Suárez y Juan Ignacio Ramón s/n, Centro, 64300, Monterrey, NL., Mexico
| | - Héctor Cobos-Aguilar
- Health Science Division, Vice-rectory of Health Sciences, Universidad de Monterrey, Av. Ignacio Morones Prieto 4500 Pte.col. Jesus M. Garza, 66238, San Pedro Garza García, N.L., Mexico
| | - Joél León-Ruíz
- Health Science Division, Unit of Spine Orthopedic Surgery, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social (IMSS), Av. José Ma. Pino Suárez y Juan Ignacio Ramón s/n, Centro, 64300, Monterrey, NL., Mexico
| | - Jesús Domínguez-Delgado
- Health Science Division, Unit of Spine Orthopedic Surgery, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social (IMSS), Av. José Ma. Pino Suárez y Juan Ignacio Ramón s/n, Centro, 64300, Monterrey, NL., Mexico
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Moni BM, Wise BL, Loots GG, Weilhammer DR. Coccidioidomycosis Osteoarticular Dissemination. J Fungi (Basel) 2023; 9:1002. [PMID: 37888258 PMCID: PMC10607509 DOI: 10.3390/jof9101002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/27/2023] [Accepted: 10/07/2023] [Indexed: 10/28/2023] Open
Abstract
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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Affiliation(s)
- Benedicte M. Moni
- Biosciences and Biotechnology Division, Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - Barton L. Wise
- Lawrence J. Ellison Musculoskeletal Research Center, Department of Orthopaedic Surgery, University of California Davis Health, 2700 Stockton Blvd., Sacramento, CA 95817, USA; (B.L.W.)
| | - Gabriela G. Loots
- Biosciences and Biotechnology Division, Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
- Lawrence J. Ellison Musculoskeletal Research Center, Department of Orthopaedic Surgery, University of California Davis Health, 2700 Stockton Blvd., Sacramento, CA 95817, USA; (B.L.W.)
| | - Dina R. Weilhammer
- Biosciences and Biotechnology Division, Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
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3
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Gamaletsou MN, Rammaert B, Brause B, Bueno MA, Dadwal SS, Henry MW, Katragkou A, Kontoyiannis DP, McCarthy MW, Miller AO, Moriyama B, Pana ZD, Petraitiene R, Petraitis V, Roilides E, Sarkis JP, Simitsopoulou M, Sipsas NV, Taj-Aldeen SJ, Zeller V, Lortholary O, Walsh TJ. Osteoarticular Mycoses. Clin Microbiol Rev 2022; 35:e0008619. [PMID: 36448782 PMCID: PMC9769674 DOI: 10.1128/cmr.00086-19] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Osteoarticular mycoses are chronic debilitating infections that require extended courses of antifungal therapy and may warrant expert surgical intervention. As there has been no comprehensive review of these diseases, the International Consortium for Osteoarticular Mycoses prepared a definitive treatise for this important class of infections. Among the etiologies of osteoarticular mycoses are Candida spp., Aspergillus spp., Mucorales, dematiaceous fungi, non-Aspergillus hyaline molds, and endemic mycoses, including those caused by Histoplasma capsulatum, Blastomyces dermatitidis, and Coccidioides species. This review analyzes the history, epidemiology, pathogenesis, clinical manifestations, diagnostic approaches, inflammatory biomarkers, diagnostic imaging modalities, treatments, and outcomes of osteomyelitis and septic arthritis caused by these organisms. Candida osteomyelitis and Candida arthritis are associated with greater events of hematogenous dissemination than those of most other osteoarticular mycoses. Traumatic inoculation is more commonly associated with osteoarticular mycoses caused by Aspergillus and non-Aspergillus molds. Synovial fluid cultures are highly sensitive in the detection of Candida and Aspergillus arthritis. Relapsed infection, particularly in Candida arthritis, may develop in relation to an inadequate duration of therapy. Overall mortality reflects survival from disseminated infection and underlying host factors.
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Affiliation(s)
- Maria N. Gamaletsou
- Laiko General Hospital of Athens and Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Blandine Rammaert
- Université de Poitiers, Faculté de médecine, CHU de Poitiers, INSERM U1070, Poitiers, France
| | - Barry Brause
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Marimelle A. Bueno
- Far Eastern University-Dr. Nicanor Reyes Medical Foundation, Manilla, Philippines
| | | | - Michael W. Henry
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Aspasia Katragkou
- Nationwide Children’s Hospital, Columbus, Ohio, USA
- The Ohio State University School of Medicine, Columbus, Ohio, USA
| | | | - Matthew W. McCarthy
- Weill Cornell Medicine of Cornell University, New York, New York, USA
- New York Presbyterian Hospital, New York, New York, USA
| | - Andy O. Miller
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | | | - Zoi Dorothea Pana
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | - Ruta Petraitiene
- Weill Cornell Medicine of Cornell University, New York, New York, USA
| | | | - Emmanuel Roilides
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | | | - Maria Simitsopoulou
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | - Nikolaos V. Sipsas
- Laiko General Hospital of Athens and Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Valérie Zeller
- Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
| | - Olivier Lortholary
- Université de Paris, Faculté de Médecine, APHP, Hôpital Necker-Enfants Malades, Paris, France
- Institut Pasteur, Unité de Mycologie Moléculaire, CNRS UMR 2000, Paris, France
| | - Thomas J. Walsh
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
- Weill Cornell Medicine of Cornell University, New York, New York, USA
- New York Presbyterian Hospital, New York, New York, USA
- Center for Innovative Therapeutics and Diagnostics, Richmond, Virginia, USA
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Abstract
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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Pulmonary Coccidioidomycosis: A Case Report and Literature Review. Medicina (B Aires) 2022; 58:medicina58050655. [PMID: 35630071 PMCID: PMC9143117 DOI: 10.3390/medicina58050655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/28/2022] [Accepted: 05/10/2022] [Indexed: 12/03/2022] Open
Abstract
Coccidioidomycosis is an infectious disease caused by Coccidioides immitis or C. posadasii fungus. Humans usually get infected by inhaling spores risen from the soil. Although in 60 percent of cases symptoms are absent, remaining patients can develop various manifestations of the disease, from flu-like symptoms to severe dissemination or meningitis. In endemic regions (California, Arizona, Mexico, Central, and South America), pulmonary coccidioidomycosis causes 25% of community-acquired cases of pneumonia. We present the first registered case of pulmonary coccidioidomycosis in Lithuania. Clinical presentation, pathogenesis, treatment options, and diagnostic alternatives are discussed.
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Koutserimpas C, Naoum S, Raptis K, Vrioni G, Samonis G, Alpantaki K. Skeletal Infections Caused by Coccidioides Species. Diagnostics (Basel) 2022; 12:diagnostics12030714. [PMID: 35328269 PMCID: PMC8947487 DOI: 10.3390/diagnostics12030714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/12/2022] [Accepted: 03/13/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Coccidioidomycosis represents an endemic and challenging disease, with rare extrapulmonary manifestations. The present review of all published cases of core and extremities osseous coccidioidomycosis aims to describe epidemiology, patients’ characteristics, symptoms as well as medical and surgical treatment options and their effectiveness. Methods: A thorough review of all published skeletal core and extremity infections due to Coccidioides species was conducted. Information regarding demographics, causative fungus, antifungal treatment (AFT), surgical management as well as the infection outcome was recorded. Results: A total of 92 cases of Coccidioides spp. skeletal infections were recorded in 87 patients. The patients’ mean age was 35.3 years. The most common site of infection was the spine (82.6%), followed by the foot (6.5%), while the predominant symptom upon presentation was pain (29.9%). Immunosuppressive conditions and/or medications were observed in 21 patients (24.1%). Regarding imaging methods, indicating diagnosis, plain X-rays or CT scans were performed in most patients (50.6%), followed by magnetic resonance imaging (MRI) (47.1%). Most cases were diagnosed through histopathology (62; 71.3%), followed by serology testing (36; 42.4%) and by cultures (35; 40.2%). In 32 cases (36.8%), Coccidioides immitis was cultured, while in the remaining 55 cases (63.2%) the fungus was not further characterized. Regarding AFT, amphotericin B was the preferred agent (52.9%), followed by fluconazole (43.3%). In most cases (78.2%) surgical treatment was also performed. Treatment was successful in 80.5% of cases. Conclusions: Skeletal core and extremity infections due to Coccidioides spp. represent a severe disease. With the available data, the combination of prolonged proper AFT with surgical intervention seems to be the optimal current therapeutic approach.
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Affiliation(s)
- Christos Koutserimpas
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, 11525 Athens, Greece; (C.K.); (S.N.); (K.R.)
| | - Symeon Naoum
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, 11525 Athens, Greece; (C.K.); (S.N.); (K.R.)
| | - Konstantinos Raptis
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, 11525 Athens, Greece; (C.K.); (S.N.); (K.R.)
| | - Georgia Vrioni
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - George Samonis
- Department of Internal Medicine, University of Crete, 71500 Heraklion, Greece
- Correspondence: ; Tel.: +30-6948712130
| | - Kalliopi Alpantaki
- Department of Orthopaedics and Traumatology, “Venizeleion” General Hospital of Crete, 71409 Heraklion, Greece;
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7
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Azeem A, Quimby D, Krajicek B, Horne J. (Ig)Easy diagnosis of disseminated coccidioidomycosis. BMJ Case Rep 2022; 15:e248894. [PMID: 35260409 PMCID: PMC8905869 DOI: 10.1136/bcr-2022-248894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 11/03/2022] Open
Abstract
An immunocompetent man in his 20s came to the hospital for shortness of breath, fevers and lower back pain with unintentional 20 lbs. weight loss. Relevant history included a recent trip to Arizona 3 months prior to presentation. On arrival, he was noted to have decreased breath sounds bilaterally, and paraspinal tenderness in the lumbar area. CT scan revealed diffuse pneumonitis and an abscess with osteomyelitis in the sacrum and right iliac bone. Continued respiratory decompensation led him to the intensive care unit where he had a bronchoscopy and later sacroiliac joint fluid collection was performed. Based on his travel history, and elevated serum IgE, liposomal amphotericin B was initiated. Later his antibodies against Coccidiodes resulted elevated and fungal cultures from the bronchoalveolar lavage and abscess from the sacral vertebrae grew mould, morphologically consistent with Coccidiodes posadasii He was transitioned to oral fluconazole and will have a close follow-up outpatient.
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Affiliation(s)
- Ahad Azeem
- Infectious Diseases, Creighton University, Omaha, Nebraska, USA
| | - David Quimby
- Infectious Diseases, Creighton University, Omaha, Nebraska, USA
| | - Bryan Krajicek
- Pulmonary, Critical Care and Sleep Medicine Department, Creighton University, Omaha, Nebraska, USA
| | - John Horne
- Infectious Diseases, Creighton University, Omaha, Nebraska, USA
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8
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Reed DS, Kostosky N, Epstein A, Blaydon S, Durairaj V, Somogyi M. Disseminated Coccidioidomycosis With Orbital Osteomyelitis and Periorbital Abscess. Ophthalmic Plast Reconstr Surg 2021; 37:e173-e176. [PMID: 33795607 DOI: 10.1097/iop.0000000000001981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Coccidioidomycosis osteomyelitis involving the orbital bones is exceedingly rare and is often misdiagnosed initially as other inflammatory or infectious conditions. No clear guidelines currently exist regarding appropriate management. The authors present an atypical presentation of disseminated coccidioidomycosis in an immunocompetent child with frontal bone superotemporal orbital rim osteomyelitis and associated periorbital abscess, successfully managed with surgical debridement through an upper eyelid crease incision.
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Affiliation(s)
- Donovan S Reed
- Department of Oculoplastics, Texas Oculoplastics Consultants (TOC) Eye & Face, Austin, Texas
| | - Nicole Kostosky
- School of Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Aliza Epstein
- Department of Oculoplastics, Texas Oculoplastics Consultants (TOC) Eye & Face, Austin, Texas
| | - Sean Blaydon
- Department of Oculoplastics, Texas Oculoplastics Consultants (TOC) Eye & Face, Austin, Texas
- Department of Ophthalmology, Dell Medical School, University of Texas, Austin, Texas, U.S.A
| | - Vikram Durairaj
- Department of Oculoplastics, Texas Oculoplastics Consultants (TOC) Eye & Face, Austin, Texas
- Department of Ophthalmology, Dell Medical School, University of Texas, Austin, Texas, U.S.A
| | - Marie Somogyi
- Department of Oculoplastics, Texas Oculoplastics Consultants (TOC) Eye & Face, Austin, Texas
- Department of Ophthalmology, Dell Medical School, University of Texas, Austin, Texas, U.S.A
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9
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Abstract
Coccidioidomycosis, caused by the dimorphic pathogenic fungi Coccidioides immitis and Coccidioides posadassi, is endemic to the southwestern United states and Central and South America. The incidence of coccidioidomycosis continues to increase. Coccidioidomycosis is typically a self-limiting influenza-like respiratory illness; however, it can lead to disseminated disease outside of the lungs. Not all nondisseminated cases require therapy, but antifungal therapy is typically beneficial requiring treatment ranging from months to lifelong. Clinical factors related to treatment decisions include severity of symptoms, radiography, coccidioidomycosis serologic results, and concurrent medical problems including immunosuppression. This review summarizes the epidemiology, clinical manifestations, and treatment options.
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Affiliation(s)
- Derek J Bays
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, 4150 V Street, PSSB, Suite G500, Sacramento, CA 95817, USA
| | - George R Thompson
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, 4150 V Street, PSSB, Suite G500, Sacramento, CA 95817, USA; Department of Medical Microbiology and Immunology, University of California, Davis, Davis, CA, USA.
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10
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Toyne JM, Esplin N, Buikstra JE. Examining variation in skeletal tuberculosis in a late pre-contact population from the eastern mountains of Peru. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2020; 30:22-34. [PMID: 32416540 DOI: 10.1016/j.ijpp.2020.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 03/31/2020] [Accepted: 04/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE AND MATERIALS This research evaluates the presence and chronology of tuberculosis (TB) in the northeastern highlands of Peru (CE 800-1535) through the analysis of osseous lesions from Pre-Contact Kuelap, Chachapoyas. METHODS We examined macroscopic lesion morphology and distribution from the skeletal series (MNI = 207). RESULTS We determined that skeletal evidence was highly consistent with advanced multifocal and spinal tuberculosis in 13 individuals. Destructive lesions of the lower thoracic and/or lumbar vertebra bodies and sacroiliac joints are evident in most cases, but we also observed lesions within the manubriosternal, hip, and knee joints. Both adult males (n = 7) and females (n = 6) present skeletal lesions from young adult to older adults, but there is only one late adolescent. Only three individuals demonstrate similar lesion distributions. CONCLUSIONS Variation in lesion distribution in this population-based study shows the importance of identifying extra-vertebral tuberculosis and suggests that the disease may have manifested differently than at other coastal sites. These cases confirm the presence of tuberculosis both before and after Inca occupation across this central Andean highlands region. SIGNIFICANCE This evidence for the likely endemic presence of TB in the New World prior to European Contact furthers our understanding of the distribution of this infectious disease across the region as well as elucidating lesion distribution. LIMITATIONS The diagnosis of tuberculosis is based on skeletal lesions and it should be confirmed by molecular analysis. FUTURE RESEARCH Additional examination of vertebral bodies (including juvenile remains) for evidence of earlier manifestations of infection.
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Affiliation(s)
- J Marla Toyne
- Department of Anthropology, University of Central Florida, Orlando, FL 32803-1361, United States.
| | - Nathan Esplin
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, United States
| | - Jane E Buikstra
- School of Human Evolution and Social Change, Arizona State University, Phoenix metropolitan area, AZ, United States
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11
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Puing AG, Couture-Cossette A, Wang AX, Zygourakis CC, Cheng X, Stevens BA, Banaei N, Novoa RA, Ho DY, Subramanian AK. Simultaneous coccidioidomycosis and phaeohyphomycosis in a kidney transplant recipient: A case report and literature review. Transpl Infect Dis 2020; 22:e13365. [PMID: 32533741 DOI: 10.1111/tid.13365] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 11/30/2022]
Abstract
Advances in solid organ transplantation have improved the survival of end-stage organ disease at the expense of an increased risk for opportunistic infections. Unusual clinical presentations and the possibility of concurrent infections make diagnosing invasive fungal infection (IFI) more difficult. Here, we present a case of simultaneous vertebral infection caused by Coccidioides immitis-posadasii and subcutaneous phaeohyphomycosis due to Nigrograna mackinnonii in a kidney transplant recipient. The diagnosis of both infections required invasive procedures to obtain tissue and a high index of suspicion that more than one IFI could be present. A multidisciplinary team approach for the management of immunocompromised patients with suspected or diagnosed IFI is warranted.
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Affiliation(s)
- Alfredo G Puing
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Antoine Couture-Cossette
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Aileen X Wang
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Corinna C Zygourakis
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Xingxing Cheng
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Bryan A Stevens
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Niaz Banaei
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Roberto A Novoa
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Dora Y Ho
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Aruna K Subramanian
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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12
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Coccidioidomycosis Presenting with Fever and Back Pain. J Gen Intern Med 2020; 35:1887-1888. [PMID: 32185657 PMCID: PMC7280379 DOI: 10.1007/s11606-020-05765-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
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13
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Ramanathan D, Sahasrabudhe N, Kim E. Disseminated Coccidioidomycosis to the Spine-Case Series and Review of Literature. Brain Sci 2019; 9:brainsci9070160. [PMID: 31284663 PMCID: PMC6680672 DOI: 10.3390/brainsci9070160] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/03/2019] [Accepted: 07/05/2019] [Indexed: 12/24/2022] Open
Abstract
Coccidioidomycosis is a fungal infectious disease caused by the Coccidioides species endemic to Southwestern United States. Symptomatic patients typically present as community-acquired pneumonia. Uncommonly, in about 1% of infections, hematogenous extra pulmonary systemic dissemination involving skin, musculoskeletal system, and meninges occur. Disseminated spinal infection is treated with antifungal drugs and/or surgical treatment. A retrospective review of medical records at our institution was done between January 2009 to December 2018 and we present three cases of spinal coccidioidomycosis and review the current literature. Disseminated coccidioidomycosis can lead to spondylitis that can present as discitis or a localized spinal or paraspinal abscess. Spinal coccidioidomycosis is typically managed with antifungal treatments but can include surgical treatment in the setting poor response to medical therapy, intractable pain, presence of neurological deficits due to compression, or structural spinal instability.
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Affiliation(s)
| | | | - Esther Kim
- Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
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14
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Cho SH, Yu YB, Park JS, Yook KD, Kim YK. Epidemiological Characterization of Imported Systemic Mycoses Occurred in Korea. Osong Public Health Res Perspect 2018; 9:255-260. [PMID: 30402381 PMCID: PMC6202016 DOI: 10.24171/j.phrp.2018.9.5.07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 09/08/2018] [Accepted: 09/13/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Imported systemic mycoses is a severe fungal infection that can cause diseases in healthy people. However, there is a serious lack of epidemiological data about imported systemic mycoses. Therefore, an epidemiological characterization of imported systemic mycoses in Korea was performed. METHODS We collected health insurance data between 2008 and 2012 from the Health Insurance Corporation and analyzed the data to determine the prevalence and treatment management of imported systemic mycoses. RESULTS The prevalence of imported systemic mycoses between 2008 and 2012 increased slowly by 0.49/100,000 to 0.53/100,000 persons. The prevalence of coccidioidomycosis increased from 0.28/100,000 in 2008 to 0.36/100,000 persons in 2012. A mean of 229.6 cases occurred each year. Children and the elderly showed higher prevalence than adults in the 20- to 59-year-old age group. The rate of infection according to region ranged from 0.18/100,000 persons in Ulsan, to 0.59/100,000 persons in Gyeonggi. The prevalence in females was higher than that in males. Inpatient treatment was 3.3% (38 cases), with 96.7% treated as outpatients. Hospitalizations cost 272.7 million won and outpatient treatments cost 111.7 million won. The treatment cost for coccidioidomycosis from 2008 to 2012 was 330.9 million won, with personal charges of 79.2 million won and insurance charges of 251.7 million won. Most of the expenses for the coccidioidomycosis treatment were for inpatient treatment. CONCLUSION The results in this study may be a useful resource for determining the changes in the trend of imported systemic mycoses.
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Affiliation(s)
- Seung-Hak Cho
- Division of Bacterial Disease Research, Center for Infectious Disease Research, Korea National Institute of Health, Cheongju, Korea
| | - Young-Bin Yu
- Department of Biomedical Laboratory Science, College of Medical Sciences, Konyang University, Daejeon, Korea
| | - Je-Seop Park
- Fire Science Laboratory, National Fire Service Academy, Asan, Korea
| | - Keun-Dol Yook
- Department of Clinical Laboratory Science, Daejeon Health College, Daejeon, Korea
| | - Young-Kwon Kim
- Department of Biomedical Laboratory Science, College of Medical Sciences, Konyang University, Daejeon, Korea
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Why is this patient's chronic knee pain worsening? JAAPA 2018; 31:50-52. [PMID: 29698371 DOI: 10.1097/01.jaa.0000531048.51513.bb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sharif S, Hussain N. What's New in Spinal Coccidioidomycosis? World Neurosurg 2018; 110:99-100. [DOI: 10.1016/j.wneu.2017.10.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 10/31/2017] [Indexed: 11/24/2022]
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Tender GC. Coccidioidomycosis for Neurosurgeons. World Neurosurg 2018; 110:1-3. [DOI: 10.1016/j.wneu.2017.10.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 10/20/2017] [Indexed: 10/18/2022]
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Galgiani JN, Ampel NM, Blair JE, Catanzaro A, Geertsma F, Hoover SE, Johnson RH, Kusne S, Lisse J, MacDonald JD, Meyerson SL, Raksin PB, Siever J, Stevens DA, Sunenshine R, Theodore N. Executive Summary: 2016 Infectious Diseases Society of America (IDSA) Clinical Practice Guideline for the Treatment of Coccidioidomycosis. Clin Infect Dis 2017; 63:717-22. [PMID: 27559032 DOI: 10.1093/cid/ciw538] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 05/26/2016] [Indexed: 11/13/2022] Open
Abstract
It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. Infectious Diseases Society of America considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.Coccidioidomycosis, also known as San Joaquin Valley fever, is a systemic infection endemic to parts of the southwestern United States and elsewhere in the Western Hemisphere. Residence in and recent travel to these areas are critical elements for the accurate recognition of patients who develop this infection. In this practice guideline, we have organized our recommendations to address actionable questions concerning the entire spectrum of clinical syndromes. These can range from initial pulmonary infection, which eventually resolves whether or not antifungal therapy is administered, to a variety of pulmonary and extrapulmonary complications. Additional recommendations address management of coccidioidomycosis occurring for special at-risk populations. Finally, preemptive management strategies are outlined in certain at-risk populations and after unintentional laboratory exposure.
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Affiliation(s)
| | - Neil M Ampel
- Division of Infectious Diseases, University of Arizona, Tucson
| | - Janis E Blair
- Division of Infectious Diseases, Mayo Clinic, Scottsdale, Arizona
| | - Antonino Catanzaro
- Division of Pulmonary and Critical Care, University of California, San Diego
| | - Francesca Geertsma
- Department of Pediatrics, Infectious Diseases, Stanford University School of Medicine, California
| | | | - Royce H Johnson
- David Geffen School of Medicine at UCLA, Department of Medicine, Kern Medical Center, Bakersfield, California
| | - Shimon Kusne
- Division of Infectious Diseases, Mayo Clinic, Scottsdale, Arizona
| | - Jeffrey Lisse
- Department of Rheumatology, University of Arizona, Tucson
| | - Joel D MacDonald
- Department of Neurosurgery School of Medicine, University of Utah, Salt Lake City
| | - Shari L Meyerson
- Division of Thoracic Surgery, Northwestern University, Feinberg School of Medicine
| | - Patricia B Raksin
- Division of Neurosurgery, John H. Stroger Jr Hospital of Cook County, Chicago, Illinois
| | | | - David A Stevens
- Division of Infectious Diseases, Stanford University School of Medicine, California
| | - Rebecca Sunenshine
- Career Epidemiology Field Officer Program, Division of State and Local Readiness, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention Maricopa County Department of Public Health
| | - Nicholas Theodore
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
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Martinez-Del-Campo E, Kalb S, Rangel-Castilla L, Moon K, Moran A, Gonzalez O, Soriano-Baron H, Theodore N. Spinal Coccidioidomycosis: A Current Review of Diagnosis and Management. World Neurosurg 2017; 108:69-75. [PMID: 28844921 DOI: 10.1016/j.wneu.2017.08.103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 08/14/2017] [Accepted: 08/16/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Coccidioidomycosis is an invasive fungal disease that may present with extrathoracic dissemination. Patients with spinal coccidioidomycosis require unique medical and surgical management. We review the risk factors and clinical presentations, discuss the indications for surgical intervention, and evaluate outcomes and complications after medical and surgical management. METHODS A review of the English-language literature was performed. Eighteen articles included the management of 140 patients with spinal coccidioidomycosis. RESULTS For the 140 patients, risk factors included male sex (95%), African American ethnicity (52%), and a recent visit to endemic areas (16%). The most frequent clinical presentation was pain (n = 80, 57%), followed by neurologic compression (52%). One-third of patients had concurrent pulmonary disease. The sensitivity of culture and histology for coccidioidomycosis was 80% and 90%, respectively. Complement fixation titers >1:128 suggest extensive or refractory vertebral infection. The most commonly affected spinal segments were the thoracic and lumbar spine (69%); an additional 40 patients (29%) had epidural and paravertebral abscesses. All patients received therapy with azoles (60%) and/or amphotericin B (43%). Surgical and medical management were used conjunctively to treat 110 patients (79%), with debridement (95% [105/110]) and fusion (64% [70/110]) being the most common surgical procedures. Clinical outcome improved/remained unchanged in 83 patients (59%) and worsened in 4 patients (3%). The mortality was 7%. Infection recurrence and disease progression were the most frequent complications. CONCLUSIONS Emphasis should be placed on continuous and lifelong appropriate azole therapy. Spinal instability and neurologic compromise are surgical indications for decompression and fusion.
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Affiliation(s)
- Eduardo Martinez-Del-Campo
- Department of Neurosurgery, Barrow Neurological Institute, Saint Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Samuel Kalb
- Department of Neurosurgery, Barrow Neurological Institute, Saint Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Leonardo Rangel-Castilla
- Department of Neurosurgery, Barrow Neurological Institute, Saint Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Karam Moon
- Department of Neurosurgery, Barrow Neurological Institute, Saint Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Ana Moran
- Infectious Disease Division, Arizona Pulmonary Specialists, Phoenix, Arizona, USA
| | - Omar Gonzalez
- Infectious Disease Division, Arizona Pulmonary Specialists, Phoenix, Arizona, USA
| | - Hector Soriano-Baron
- Department of Neurosurgery, Barrow Neurological Institute, Saint Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Barrow Neurological Institute, Saint Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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Bajema KL, Dalesandro MF, Fredricks DN, Ramchandani M. Disseminated coccidioidomycosis presenting with intramedullary spinal cord abscesses: Management challenges. Med Mycol Case Rep 2016; 15:1-4. [PMID: 28053850 PMCID: PMC5198726 DOI: 10.1016/j.mmcr.2016.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 11/29/2016] [Accepted: 12/01/2016] [Indexed: 01/05/2023] Open
Abstract
Coccidioides species are endemic to the southwestern United States and typically cause a mild or asymptomatic primary infection. In some instances, infection can disseminate and involve the central nervous system with meningitis being the most common manifestation. Non-osseous spinal cord involvement is exceedingly rare. We report a case of disseminated coccidioidomycosis in an otherwise healthy 20 year old man with diffuse leptomeningeal enhancement, cerebrospinal fluid findings suggestive of meningitis, and intramedullary spinal cord abscesses. Response to treatment occurred with prolonged systemic liposomal amphotericin B and voriconazole. An extended course of steroids was needed to blunt inflammation.
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Affiliation(s)
- Kristina L Bajema
- Department of Medicine, Divison of Allergy and Infectious Diseases, University of Washington, 1959 NE Pacific Street Box 356423, Seattle, WA 98195, USA
| | | | - David N Fredricks
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Meena Ramchandani
- Department of Medicine, Divison of Allergy and Infectious Diseases, Harborview Medical Center, Seattle, WA, USA
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Galgiani JN, Ampel NM, Blair JE, Catanzaro A, Geertsma F, Hoover SE, Johnson RH, Kusne S, Lisse J, MacDonald JD, Meyerson SL, Raksin PB, Siever J, Stevens DA, Sunenshine R, Theodore N. 2016 Infectious Diseases Society of America (IDSA) Clinical Practice Guideline for the Treatment of Coccidioidomycosis. Clin Infect Dis 2016; 63:e112-46. [PMID: 27470238 DOI: 10.1093/cid/ciw360] [Citation(s) in RCA: 318] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 05/26/2016] [Indexed: 12/17/2022] Open
Abstract
It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. Infectious Diseases Society of America considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.Coccidioidomycosis, also known as San Joaquin Valley fever, is a systemic infection endemic to parts of the southwestern United States and elsewhere in the Western Hemisphere. Residence in and recent travel to these areas are critical elements for the accurate recognition of patients who develop this infection. In this practice guideline, we have organized our recommendations to address actionable questions concerning the entire spectrum of clinical syndromes. These can range from initial pulmonary infection, which eventually resolves whether or not antifungal therapy is administered, to a variety of pulmonary and extrapulmonary complications. Additional recommendations address management of coccidioidomycosis occurring for special at-risk populations. Finally, preemptive management strategies are outlined in certain at-risk populations and after unintentional laboratory exposure.
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Affiliation(s)
| | - Neil M Ampel
- Division of Infectious Diseases, University of Arizona, Tucson
| | - Janis E Blair
- Division of Infectious Diseases, Mayo Clinic, Scottsdale, Arizona
| | - Antonino Catanzaro
- Division of Pulmonary and Critical Care, University of California, San Diego
| | - Francesca Geertsma
- Department of Pediatrics, Infectious Diseases, Stanford University School of Medicine, California
| | | | - Royce H Johnson
- David Geffen School of Medicine at UCLA, Department of Medicine, Kern Medical Center, Bakersfield, California
| | - Shimon Kusne
- Division of Infectious Diseases, Mayo Clinic, Scottsdale, Arizona
| | - Jeffrey Lisse
- Department of Rheumatology, University of Arizona, Tucson
| | - Joel D MacDonald
- Department of Neurosurgery School of Medicine, University of Utah, Salt Lake City
| | - Shari L Meyerson
- Division of Thoracic Surgery, Northwestern University, Feinberg School of Medicine
| | - Patricia B Raksin
- Division of Neurosurgery, John H. Stroger Jr Hospital of Cook County, Chicago, Illinois
| | | | - David A Stevens
- Division of Infectious Diseases, Stanford University School of Medicine, California
| | - Rebecca Sunenshine
- Career Epidemiology Field Officer Program, Division of State and Local Readiness, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention Maricopa County Department of Public Health
| | - Nicholas Theodore
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
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Affiliation(s)
- Joshua Fierer
- Veterans Affairs San Diego Healthcare System and University of California, San Diego School of Medicine, Division of Infectious Diseases
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Abstract
Therapy of coccidioidomycosis continues to evolve. For primary pulmonary disease,
antifungal therapy is frequently not required while prolonged courses of antifungals
are generally needed for those in whom extrathoracic disseminated has occurred.
Intravenous amphotericin B should be reserved for those with severe disease. Oral
triazole antifungals have had a great impact on the management of coccidioidomycosis.
Both fluconazole and itraconazole at 400 mg daily have been effective for various
forms of coccidioidomycosis, including meningitis, although relapse after therapy is
discontinued is a problem. Individuals with suppressed cellular immunity are at
increased risk for symptomatic coccidioidomycosis and they include those with HIV
infection, those on immunosuppressive medications, and those who have received a
solid organ transplant. Pregnant women and African-American men have been identified
as two other groups who are at an increased risk for symptomatic and severe
infection.
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Affiliation(s)
- Neil M Ampel
- College of Medicine, University of Arizona, Tucson, AZ, USA
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Martirosyan NL, Skoch JM, Zaninovich O, Zoccali C, Galgiani JN, Baaj AA. A paradigm for the evaluation and management of spinal coccidioidomycosis. Surg Neurol Int 2015; 6:107. [PMID: 26167359 PMCID: PMC4483783 DOI: 10.4103/2152-7806.158979] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 04/24/2015] [Indexed: 12/31/2022] Open
Abstract
Background: Coccidioidomycosis is a fungal infection that is endemic to parts of the Southwestern United States. When infection involves the spine, the treatment strategies can be challenging. We have devised a management protocol for spinal coccidioidomycosis based on a review of the literature and our experience. Methods: The electronic literature search of National Library of Medicine for publications from 1964 to 2014 was performed using the following keywords: Coccidioidomycosis and spine. The search yielded 24 papers. Treatment strategies were summarized into a treatment protocol. Results: A total of 164 cases of spinal coccidioidomycosis were identified, ranging in age from <10 to >80 years. Males (n = 131) and African-Americans (n = 79) were strikingly over-represented. Medical therapy: Once a diagnosis of spinal coccidioidomycosis is established, antifungal therapy should always be started. Antifungal therapy with amphotericin B or azoles like fluconazole. Medical therapy needs to be continued for many years and sometimes indefinitely to reduce disease recurrence or progression. Surgical management is indicated in cases with mechanical instability, neurologic deficit, medically intractable pain, or progression of infection despite antifungal therapy. Conclusions: This work provides a working protocol involving assessment and reassessment for the management of spinal coccidioidomycosis. Medical management with antifungal agents in some cases can provide satisfactory disease control. However, in patients with mechanical instability, neurologic deficit, medically intractable pain or disease progression disease control may only be achieved with surgical debridement and stabilization.
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Affiliation(s)
| | - Jesse M Skoch
- Division of Neurosurgery, University of Arizona, Tucson, Arizona, USA
| | - Orel Zaninovich
- Division of Neurosurgery, University of Arizona, Tucson, Arizona, USA
| | - Carmine Zoccali
- Division of Neurosurgery, University of Arizona, Tucson, Arizona, USA
| | - John N Galgiani
- Valley Fever Center for Excellence, University of Arizona Medical Center, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Ali A Baaj
- Division of Neurosurgery, University of Arizona, Tucson, Arizona, USA
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A 59-Year-Old Immunocompetent Man With a Vertebral Lesion. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2014. [DOI: 10.1097/ipc.0b013e3182a01f66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Li YC, Calvert G, Hanrahan CJ, Jones KB, Randall RL. Coccidiomycosis infection of the patella mimicking a neoplasm - two case reports. BMC Med Imaging 2014; 14:8. [PMID: 24548622 PMCID: PMC3939934 DOI: 10.1186/1471-2342-14-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 02/14/2014] [Indexed: 11/15/2022] Open
Abstract
Background Coccidioidomycosis is an endemic fungal infection in the southwestern of United States. Most infections are asymptomatic or manifest with mild respiratory complaints. Rare cases may cause extrapulmonary or disseminated disease. We report two cases of knee involvement that presented as isolated lytic lesions of the patella mimicking neoplasms. Case Presentation The first case, a 27 year-old immunocompetent male had progressive left anterior knee pain for four months. The second case was a 78 year-old male had left anterior knee pain for three months. Both of them had visited general physicians without conclusive diagnosis. A low attenuation lytic lesion in the patella was demonstrated on their image studies, and the initial radiologist’s interpretation was suggestive of a primary bony neoplasm. The patients were referred for orthopaedic oncology consultation. The first case had a past episode of pulmonary coccioidomycosis 2 years prior, while the second case had no previous coccioidal infection history but lived in an endemic area, the central valley of California. Surgical biopsy was performed in both cases due to diagnostic uncertainty. Final pathologic examination revealed large thick walled spherules filled with endospores establishing the final diagnosis of extrapulmonary coccidioidomycosis. Conclusions Though history and laboratory findings are supportive, definitive diagnosis still depends on growth in culture or endospores identified on histology. We suggest that orthopaedic surgeons and radiologists keep in mind that chronic fungal infections can mimic osseous neoplasm by imaging.
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Affiliation(s)
| | | | | | | | - Robert Lor Randall
- Sarcoma Services, Department of Orthopaedics, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah, USA.
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Rapidly progressive quadriparesis heralding disseminated coccidioidomycosis in an immunocompetent patient. J Clin Neurosci 2013; 21:1049-51. [PMID: 24321458 DOI: 10.1016/j.jocn.2013.07.040] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 07/19/2013] [Indexed: 11/23/2022]
Abstract
Coccidioides species are dimorphic fungi endemic to southwestern USA and northern Mexico. Disseminated coccidioidomycosis is rare with an estimated incidence of 1% in affected individuals and usually presents as meningitis when the central nervous system is involved. Spinal involvement with coccidioidomycosis, though not uncommon, predominantly manifests as osseous involvement leading to osteomyelitis and epidural abscess formation. Progressive quadriparesis as a presenting symptom secondary to intramedullary spinal cord coccidioidomycosis is very unusual and to our knowledge has not been described. We report a patient with disseminated coccidioidomycosis who presented with rapidly progressive quadriparesis due to cervical intramedullary spinal cord involvement. The absence of known coccidioidomycosis with atypical clinical presentation made the diagnosis elusive, requiring emergent cervical laminectomies with dural biopsy for decompression of the spinal cord and confirmation of the diagnosis. The patient eventually succumbed to the progressive course of the disease. Although rare, disseminated coccidioidomycosis can present as new, rapidly progressing quadriparesis in patients who have traveled to endemic areas. A high index of suspicion in such patients with appropriately directed laboratory investigations and consideration of early biopsy might unravel the diagnosis facilitating early antifungal treatment with the potential to minimize morbidity and mortality associated with disseminated coccidioidomycosis.
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